Practical Considerations in The Assessment of Potential

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AdvancesinSocialSciencesResearchJournal–Vol.7,No.3PublicationDate:Mar.25,2020DoI:10.14738/assrj.73.7923.Wildman,R.W.(2020)PracticalConsiderationsintheAssessmentofPotentialAbilitiesinApplicantsforBenefitPrograms.AdvancesinSocialSciencesResearchJournal,7(3)448-460.

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PracticalConsiderationsinTheAssessmentofPotentialAbilities

InApplicantsForBenefitPrograms

RobertW.Wildman,II.

RENONVInthisandothercountries,millionsofpeopleeveryyearapply forprogramsthroughwhichformsofgovernmentfinancialassistanceareavailable.Theseprogramsincluderentassistance,applicationsforfoodstamps,vocationaltraining,etc.OneoftheclearestexamplesofsuchagovernmentassistanceprograminvolvesapplicationsforSocialSecuritydisability,ofwhichthereareabouttwomillionannuallyintheUnitedStates(Leo,2002).Theseapplications,toputitcrudely,involveaworkersaying,ineffect,thatnotonlyissheorhenolongerabletosupporthim-/herselfandher/hisfamily,aswellascontributetothewelfareofthosewhoareunabletowork,butisactuallyinneedoffinancialaidfromthosewhoareworking and paying payroll taxes. Therefore, great care is called for in doing qualifyingevaluationsinthatasevereerrorcouldcauseapersonwhoisactuallycapableofworkingtoreceivebenefitsattheexpenseofthetrulydisabledandadditionallytonotcontributetotheupkeepofthosewithgenuinedisablingconditions.Obviously,thereversenegativescenarioisalsopossible.Not only are these evaluations important, but they are quite different in focus fromgeneralclinical evaluations conducted in hospitals and clinics in which an emphasis is placed on adiagnosticformulationofthecase.Whileintheseexaminationsalabeleddisabledpersonmusthaveadiagnosis(Onecan’thaveadisabilitywithoutadiagnosis.),thebulkofthereportsfocusonthefunctionalabilitiesofpersonswithsuchconditionsasdiabetes,depression,anxietyandsubstance abuse disorders, which vary widely among individuals placed into the samediagnosticcategories.Giventhat functionalability is thekeyquestion,peopleapplying forbenefitsmayattempttopresentthemselvesasbeingpotentiallylessfunctionalthanmightactuallybethecase.Perhapsthe best example of such a situation occurs during the course of Social Security disabilityapplications.Infact,thesearesortofreversejobinterviewsinwhichthedesiredoutcomeisthatthepatientcan’twork!Thereseemtothiswritertobethreeprongsinattemptingtoqualifyforsuchbenefits

1. Iamaveryhonestandresponsibleperson.Ihavealwaysworkedandhavenevertakenanythingfromanybody.Ilovetowork!

2. Unfortunatelyhowever, Ihavethis(mentalorphysical)conditionorconditionswhichmakeitimpossibleformetowork.

3. Also unfortunately, I was never good at school/am not too bright, so I couldn’t beretrained for some kind of office desk job inwhichmy physical limitationswouldn’tinterfere.

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ContentionNumberOneabovecan,potentiallyandobviously,beconfirmedordisconfirmedbysuchdocumentsasemploymentandwelfarerollrecords.NumberTwoismorechallenginginthatnoevaluatorordecisionmakercanbeanexpertinallmedicalfields,includingherementalhealth.Hopefully,however,sheorhewillhaveaccesstoreports,suchasfromtreatingphysicians.Also,Inboththephysicalandmentalhealthfields,anevaluatormay choose to use theWildman Symptom Checklist (Wildman&Wildman, 1999;Wildman&Wildman,2014) inaneffort to identifypersonswhoare claiming tosuffer frombogusphysicalandpsychiatricsymptoms,aswellaspresentingthemselvesaspossessinganunrealisticallyhighlevelofmorality.Thisbrief,self-administeredinstrumentalongwithscoringandinterpretiveinstructionsispresentedasAppendixAtothisarticle.NumberThreeofour“three-leggedstool”relatestoaperson’sfunctionality.Intheveryfrequentcaseofaninjuredworkerwhoisunabletoreturntohispreviousconstructionjob,therelevantquestion could come down towhether such a person could be retrained for less physicallydemandingwork,suchasinanoffice.Parentheticallyhere,manyoutsideworkersseenbythiswriterexpressoutrightdisgustattheprospectofbeing“coopedupinacubicle.”Given theabove-mentionedavoidanceon thepartof somephysically impairedapplicants, itmakes sense that some of them might attempt to downplay their intelligence in theirinteractionswithevaluators,reasoningherethatiftheysucceedinhidingtheirtrueintellectualabilities/potentials,thedecisionmakerreadingtheirreportwillconcludethatheorsheisnoteducableforalight-dutydeskjobandjustgoaheadandgranttherequestedbenefits.Thereareinthispsychologist’sexperienceanumberofwaystodetectsuch“dumbed-down”presentations:

1. Markeddiscrepanciesbetweenaperson’slevelofpresentation,suchasinthecompletionof the intake forms and during the interview, and the educational and vocationalbackground and in the absence of a dementing condition. For example, a high schoolgraduate fromaregulareducationalprogramwhorestrictsherself toa fourthor fifthgrade vocabularymight be suspected of downplaying her intelligence for the reasonsexplainedabove.

2. Inconsistent presentations. It often occurs that an applicantwill use a higher levelofverbalabilityduringonepartoftheevaluationthananother.Forexample,theintervieworpastorpresentintakeformsmayreflectvaryinglevelsofintellectualability.

Theauthorhasfounditusefultoprobeapatient’sreceptivevocabularyfollowinganassessmentofherorhisexpressivevocabulary.Asan illustrationhere, Ihavehadsuccesswithabruptlyaskinganapplicantdisplayingaverylowlevelofspeechaboutthelaststatement,“Butdoesn’tthatnegatewhatyousaidearlieraboutthismatter?”Onanumberofoccasions,patientshavequicklyexplainedawayanyapparentinconsistencies,obviouslyindicatinganunderstandingofthemeaningof theword “negate”andstrongly suggesting thepotential forahigher levelofcognitivefunctioningthanhadbeenpresenteduptothatpoint.

Wildman,R.W.(2020)PracticalConsiderationsintheAssessmentofPotentialAbilitiesinApplicantsforBenefitPrograms.AdvancesinSocialSciencesResearchJournal,7(3)448-460.

URL:http://dx.doi.org/10.14738/assrj.73.7923

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HELPFROMPSYCHOLOGICALTESTINGWhileitisnotusuallypossibletoorderfull-lengthpsychologicaltests,suchasaformalIQtest,manyofwhichcanbescoredtodetectmalingering(Rogers&Bender,2018),thereexistbriefcognitiveassessment toolswhichare sensitive to such formsofnegativepatient impressionmanagementasaredescribedinthisreport.The Nevada Brief Cognitive Assessment Instrument (NBCAI; Wildman, 2008) is a 50-itemmatchingtestwhichcorrelates.83withtheWAIS-IIIVerbalIQscore,certainlyqualifyingitasascreeningmeasureforintelligence.Todate,ithasbeenusedinpublishedstudiesofscreeningforearlydementia(Brown,Lawton,McDaniel&Wildman,2012;Wildman&McDaniel,2014).ThisinstrumentisincludedasAppendixBtothisarticle.Researchwith this brief, self-administered instrument shows that it can be used to predictformally-assessedIQs.ThetableformakingthesepredictionsispresentedasTable1.

Bywayofroughsummary,ascoreof20predictsanIQofabout70,obviouslyontheborderlineofintellectualdisability,andascoreof40wouldbeconsistentwithnormalintelligence(about100).In terms of detecting negative patient impressionmanagement on the NBCAI, an evaluatorshould become suspicious if an applicant’s educational/vocational background is grosslyinconsistentwiththepredictedIQ.Ihavefoundittobeparticularlyusefultocomparetheclient’swrittenresponsesontheintakeformswiththeresultoftheNBCAIvocabularysubtest,inmanycasesconcludingthatitwouldnotbepossibleforsomeonewithsuchalow-levelvocabularytohaveproducedsuchhigh-levelwritten(orsubsequentlyspoken)responses.



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AmorerigorousandstatisticalmethodforusingtheNBCAItodetectfeigninglowerlevelsofintelligenceemergedfromthereportofWildman(2018).Briefly,aratioiscalculatedbydividingthenumberofthe20empirically-determinedeasiestitemsontheinstrument(1,2,3,12,15,20,21,23,24,28,31,32,33,34,35,36,37,38,39,40)bythetotalnumberofmatchingitemswithincorrectanswers.Predictingthatpatientsscoring.125andhigheronthisindexaretryingtohidetheirtruelevelofintelligence,whilelower-scorersaremakingagood-faitheffortproducesa“hit-rate”(Wildman&Wildman,1975)of77%.Specifically,thisindexcorrectlyidentifies87%ofthosedownplayingtheirabilitiesand67%ofthoserespondinghonestly,employinghereabroadrangeofdatasourcesoutsidetheNBCAIitself,suggestingmorefalsepositivesthanfalsenegativeswithrespecttohavingtheconditionofmalingering.Alessdramaticformofpatientnegativeimpressionmanagementrelatestosimplynotmakingagood-faithefforttodoaswellaspossible,asopposedto,say,givingwronganswers.TheRenoEffortTest(Wildman,2015),reproducedasAppendixCtothisreport,wasdesignedtohelpindetecting such failure to exert oneself maximally during evaluations. The average personcompletesalittleover100oftheseitemsinatwo-minuteperiod,soscoresmarkedlybelowthatfigureshouldinspiresomedoubtastohowhardthepersonbeingevaluatedwastrying.Howeverandperhapsobviously,nostatisticalcalculation,suchastheonesdiscussedabove,canbe reliedupon todetector rule-outnegativepatient impressionmanagement.But theymayprovidewarningsduringthegeneralclinicalevaluationprocess,suchaswhentheeasyitemsmissed/totalitemsmissedratioontheNBCAIistwoorthreetimesthecutoffforsuggestingthedownplayingofone’slevelofintellectualability.ReferencesBrown,D.H.,Lawson,L.E.,McDaniel,W.F.&Wildman,R.W. II. (2012).Relationshipsbetween theNevadaBriefCognitive Assessment Instrument and the Saint Louis Mental Status Examination in the assessment of disabilityapplicants.PsychologicalReports:Disability&Trauma.111,3,939-957.Leo,R.J.(2002).SocialSecurityandpsychiatricillness.Psychiatricillness.PsychiatricAnnals,32,279-280.Rogers,R.&Bender,S.D.(2018).Clinicalassessmentofmalingeringanddeception,Fourthedition.NewYork:TheGuilfordPress.Wildman,R.W.&Wildman,R.W.II.(1999).Thedetectionofmalingering.PsychologicalReports,84,386-388.Wildman,R.W.&Wildman,R.W.II.(1975).Aninvestigationintothecomparativevalidityofseveraldiagnostictestsandtestbatteries.JournalofClinicalPsychology,31,455-456.Wildman,R.W.II.(2018).ThedetectionofmalingeredlevelsofcognitiveimpairmentontheNevadaBriefCognitiveAssessmentInstrument:Towardthedevelopmentofbrief,quantitativemeasuresoffeignedlowintelligence.AdvancesinSocialScienceResearchJournal,5(7),474-476.Wildman,R.W.II.(2015).AResourceManualforPsychologistsandpsychiatristsConductingSocialSecurityDisabilityEvaluations.RenoNV:EmpiriPsyPress.Wildman,R.W.II.(2008).TestManualfortheNevadaBriefCognitiveAssessmentInstrument.RenoNV:EmpiriPsyPress.Wildman,R.W, II&McDaniel,W.F. (2014) Investigations intotheconstructvalidityof theSaintLouisUniversityMental StatusExamination:Crystalized versus fluid intelligence. Journal of Psychology andBehavioral Science, 2,2,187-191.Wildman,R.W.II.&Wildman,R.W.(2014).AnoteontheclinicalutilityoftheWildmanSymptomChecklist.JournalofPsychologyandBehavioralScience,2(3&4),51-53.



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APPENDIXATheWildmanSymptomChecklist



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Ascoreabove15wouldbesuggestiveofmalingering,and,quiteobviously,alookatfromwhichofthethreesectionsthesesuggestiveanswerscomecanhelpanevaluatorwithhypothesesastothenatureoftheinvolvednegativepatientimpressionmanagement.



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APPENDIXB

TheNevadaBriefCognitiveAssessmentInstrument(Nbcai)



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APPENDICCTheRenoEffortTest(Ret)

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Practical Considerations in The Assessment of Potential