Dissimulation strategies on neuropsychological tests: A qualitative investigation

People are known to feign or exaggerate symptoms of cognitive impairment
for a wide range of reasons, such as for financial gain or avoidance of criminal
responsibility. With £5.2 million paid out daily in compensation claims
(Association of British Insurers, 2011), it is important that neuropsychologists
have as much information as possible at their disposal for detecting unworthy
claims. This study investigates the strategies employed by individuals
attempting to feign cognitive impairment on standard neuropsychological
tests. A review of the literature revealed that most previous studies in the area
of malingering neuropsychological deficits have focused on developing and
validating measures to detect falsification of symptoms or poor performance
on standard tests. The only qualitative study published in this area
investigated strategies employed by individuals feigning memory impairment
(Iverson, 1995). Iverson (1995) used questionnaires and brief interviews,
subjected to a simple content analysis. The present research constitutes a
more thorough and in-depth qualitative study than any that have been
previously disseminated in this area. Detailed semi-structured interviews were
administered to 15 non-neurological individuals instructed to feign cognitive
impairment on a battery of standard neuropsychological tests. The interviews
examined both the strategies used and the thinking underlying participants’
choices to achieve a richer and more detailed understanding of the
phenomena of feigning. Thematic Analysis revealed three main organising
themes. Participants described Using Strategies, on specific tests and
generally across the battery, offered explanations of the Rationale behind their
decisions and spontaneously commented on their Experience of the Task.
The findings of the present study reveal numerous potentially useful identifiers
of feigning strategies, including many not previously reported. The resulting
themes point to the development of more effective methods for detecting
feigned cognitive impairments and could have a significant impact on the way
that neuropsychological testing sessions are conducted.