Encyclopedia of Psychology and Law

low sensitivity score was the dementia group. Even these

individuals still obtained a score of greater than 92% on

Trial 2. The finding that the scores on the TOMM were

less than 95% for the dementia group is not particularly

negative since it is unlikely that feigning memory impair-

ment is a major issue when dementia patients undergo

neuropsychological assessment.

It should be noted that “below-chance” perfor-

mance (<18 correct at the 95% confidence level) also

can be used as a statistical decision rule. However,

experience has shown that malingerers or individuals

simulating malingerers do not ordinarily obtain below-

chance scores on the TOMM on any trial. Of course, if

they do, the decision rule can be applied.

Five experiments using different types of partici-

pants and different types of experimental designs pro-

vide evidence that the TOMM readily differentiated

between malingering and nonmalingering individuals

and show that the TOMM is a useful psychometric test

for detecting exaggerated or deliberately faked memory

impairment. In this context, it should be noted that the

TOMM meets all the guidelines established in Daubert

v. Merrell Dow Pharmaceuticals(1993) to define the

generally accepted standards for judges to use in deter-

mining the scientific admissibility of evidence, particu-

larly when presented by expert witnesses.

Interpreting the TOMM

Interpretation of the TOMM should never be made

solely on the basis of the TOMM score that a patient

achieves. It depends on many factors, starting with the

basic conceptual issues on how malingeringis defined.

The TOMM does not measure a general trait called

“malingering.” In forensic assessments, the TOMM is

not an appropriate test to evaluate whether or not a per-

son is faking a psychiatric disorder any more than it

would be appropriate to use it to determine if a person is

faking a back injury. Moreover, the interpretation of the

TOMM should not be used to identify a “malingerer”

but rather to indicate that a person is putting forth less

than the maximum effort. Although individuals

malinger, malingering cannot be legitimately viewed as

a personality trait. Malingering in one situation does not

necessarily mean that the person will always malinger

or, in fact, will ever malinger again. In many, if not most,

instances, individuals with TBI who malinger are

“good” people caught in “bad” situations. It must also

be remembered that malingering is not an all-or-none

phenomenon but that it exists in different degrees,

ranging from minor exaggeration of existing symptoms

to flagrant faking of nonexistent symptoms.

Tom N. Tombaugh

See alsoForensic Assessment; Malingering

Further Readings

Daubert v. Merrell Dow Pharmaceuticals, 509

U.S. 579 (1993).

Lynch, W. J. (2004). Determination of effort level,

exaggeration, and malingering in neurocognitive

assessment. Journal of Heat Trauma Rehabilitation,

19,277–283.

Multi-Health Systems. (2006). Test of Memory Malingering

(TOMM). Research monograph: Summary application

in clinical and research settings.Toronto, ON,

Canada: Author.

Tombaugh, T. N. (1996). The Test of Memory Malingering

(TOMM). Toronto, ON, Canada: Multi-Health

Systems.

Tombaugh, T. N. (2002). The Test of Memory Malingering

(TOMM) in forensic psychology. Journal of Forensic

Neuropsychology, 2,69–96.

Vallabhajosula, B., & VanGorp, W. G. (2001). Post-Daubert

admissibility of scientific evidence on malingering of

cognitive deficits. Journal of the American Academy of

Psychiatry and the Law, 29,207–215.

THERAPEUTICCOMMUNITIES FOR

TREATMENT OFSUBSTANCEABUSE

Therapeutic communities use interpersonal interactions

within a structured community milieu to treat substance

abuse. They have shown promising outcomes, espe-

cially among people with substance use disorders who

require a highly structured environment to succeed.

Therapeutic communities are used frequently in correc-

tional institutions to treat inmates with severe substance

use disorders and who exhibit antisocial behavior.

Positive outcomes have been found for many partici-

pants, such as reduced substance use and recidivism

after release from incarceration. Since therapeutic com-

munities focus on communal processes to facilitate

change, this treatment may not be an effective means to

individualize care. In addition, the communities may

not be helpful for autonomous, high-functioning indi-

viduals or people with severe co-occurring psychiatric

802 ———Therapeutic Communities for Treatment of Substance Abuse

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