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Clinical Myths of Forensic Neuropsychology

Manfred F. Greiffensteina
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Psychological Systems, Inc., Royal Oak, MI, USA

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 The Clinical Neuropsychologist, 23: 286–296, 2009
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DOI: 10.1080/13854040802104873

CLINICAL MYTHS OF FORENSIC NEUROPSYCHOLOGY

Manfred F. Greiffenstein
Psychological Systems, Inc., Royal Oak, MI, USA

Clinical myths and lore are unfounded beliefs that still influence practice decisions. I
examine the validity of six beliefs commonly encountered in forensic neuropsychology
practice: the admissibility of test batteries; avoidance of practice effects; forewarning
insures good effort; average deficits in bright persons; 15% chronic impairment in mild
brain injury; and examiner bias causing malingering. I show these beliefs are invalid
because of material misunderstandings of case law and literature, falsification by empirical
findings, and lack of authoritative sources. The benefits, costs, and persistence of clinical
myths are discussed.
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Keywords: Myths; Neuropsychology; Forensic; Clinical folklore.

INTRODUCTION
In 1958, the economist John Kenneth Galbraith introduced the term
‘‘conventional wisdom’’ to describe faulty beliefs held by political elites.
The psychology equivalent is clinical myth or folklore, defined as strongly held
beliefs that influence clinical decisions, despite lacking evidence or logic. Myths can
originate from: overgeneralizations from a single anecdotal report (Paauw, 1999);
uncritically accepted insights passed from instructors to students; or illusory
correlation shaped by cultural associations (Chapman & Chapman, 1969).
Although forensic neuropsychology is relatively new, a set of myths may have
emerged. I identify six ideas that I regularly encounter in my forensic
neuropsychology work. My list is not exhaustive; there may be other beliefs that
I have not encountered or that have not achieved penetrance in the community. My
writing plan is to describe and discuss the following assertions, which I will examine
for mythical versus factual status:
 Fixed battery admissibility – ‘‘Only Halstead-Reitan legally admissible under
Daubert’’
 Practice effects prohibition – ‘‘One must wait at least six months to re-test’’
 Average is the new impaired – ‘‘Average scores in bright persons represent
deficits’’
 Forewarning improves motivation – ‘‘Warning examinees stops them from
faking’’

Address correspondence to: Manfred F. Greiffenstein, Psychological Systems, Inc., 32121

Woodward, Suite 201, Royal Oak, MI, 48073, USA. E-mail: mfgreiff@comcast.net
Accepted for publication: April 4, 2008. First published online: June 10, 2008.

ß 2008 Psychology Press, an imprint of the Taylor & Francis group, an Informa business
 MYTHS AND FORENSICS 287

 Residual impairment in mild TBI – ‘‘15% of mild TBI patients have chronic
deficits’’
 Examiner bias causes malingering – ‘‘People only fake to punish the defense
examiner’’

‘‘ONLY FIXED BATTERY ADMISSIBLE UNDER DAUBERT’’

The famous Supreme Court ruling in Daubert v. Dow Chemical was a
landmark legal decision. In brief, the Daubert (1993) ruling of law was that the
admissibility of scientific evidence was controlled by the Federal Rules of Evidence,
not the old Frye (1923) ruling. Some neuropsychologists interpreted the Daubert
ruling as a warning that only ‘‘fixed’’ test batteries such as the Halstead-Reitan test
battery (HRB) would be legally admissible. Conversely, a number of commentators
expressed strong certainty that test groupings other than fixed batteries would
be ruled inadmissible under Daubert (Posthuma, Podrouzek, & Crisp, 2002;
Reitan & Wolfson, 2002; Russell, 2007). The common source for this belief is a
commentary article by Reed (1996, p. 315). He cited the brain injury case of
Chapelle v. Ganger and reported the following: ‘‘The Daubert standard was applied
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for the first time to the use of fixed (standardized) vs. flexible neuropsychological
test batteries in the federal court.’’ Reed further asserted (p. 315) that the trial judge
barred admission of flexible test battery evidence for ‘‘lack of medical and scientific
evidence to support the conclusions made from the flexible batteries’’.
The assertion of the Halstead-Reitan battery’s superior admissibility is a myth
for two reasons. It is easily disproved by showing that Reed (1996) materially
mischaracterized the Chapelle ruling. The Chapelle text (available through
www.westlaw.com) reveals the following facts: There was no Daubert challenge to
a ‘‘flexible’’ test battery; both the flexible test battery (plaintiff expert) and fixed
battery data (defense expert) were admitted into evidence. Even testimony based on
partial Halstead-Reitan results was admitted. Instead, the court’s verdict was
based on evidentiary weight: The testimony of a ‘‘fixed battery’’ specialist was
preferred because he integrated extra-test records into his opinion. Hence, it was the
multi-method approach and thoroughness of the reasoning process, not the type of
test battery, which swayed that court. Second, 15 years of Daubert jurisprudence
have not been accompanied by any increase in Halstead-Reitan use or decline in
flexible approaches. If courts had dismissed flexible test batteries or trumpeted fixed
ones, repeated rulings should have changed the face of our practice. But serial
practice surveys show the opposite: Fixed battery use underwent dramatic decline
since the Daubert decision. In 1994, the year after Daubert, 14% of our community
used a fixed battery but in 2005, 12 years post-Daubert, only 7% report using such a
battery (Sweet, Nelson, & Moberg, 2006). In contrast, flexible batteries rose from
60% to 76% in the same time period.
In closing, Reed (1996) likely conflated the different issues of admissibility
versus weight of evidence, not recognizing that Daubert only goes to admissibility.1

1
There was a Daubert challenge in this case to the testimony of a ‘‘vocational specialist’’ who speculated
about the minor plaintiff’s future job prospects. The judge excluded that intuitive testimony.
 288 MANFRED F. GREIFFENSTEIN

In summary, the belief that ‘‘Daubert requires fixed battery only’’ is a clinical
folklore originating in overgeneralization from a materially misunderstood and
nonbinding single case ruling.2

THE ‘‘PRACTICE EFFECTS’’ PROHIBITION

A recurring forensic issue is the impact of ‘‘practice effect’’ (PE) on cognitive
scores. PE refers to gains in neurocognitive scores when a person is retested on the
same instrument (Kaufman, 1994). PE issues are often raised in forensic cases,
because parties undergo examination by two or more neuropsychologists retained
by opposing sides. Some neuropsychologists and lawyers assert a blanket
prohibition against any repeat testing for a ‘‘protected’’ period after their own
testing. Proponents for minimum test–retest intervals (e.g., ‘‘six months’’) justify the
prohibition by arguing that PE may ‘‘mask’’ or ‘‘hide’’ underlying neurocognitive
deficits they believe are present. This is not a view limited to plaintiff-selected
psychologists. In my experience, assertions about PE are common among both
defense and plaintiff attorneys, and claims adjustors.
The widespread ‘‘PE avoidance’’ belief is irrational, and a correction of this
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misapprehension is long overdue. First, it is impossible to identify any authority for

this belief, suggesting it rose up de novo on some unknown basis. One psychologist’s
website, www.brainevaluation.com (last downloaded March, 2007) makes the
unsupported assertion that it is official APA policy to avoid retesting within a
6-month interval. However, I found no such position statement during a restricted
field search of the term 5practice effects4 at the APA website. Another potential
source for the myth could be material misunderstanding of intelligence test
manuals. For example, the Wechsler Adult Intelligence Scale Revised manual
(WAIS-R; Wechsler, 1981) cites mean practice effects of 8–9 point gains in
Performance IQ if re-tested within 2–7 weeks. The purpose of reporting this finding
is to qualify or modify conclusions about intelligence, but the WAIS-R manual does
not prohibit retesting at all. Second, PE is not methodological artifact from which
no conclusions can be drawn. If PE was random error, change scores should be
evenly distributed around a mean of zero. But PE is reliably unidirectional towards
better scores in motivated subjects (Theisen, Rapport, Axelrod, & Brines, 1998), so
improved scores must represent the operation of normal memory retrieval. The
third objection is one of illogic: The myth places its advocate in the contradictory
position of asserting organic memory loss while simultaneously refusing to consider
score improvement as evidence for improvement. Only cognitively intact or mildly
impaired persons show benefit from re-testing, assuming good effort. Otherwise,
more severe organic deficits do not improve with retesting (Shatz, 1981). Fourth,
there is no authority for any mandated length of test–retest interval. Putnam,
Adams, and Schneider (1992) found equivalent results with a 1-day retest interval in

2
As this article went to production, the New Hampshire Supreme Court struck down the ‘‘only a fixed
battery is admissible’’ position. In Baxter v. Temple, a lead exposure case, the initial trial court ruled as
inadmissible any testimony based on flexible battery evidence. The state’s supreme court reinstated the
evidence, finding the ‘‘fixed battery’’ argument to be fallacious and inconsistent with accepted practice.
 MYTHS AND FORENSICS 289

an injured scuba diver, based on application of the standard error of measurement

(SEM; standard deviation divided by the square root of N ).
Finally, a rich empirical literature on repeat testing is available for the
clinician to guide interpretation of PE. This vast literature shows that PE magnitude
depends on factors such as nature of the task (e.g., timed versus untimed),
demographics, baseline performance level, the severity of the brain disease in
question and the cognitive domain tested (Horton, 1992; McCaffrey & Westerveld,
1995; Mitrushina & Satz, 1991; Shatz, 1981). As one example, Dodrill and Troupin
(1975) showed negligible PE for most tests in the Halstead-Reitan battery except for
the Category Test. Even the absence of PE where it is expected can sometimes be
crucial evidence. Chelune, Naugle, Lueders, Sedlak, et al. (1993) found small
decrements in post-lobectomy memory scores compared to presurgical baseline;
decrements on tasks with known high PE must represent substantial learning loss.
Of course, declining scores on repeat testing in the context of remote or minor injury
can also represent noncredible impairment (Reitan & Wolfson, 1996).
Nobody disputes that PEs pose an interpretive problem, but such recognition
is far removed from the false belief that re-testing is time barred. PE can provide
much useful information to clinicians. PE, present or absent, is just another
important piece of psychological datum that needs to be explained in the context of
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other case-specific knowledge. For example, Lezak, Howieson, Loring, Hannay,

and Fischer (2004, p. 760) write: ‘‘Repeated performances on the same tests may
have different response patterns that can shed light on response validity.’’
The meaning of PE depends solely on the generalization sought or needed
(Kaufman, 1994), and many data are available to help determine the meaning of
test–retest effects of specific measures (McCaffrey & Westervelt, 1995).
Neuropsychologists offer opinions on any phenomenon relevant to understanding
an individual’s capacity for memory and new learning. Whether a robust practice
effect represents intact memory or whether it represents recovery from a brain injury
cannot be answered in isolation from extra-test data (e.g., initial injury severity) and
statistical considerations.

AVERAGE IS THE NEW IMPAIRMENT

A special population in forensic neuropsychology is intellectually or
artistically gifted individuals who assert permanent cognitive impairment
following mTBI. Some neuropsychologists argue that average/normal scores
from gifted individuals represent acquired deficits. Relying on dose–response
considerations, they reason that mTBI causes mild reduction from premorbid levels.
If premorbid function was at the superior level, a mild reduction would place scores
in the average or high-average range. For example, an average or high-average score
on a memory test by an intellectually gifted person is viewed as acquired
impairment.
There are two problems that invalidate this assertion. The first problem is the
false premise that IQ correlates not only strongly but uniformly with all
neuropsychological measures. But literature shows IQ has varying associations of
widely different strengths. Diaz-Asper, Schretlen, and Pearlson (2004) reported that
IQ and neuropsychological performance were related, but the association was
 290 MANFRED F. GREIFFENSTEIN

stronger in persons with low to average IQs, but weaker for persons with high IQ.3
Other contrary evidence includes Dodrill’s (1997) demonstration of a curvilinear
relationship between intelligence and performance on the Halstead Reitan Battery
(HRB). HRB scores plotted against IQ scores in a range from 70–109 show a clear
negative slope (the higher the IQ, the lower the impairment rating) in otherwise
normal persons. But the relationship is flat beyond the bright-normal range
(IQ4110). Thus, superior intelligence does not predict superior scores on
neurocognitive measures.
It bears separate mention that the psychometric properties of many
neuropsychological measures make them prone to high floors, (i.e., simpler than
intelligence measures). Some tests are so easy and score distributions so negatively
skewed that the modal performance is close to 100%. A perfect score on
an easy test would be ‘‘average’’ but mislead some neuropsychologists to say,
‘‘This represents a deficit’’.

FOREWARNING GUARANTEES MOTIVATION

A universal procedural concern is obtaining maximal performance. Many
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manuals and texts offer general guidelines for encouraging best performances
(Lezak et al., 2004), suggestions tempered by standardized administration rules.
Most neuropsychologists try to find the balance between obtaining optimal
performance and allowing deficits to emerge (Vanderploeg, 1994). Nevertheless,
some neuropsychologists have drawn unsupportable conclusions from these guides,
creating the following myth: Forewarning the respondent about specific effort tests
safeguards the examination from insufficient effort or malingering. Put differently,
warning about specific effort tests ensures that poor scores on the ‘‘real’’
neuropsychology tests will represent valid deficits.
This belief achieves myth status for lack of logical or empirical evidence.
Logically, simulation research with undergraduates is a paradox that limits
prospects for generalization. Rogers and Cavanaugh (1983) illustrate the absurdity
of asking undergraduates to comply with instructions to fake deficits, in order to
draw conclusions about real-life litigants who fake deficits in defiance of compliance
expectations. Empirically, the ‘‘forewarning improves motivation’’ belief is linked to
a single study, a role-play simulation by Johnson and Lesniak-Karpiak (1997).
Johnson et al. asked undergraduates to feign neuropsychological deficits for
imaginary compensation, and found an effect for warning: A warned group
produced higher motor and memory scores than unwarned (‘‘naı̈ve’’) simulators.
Despite also finding that 55% of warned simulators still produced noncredible
scores, Johnson et al. (1997, p. 152) made the blanket conclusion that ‘‘(the) results
provide support for effectiveness of warning in reducing malingering behavior on
selected measures.’’ Young john, Lees-Haley, and Binder (1999) criticized
Johnson et al.’s conclusions as unsupported by the data. Their reanalysis showed

3
Diaz-Asper reported a mean effect size of 0.73 for the low to average group, and the above average
group showed a mean effect size of 0.41.
 MYTHS AND FORENSICS 291

the coached group’s general level of performance was still well below that of a good
effort control.
The Johnson et al. (1997) results have not been replicated. Johnson was unable
to replicate her initial findings; instead she found that warned and unwarned
simulators performed similarly (Johnson, Bellah, Dodge, Kelley, & Livingston,
1998). Independent researchers also failed to replicate. Wong, Lerner-Poppen, and
Durham (1998) reported no benefit to warning, as both unwarned and warned
simulators exhibited equally poor scores on attention-concentration, memory, and
executive function tests. In another study, Suhr (2002) showed that naı̈ve and
warned simulator groups still showed suspiciously low primacy scores on list
learning, suggesting that forewarning does not correct erroneous stereotypes of
brain-injured performance. Other work by Julie Suhr suggests forewarning may
even change the style of misrepresentation (Suhr & Gunstad, 2000).
In conclusion, warning litigants about upcoming ‘‘specific malingering
measures’’ is an ineffective way of improving motivation in persons intending to
feign deficits. Instead, the relevant body of research indicates ‘‘tipping off’’ may
only change the preferred malingering style, making it less extreme and hence harder
to detect when present (see Storm & Graham, 2000, for MMPI-2 literature
example).
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THE MISERABLE 15%

Much of forensic private practice is driven by persistent postconcussive
complaints long after mild traumatic brain injury (mTBI). The best studies inform
us that recovery from mTBI is spontaneous and rapid, and there is no residual
neurocognitive deficit (McCrea, 2007). Nonetheless, it is frequently stated that
roughly 15% of persons with mTBI are said to have permanent impairments. Some
clinicians have labeled this dramatic subgroup as the ‘‘miserable minority’’
(Ruff, Camenzuli, & Mueller, 1996). This view is traceable to an influential mTBI
review article by neurologist Michael Alexander (1995). He wrote: ‘‘At one year
after injury approximately 15% of mTBI patients have not recovered’’ (p. 1256).
This percentage is now woven into the fabric of our belief systems, with
neuropsychologists making statements like ‘‘15% of people who sustained mTBI
still have impairments and disability one year after injury’’. For example, Guerrero,
Thurman, and Snieziek (2000) cite the Alexander estimate but provide no new
empirical data. Until recently, the Center for Disease Control mTBI fact sheet (per a
May 2007 download from http://www.cdc.gov/ncipc/factsheets/tbi.htm) presented
this number as common knowledge.
In actuality, the 15% disability number is clinical lore. Iversen (2005) wrote,
‘‘This estimate . . . is frankly wrong’’ (p. 306). Why is the number wrong? Alexander
(1995) based his 15% estimate on a material misunderstanding of two studies:
McLean, Temkin, Dikmen and Wyler (1983), and Rutherford, Merrett, and
McDonald (1979). The McLean et al. (1983) study followed only 20 patients for
1 month; there was no 1-year follow-up. The Rutherford et al. (1979) study followed
145 consecutively admitted mTBI cases. Although it was true that 19 persons
(14.5%) still reported complaints at 1-year follow-up, eight were involved in
lawsuits, six showed malingering signs at 6 months, and most complained of new
 292 MANFRED F. GREIFFENSTEIN

symptoms at 1 year that were not reported at 6 weeks post-injury. There was no
control group, an omission making it difficult to draw conclusions about population
base rates for symptoms.
There is little dispute that a small percentage of mTBI patients chronically
complain. The 15% number is only myth if one equates a symptom, which is a
verbal report of distress, with brain impairment, which is an objective finding.
But complaint is not synonymous with disability. This important distinction was
evaluated by clinicians empanelled by the World Health Organization. Carroll et al.
(2004) exhaustively reviewed, compiled, and analyzed the mTBI literature. They
concluded that postconcussive complaints correlated strongest with litigation and
secondary gain, but had no valid association with initial injury severity or any other
neurological factor.

EXAMINER BIAS CAUSES POOR EFFORT

The assessment of effort and validity is fundamental to modern neuropsycho-
logical assessment in forensic settings (Larrabee, 2007). Failures on validity tests are
difficult to disregard and there are pressures to explain them. One explanation
I regularly encounter is this: Examinees only distort responses when seen by defense
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examiners; they never misrepresent when seen by plaintiff-selected examiners.

The proposed mechanism is that validity failure is not money motivated; instead,
it is a personal revolt against the adversarial process and the scrutiny of the
defense-selected expert. A variation on this theme is illustrated in the respected
textbook Psychological Evaluations for the Courts, in which Melton, Petrilla,
Poythress, and Slobogin (1997) qualitatively describe the dynamics as follows
(pp. 374–375, emphasis added):
The [plaintiff selected] examiner gets the picture of a sincere, friendly,
and trusting soul. The defense examiner sees a surly and suspicious one.
These differences obviously affect the examination technique, as well as the credibility
of the history and subjective symptoms.
But the influence of examiner status does not so ‘‘obviously affect’’ validity if
one considers empirical findings. Although small, the literature may support an
opposite conclusion. Fox, Gerson, and Lees-Haley (1995) divided 289 MMPI-2
protocols into those administered by plaintiff and those by defense examiners. The
main finding: patients evaluated by plaintiff examiners showed a greater symptom
exaggeration than did patients seen by defense-selected examiners. During the
course of defense-selected examinations, Greiffenstein and Baker (2001) repeated
MMPI testing on 23 mTBI litigants whose medical records contained pre-accident
MMPI profiles. If defense-selection ‘‘caused’’ exaggeration, the prediction must be
that post-accident MMPI profiles are more abnormal than profiles from
‘‘friendlier’’ pre-accident circumstances. But Greiffenstein and Baker (2001)
found the defense-selected examinations produced group MMPI profiles lower
than pre-accident profiles. In particular, there was no group effect for Infrequency
(‘‘F’’) scale means.
Defense-selection as ‘‘cause of malingering’’ is an unsupported belief and is
likely a myth. The opposite may be true: exaggeration is more prominent during
plaintiff-selected evaluations. But further research is necessary because the two cited
 MYTHS AND FORENSICS 293

studies have limitations. The Fox et al. (1995) study used a between-groups format:
The same patients were not necessarily seen by both examiners. The Greiffenstein
and Baker study (2001) used repeated measures but is still incomplete; we did not
have the MMPI-2 profiles produced for the plaintiff-selected examiners in the case
files. The research solution is a large-scale, within-groups design (repeated MMPI-2)
that also codes order (plaintiff or defense expert first). Such findings will better
illuminate the influence, if any, of examiner status.

CONCLUDING COMMENTS
I have summarized and assessed six assertions that are commonly encountered
in forensic neuropsychology settings. As reviewed above, the six beliefs were either
contradicted, or were unsupported, by relevant literature. The idea that only fixed
test batteries are legally admissible was easiest to contradict. Other beliefs,
such as ‘‘defense examiner bias’’ were not supported by limited empirical literature.
I conclude that all six beliefs are either clinical myths or at best unsupported
hypotheses.
The evidence-based movement in medicine could be a model for
neuropsychology as a corrective to myths (Paauw, 1999). As one example,
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Weinstein, Tosteson, Lurie, Tosteson et al. (2006) tested the conventional wisdom
that immediate spine surgery is critical to treat sciatica. After comparing surgery
versus non-operated controls, pain relief was not significantly greater following
surgery, for all periods of time. But research does not automatically dispel
false beliefs. Conventional wisdom can even act as a barrier against conducting
research. As the New York Times reportage of the Weinstein study showed,
many surgeons resisted even asking researchable questions. Why? Because they
just ‘‘knew’’ the surgery was a superior solution (Kolata, 2006).
Why do myths arise to begin with? Myths may evolve to fill the gaps between
science and everyday practice (McNally, 2005). For example, very little research
examines the influence, if any, of examiner status on litigants’ compliance behavior.
This gap may be filled by what Melton et al. (1997) term a ‘‘personal philosophy’’ of
interpersonal dynamics in mental injury claims. Myths could also represent
‘‘orienting assumptions’’, meaning they are useful tools for managing data in
complex medical-legal matters, the self-evident time demands of clinical practice,
and the sheer volume of new literature that requires scrutiny (Lezak et al., 2004;
Strauss, Sherman, & Spreen, 2006; Morgan & Ricker, 2008). Another idea is the
attitude of naı̈ve realism (‘‘A memory complaint must mean there is brain
damage’’). Such an assumption could maintain the belief in a ‘‘15% disability rate’’
as a chronic outcome of mTBI.
Why does folklore persist? The factors that maintain widespread assumptions
against disconfirming evidence have long been studied. Social psychology
researchers show that many persons are naturally prone to confirmatory bias:
Seeking out only information that sustains beliefs (Nisbett & Ross, 1980;
Wortman & Silver, 1989). Illusory correlation is a form of confirmatory bias
(Chapman & Chapman, 1969). For example, the ‘‘practice effect avoidance’’ myth
has repeatedly been contradicted by literature, yet it is regularly raised as a
roadblock to follow-up scrutiny.
 294 MANFRED F. GREIFFENSTEIN

One school of thought holds that cognitive biases are not moral or cultural
failings. According to evolutionary psychologists, cognitive biases may be universal
mechanisms that evolved through natural selection to aid in adaptation and
self-preservation (Buss, 2005). As with the Stroop effect, extra effort is necessary to
suppress natural cognitive biases, in order to consider alternative data. In writing
this commentary, I made every effort to find evidence supporting the six beliefs.
My efforts may still not be enough. In Galbraith’s (1958, p. 13) words, the ‘‘enemy
of the conventional wisdom is not ideas but the march of events’’.

ACKNOWLEDGMENTS
This review paper is unfunded. Part of my practice includes defense-selected
evaluations in personal injury matters. A portion of this paper derives from a book
chapter (Greiffenstein, 2008). I wish to thank Laurence Binder and Glenn Larrabee
for their preliminary reviews and helpful criticisms.
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REFERENCES

Alexander, M. P. (1995). Mild traumatic brain injury: Pathophysiology, natural history and
clinical management. Neurology, 45, 1253–1260.
Buss, D. M. (Ed). (2005). The handbook of evolutionary psychology. Hoboken, NJ: John Wiley
& Sons Inc.
Carroll, L. J., Cassidy, J. D., Peloso, P. M., Borg, J., von Holst, H., Holm, L., et al. (2004).
Prognosis for mild traumatic brain injury: Results of the WHO collaborating centre task
force on mild traumatic brain injury. Journal of Rehabilitation Medicine, 43(Suppl),
84–105.
Chapman, L. J., & Chapman, J. P. (1969). Illusory correlation as an obstacle to
the use of valid psychodiagnostic signs. Journal of Abnormal Psychology, 74,
271–280.
Chappelle v Ganger, 851 F.Supp. (1998). 1481 (E.D. of Washington).
Chelune, G. J., Naugle, R. I., Lueders, H., Sedlak, J., et al. (1993). Individual change after
epilepsy surgery: Practice effects and base-rate information. Neuropsychology, 7, 41–52.
Daubert v. Merrell Dow, 509 U.S. 579 (1993).
Diaz-Asper, C. M., Schretlen, D. J., & Pearlson, G. D. (2004). How well does IQ predict
neuropsychological test performance in normal adults? Journal of the International
Neuropsychological Society, 10, 82–90.
Dodrill, C. B. (1997). Myths of neuropsychology. Clinical Neuropsychologist, 11, 1–17.
Dodrill, C. B., & Troupin, A. S. (1975). Effects of repeated administrations of a
comprehensive neuropsychological battery among chronic epileptics. Journal of
Nervous & Mental Disease, 161, 185–190.
Fox, D. D., Gerson, A., & Lees-Haley, P. R. (1995). Interrelationship of MMPI-2
validity scales in personal injury claims. Journal of Clinical Psychology, 51, 42–47.
Frye v. U.S. (D.C. Cir. 1923) 293 F. 1013.
Galbraith, J. K. (1958). The affluent society. New York: Houghton Mifflin.
Greiffenstein, M. F. (2008). Basics of forensic neuropsychology. In J. E. Morgan &
J. H. Ricker (Eds.), Textbook of clinical neuropsychology (pp. 905–941). New
York: Taylor & Francis.
 MYTHS AND FORENSICS 295

Greiffenstein, M. F., & Baker, W. J. (2001). Comparison of premorbid and postinjury

MMPI-2 profiles in late postconcussion claimants. Clinical Neuropsychologist, 15,
162–170.
Guerrero, J. L., Thurman, D. J., & Sniezek, J. E. (2000). Emergency department visits
associated with traumatic brain injury: United States, 1995–1996. Brain Injury, 14,
181–186.
Horton, A. M. (1992). Neuropsychological practice effects and age: A brief note.
Perceptual & Motor Skills, 75, 257–258.
Iverson, G. L. (2005). Outcome from mild traumatic brain injury. Current Opinion in
Psychiatry, 18, 301–317.
Johnson, J. L., Bellah, C. G., Dodge, T., Kelley, W., & Livingston, M. M. (1998). Effect of
warning on feigned malingering on the WAIS-R in college samples. Perceptual & Motor
Skills, 87, 152–154.
Johnson, J. L., & Lesniak-Karpiak, K. (1997). The effect of warning on malingering on
memory and motor tasks in college samples. Archives of Clinical Neuropsychology, 12,
231–238.
Kaufman, A. S. (1994). Practice effects. In Sternberg R. J. (Ed.), Encyclopedia of human
intelligence, Vol. 2 (pp. 828–833). New York: Oxford University Press.
Kolata, G., (2006). Study questions need to operate on ruptured disks. New York Times,
November 22.
Downloaded At: 10:27 8 November 2010

Larrabee, G. (2007). Assessment of malingered neuropsychological deficits. New York:

Oxford.
Lezak, M. D., Howieson, D. B., Loring, D. W., Hannay, H. J., & Fischer, J. S.
(2004). Neuropsychological assessment (4th ed.). New York: Oxford University
Press.
McCaffrey, R. J., & Westervelt, H. J. (1995). Issues associated with repeated
neuropsychological assessments. Neuropsychology Review, 5, 203–221.
McCrea, M. (2007). Mild traumatic brain injury and postconcussion syndrome. The new
evidence base for diagnosis and treatment. New York: Oxford University Press.
McLean, A., Temkin, N. R., Dikmen, S., & Wyler, A. R. (1983). The behavioral sequelae of
head injury. Journal of Clinical Neuropsychology, 5, 361–376.
McNally, R. J. (2005). The science and controversy of traumatic memory. American Journal
of Psychology, 118, 152.
Melton, G. B., Petrilla, J., & Poythress, N. G. (1997). Psychological evaluations for the courts.
A handbook for mental health professionals and lawyers, (2nd ed.). New York: Guilford
Press.
Mitrushina, M., & Satz, P. (1991). Effect of repeated administration of a neuropsychological
battery in the elderly. Journal of Clinical Psychology, 47, 790–801.
Morgan, J. E., & Ricker, J. H. (2008). Textbook of clinical neuropsychology. New York:
Taylor & Francis.
Nisbett, R. E., & Ross, L. (1980). Human inference: Strategies and shortcomings of social
judgment. Englewood Cliffs, NJ: Prentice-Hall.
Paauw, D. S. (1999). Did we learn evidence-based medicine in medical school? Some
common medical mythology. Journal of the American Board of Family Practice, 12,
143–149.
Posthuma, A., Podrouzek, W., & Crisp, D. (2002). The implications of Daubert on
neuropsychological evidence in the assessment of remote mild traumatic brain injury.
American Journal of Forensic Psychology, 20, 21–38.
Putnam, S. H., Adams, K. M., & Schneider, A. M. (1992). One-day test–retest reliability
of neuropsychological tests in a personal injury case. Psychological Assessment, 4,
312–316.
 296 MANFRED F. GREIFFENSTEIN

Reed, J. E. (1996). Fixed vs. flexible neuropsychological test batteries under the Daubert
standard for the admissibility of scientific evidence. Behavioral Sciences & the Law, 14,
315–322.
Reitan, R. M., & Wolfson, D. (1996). The question of validity of neuropsychological test
scores among head-injured litigants: Development of a dissimulation index. Archives of
Clinical Neuropsychology, 11, 573–580.
Reitan, R. M., & Wolfson, D. (2002). Detection of malingering and invalid test
results using the Halstead-Reitan Battery. Journal of Forensic Neuropsychology, 3,
275–314.
Rogers, R., & Cavanaugh, J. L. (1983). Nothing but the truth. A reexamination of
malingering. Journal of Psychiatry & Law, 11, 443–459.
Ruff, R. M., Camenzuli, L., & Mueller, J. (1996). Miserable minority: Emotional risk factors
that influence the outcome of a mild traumatic brain injury. Brain Injury, 10, 551–565.
Russell, E. W. (2007). Commentary on ‘‘A motion to exclude and the ‘fixed’ versus ‘flexible’
battery in ‘forensic’ neuropsychology’’. Archives of Clinical Neuropsychology, 22,
787–790.
Rutherford, W. H., Merrett, J. D., & McDonald, J. R. (1979). Symptoms at one year
following concussion from minor head injuries. Injury, 10, 225–230.
Shatz, M. W. (1981). WAIS practice effects in clinical neuropsychology. Journal of Clinical
Neuropsychology, 3, 171–179.
Downloaded At: 10:27 8 November 2010

Storm, J., & Graham, J. R. (2000). Detection of coached general malingering on the MMPI-2.
Psychological Assessment, 12, 158–170.
Strauss, E., Sherman, E. M. S., & Spreen (2006). A compendium of neuropsychological tests.
Third edition. New York: Oxford University.
Suhr, J. A. (2002). Malingering, coaching, and the serial position effect. Archives of Clinical
Neuropsychology, 17, 69–77.
Suhr, J. A., & Gunstad, J. (2000). The effects of coaching on the sensitivity and specificity of
malingering measures. Archives of Clinical Neuropsychology, 15, 415–424.
Sweet, J. J., Nelson, N. W., & Moberg, P. J. (2006). The TCN/AACN 2005 ‘‘salary survey’’:
Professional practices, beliefs, and incomes of U.S. neuropsychologists. Clinical
Neuropsychologist, 20, 325–364.
Theisen, M. E., Rapport, L. J., Axelrod, B. N., & Brines, D. B. (1998). Effects of practice in
repeated administrations of the Wechsler Memory Scale–Revised in normal adults.
Assessment, 5, 85–92.
Vanderploeg, R. D. (1994). Interview and testing. The data collection phase of
neuropsychological evaluations. In R. D. Vanderploeg (Ed.), Clinician’s guide to
neuropsychological assessment (pp. 1–42). New York: Lawrence Erlbaum Associates Inc.
Wechsler, D. (1981). Wechsler Adult Intelligence Scale Revised. Manual. New York: The
Psychological Corporation.
Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N., Hanscom, B., Skinner, J. S.,
et al. (2006). Surgical vs. nonoperative treatment for lumbar disk herniation: The Spine
Patient Outcomes Research Trial (SPORT) observational cohort. Journal of the
American Medical Association, 296, 2441–2450.
Wong, J. L., Lerner-Poppen, L., & Durham, J. (1998). Does warning reduce obvious
malingering on memory and motor tasks in college samples? International Journal of
Rehabilitation & Health, 4, 153–165.
Wortman, C. B., & Silver, R. C. (1989). The myths of coping with loss. Journal of Consulting
and Clinical Psychology, 57, 349–357.
Youngjohn, J. R., Lees-Haley, P. R., & Binder, L. M. (1999). Comment: Warning
malingerers produces more sophisticated malingering. Archives of Clinical
Neuropsychology, 14, 511–515.