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Objective: This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample (n = 76) and academic medical sample (AMC; n = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. Method: All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs. Neurocognitive test performance differences were examined based on number of PVT failures (0, 1, 2+) for both samples, and effect of number of criterion failures on embedded PVT performance was analyzed among the AMC sample. Results: Both groups with 0 or 1 PVT failures performed better than those with ≥2 PVT failures across most cognitive tests. There were nonsignificant differences between those with 0 or 1 PVT failures except for one test in the AMC sample. Receiver operator characteristic curve analyses found no differences in optimal cut score based on number of PVT failures when retaining/excluding one PVT failure. Conclusion: Findings support the use of ≥2 PVT failures as indicative of performance invalidity. These findings strongly support including those with one PVT failure with those with zero PVT failures in diagnostic accuracy studies, given that their inclusion reflects actual clinical practice, does not reduce sample sizes, and does not artificially deflate neurocognitive test results or inflate PVT classification accuracy statistics. [ABSTRACT FROM AUTHOR]

Objective: Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) assesses neurocognitive functioning in sports-related concussion. Previous work demonstrates ImPACT's validity indices detect poor effort at disproportionately higher rates in athletes with histories of attention deficit hyperactivity disorder (ADHD) or academic difficulties. The present study examines whether previously suggested 'dormant' validity indices, Word Memory Correct Distractors (WMCD), and Design Memory Correct Distractors (DMCD), reduce disproportionate invalidity in collegiate athletes with such histories.Method: Six seasons of ImPACT protocols were examined (n = 1727). Athletes were grouped by self-reported histories of ADHD, academic difficulties, or comorbid ADHD and academic difficulties. Chi-square analyses compared invalidity rates using existing validity indices and both standard and conservative cutoffs for WMCD and DMCD.Results: Using standard cutoffs for dormant indices (WMCD < 22, DMCD < 16) produced significant differences in rates of athletes identified as having an invalid protocol, with the comorbid group exhibiting the highest invalidity rate (63.2%) and the no history group producing the lowest (42.0%), χ2 (3) = 11.57, p <.01, Cramer's V = 0.08. This difference remained when utilizing conservative cutoffs (WMCD < 18, DMCD < 10), with the comorbid group again producing the highest (26.3%) and the no history group producing the lowest (10.4%), χ2 (3) = 15.64, p <.005, Cramer's V = 0.10.Conclusions: Student-athletes with self-reported histories of ADHD and academic difficulties are more likely to produce invalid protocols, even with dormant indices. These findings emphasize the difficulty in assessing validity in special populations of athletes and encourage further work in this area. [ABSTRACT FROM AUTHOR]