Psychological Testing
in the Service of
Disability Determination

Committee on Psychological Testing, Including Validity Testing,
for Social Security Administration Disability Determinations

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
         OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Task Order No. SS00-13-60048/0003 between the National Academy of Sciences and the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

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Suggested citation: IOM (Institute of Medicine). 2015. Psychological testing in the service of disability determination. Washington, DC: The National Academies Press.

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COMMITTEE ON PSYCHOLOGICAL TESTING, INCLUDING VALIDITY TESTING, FOR SOCIAL SECURITY ADMINISTRATION DISABILITY DETERMINATIONS

HERBERT PARDES (Chair), Executive Vice Chairman of the Board, New York-Presbyterian Hospital, New York, New York

ARTHUR J. BARSKY III, Professor of Psychiatry, Harvard Medical School, and Vice Chair for Psychiatric Research, Brigham and Women’s Hospital, Boston, Massachusetts

MARY C. DALY, Senior Vice President and Associate Director of Economic Research, Federal Reserve Bank of San Francisco, California

KURT F. GEISINGER, W. C. Meierhenry Distinguished University Professor of Educational Psychology and Director, Buros Center for Testing, University of Nebraska–Lincoln

NAOMI LYNN GERBER, University Professor, Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia

ALAN M. JETTE, Professor of Health Policy & Management, Boston University School of Public Health

JENNIFER I. KOOP, Associate Professor, Department of Neurology, Medical College of Wisconsin, Milwaukee

LISA A. SUZUKI, Associate Professor of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York

ELIZABETH W. TWAMLEY, Associate Professor of Psychiatry, University of California, San Diego

PETER A. UBEL, Madge and Dennis T. McLawhorn University Professor of Business, Fuqua School of Business, and Professor of Public Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina

JACQUELINE REMONDET WALL, Professor, School of Psychological Sciences, University of Indianapolis, Indiana, and Director, Office of Program Consultation and Accreditation, American Psychological Association, Washington, DC

Liaison to IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues

HOWARD H. GOLDMAN, Professor Psychiatry, University of Maryland School of Medicine, Baltimore

IOM Project Staff

CAROL MASON SPICER, Study Director

FRANK R. VALLIERE, Associate Program Officer

ALEJANDRA MARTÍN, Research Associate (since January 2015)

NICOLE GORMLEY, Senior Program Assistant (since December 2014)

JONATHAN PHILLIPS, Senior Program Assistant (April to November 2014)

JON SANDERS, Program Coordinator (through January 2015)

PAMELA RAMEY-McCRAY, Administrative Assistant

FREDERICK ERDTMANN, Director, Board on the Health of Select Populations

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

David Autor, Massachusetts Institute of Technology Economics

Leighton Chan, National Institutes of Health

Allen W. Heinemann, Northwestern University

Anita Hubley, University of British Columbia, Vancouver Campus

Michael Kirkwood, Children’s Hospital Colorado-Aurora

Glenn J. Larrabee, Clinical Neuropsychology

Brian Levitt, Kaplan Psychologists

Patricia Owens, Health and Disability Policy Programs

Stephen M. Raffle, Forensic and Clinical Psychiatry

Jerry Sweet, University of Chicago, Pritzker School of Medicine

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions

or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Nancy Adler, University of California, San Francisco, and Randy Gallistel, Rutgers University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Preface

The U.S. Social Security Administration (SSA) disability programs provide important, sometimes vital, benefits to millions of adults and children annually in the United States. The programs are an expression of the nation’s principle of caring for individuals who need support from the larger community. Within the confines of SSA policy, the state Disability Determination Services (DDS) agencies, which implement the policy, have the latitude to do so in whatever way they deem fit. It is not surprising that in a country as diverse as the United States we would find geographic variations in the style and methods with which that process is undertaken.

One element of such variation is the use or not of standardized psychological tests during the disability determination process, other than the use of intelligence tests in determinations of intellectual disability in children and adults. SSA asked the Institute of Medicine (IOM) to review selected psychological tests and to provide guidance on the use of psychological testing in SSA disability determinations.

SSA and the DDS agencies have the critical task of determining which applicants qualify for disability benefits, a task complicated by the lack of direct correlation between the presence of an impairment and disability, which SSA defines as the inability to work. DDS examiners undertake the very complex task of reviewing and developing applicants’ files to determine which requests for disability benefits are justified. As described in the report, the committee felt that it was worth considering whether increased systematic use of standardized psychological testing in specific circumstances would strengthen the current process for disability determination.

The committee thanks colleagues, organizations, and agencies that were willing to share their expertise, time, and information during the committee’s information-gathering meetings. The names of the speakers are included in the meeting agendas provided in Appendix A. The committee is grateful to the authors of the two commissioned papers, Erin Bigler, David Freedman, and Jennifer Manly, for the in-depth analyses they provided. The study sponsor, SSA, gladly provided information and data and responded to questions. We also thank Howard Goldman, chair of the IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues, who served as a consultant to the committee and provided valuable insight. The contributions from all of these sources informed the committee deliberations and enhanced the quality of this report.

I want also to pay tribute to and thank the expert members of our committee. A diversity of views, at times a difference of views, all contributed to generating a consensus about issues important to SSA and to the country. Throughout the project, they put in an enormous amount of time and effort; contributed their experience, knowledge, and perspective; listened to contending arguments; and ultimately generated the recommendations in this report. It is heartening to me and the other committee members to experience the excellence and the commitment of so many good colleagues. I trust this report will be helpful to and well received by SSA.

Finally, the committee thanks the IOM staff members who contributed to the production of this report, including Frederick “Rick” Erdtmann (board director), Carol Mason Spicer (study director), Frank Valliere (associate program officer), Alejandra Martín (research associate), Nicole Gormley (senior program assistant), Jonathan Phillips (senior program assistant), Jon Sanders (program coordinator), Julie Wiltshire (financial associate), and other staff of the Board on the Health of Select Populations and the IOM, who provided support. Research assistance was provided by Daniel Bearss, Rebecca Morgan, and Catherine van der List.

Herbert Pardes, Chair
Committee on Psychological Testing, Including
Validity Testing, for Social Security Administration
Disability Determinations

Contents

ACRONYMS AND ABBREVIATIONS

SUMMARY

1 INTRODUCTION

Committee’s Approach to Its Charge

Report Organization

References

2 DISABILITY EVALUATION AND THE USE OF PSYCHOLOGICAL TESTS

Social Security Administration Disability Determination Process

Composition of SSA Beneficiaries

Psychological Testing in SSA Disability Evaluations

Malingering and Credibility

Use of Psychological Tests in Non-SSA Disability Evaluations

Findings

References

3 OVERVIEW OF PSYCHOLOGICAL TESTING

Types of Psychological Tests

Psychometrics: Examining the Properties of Test Scores

Test User Qualifications

Psychological Testing in the Context of Disability Determinations

References

4 SELF-REPORT MEASURES AND SYMPTOM VALIDITY TESTS

Assessing Self-Report of Symptoms

Psychological Self-Report Measures and Disability Evaluation

Administration and Interpretation of Non-Cognitive Psychological Measures

Assessing the Validity of Non-Cognitive Symptom Report

Use of Non-Cognitive Measures with Specific Populations

References

5 COGNITIVE TESTS AND PERFORMANCE VALIDITY TESTS

Administration of Cognitive and Neuropsychological Tests to Evaluate Cognitive Impairment

Psychometrics and Testing Norms for Cognitive Tests

Interpretation and Reporting of Test Results

Assessing Validity of Cognitive Test Performance

Applicant Populations for Whom Performance-Based Tests Should Be Considered or Used

Conclusion

References

6 ECONOMIC CONSIDERATIONS

Costs of Psychological Testing

Assessing the Benefits of Psychological Testing

Estimates of Cost Savings from Psychological Testing

Findings

References

7 CONCLUSIONS AND RECOMMENDATIONS

Role of Psychological Testing in Social Security Administration Disability Programs

Standardized Non-Cognitive Psychological Measures and Symptom Validity Tests

Standardized Cognitive Tests and Performance Validity Tests

Qualifications for Test Administration and Interpretation

Economic Considerations

Evaluation and Research

APPENDIXES

A PUBLIC WORKSHOP AGENDAS

B BIOGRAPHICAL SKETCHES OF COMMITTEE MEMBERS

C GLOSSARY

Boxes, Figures, and Tables

BOXES

S-1 Statement of Task

1-1 Statement of Task

1-2 Major Concepts in the International Classification of Functioning, Disability and Health

3-1 Descriptions of Tests by Four Areas of Core Mental Residual Functional Capacity

4-1 SSA Definitions of Symptoms, Signs, and Laboratory Findings

4-2 SSA Definitions of Relevant Mental Disorders

4-3 Definitions of Relevant Disorders with Disproportionate Somatic Symptoms

4-4 SSA Proposed Functional Domains

4-5 Embedded/Derived SVTs for Negative Self-Presentation

4-6 Stand-Alone SVTs for Negative Self-Presentation

FIGURES

S-1 Components of psychological assessment

1-1 ICF Model of disability and functioning

1-2 Components of psychological assessment

2-1 Overview of the SSA disability process

2-2 Disability determination process for adults by the numbers

2-3 Disability determination process for children by the numbers

2-4 Filing rates by state, fiscal year 2013

2-5 Allowance rates by state, fiscal year 2013

2-6 Composition of new beneficiaries in 2013 for SSDI and SSI adults and children

3-1 Components of psychological assessment

4-1 Psychological versus nonpsychological self-report measures

TABLES

1-1 Characteristics of SSDI and SSI Beneficiaries, 2012

1-2 SSDI and SSI Beneficiaries by Diagnostic Category, 2012

1-3 Definitions of Psychological Terms

2-1 Components of Total Variation in Allowance Rates from Level Fixed-Effects OLS Regressions Models, by SSA Program Group (in percent), 1993–2008

2-2 Summary of Reported Base Rates of Malingering

2-3 Psychological Testing in Different Settings

3-1 Listings for Mental Disorders and Types of Psychological Tests

5-1 Embedded and Derived PVTs

5-2 Forced-Choice PVTs

6-1 Costs of Psychological and Neuropsychological Testing Services

6-2 Estimated Costs of Testing

6-3 Calculation of 2011 SSDI Costs for Each Level of Malingering of Mental Disorders

6-4 Calculation of 2011 SSI (Adult) Costs for Each Level of Malingering of Mental Disorders

6-5 Estimated Annual Savings of Testing New Disability Awardees

6-6 Estimated Lifetime Spending on an Individual Disability Awardee, 2 Percent Annual Discounting

Acronyms and Abbreviations

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