Clinical Utility of Reliable Digit Span in Assessing Effort in Children and Adolescents with Epilepsy

Antoinette Welsh · Lindsay A. Whitman · Marsha Vasserman · William S. MacAllister

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Abstract

The assessment of effort is an important aspect of a comprehensive neuropsychological evaluation, as this can significantly impact data interpretation. While recent work has validated the appropriateness of adult-derived cutoffs for standalone effort measures in younger populations, little research has focused on embedded effort measures in children. The present study includes 54 clinically referred children and adolescents (32 males/22 females; aged 6-17) with a confirmed diagnosis of epilepsy. Reliable Digit Spans (RDSs) were calculated and the Test of Memory Malingering (TOMM) was administered in the context of a comprehensive neuropsychological evaluation. Using a previously published RDS cutoff of ≤6, a pass rate of only 65% was obtained, well below the recommended 90% pass rate for an effective effort index. In contrast, when adult criteria were used on TOMM Trial 2, a 90% pass rate was observed. RDS scores were significantly correlated with IQ estimates (r = .59, p < .001) and age (r = .61, p < .001). The difference between RDS and the TOMM on the participant outcome was statistically significant (χ(2) = 9.05, p = .003). These results suggest that RDS appears to yield a large number of false positives and, therefore, may be of limited utility in detecting poor effort in a pediatric epilepsy population. These findings likely extend to other pediatric populations that are known to have significant cognitive loss.

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References

2009American Academy of Clinical Neuropsychology Consensus Conference Statement on the Neuropsychological Assessment of Effort, Response Bias, and Malingering 2005Symptom validity assessment: Practice issues and medical necessityNAN Policy & Planning Committee 1994Validation of malingered amnesia measures with a large clinical sample.1994Validation of malingered amnesia measures with a large clinical sample.1999Deception by young children following noncompliance.2000Children's everyday deception and performance on false‐belief tasks 2008The Need For Continuous and Comprehensive Sampling of Effort/Response Bias During Neuropsychological Examinations 2003Word Memory Test Performance in Children

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