1. Suboptimal Performance: When Do Methods & Mood Matter?
Martin L. Rohling, Ph.D. University of South Alabama

2. Definition of “Education”
“Education is the process of going from cocksure ignorance to thoughtful uncertainty”
(Source Unknown)

3. Study 1: Reference
Rohling, M. L., Green, P., Allen, L. M., & Williamson, D. J. (2000). Comparisons between a Logistic Regression Formula for the CVLT and the Word Memory Test as Indicators of Suboptimal Performance in a Sample of Litigants. Poster presented at the 20th annual convention of NAN in Orlando, FL.

4. California Verbal Learning Test
Original version of verbal learning and memory task (Delis et al., 1987)
16-item list learning task
dependent measures used
immediate FR
20 min. DFR
recognition memory
Sensitive to neurological disease (e.g., Delis et al., 1991, Deweer et al., 1994), age (Kausler, 1994), and gender (Wiens et al., 1994)

5. Study 1: Specific Questions
Within a compensation-seeking sample
Do the WMT and the CVLT-Logit Formula of Millis (1999) identify the same patients as exerting suboptimal effort?
If not, how do the identified groups differ on
Tests of neurocognitive abilities
Self-report of memory functioning
Other tests that have been cross-validated and found to be sensitive to suboptimal effort

6. Study 1: Participants
794 patients referred for evaluation for compensation-related purposes
All diagnostic groups included
53% Head injury referral
27% Medical referrals
12% Psychiatric referrals
8% Other neurological
Age = 42 (11); Education = 12 (4); Sex = 63% males; Non-Native English = 14%; Handedness = 9% Left

7. Study 1: Effort Groups WMT: Invalid if any of the 3 criteria violated
IR < 82.5%
DR < 82.5%
CON1 < 75%
CVLT-Logit Formula: Invalid if the Logistic equation, (e^g) / [1 + (e^g)], is less than .50
the constant g is defined as follows:
g = (SDFR * .56) - (LDFR * .52) - (RG Hits * .72)

8. Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating
OVERALL SAMPLE
CVLT
Genuine
Exaggerating
WMT
100
(13%)
112
(14%) 59
(7%)
523
(66%)
582
(73%)
Genuine
Exaggerating
212
(27%)
635
(80%)
159
(20%)

9. Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating
Relative to the WMT:
CVLT identified 25% fewer exaggerators
CVLT identified 9% more genuine patients
79% overall agreement
However, for patients identified by one or the other method (n = 271)
methods agreed just 37% of the time

10. Study 1: Patients Identified as Exaggerating Differed by Method
Demographic Differences
Relative to WMT-poor effort group:
CVLT-Logit group was older
CVLT-Logit group less educated
CVLT-Logit group had more patients whose 1st language was not English

11. Graphic’s Abbreviations
G-W Genuine WMT - ABOVE cut score
G-C Genuine CVLT - ABOVE cut score
E-W Exaggerated WMT - BELOW cut score
E-C Exaggerated CVLT - BELOW cut score
Composite Summary Scores
MCI Memory Complaints Inventory
NPT Neuropsychological Tests
EPT Emotional & Personality Tests

12. Differences on Summary Measures

13. Examples on Specific NPTs

14. Gervais’ & Green’s Samples Summary Measure Similarities

15. Green’s & Gervais’ Samples

16. Study 1: Conclusions Measures identified different patients
Findings replicated in independent sample
Compared to the CVLT, the WMT groups had larger differences on
Measures sensitive to symptom exaggeration (i.e., RCFT, Warr-F)
Other validated SVTs (e.g., CARB)
Self-reports of memory & emotional functioning (i.e., MCI & MMPI-2)

17. Study 1: Why Did Results Differ?
WMT less confounded by Age & Education
CVLT sensitive to cognitive impairment
works against it as a SVT
However,
CVLT congruence with WMT (79%)
CT algorithms (64% to 73%)

18. Study 2: Reference
Rohling, M. L., Green, P., Allen, L. M., & Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17,

19. Study 2: Specific Questions
Within an optimally performing compensation-seeking sample
Memory Complaints correlate with mood
Depressed mood impairs cognition
Memory Complaints unrelated to cognition

20. Study 2: Depression Measures
3 measures of mood
Beck Depression Inventory
MMPI-2 Depression scale
r = .70 with BDI
SCL-90-R Depression scale
r = .74 with BDI
r = .63 MMPI-De

21. Study 2: Mood Group Assignment
Patients classified into 2 subgroups
From entire sample, 420 passed all SVTs
Sample split based on BDI
Low-Depressed 25%ile on BDI (< 10)
n = 178, M = 6 (3)
High-Depressed 75%ile on BDI (> 25)
n = 187, M = 31 (6)

22. Study 2: Participants
All 365 patients referred for evaluation for compensation-related purposes
All diagnostic groups included
53% Head injury referrals
22% Medical referrals
14% Psychiatric referrals
11% Other neurological
Age = 42 (11); Education = 13 (3); Sex = 64% males; Non-Native English = 18%; Handedness = 9% Left

23. Study 2: Results Mood & Validity Status
SVT Status
Genuine
Exaggerating
Mood BDI
107
(30%) 68
(19%)
159
(44%) 27
(7%)
175
(48%)
Depress 75%ile
186
(52%)
Non-Dep 25%ile
266
(74%) 95
(26%)

24. Study 2: Results Sample Split by Validity Status
-1.5
-1.3
-1.1
-.9
-.7
-.5
-.3
-.1 .1 .3 .5 .7 .9
1.1
1.3
High-Dep
Low-Dep
EPT MCI OTBM
EPT MCI OTBM
EPT MCI OTBM
Total Sample
Genuine Pts
Exaggerating Pts
Z-scores

25. Study 2: Results Effect of Mood Depends on Effort
Exaggerating patients accounted for
39% of High-Dep group
14% of Low-Dep group
Mood & Effort used as IVs and Cognition DV
effect for Effort, no effect for Mood
However, when Memory Complaints DV
effects for both Effort and Mood
Also, when other Emotion/Personality DV

26. Study 2: Answers to Specific Questions
When both mood groups were included in regression analysis, as predicted
Memory ratings related to mood
(r = .60; p < .0001)
Mood not correlated with cognition
(r = .10; p > .10)
Memory ratings not related to cognition
(r = .13, p = .06)

27. Study 2: Mood Replication
Gervais’ pain sample findings (n = 177)
Exaggerating patients accounted for
55% of High-Dep; 33% of Low-Dep group
Memory ratings related to mood (r = .55)
Mood not correlated with cognition (r = .06)
Memory ratings related to cognition (r = .15)
Group means correlated with Green’s .94
all patient (High-D, Low-D, Gen, & Exag).

28. Study 2: Conclusions
Memory complaints not synonymous with impairment in compensation seeking sample
Findings replicated
Effort accounts for more variance in self-ratings of cognition and objective performance than mood

29. Study 1 & 2: Summary
Ability test algorithms less effective for the assessment of effort than tests designed for this purpose
In a compensation-seeking sample
Mood not related to cognitive impairment
Mood is related to memory complaints
More variance accounted for by Effort than by Mood

30. Neuropsychological Tests .33 (.62) .19 (.64) -.60a, b (.80) -.79a, b
Genuine
(n = 412)
Exaggerating
(n = 149)
Dependent Domain
Normal
(n = 311)
Neuro
(n=101)
(n = 144)
(n = 5)
Neuropsychological Tests
.33
(.62)
.19
(.64)
-.60a, b
(.80)
-.79a, b
(.65)
Symptom Validity Tests
.51
(.38)
.50
(.30)
-1.25a, b
(.94)
-.50a, b, c
(.52)
Memory Complaints Inv.
.14
(.93)
.41a
(.92)
-.62a, b
.49c
(.54)
Psychiatric Symptoms
.10
(.95)
.46a
(.96)
-.39a, b
(.85)
(.99)

31. Gen (n=412) Ex (n=149) ES Cognitive Domain M SD t p (d)ES
Cognitive Domain M SD t p
(d)
Neuropsych Ability
.34
.75
-.86
1.01
15.3
.0001
1.43
Attention/Work Mem
.29
.76
-.74
1.13
12.0
1.16
Visual Mem Learn
.28
.85
-.72
.99
11.8
1.12
Perceptual Organ
.27
.79
-.68
1.15
11.1
1.05
Auditory Mem Learn
.23
.88
-.60
1.04
9.5
.89
Executive Function
Verbal Comprehen
.18
.92
-.45
1.06
7.0
.65
Psychomotor Speed
.17
.80
-.41
1.29
6.1
.60

32. Neuropsych Ability Symptom Validity -1.5 -1.3 -1.1 -.9 -.7 -.5 -.3 -.1
Cell Mean
Neuropsych Ability
Symptom Validity
Exag-Neuro
Exag-Norm
Gen-Neuro
Gen-Norm

33. -1.5
-1.3
-1.1
-.9
-.7
-.5
-.3
-.1 .1 .3 .5
Cell Mean
Memory Complaints
Psychiatric Symptoms
Exag-Neuro
Exag-Norm
Gen-Neuro
Gen-Norm