Access Type

Open Access Thesis

Date of Award

January 2012

Degree Type


Degree Name




First Advisor

Lisa J. Rapport


Purposeful presentation of suboptimal effort is a primary pitfall to accurate assessment, especially among individuals seeking compensation. It is known that successful simulation of impairment becomes increasingly difficult when feigning is required across multiple measures. This study evaluated the diagnostic efficiencies and predictive ability of five symptom validity tests: Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), California Verbal Learning Test - Forced Choice (CVLT), Reliable Digit Span, and Word Choice Test. Participants were 57 adults with moderate to severe traumatic brain injury and 60 healthy adults coached to simulate memory impairment. Tests were evaluated using logistic regression, ROC curve, and Bayesian Information Criterion statistics. Results indicate that the TOMM and MSVT performed best; however, they operated less effectively than combined use of the TOMM and CVLT in differentiating bona fide TBI and simulators. The limitations of comparing multivariable models psychometrically are discussed, as are areas of future research.