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Cognitive Underperformance in Neuropsychological Testing / Medico-Legal Cases and How to Address It - Dr Linda Monaci, Consultant Clinical Neuropsychologist and Chartered Clinical Psychologist

04/05/16. Neuropsychological testing is employed in medico-legal cases to assist in assessing the extent, and validity, of claimants’ symptoms. There are occasions when a patient’s clinical presentation during neuropsychological testing is inconsistent with the expectations of his/her abilities based on their clinical history, behavioural observations and/or established medical knowledge of the condition in question. This phenomenon is called cognitive underperformance.

The reasons for this inconsistency may be one of several, including poor effort, symptom overreporting/underreporting, malingering, somatisation, or the controversial factitious disorder. The processes that underlie these effects are not well understood and research in this area is lacking. Studies that have been conducted in medico-legal settings in the USA, have largely attributed cognitive underperformance to malingering (fabricating/exaggerating the symptoms of mental or physical disorders for a variety of ‘secondary gain’ motives). Other theories of cognitive underperformance include stereotype threat, diagnostic threat and symptom underreporting...

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