Re-instructing suspected feigners shifts their decision criterion toward true thresholds

Evidence

For patients with bilateral pseudohypacusis, the audiologist must make modifications to the audiometric procedures in order to determine true absolute thresholds. The procedures in place were specifically designed in order to encourage patients to provide a neutral or liberal criterion. However, in the cases of pseudohypacusis, these practices have not achieved that goal. To obtain a more accurate audiologic threshold, the audiologist essentially applies the principles of Signal Detection Theory to encourage the patient to adopt a more neutral or liberal criterion. Consequently, the first step in audiometric testing for patients with suspected pseudohypacusis is to re-instruct the patient. This allows patients to be aware that you are suspicious of their thresholds and gives them the opportunity to readjust their criterion (whether it is consciously or unconsciously overly conservative). In many cases, re-instruction is sufficient to obtain a true audiogram. During the audiometric threshold search, the audiologist may need to adjust the step size used in testing (often it is lowered to 2 dB), increase the variability in presentation intervals, or estimate the thresholds using descending trials to ensure that the threshold is commensurate with that obtained using ascending trials. Ultimately, these practices effectively make it difficult for the patient to maintain an overly conservative criterion. — Jennifer Lentz, Psychoacoustics- Perception of Normal…, 1766

Categorization

• XREF: Signal Detection Theory reapplied clinically — directly connects to the book’s earlier chapters laying out SDT criterion and sensitivity concepts.