Combining the test of memory malingering trial 1 with behavioral responses improves the detection of effort test failure.

Validity measures derived from the Test of Memory Malingering Trial 1 (TOMM1) and errors across the first 10 items of TOMM1 (TOMMe10) may be further enhanced by combining these scores with "embedded" behavioral responses while patients complete these measures. In a sample of nondemented veterans (n = 151), five possible behavioral responses observed during completion of the first 10 items of the TOMM were combined with TOMM1 and TOMMe10 to assess any increased sensitivity in predicting Medical Symptom Validity Test (MSVT) performance. Both TOMM1 and TOMMe10 alone were highly accurate overall in predicting MSVT performance (TOMM1 [area under the curve (AUC)] = .95, TOMMe10 [AUC] = .92). The combination of TOMM measures and behavioral responses did not increase overall accuracy rates; however, when specificity was held at approximately 90%, there was a slight increase in sensitivity (+7%) for both TOMM measures when combined with the number of "point and name" responses. Examples are provided demonstrating that at a given TOMM score (TOMM1 or TOMMe10), with an increase in "point and name" responses, there is an incremental increase in the probability of failing the MSVT. Exploring the utility of combining freestanding or embedded validity measures with behavioral features during test administration should be encouraged.