Nov 16, 2015

Should I Worry About My Clients Being Thrown Into This Briar Patch?

     The Clinical Neuropsychologist, a scientific journal, has published Official Position of the American Academy of Clinical Neuropsychology Social Security Administration Policy on Validity Testing: Guidance and Recommendations for Change. This is their summary of the paper:
The milestone publication by Slick, Sherman, and Iverson (1999) of criteria for determining malingered neurocognitive dysfunction led to extensive research on validity testing. Position statements by the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology (AACN) recommended routine validity testing in neuropsychological evaluations. Despite this widespread scientific and professional support, the Social Security Administration (SSA) continued to discourage validity testing, a stance that led to a congressional initiative for SSA to reevaluate their position. In response, SSA commissioned the Institute of Medicine (IOM) to evaluate the science concerning the validation of psychological testing. The IOM concluded that validity assessment was necessary in psychological and neuropsychological examinations (IOM, 2015 ). Objective : The AACN sought to provide independent expert guidance and recommendations concerning the use of validity testing in disability determinations. Method : A panel of contributors to the science of validity testing and its application to the disability process was charged with describing why the disability process for SSA needs improvement, and indicating the necessity for validity testing in disability exams. Results : This work showed how the determination of malingering is a probability proposition, described how different types of validity tests are appropriate, provided evidence concerning non-credible findings in children and low-functioning individuals, and discussed the appropriate evaluation of pain disorders typically seen outside of mental consultations. Conclusions : A scientific plan for validity assessment that additionally protects test security is needed in disability determinations and in research on classification accuracy of disability decision.
     I notice that this is the "Official Position" of the American Academy of Clinical Neuropsychology but it makes reference to the National Academy of Neuropsychology. In addition there are the American Board of Professional Psychology which certifies neuropsychologists, the American Board of Clinical Neuropsychology, the International Neuropsychological Society and the Society for Clinical Neuropsychology. There aren't that many neuropsychologists in the U.S. There may not be 50 in my state, North Carolina. Why do neuropsychologists have so many professional organizations? What is the standing of the American Academy of Clinical Neuropsychology? I don't know. I can say that one of the eight co-authors of this "Official Position" derives at least part of his income from one of the tests that the authors of this report recommend. That's revealed at the end of the report itself. I can also say that widespread use of validity testing by Social Security would create a lot of business for psychologists. It doesn't prove that what they're saying is wrong but it is best to keep in mind that the financial interest of some psychologists is at stake here.
     You might expect me to oppose validity testing but I'm not sure what to think. If anything, I suspect it might help claimants. As a practical matter, at the initial and reconsideration levels of review of Social Security disability claims, Social Security is applying a near conclusive presumption that claimants alleging disability due to pain, intellectual disability or mental illness are malingering. Those claims aren't being approved at those levels except in the most extreme cases. It's not quite like that when these cases get before Administrative Law Judges but there's still a significant bias against claimants who have these problems. I suspect that many claimants who complain of pain, intellectual disability or mental illness would test out as "valid" on the tests being recommended and would be approved more quickly.
     I'm old enough to have been around when the grid regulations were introduced. There was great fear then that those regulations would result in fewer disability claims being approved. What actually happened was that more disability claims were approved.
     Should I worry about my clients being thrown into this briar patch?


Anonymous said...

Somewhat of a paradox, or at least one dox....

But seriously, if implemented, I think the test results would be used only against claimants. That is, if the test came back indicating malingering it would be used to deny the claimant. But if it came back "no indication of malingering" or whatever the 'positive' result is, I doubt the agency would use that to bolster a claimant's case.

my 1.432472893729083 cents

Anonymous said...

I think you need to study the history of the MMPI (Google the WSJ article too where it's use was invalidated in a couple of courtrooms) to get a better understanding of what's going to play out here.

What one person ultimately answers on the tests will end up getting used to judge and score others. The only winner in this sick mess is the people making money off of the test.

There's no fouler or more disgusting bunch than forensic psychologists that think everyone is a fraud. And keep mind these are the same folks that helped the CIA for a big fee.