Psychological Assessment of Symptom and Performance Validity, Response Bias, and Malingering

Posted in About Brain Injuries, Brain Injury Legal Cases, Brain Injury Legislation, Brain Injury News, Brain Injury Resources & Links

The Association for Scientific Advancement in Psychological Injury in the Law has published an official position regarding psychological assessment of symptom and performance validity, response bias, and malingering. Psychol. Inj. And Law (214) 7:197-205.  Bush, SS, Heilbronner and Ruff RM.  According to the abstract, the “purpose of this position statement is to promote ethical psychological practice in legal context by reviewing validity assessment issues and their ethical foundations.”  The authors find the position statement necessary as “no previously published document focuses specifically on symptom, performance, and response validity assessment that is pertinent for all psychological evaluation performed in forensic context.”

The authors make the following recommendations: Recommendations for Forensic Practitioners

1. Strive to be familiar and practice consistent with relevant practice, ethical, and legal/legislative requirements pertaining to validity assessment, including the present statement and extant position statements (e.g., Bush et al. 2005a, 2005b; Heilbronner et al., 2009).

2. Only validity measures having appropriate psychometric properties are used, selected based on the characteristics of the examinee and the circumstance(s) for which the examinee is referred.

3. List all validity measures and psychometric indicators used but avoid describing them in detail.

4. Interpretations of the results of assessment measures are based on consideration of all the relevant reliable assessment data, and then considered with the full data set (e.g., from examinee interview, collateral sources, records). These other data sets might contain substantial inconsistencies or discrepancies. The conclusions that best fit the full data set are offered in opinions and testimony, independent of the desires of the referral source.

5. Be wary of inferring motivation, volition, intention, and consciousness when there is insufficient evidence. However, do not avoid making such judgments when sufficient evidence is available. Consistently using preferred inferences, such as feigning or a “cry for help,” can be unhelpful or misleading in individual cases unless the evidence overwhelmingly supports such a conclusion.

6. Use of validity measures and indicators is maximized when practitioners understand the various items and definitions, and how to resolve inconsistencies therein in their conclusions. Understanding inconsistencies within and across relevant ethics codes, professional guidelines, practice regulations, legal/legislative frameworks, and position statements, enables practitioners to address them effectively in court.

7. Repeatedly check for biases and incentives in one’s own practices and conclusions. Internal or external influences that detract from an unbiased approach to evaluations need to be considered and countered. It is the forensic practitioner’s responsibility to guard against biases and strive to maintain a balanced perspective.


Banyan Biomarkers Inc. Licenses Protein Markers to Help Evaluate Traumatic Brain Injury

Posted in Brain Injury News

It is well understood that CT and MRI are often insensitive in the detection of mild to moderate traumatic brain injury. By the time a patient is seen in the emergency room, acute neurological abnormal findings may also be absent. Thus, to date, it is often difficult for physicians to diagnose that an individual has sustained a mild to moderate traumatic brain injury. As a result, patients are often released from the emergency room with instructions to follow up with their family physicians should they begin to develop symptoms consistent with a mild to moderate traumatic brain injury.

Recently, Banyan Biomarkers, Inc. has been working on a blood test that could be used by physicians to directly detect the presence of mild and moderate traumatic brain injury and improve the medical management of brain injured patients. By assessing protein biomarkers, Banyan Biomarkers believes that physicians will be able to objectively test to evaluate patients who may have suffered a concussion. Most recently, Banyan Biomarkers has licensed its intellectual property related to traumatic brain injury biomarkers to Abbot for assessment and verification.

The Banyan Biomarkers’ press release can be found by clicking here.

Impact Location and Concussion Outcomes in High School Football Players

Posted in Brain Injuries in Sports

A new study out of the University of Colorado-Denver found that regardless of the location of impact of high school football players who sustained a concussion, there was no difference in the outcome.  Researchers, noting that “little research has examined concussion outcomes in terms of impact location (i.e., the area on the head in which the impact occurred), utilized the National High Schools Sports-Related Injury Surveillance Study dated between 2008/2009-2012/2013 to calculate rates and describe circumstances of football concussion (e.g., symptomatology, symptom resolution time, return to play) resulting from player-to-player collisions by impact location.”

Not surprisingly, the researchers found that most concussions resulting from player-to player collisions occurred from front-of-the-head and side-of-the-head impacts.  While a larger proportion of football players who sustained concussions from the top-of-the-head impacts experienced loss of concussion than those suffering concussions in other locations of the head, concussions outcomes were generally independent of impact location. 

Dawn Comstock, the lead author of the study, was quoted as saying “we can’t predict which athletes are more likely to have more severe symptoms or worse outcomes based only on how their injuries occurred.  Every clinician needs to take every concussion very seriously.”  “What we can say is that these findings definitely support the call to take the head out of the game if you will.” If you or a loved one has suffered an injury, contact Stark & Stark today.

Shareholder, Bruce H. Stern, Esq. Elected Parliamentarian of American Association for Justice (AAJ)

Posted in Events

Stark & Stark would like to congratulate Accident and Personal Injury Shareholder Bruce Stern. Mr. Stern has been elected Parliamentarian of the American Association for Justice (AAJ) at the organization’s annual convention in Baltimore, Md. AAJ is the world’s largest trial bar, working to make sure people have a fair chance to receive justice through the legal system when they are injured by the negligence or misconduct of others. Mr. Stern concentrates his practice in the area of traumatic brain and spinal cord injuries and wrongful death.

Stern Inducted into International Academy of Trial Attorneys

Posted in Brain Injury News

This past weekend I was honored to be inducted as a Fellow in the International Academy of Trial Lawyers at this year’s mid-year meeting in Manchester Village, Vermont. I was privileged to be introduced by my friend and colleague Kathleen Flynn Peterson, a past president of the American Association for Justice. 

The Academy is a group of truly elite trial lawyers representing both sides of the bar: prosecutors and defense lawyers in criminal cases, and plaintiffs’ and defense counsel in civil litigation, including business and personal injury cases. While the majority of Fellows come from the United States, the Academy includes lawyers from more than thirty countries. Fellowship is by invitation only, and the trial lawyers are invited to become Fellows only after an extremely careful vetting process. As to U.S. Fellows, the academy’s by-laws limit fellowship to 500 active trial lawyers.

Headache and Depression Following Mild Traumatic Brain Injury Is There a Relationship?

Posted in Brain Injury News

At the American Headache Society’s 56th Annual Scientific Meeting, Sylvia Lucas, M.D., Ph.D., a clinical professor of neurology and neurological surgery at the University of Washington Medical Center reported on her research looking at the correlation between headache and depression following mild traumatic brain injury. 

The study looked at 212 patients with mild traumatic brain injury at the University of Washington who sustained a mild traumatic brain injury. Participants had a mean age of 44 years and were mostly male (76%), white (75%), and had at least a high school education (83%). Their injuries primarily involved vehicle accidents (58%), followed by falls (24%), assaults (5%), and sports mishaps (3%). Researchers carried out baseline assessments during face-to-face interviews within 7 days of the injury. Follow-up interviews using a structured questionnaire were completed over the telephone at 3, 6, and 12 months post-injury.

The study found that a year after suffering mild traumatic brain injury, patients with headache were five times more likely to be depressed than patients with mild traumatic brain injury without headache and those who were depressed were more likely suffer headaches.

Click here to see the article published in Medscape Medical News, July 3, 2014.

Traumatic Brain Injury and Risk of Dementia in Older Veterans

Posted in Brain Injury News

A recent publication in Neurology, the official journal of the American Academy of Neurology, found that traumatic brain injury and the risk of dementia in older military veterans. “Traumatic brain injury and risk of dementia in older veterans,” Deborah E. Barnes, PhD, MPH, Allison Kaup, PhD, Katharine A. Kirby, MA, Amy L. Byers, PhD, MPH, Ramon Diaz-Arrastia, MD, PhD and Kristine Yaffe, MD.

The researchers from the University of California, San Francisco, San Francisco Veterans Affairs Medical Center and the Uniform Services University of the Health Sciences and Center for Neuroscience and Regenerative Medicine in Bethesda, Maryland, examined the association between traumatic brain injury and risk of dementia in veterans.

The researchers performed a “retrospective cohort study” of 188,000 U.S. veterans age 55 years or older who had at least one in-patient or out-patient visit during the baseline (2000-2003) and follow-up (2003-2012) and did not have a dementia diagnosis at baseline.

According to the abstract, which can be found here, traumatic brain injury in older veterans was associated with a 60 percent increase in the risk of developing dementia over nine years after accounting for continuous and potential confounders. “Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of traumatic brain injury in younger veterans and civilians."

New CDC App for Brain Injury

Posted in Brain Injury News

The Centers for Disease Control and Prevention has released a new “Heads Up" app. According to their website, “The Heads Up"app will help you learn how to spot and what to do if you think your child or teen has a concussion of other serious brain injury. This app will also teach you about helmet safety and features information on selecting the right helmet for your child’s or teen’s activity, including information on what to look for and what to avoid.”

We know that there is no medical cure to traumatic brain injury. The best thing is prevention.  I recommend this app to everyone.

Find out more about this app by clicking here.

New Study Finds Increase in Number of Concussions in High School Athletes

Posted in Brain Injury News

A new study out of the Ohio State University and published in the American Journal of Sports Medicine found “concussion rates in the US High‑School athletes more than doubled between 2005 and 2012."  During this time period, the researchers, led by Joseph Rosenthal, M.D. a clinical assistant professor of physical medicine and rehabilitation at the Ohio State University looked at 4024 concussions suffered by athletes in nine sports. Click here to read the full story.

While some may find these statistics alarming, it is much more likely that this increase demonstrates to some extent a recognition of the seriousness of concussion and the need for appropriate care.  In its press release, Dr. Rosenthal was quoted as saying “our theory is that more people are looking for concussions, and athletes, parents, and coaches are being educated on the symptoms and importance of removal from participation, as well as treatment.  There is a greater emphasis on monitoring for injury.” 

Recent articles, also published in the American Journal of Sports Medicine give some support to that view.  Two papers out of Harbor View Injury Prevention and Research Center in Seattle, Washington looked at the implementation of concussion legislation and extent of concussion education for athletes, parents, and coaches.  There, the researchers conducted a survey in 2012 and 2013 on a random sample of public high school football, girls’ soccer, and boys’ soccer coaches in Washington State, stratified by urban and rural locality.  The survey was constructed to cover the extent of concussion education for coaches, athletes, and parents as well as coaches’ concussion knowledge and experience. 

According to the abstract, “three years after the passage of a concussion law in Washington State, high school football and soccer coaches are receiving substantial concussion education and have good concussion knowledge.  Concussion education for athletes and parents is more limited.  Football players receive more extensive concussion education than do soccer players." To read more, click here.

In a second study, these researchers concluded, “more objective and accurate methods are needed to identify concussions.  Changes in athlete attitudes on reporting concussive symptoms will likely not be accomplished through legislation alone.” To read more, click here.