In sum, due to the influence that motivation may have on the outcome of a neuropsychological evaluation, the importance of measuring effort in pediatric populations is gaining recognition. Indeed, boredom, playfulness, or fatigue may cause a child to put forth suboptimal or inconsistent effort ( Faust et al., 1988). ![]() Further, deception in children is often difficult to detect and is not always a deliberate effort by the child to produce false results. Moreover, children older than 9 may even exhibit the capability of feigning neuropsychological impairment after being coached, as well as “faking bad” and “faking good” to convey certain personality characteristics ( Faust, Hart, & Guilmette, 1988 Hall & Pritchard, 1996 Oldershaw & Bagby, 1997 Power & Stoppard, 1973). This occurs in 50%–79% of preschoolers as a result of material gain, avoidance of punishment, confusion, or playfulness ( Newton, Reddy, & Bull, 2000 Polak & Harris, 1999 Stouthamber-Loeber & Loeber, 1986). Unfortunately, the literature indicates that children are able to feign ignorance when it benefited them. Despite prior research demonstrating that children can be coached to feign cognitive deficits on neuropsychological evaluations ( Heubrock, 2001), many pediatric-oriented clinicians continue to believe that children do not “malinger” or that poor effort is always easy to detect through qualitative observation. This said, it is also strongly recommended that objective measures of effort assessment become part of routine clinical practice to maximize the confidence in test findings ( Bush et al., 2005 Richman et al., 2006).Īlthough the formal assessment of effort has become largely customary in adult neuropsychological evaluations, those working with younger populations have been slower to adopt such practices. This is particularly true in forensic evaluations, where secondary gain may be involved, and thus, it is incumbent upon the neuropsychologist to formally measure and document effort and response bias ( Lee, Loring, & Martin, 1992). Given potential effects on the interpretation of neuropsychological data, the evaluation of effort is increasingly becoming standard practice ( Bush et al., 2005). These findings likely extend to other pediatric populations that are known to have significant cognitive loss.Ĭhildhood neurologic disorders, Epilepsy, Malingering/symptom validity testing, Assessment Introduction These results suggest that RDS appears to yield a large number of false positives and, therefore, may be of limited utility in detecting poor effort in a pediatric epilepsy population. ![]() The difference between RDS and the TOMM on the participant outcome was statistically significant ( χ 2 = 9.05, p =. RDS scores were significantly correlated with IQ estimates ( r =. ![]() In contrast, when adult criteria were used on TOMM Trial 2, a 90% pass rate was observed. Using a previously published RDS cutoff of ≤6, a pass rate of only 65% was obtained, well below the recommended 90% pass rate for an effective effort index. Reliable Digit Spans (RDSs) were calculated and the Test of Memory Malingering (TOMM) was administered in the context of a comprehensive neuropsychological evaluation. The present study includes 54 clinically referred children and adolescents (32 males/22 females aged 6–17) with a confirmed diagnosis of epilepsy. While recent work has validated the appropriateness of adult-derived cutoffs for standalone effort measures in younger populations, little research has focused on embedded effort measures in children. The assessment of effort is an important aspect of a comprehensive neuropsychological evaluation, as this can significantly impact data interpretation.
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