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Assessment of effort in clinical testing of cognitive functioning for adults

Purpose To provide guidance and highlight key issues in the assessment of effort during cognitive testing in adults in clinical settings. In addition to identify issues relevant to the interpretation of findings. Finally to provide further reading and highlight areas for future research Readership This document is for professional psychologists who are trained in clinical assessment of cognitive function in adults. Cognitive test results are not valid if the testee does not try hard on the tests. ● Effort tests should be given routinely as part of clinical assessment of cognitive function. ● There are some exceptions where routine assessment of effort is not appropriate. ● Failure on effort tests requires careful interpretation. Although a number of causes are possible, deceit should always be considered. ● Clinicians should be aware of the sensitivity and specificity of the effort tests that they use and the base rates of sub-optimal performance in the population from which their testee comes and take these factors into account when interpreting findings. ● Interpretation of failure on effort tests needs to be reported as clearly as possible. ● There is little UK research literature on effort testing; there is a need for this to be developed. Purpose The aims of the present document are to highlight key issues in the assessment of effort, provide guidance and suggest further reading. Specifically, the document focuses on the assessment of effort as part of a clinical assessment of cognitive function in a wide range of settings. It further aims to identify issues relevant to the interpretation of findings and the potential courses of action when an individual fails cognitive tests of effort. The primary concern of this document is the validity of cognitive symptoms and not with a broader-based assessment of the validity of symptom complaint. The document will highlight important areas for future research The scope of this document This document is written for professional psychologists who have been trained in clinical assessment of cognitive function. The majority of research on testing effort is on adults, and it is to this group that this guidance refers. Modification of this document or a further document would be needed if this guidance is to be extended to other client groups, such as children and young people and those with learning disabilities. Introduction Cognitive testing is used in many clinical contexts because it is judged that the resulting scores, together with …