偽裝認知障礙者在魏氏智力量表第三版之表現：以偽裝外傷性腦損傷者為例

魏氏智力量表第三版中文版是台灣目前最常在臨床中使用的衡鑑工具，也是台灣勞工保險局審核精神失能時必含之評估工具之一。部分申請者可能為獲金錢補助，而故意偽裝或誇大症狀。國外雖已累積許多研究成果，但目前國內仍極度缺乏使用魏氏智力量表來偵測偽病之相關研究，而已有一些研究指出中文使用者在魏氏智力量表中文版之表現，在某些記憶廣度相關的指標分數高於英文使用者在魏氏智力量表英文版之表現。因此在臨床的使用及偽病之偵測上，實不宜直接沿用國外之切截分數。本研究之目的即在，針對台灣樣本，使用魏氏智力量表中文版於偵測偽裝認知障礙者，並找尋合適之切截分數。本研究採參與者間設計，將參與者分成兩組：偽裝認知障礙之健康參與者與一般控制組，並施測魏氏智力量表分測驗1至分測驗13。研究結果發現，偽裝認知障礙者在三個智商分數、四個因素指數分數及13個分測驗量表分數的得分皆達顯著低於一般控制組。此外，記憶廣度相關指標，兩組在最長順背長度、最長逆背長度及最長順背加最長逆背長度的表現，偽裝認知障礙者的得分也顯著低於一般控制組；但，詞彙與記憶廣度量表分數差異此指標對於本研究樣本的區辨度低。針對達顯著差異的指標，進一步使用ROC曲線分析尋找合適之切截分數，所得之切截分數較目前國外已有之研究結果高，此研究結果再次支持詞長效果，故針對台灣樣本使用與記憶廣度相關的指標時，應考慮把切截分數提高。

關鍵字

魏氏智力量表；偽裝認知障礙；詞長效果；切截分數

並列摘要

Wechsler Adult Intelligence Scale-Third Edition Chinese version(WAIS-IIIC) is a common assessment tool that being used a lot in clinical practice these days, and it’s also one of the necessary tools for mental disability evaluation in Taiwan Bureau of Labor Insurance. It is possible that some patients may simulate or exaggerate their deficits in order to get the monetary compensation. There has accumulated researches in Western societies to detect malingering with WAIS-III, but using WAIS-IIIC for malingering detection has still not been explored thoroughly in Taiwan. However, some studies found Chinese speakers’ performance in some embedded Digit Span-related scores in WAIS-IIIC are relatively higher when compare to English speakers in WAIS-III. When using WAIS-IIIC for malingering detection, it's better not to apply cut-off points from research in Western societies directly. The aims of the present study were to examine the applicability of WAIS-IIIC for detecting malingered neurocognitive dysfunction in Taiwan sample and find out the adequate cut-off points. The present study was based on a between-participant design. The participants were randomly assigned to two groups: dissimulated group and control group. All of the participants were administered WAIS-IIIC (include subtest 1-13) for malingering detection. The results showed that the scores of the dissimulated group in Verbal IQ, Performance IQ, Full Scale IQ, 4 index scores, and 13 subtest scores were significantly lower than control group. When using Digit Span performance as an embedded indicator for malingering detection, the results revealed that the performance of the dissimulated group in the longest string of digits forward and backward, and Reliable Digit Span scores were significantly lower than control group, but Vocabulary minus Digit Span difference score might not be an effective indicator for malingering detection in the present study. In addition, the study tried to find out the adequate cut-off points via receiver operating characteristic analysis. The cut-off point in Digit Span tasks were higher than the suggestions from studies in Western societies. It further supported the ‘’word-length effect’’. When using Digit Span performance as an embedded indicator for malingering detection, it’s better to raise the cut-off points.

並列關鍵字

Wechsler Adult Intelligence Scale ； Malingered Neurocognitive Dysfunction ； word-length effect ； cut-off point

參考文獻

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders(3rd ed., revised). Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders(4rd ed., revised). Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5rd ed.). Washington, DC: Author.

Baddeley, A. D., Thomson, N., & Buchanan, M. (1975). Word length and the structure of short-term memory. Journal of Verbal Learning and Verbal Behavior. 14, 575-589.

Baer, R.A., Wetter, M.W., Berry, D.T.R. (1995). Effects of information about validity scales on under-reporting of symptoms on the MMPI-2: An analogue investigation. Assessment , 2, 189–200.

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偽裝認知障礙者在魏氏智力量表第三版之表現：以偽裝外傷性腦損傷者為例

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