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Lee H. Ensalada


Symptom validity testing (SVT), also known as forced-choice testing, is a means of assessing the validity of sensory and memory deficits, including tactile anesthesias, paresthesias, blindness, color blindness, tunnel vision, blurry vision, and deafness. The common feature among these symptoms is a claimed inability to perceive or remember a sensory signal. SVT comprises two elements: a specific ability is assessed by presenting a large number of items in a multiple-choice format, and then the examinee's performance is compared to the statistical likelihood of success based on chance alone. These tests usually present two alternatives; thus the probability of simply guessing the correct response (equivalent to having no ability at all) is 50%. Thus, scores significantly below chance performance indicate that the sensory cues must have been perceived, but the examinee chose not to report the correct answer—alternative explanations are not apparent. SVT also has the capacity to demonstrate that the examinee performed below the probabilities of chance. Scoring below a norm can be explained by fatigue, evaluation anxiety, inattention, or limited intelligence. Scoring below the probabilities of chance alone most likely indicates deliberate deceptions and is evidence of malingering because it provides strong evidence that the examinee received the sensory cues and denied the perception. Even so, malingering must be evaluated from the total clinical context.

in AMA Guides® Newsletter