Neuroimaging and Invalid Neuropsychological Test Performance

Positive neuroimaging findings, when present, objectively demonstrate structural and functional brain abnormalities. Neuropsychological testing provides the framework that provides clinical correlation of abnormal brain states and their influence on cognitive, emotional, and behavioral functioning. Contemporary neuroimaging utilizes a network approach to demonstrating the potential influence of brain pathology on neuropsychological test performance, including symptom validity testing (SVT) and performance validity testing (PVT). In this chapter, some basic neuroimaging and neuropathology findings in the context of neurocognitive and neurobehavioral functioning are overviewed, followed by how neuropsychological test validity and neuroimaging results inform the neuropsychological clinician about test validity. The chapter first examines how regional as well as global pathology may influence SVT and PVT measures and their interpretation. A number of case examples are provided, demonstrating why given certain neuroimaging findings, considerations about cut-scores and explanation of the results may require individualized commentaries about validity, rather than a blanket interpretation. The next section discusses neuroimaging results in forensic settings and the role of SVT/PVT findings within the context of abnormal neuroimaging. Again, case examples are given. The last section overviews experimental paradigms using various functional neuroimaging techniques in the detection of malingering and the potential for future functional neuroimaging in assessing SVT/PVT measures.