in the Service of
Committee on Psychological Testing, Including Validity Testing,
for Social Security Administration Disability Determinations
Board on the Health of Select Populations
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Task Order No. SS00-13-60048/0003 between the National Academy of Sciences and the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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Suggested citation: IOM (Institute of Medicine). 2015. Psychological testing in the service of disability determination. Washington, DC: The National Academies Press.
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COMMITTEE ON PSYCHOLOGICAL TESTING, INCLUDING VALIDITY TESTING, FOR SOCIAL SECURITY ADMINISTRATION DISABILITY DETERMINATIONS
HERBERT PARDES (Chair), Executive Vice Chairman of the Board, New York-Presbyterian Hospital, New York, New York
ARTHUR J. BARSKY III, Professor of Psychiatry, Harvard Medical School, and Vice Chair for Psychiatric Research, Brigham and Women’s Hospital, Boston, Massachusetts
MARY C. DALY, Senior Vice President and Associate Director of Economic Research, Federal Reserve Bank of San Francisco, California
KURT F. GEISINGER, W. C. Meierhenry Distinguished University Professor of Educational Psychology and Director, Buros Center for Testing, University of Nebraska–Lincoln
NAOMI LYNN GERBER, University Professor, Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
ALAN M. JETTE, Professor of Health Policy & Management, Boston University School of Public Health
JENNIFER I. KOOP, Associate Professor, Department of Neurology, Medical College of Wisconsin, Milwaukee
LISA A. SUZUKI, Associate Professor of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York
ELIZABETH W. TWAMLEY, Associate Professor of Psychiatry, University of California, San Diego
PETER A. UBEL, Madge and Dennis T. McLawhorn University Professor of Business, Fuqua School of Business, and Professor of Public Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina
JACQUELINE REMONDET WALL, Professor, School of Psychological Sciences, University of Indianapolis, Indiana, and Director, Office of Program Consultation and Accreditation, American Psychological Association, Washington, DC
Liaison to IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues
HOWARD H. GOLDMAN, Professor Psychiatry, University of Maryland School of Medicine, Baltimore
IOM Project Staff
CAROL MASON SPICER, Study Director
FRANK R. VALLIERE, Associate Program Officer
ALEJANDRA MARTÍN, Research Associate (since January 2015)
NICOLE GORMLEY, Senior Program Assistant (since December 2014)
JONATHAN PHILLIPS, Senior Program Assistant (April to November 2014)
JON SANDERS, Program Coordinator (through January 2015)
PAMELA RAMEY-McCRAY, Administrative Assistant
FREDERICK ERDTMANN, Director, Board on the Health of Select Populations
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
David Autor, Massachusetts Institute of Technology Economics
Leighton Chan, National Institutes of Health
Allen W. Heinemann, Northwestern University
Anita Hubley, University of British Columbia, Vancouver Campus
Michael Kirkwood, Children’s Hospital Colorado-Aurora
Glenn J. Larrabee, Clinical Neuropsychology
Brian Levitt, Kaplan Psychologists
Patricia Owens, Health and Disability Policy Programs
Stephen M. Raffle, Forensic and Clinical Psychiatry
Jerry Sweet, University of Chicago, Pritzker School of Medicine
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions
or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Nancy Adler, University of California, San Francisco, and Randy Gallistel, Rutgers University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The U.S. Social Security Administration (SSA) disability programs provide important, sometimes vital, benefits to millions of adults and children annually in the United States. The programs are an expression of the nation’s principle of caring for individuals who need support from the larger community. Within the confines of SSA policy, the state Disability Determination Services (DDS) agencies, which implement the policy, have the latitude to do so in whatever way they deem fit. It is not surprising that in a country as diverse as the United States we would find geographic variations in the style and methods with which that process is undertaken.
One element of such variation is the use or not of standardized psychological tests during the disability determination process, other than the use of intelligence tests in determinations of intellectual disability in children and adults. SSA asked the Institute of Medicine (IOM) to review selected psychological tests and to provide guidance on the use of psychological testing in SSA disability determinations.
SSA and the DDS agencies have the critical task of determining which applicants qualify for disability benefits, a task complicated by the lack of direct correlation between the presence of an impairment and disability, which SSA defines as the inability to work. DDS examiners undertake the very complex task of reviewing and developing applicants’ files to determine which requests for disability benefits are justified. As described in the report, the committee felt that it was worth considering whether increased systematic use of standardized psychological testing in specific circumstances would strengthen the current process for disability determination.
The committee thanks colleagues, organizations, and agencies that were willing to share their expertise, time, and information during the committee’s information-gathering meetings. The names of the speakers are included in the meeting agendas provided in Appendix A. The committee is grateful to the authors of the two commissioned papers, Erin Bigler, David Freedman, and Jennifer Manly, for the in-depth analyses they provided. The study sponsor, SSA, gladly provided information and data and responded to questions. We also thank Howard Goldman, chair of the IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues, who served as a consultant to the committee and provided valuable insight. The contributions from all of these sources informed the committee deliberations and enhanced the quality of this report.
I want also to pay tribute to and thank the expert members of our committee. A diversity of views, at times a difference of views, all contributed to generating a consensus about issues important to SSA and to the country. Throughout the project, they put in an enormous amount of time and effort; contributed their experience, knowledge, and perspective; listened to contending arguments; and ultimately generated the recommendations in this report. It is heartening to me and the other committee members to experience the excellence and the commitment of so many good colleagues. I trust this report will be helpful to and well received by SSA.
Finally, the committee thanks the IOM staff members who contributed to the production of this report, including Frederick “Rick” Erdtmann (board director), Carol Mason Spicer (study director), Frank Valliere (associate program officer), Alejandra Martín (research associate), Nicole Gormley (senior program assistant), Jonathan Phillips (senior program assistant), Jon Sanders (program coordinator), Julie Wiltshire (financial associate), and other staff of the Board on the Health of Select Populations and the IOM, who provided support. Research assistance was provided by Daniel Bearss, Rebecca Morgan, and Catherine van der List.
Herbert Pardes, Chair
Committee on Psychological Testing, Including
Validity Testing, for Social Security Administration
Boxes, Figures, and Tables
|AACN||American Academy of Clinical Neuropsychology|
|AADEP||American Academy of Disability Evaluating Physicians|
|ABCN||American Board of Clinical Neuropsychology|
|ABIME||American Boards of Independent Medical Examiners|
|ADL||activity of daily living|
|AFB||Ability-Focused Neuropsychological Test Battery|
|ALJ||administrative law judge|
|AMA||American Medical Association|
|APA||American Psychological Association|
|ASAPIL||Association for Scientific Advancement in Psychological|
|Injury and Law|
|BDI||Beck Depression Inventory|
|BLS||Bureau of Labor Statistics|
|BPRS||Brief Psychiatric Rating Scale|
|BSI||Brief Symptom Inventory|
|BVMT-R||Brief Visuospatial Memory Test-Revised|
|C&P||compensation and pension|
|CASL||Comprehensive Assessment of Spoken Language|
|CBCL||Child Behavior Checklist|
|CDMI||Composite Disability Malingering Index|
|CELF-4||Clinical Evaluation of Language Fundamentals-4|
|CFS||chronic fatigue syndrome|
|CIDI||Composite International Diagnostic Interview|
|CPP||Canada Pension Plan|
|CRPS||complex regional pain syndrome|
|CVLT-II||California Verbal Learning Test—second edition|
|DDS||Disability Determination Services|
|DIF||differential item functioning|
|DOM||Depression Outcomes Module|
|DSM||Diagnostic and Statistical Manual of the American|
|GAF||Global Assessment of Functioning Scale|
|GAO||Government Accountability Office|
|HVLT-R||Hopkins Verbal Learning Test-Revised|
|ICF||International Classification of Functioning, Disability and Health|
|IDES||Integrated Disability Examination System|
|IME||independent medical examination|
|IOM||Institute of Medicine|
|IRT||item response theory|
|MDI||medically determinable impairment|
|MEDCOM||U.S. Army Medical Command|
|M-FAST||Miller Forensic Assessment of Symptom Test|
|MINI||Mini International Neuropsychiatric Interview|
|MMPI||Minnesota Multiphasic Personality Inventory|
|MMY||Mental Measurements Yearbook|
|MRFC||Mental Residual Functional Capacity|
|MSVT||Medical Symptom Validity Test|
|NAN||National Academy of Neuropsychology|
|NIH||National Institutes of Health|
|NPP||negative predictive power|
|NPRM||Notice of Proposed Rulemaking|
|NRC||National Research Council|
|OIDAP||Occupational Information Development Advisory Panel|
|OIS||Occupational Information System|
|OTSG||Office of the Surgeon General|
|P-3||Pain Patient Profile|
|PAI||Personality Assessment Inventory|
|PCE||psychological consultative examination|
|PDRT||Portland Digit Recognition Test|
|PHQ||Patient Health Questionnaire|
|POMS||Program Operations Manual System|
|PPP||positive predictive power|
|PTSD||posttraumatic stress disorder|
|PVT||performance validity test|
|RAVL||Rey Auditory Verbal Learning|
|RDS||Reliable Digit Span|
|RMFIT||Rey Memory for Fifteen Items Test|
|RMT||Recognition Memory Test|
|RMTF||Warrington Recognition Memory Test for Faces|
|SCAN||Schedule for Clinical Assessment in Neuropsychiatry|
|SCL-90-R||Symptom Checklist 90-Revised|
|SGA||substantial gainful activity|
|SIMS||Structured Inventory of Malingered Symptomology|
|SIRS||Structured Interview of Reported Symptoms|
|SSA||U.S. Social Security Administration|
|SSDI||Social Security Disability Insurance|
|SSI||Supplemental Security Income|
|SVT||symptom validity test|
|TBI||traumatic brain injury|
|TMJ||temporomandibular joint disorder|
|TOMM||Test of Memory Malingering|
|VA||U.S. Department of Veterans Affairs|
|VBA||Veterans Benefits Administration|
|VHA||Veterans Health Administration|
|WAIS||Wechsler Adult Intelligence Scale|
|WHO||World Health Organization|
|WISC||Wechsler Intelligence Scale for Children|
|WMS||Wechsler Memory Scale|
|WMT||Word Memory Test|