Commentary: Applications of Functional Neuroimaging to Civil Litigation of Mild Traumatic Brain Injury

The current definition of mild traumatic brain injury (MTBI) is in flux. Presently, there are at least three working definitions of this disorder in the United States, with no clear consensus. Functional neuroimaging, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET), initially showed promise in their ability to improve the diagnostic credibility of MTBI. Over the past decade, that promise has not been fulfilled and there is a paucity of quality studies or standards for the application of functional neuroimaging to traumatic brain injury, particularly in litigation. The legal profession is ahead of the science in this matter. The emergence of neurolaw is driving a growing use of functional neuroimaging, as a sole imaging modality, used by lawyers in an attempt to prove MTBI at trial. The medical literature on functional neuroimaging and its applications to MTBI is weak scientifically, sparse in quality publications, lacking in well-designed controlled studies, and currently does not meet the complete standards of Daubert v. Merrell Dow Pharmaceuticals, Inc., for introduction of scientific evidence at trial. At the present time, there is a clear lack of clinical correlation between functional neuroimaging of MTBI and behavioral, neuropsychological, or structural neuroimaging deficits. The use of SPECT or PET, without concurrent clinical correlation with structural neuroimaging (CT or MRI), is not recommended to be offered as evidence of MTBI in litigation

Response Validity in Forensic Neuropsychology: Exploratory Factor Analytic Evidence of Distinct Cognitive and Psychological Constructs

Forensic neuropsychology studies usually address either cognitive effort or psychological response validity. Whether these are distinct constructs is unclear. In 122 participants evaluated in a compensation-seeking context, the present Exploratory Factor Analysis examined whether forced-choice cognitive effort measures (Victoria Symptom Validity Test, Test of Memory Malingering, Letter Memory Test) and Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) validity scales (L, F, K, FBS, Fp, RBS, Md, Dsr2, S) load on independent factors. Regardless of factor rotation strategy (orthogonal or oblique), four response validity factors emerged by means of both Principal Components Analysis (82.7% total variance) and Principal-Axis Factor Analysis (74.1% total variance). The four factors were designated as follows: Factor I, with large loadings from L, K, and S—underreporting of psychologicalsymptoms; Factor II, with large loadings from FBS, RBS, and Md—overreporting of neurotic symptoms; Factor III, with large loadings from VSVT, TOMM, and LMT—insufficient cognitive effort; and Factor IV, with the largest loadings from F, Fp, and Dsr2—overreporting of psychotic/rarely endorsed symptoms. Results reflect the heterogeneity of response validity in forensic samples referred for neuropsychological evaluation. Administration of both cognitive effort measures and psychological validity scales is imperative to accurate forensic neuropsychological assessment. (JINS, 2007, 13, 440–449.

Use of MMPI-2 to Predict Cognitive Effort: A Hierarchically Optimal Classification Tree Analysis

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After “pruning” of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context. (JINS, 2008, 14, 842–852.

It\u27s Not All in Your Head (or at Least Your Brain): Association of Traumatic Brain Lesion Presence and Location with Performance on Measures of Response Bias in Forensic Evaluation

This study examined the relationship between lesion presence and localization and performance on measures of cognitive response bias, specifically in individuals purporting to have a traumatic brain injury. Ninety-two participants, all of whom were involved in workers’ compensation or personal injury litigation, were administered an extensive neuropsychological battery, including neuroimaging (magnetic resonance imaging and computed tomography), at a neuropsychiatric clinic in Lexington, KY. Those with evidence of intracranial injury on neuroimaging findings were placed in the head injury lesion litigation group and were coded based on the anatomical location and type of intracranial injury. Results demonstrated no significant relationships between lesion location and performance on performance validity tests (PVTs), as well as the Response Bias Scale of the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Given the lack of research concerning lesions and performance validity tests, this study addresses important questions about the validity of PVTs as specific measures of response bias in patients who have structural changes secondary to traumatic brain injury. Copyright#2013 John Wiley & Sons, Ltd

Traumatic brain injury : Methods for clinical and forensic neoropsychiatric assessment, 2nd ed./ Granacher

xxiii, 560 hal.: ill.; 25 cm

Traumatic brain injury : Methods for clinical and forensic neoropsychiatric assessment, 2nd ed./ Granacher

xxiii, 560 hal.: ill.; 25 cm

Mild Traumatic Brain Injury Update: Forensic Neuropsychiatric Implications

Traumatic brain injury (TBI) involves a wide range of potential neuropsychiatric outcomes, from death or profound impairment to full and fast recovery. This circumstance has contributed to an atmosphere with considerable potential for both clinical confusion and unjustified medicolegal outcomes. Given that mild (m)TBI accounts for most (ϳ80%) TBI events and is generally associated with an excellent prognosis, the risk for erroneous clinical formulations and unmerited legal outcomes seems particularly high in cases involving mTBI. In this article, we summarize the recent results published by the International Collaboration on Mild Traumatic Brain Injury Prognosis (ICMTBIP) and the new approach of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to TBI, and we explore the clinical and medicolegal implications. Symptoms that emerge after mTBI remain nonspecific, and potential etiologies are diverse. Clinicians and medicolegal experts should be familiar with the natural history of mTBI, able to recognize atypical outcomes, and willing to search for alternative explanations when confronted with persistent or severe impairment

Association of the MMPI-2 Restructured Form (MMPI-2-RF) Validity Scales with Structured Malingering Criteria

The current study examined the validity scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen 2008) in relation to the structured malingering criteria developed to assess malingered neurocognitive dysfunction and pain-related disability. These criteria examined a sample of 251 individuals undergoing compensation-seeking evaluations, who completed a battery of response bias measures. The MMPI-2-RF over-reporting scales yielded large effect sizes in contrasting those in the probable/definite malingering groups from the incentive only groups. The largest effects were found for the Infrequent Responses and Gervais et al. (Assessment, 14, 196-208, 2007) Response Bias Scale, an experimental scale that can be scored on the MMPI-2-RF. Classification analyses were also utilized to examine various cut scores for the individual validity scales, as well as their use in combination. These results suggest that the MMPI-2-RF validity scales can be used to screen for malingering, as they exhibited good sensitivity at lower cutoffs. The implications of these results and their use in forensic evaluations are discussed