Comments on the WMT and the MSVT

From the foreword to the WMT Test Manual
by Dr. Paul Lees-Haley

In the plethora of methods for identifying invalid test data, Dr. Paul Green's Word Memory Test (WMT) stands out as the most thoroughly researched and intensively cross-validated of them all. With his focus on measuring effort, Dr. Green has effectively concentrated on the behavior of the examinee most relevant to the validity of neuropsychological assessment. This was a critical decision because it permits the user of the WMT to assess the primary issue - validity of the results - without becoming ensnared in the thicket of differentiating various response biases, malingering, confusion between subjective reporting and objective testing, and the worrisome issue of conscious intent. Using extensive data from relevant comparison groups, Dr. Green measures effort empirically rather than based on subjective impressions of experts or self-reports of examinees.

Most research on assessment of invalid psychological and neuropsychological test results has used data produced by simulators (usually college students) rather than known groups. Dr. Green, along with colleagues including Dr. Roger Gervais and Dr. Lloyd Flaro, has collected comparison data from numerous groups ranging from compensation-seeking claimants to neurological patients with brain tumors, strokes, ruptured aneurysms, et cetera, depressed adults, both mild and severe traumatically brain injured adults, children with fetal alcohol syndrome, children with neurological diseases, and others.

The importance of the effort assessment research led by Dr. Paul Green cannot be overstated. Recent findings on the amount of variance accounted for by effort raise questions about the validity of a host of neuropsychological and psychological research studies dating back to the origins of cognitive assessment. A random perusal of empirical studies in neuropsychological and psychological journals reveals a pervasive tendency to presume that diagnoses and test results are valid based on various methods of clinical assessment with no correction for effort based on any empirical method.

Although blatantly uncooperative participants are typically excluded, empirically measured effort has not been used as an exclusion factor in literally thousands of studies in which effort is essential to the validity of the results. This omission is present in normative studies and validation studies of widely used tests as well as most other studies employing neuropsychological or neurobehavioral tests. The implication is that a cross validation of prior research using effort as an exclusion criterion may lead to significantly different conclusions in many studies presently relied upon by experts in the field. Neuropsychological assessments are no longer complete without evaluation of effort.

Paul R. Lees-Haley, Ph.D., ABPP
Huntsville, Alabama,
September 6, 2003

Ethics & SVTs by Iverson

From the foreword to the MSVT Test Manual
by Hamilton Hall M.D.

For over three decades as a practicing spine surgeon, I have repeatedly faced the challenge of separating those patients with genuine disability from those who grossly exaggerate their concerns. Physicians and any health professionals who evaluate disability must constantly balance the need to accurately diagnose and treat people with legitimate maladies with the desire to avoid extended potentially harmful interactions with those who exhibit fraudulent behavior. There is no merit to naive acceptance of absurd or implausible symptoms nor any benefit to prescribing treatments based upon incorrect information. Consummate clinical skill, refined clinical judgment and objective detachment are needed to recognize and disregard exaggerated or fantasized symptoms (such as blanket amnesia for all personal history prior to a whiplash injury) yet diagnose a genuine underlying complaint.

An example from my area of spinal assessment is the inevitable, involuntary cogwheel release that occurs when a patient, feigning maximum effort, deliberately relaxes a muscle during resistance testing. Most health care professionals are uncomfortable, even confused, without such objective signs to guide them along the watershed between fact and hyperbole.

During the past ten years, objective measures of symptom exaggeration have become so widely accepted in clinical practice that they are now required in all neuropsychological assessments. Dr. Green's original test for effort and memory, the Word Memory Test, has been acknowledged as a reliable model for assessing symptom validity. His work has shown that complaints of poor memory are widespread across many diagnoses, including pain focused behavior, depression and chronic fatigue syndrome. Allegations of faulty memory frequently accompany patients suffering a range of orthopedic ailments and stress. Dr. Green's new Medical Symptom Validity Test (MSVT) quickly and accurately measures the level of effort applied to a self-administered computerized examination of verbal memory.

Self-reported memory complaints can rarely be accepted at face value and a memory test with no associated measure of effort adds little useful information. In contrast the MSVT provides a rapid, validated screen for memory with an intrinsic sensitivity to exaggeration of impairment. The MSVT is one of the first tests to provide clear landmarks that sharply define the difference between a fully cooperative effort and a poorly motivated or frankly manipulative approach. Its computerized and automated design enables standardized administration and consistent interpretation. The MSVTs clarity, reproducibility and unequivocal output are welcome additions to clinicians' judgment.

It remains to be proven whether measures of genuine effort in memory testing can predict successful outcomes in rehabilitation routines, particularly where the effectiveness of treatment is dependent on high levels of patient compliance. From the early results for the MSVT, I expect that objective tests of mental effort will become as useful in many aspects of physical medicine as they have already become in psychology.

Hamilton Hall M.D. FRCSC
Professor, Department of Surgery,
University of Toronto,
Medical Director CBI Health

REVIEWS & Comparisons with TOMM

Comparison between the WMT & TOMM in 1,315 cases in two countries.

Power Point Show Lecture given by Dr. Paul Green at the National Academy of Neuropsychology annual meeting in Tampa, Florida on October 18, 2005.

Independent study: link "When the Word Memory Test (WMT) was used as the “gold standard” to which the Test of Memory Malingering (TOMM) was compared, the TOMM achieved very high PPV (.98) and acceptable NPV (.78). How to incorporate the strategy used into clinical practice is discussed".

2005 independent review of Green's WMT by Wynkoop & Denney PDF

Hartman's WMT Review PDF
Note on copyright: As the inventor, first author and main researcher of the WMT, MSVT, NV-MSVT & MCI, Dr. Green is the legally registered owner of copyright of the WMT, MSVT, NV-MSVT & MCI internationally. Legitimate copies of the CDs and test manuals and the licenses to use the WMT, MSVT, NV-MSVT or MCI in any format are sold only by Green's Publishing.