Public Release: 

Psychological testing in the service of disability determination

National Academies of Sciences, Engineering, and Medicine

WASHINGTON - Broader use of standardized psychological testing for applicants submitting disability claims to the U.S. Social Security Administration (SSA) should improve the accuracy and consistency of disability determinations, says a new report from the Institute of Medicine. Some proponents of mandatory psychological testing, in particular validity testing, for SSA disability applicants argue that it would result in a significant reduction of individuals allowed onto the benefits rolls and a substantial cost savings. The committee that conducted the study and wrote the report said the data necessary to accurately assess the effects on the rolls or calculate financial costs and benefits are limited, and estimates based on available data are subject to considerable error. However, the report provides a framework for evaluating the financial impact of implementing the committee's recommendations.

In 2012, SSA provided benefits to nearly 15 million disabled adults and children. Under SSA, state agencies determine disability based on medical and other evidence considered relevant in an applicant's case record, which may include standardized psychological tests. Cognitive psychological tests are performance-based and have people answer questions and solve problems as well as they possibly can. Non-cognitive psychological tests are measures of typical behavior -- such as personality, interests, values, and attitudes. Validity tests can be used in conjunction with these standardized psychological tests to assess whether a test-taker is exerting sufficient effort to perform well, responding to the best of his or her capability, or providing an accurate report of his or her symptoms. SSA recognizes that some psychological tests are valid and reliable and provide useful data, but it does not require psychological testing in cases involving mental disorders other than intellectual disability. In addition, SSA policy precludes the purchase of validity tests as part of a consultative examination to supplement an applicant's case record. However, applicants and their representatives sometimes submit validity test results in support of their claims, and there are different opinions in the use and value of validity tests for work disability evaluations. In this context, the SSA asked IOM to carry out its study.

The committee recommended that under specified conditions, SSA should require standardized, non-cognitive psychological testing for all applicants whose allegation of non-cognitive functional impairment relates to a mental disorder unaccompanied by cognitive complaints or to a disorder with physical symptoms that are disproportionate to the medical findings. Testing should be required when the allegation is based primarily on the applicant's self-reporting of symptoms and is not accompanied by objective medical evidence or longitudinal medical records sufficient to make a disability determination. In addition, the SSA should require standardized cognitive testing be included in the case record for all applicants whose allegation of cognitive impairment is not accompanied by objective medical evidence. All non-cognitive and cognitive psychological testing should include a statement of evidence asserting the validity of the results. Assessment of validity, including the use of validity tests, helps the evaluator interpret the accuracy of an individual's non-cognitive and cognitive test results. Therefore it is an important addition to the case record, the committee said. However, validity tests do not provide information about whether an individual is disabled, and a determination that the validity testing alone was not proved valid is insufficient grounds for denying a disability claim. For cases in which validation is not achieved, SSA should pursue additional evidence of the applicant's allegation.

One of the main purported benefits of mandatory psychological testing, specifically validity testing, is the potential to generate substantial savings for the SSA disability programs. The committee found that potential cost savings associated with testing vary considerably based on the assumptions about the groups to whom it is applied and how many false claims it detects, and thus rejects. A full financial cost-benefit analysis of psychological testing will require SSA to collect additional data both before and after the implementation of the report's recommendations.

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The study was sponsored by the U.S. Social Security Administration. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.

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Pre-publication copies of Psychological Testing in the Service of Disability Determination are available from the National Academies Press on the Internet at http://www.nap.edu or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

INSTITUTE OF MEDICINE

Board on the Health of Select Populations

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

Herbert Pardes, M.D.* (chair)
Executive Vice Chair of the Board of Trustees
New York-Presbyterian Hospital
New York City

Arthur J. Barsky III
Professor
Department of Psychiatry
Harvard Medical School, and
Vice Chair for Psychiatric Research
Brigham and Women's Hospital
Boston

Mary C. Daly
Senior Vice President and Associate Director of Research
Federal Reserve Bank of San Francisco
San Francisco

Kurt F. Geisinger
Director
Buros Center for Testing, and
W.C. Meierhenry Distinguished Professor
University of Nebraska
Lincoln

Naomi L. Gerber, M.D.*
University Professor
Center for the Study of Chronic Illness and Disability
College of Health and Human Services
George Mason University
Fairfax, Va.

Alan M. Jette, P.T., M.P.H., Ph.D.*
Professor of Health Policy and Management
Boston University School of Public Health
Boston

Jennifer I. Koop
Associate Professor
Department of Neurology
Medical College of Wisconsin
Milwaukee

Lisa A. Suzuki
Associate Professor
Department of Applied Psychology
Steinhardt School of Culture, Education, and Human Development
New York University
New York City

Elizabeth W. Twamley
Associate Professor of Psychiatry
University of California
San Diego

Peter Ubel
Madge and Dennis T. McLawhon University Professor of Business
Fuqua School of Business, and
Professor of Public Policy
Sanford School of Public Policy
Duke University
Durham, N.C.

Jacqueline Remondet Wall
Professor
School of Psychological Sciences
University of Indianapolis
Indianapolis, and
Director
Office of Program Consultation and Accreditation
American Psychological Association
Washington, DC

STAFF

Carol Mason Spicer
Study Director

*Member, Institute of Medicine

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