The influence of effort on neuropsychological performance in children: is performance on the TOMM indicative of neuropsychological ability?

The Test of Memory Malingering (TOMM) is a measure of effort that has traditionally been utilized with adults but is being increasingly used with children, though it is not yet entirely clear what suboptimal TOMM performance means in terms of neuropsychological test scores. The purpose of this study was to investigate whether performance on the TOMM can be used as a predictive marker for neuropsychological performance in children. Participants (N = 75) completed the TOMM, Wechsler Intelligence Scale for Children-Fourth Edition, Wisconsin Card-Sorting Test (WCST), Children's Memory Test, and Delis-Kaplan Executive Function System Trails. Results revealed significant correlations between age, education level, IQ, and many of the neuropsychological measures administered, indicating that as children's TOMM scores increase, so do their cognitive performances. Children were subsequently divided into two groups: optimal effort and suboptimal effort, based on their TOMM Trial 2 scores. Results suggest significant differences in IQ performance and WCST Failure to Maintain Set; however, there were no differences in regard to any other neuropsychological measures administered. It was also found that a larger proportion of the younger children (aged 6 to 10 years old) scored below the TOMM cutoff compared with older children. This study illustrates that although correlations exist, suboptimal effort on the TOMM may not predict poorer performance on a neuropsychological evaluation in children as has been reported in other studies.