There is overwhelming evidence that the presence of secondary gain is an independent predictor of both performance validity and neuropsychological test outcomes. In addition, studies have demonstrated that genuine cognitive and/or psychological conditions can influence performance validity testing, both in the presence and absence of secondary gain. However, few studies have examined these factors in a large sample of academic accommodation seeking college students. The current study examined base rates of symptom validity test failure, the possibility of a “Near-Pass” intermediate group on symptom validity tests, the influence of diagnoses on performance indicators, and whether performance validity differed for “Near-Pass” patients relative to those who pass and those who fail performance validity indicators.

The Word Memory Test (WMT) is a popular effort test that requires participants to memorize lists of paired words and repeat them back in a variety of different memory tasks. Four brain injured patients participated in two trials of the delayed recall (DR) portion of the WMT while undergoing fMRI scanning. In the first trial subjects put forth full effort, and during the second trial subjects were instructed to simulate increased memory impairment in order to represent poor effort. fMRI activation from both trials were compared in order to contrast full and simulated poor effort activation patterns during the WMT. Raw scores from full effort and simulated poor effort trials were compared to a control group to test the hypothesis that a brain injured population will score lower than a healthy population on the WMT while putting forth full effort. Raw score results showed lower WMT scores for TBI group. fMRI results showed larger between-group differences than between-condition differences, suggesting that the WMT is sensitive to TBI.