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Objective To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB). Method Participants (N  = 753; ages 18–85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e. Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores. Results The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e. 18–49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity. Conclusions Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine the prevalence of low scores on eight commonly used neuropsychological tests to evaluate learning and memory, language, and executive functions in individuals with coca paste use disorders (CPUD) and to identify the differences with respect to a group of healthy nonconsuming subjects (HCs). Methods 162 Colombian adults with CPUD and a group of 162 Colombian adult HCs participated in this comparative study. Eight tests (eighteen test scores) were grouped into three categories: learning and memory, language, and executive functions. Each participant was categorized based on the number of low scoring tests in specific percentile cut-off groups (25th, 16th, 10th, 5th, and 2nd). Results In the learning and memory domain, 89.5% of individuals with CPUD and 55.6% of HCs scored below the 25th percentile on at least one of the five test scores, in the language domain, 80.7% of individuals with CPUD and 58% of HCs and in the executive function domain, 92% of individuals with CPUD and 67.3% of HCs. Having two or more scores below the 10th percentile or 10 or more at the 5th percentile shows an optimal cut-off for determining the sensitivity and specificity for discriminating between the two groups. Conclusions The individuals with CPUD had a higher percentage of low scores than the HCs in the domains of learning and memory, language, and executive function. It is important for clinicians to be aware of low scores in individuals with CPUD to avoid false-positive diagnoses of cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective It is essential to interpret performance validity tests (PVTs) that are well-established and have strong psychometrics. This study evaluated the Child and Adolescent Memory Profile (ChAMP) Validity Indicator (VI) using a pediatric sample with traumatic brain injury (TBI). Method A cross-sectional sample of N  = 110 youth (mean age = 15.1 years, standard deviation [ SD ] = 2.4 range = 8–18) on average 32.7 weeks (SD  = 40.9) post TBI (71.8% mild/concussion; 3.6% complicated mild; 24.6% moderate-to-severe) were administered the ChAMP and two stand-alone PVTs. Criterion for valid performance was scores above cutoffs on both PVTs; criterion for invalid performance was scores below cutoffs on both PVTs. Classification statistics were used to evaluate the existing ChAMP VI and establish a new VI cutoff score if needed. Results There were no significant differences in demographics or time since injury between those deemed valid (n  = 96) or invalid (n  = 14), but all ChAMP scores were significantly lower in those deemed invalid. The original ChAMP VI cutoff score was highly specific (no false positives) but also highly insensitive (sensitivity [SN] = .07, specificity [SP] = 1.0). Based on area under the curve (AUC) analysis (0.94), a new cutoff score was established using the sum of scaled scores (VI-SS). A ChAMP VI-SS score of 32 or lower achieved strong SN (86%) and SP (92%). Using a 15% base rate, positive predictive value was 64% and negative predictive value was 97%. Conclusions The originally proposed ChAMP VI has insufficient SN in pediatric TBI. However, this study yields a promising new ChAMP VI-SS, with classification metrics that exceed any other current embedded PVT in pediatrics. [ABSTRACT FROM AUTHOR]

Objective To avoid misdiagnosing mild cognitive impairment (MCI), knowledge of the multivariate base rates (MVBRs) of low scores on neuropsychological tests is crucial. Base rates have typically been determined from normative population samples, which may differ from clinically referred samples. The current study addresses this limitation by calculating the MVBR of low or high cognitive scores in older adults who presented to a memory clinic experiencing subjective cognitive decline but were not diagnosed with MCI. Method We determined the MVBRs on the Kaplan–Baycrest Neurocognitive Assessment for 107 cognitively healthy older adults (M age = 75.81), by calculating the frequency of patients producing n scores below or above different cut-off values (i.e. 1, 1.5, 2.0, 2.5 SD from the mean), stratifying by education and gender. Results Performing below or above cut-off was common, with more stringent cut-offs leading to lower base rates (≥1 low scores occurred in 84.1% of older adults at −1 SD , 55.1% at −1.5 SD , and 39.3% at −2 SD below the mean; ≥1 high scores occurred in 80.4% of older adults at +1 SD , 35.5% at +1.5 SD , and 16.8% at +2 SD above the mean). Higher education was associated with varying base rates. Overall, the MVBR of obtaining a low cognitive test score was higher in this clinic sample, compared with prior studies of normative samples. Conclusions MVBRs for clinically referred older adults experiencing memory complaints provide a diagnostic benefit, helping to prevent attributing normal variability to cognitive impairment and limiting false positive diagnoses. [ABSTRACT FROM AUTHOR]

Objective We aimed to assess the utility of a novel and easy-to-administer performance validity test (PVT), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Forced Choice recognition trial (RFC), compared with previously developed RBANS PVTs. Method We compared the RFC with the RBANS Effort Index (EI) and Effort Scale (ES) in a sample of 62 non-litigating older adults (mean age = 74 years, 52% female) with varying levels of cognitive impairment. Results A significantly greater proportion of the sample met EI criteria for non-credible performance (EI > 2; 31%) compared with RFC criteria (RFC < 9; 15%). Among participants with Major Neurocognitive Disorder, 60% met EI criteria for non-credible performance, 32% met ES criteria (ES > 12), and 24% met RFC criteria. Conclusions The RFC may have greater specificity than other RBANS PVTs among individuals with more severe cognitive impairment. Further research is needed to establish the classification accuracy of the RFC for assessing performance validity. [ABSTRACT FROM AUTHOR]

Background Cognitive symptoms in the absence of neurological disease are common. Functional cognitive disorder (FCD) has been conceptualized as a cognitive subtype of functional neurological disorder. Although FCD is understood as different from exaggerated or feigned cognitive complaints, previous accounts have provided little practical advice on how FCD can be separated from factitious or malingered cognitive complaints. Also, the distinction of FCD from other medical or mental health disorders that impact on cognition is an area of ongoing study and debate. Diagnostic precision is important to prevent iatrogenesis and for the development of needed treatment protocols. Method We summarize the current literature and present seven anonymized case vignettes to characterize the challenges in this area and develop proposals for solutions. Results/Conclusions Recognizing the limitations of categorical diagnostic systems, we position FCD as distinct from feigning and cognitive symptoms of psychiatric disorders, although with overlapping features. We set out typical clinical features and neuropsychological profiles for each category of cognitive disorder and a statistical method to analyze performance validity tests/effort tests to assist in determining feigned or invalid responding. [ABSTRACT FROM AUTHOR]

Objective Individuals with early-onset dysexecutive Alzheimer's disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom misinterpretation and misdiagnosis. Method The aim of this retrospective study is to evaluate rates of failure on a common PVT, the test of memory malingering (TOMM), in a sample of clinical patients with biomarker-confirmed early-onset dAD who completed neuropsychological testing. Results We identified seventeen patients with an average age of symptom onset at 52.25 years old. Nearly fifty percent of patients performed below recommended cut-offs on Trials 1 and 2 of the TOMM. Four of six patients who completed outside neuropsychological testing were misdiagnosed with alternative etiologies to explain their symptomatology, with two of these patients' performances deemed unreliable based on the TOMM. Conclusions Low scores on the TOMM should be interpreted in light of contextual and optimally biological information and do not necessarily rule out a neurodegenerative etiology. [ABSTRACT FROM AUTHOR]

Objective Prior research has focused on the normal frequency of obtaining low scores on a neuropsychological test battery, but few studies have examined the normal frequency of obtaining high scores. This study involved the preparation of high score multivariate base rates for the Spanish-language National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB). Method Participants included 250 healthy Latinx adults (age range: 19–80) from the Spanish-language NIHTB-CB normative sample who completed the full battery (two crystallized and four fluid cognition tests). Multivariate base rates, stratified by education, crystallized ability, and sociocultural characteristics, quantified the frequency at which participants obtained one or more "high" fluid test scores (i.e. ≥50th, ≥63rd, ≥75th, ≥84th, ≥91st, ≥95th, and ≥ 98th percentile). Results It was common for participants to obtain one or more high scores (i.e. 50.8% obtained one or more scores ≥84th percentile) and uncommon for participants to obtain "no" high scores, especially when using non-conventional thresholds for defining a high score (i.e. 10.8% obtained no scores ≥50th percentile). High scores were more commonly obtained by participants with greater education and higher crystallized ability, who were bilingual, born and educated within the United States, and from higher income households. Conclusions This study demonstrated that participants administered multiple neuropsychological tests commonly obtain high scores, and that the frequency of high scores varies by education, crystallized ability, and sociocultural characteristics. The absence of high scores may be indicative of cognitive impairment among examinees who are higher functioning, have greater education, and have specific sociocultural characteristics (e.g. bilingualism, higher socioeconomic status). [ABSTRACT FROM AUTHOR]

Objective In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering—TOMM Trial 1—differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. Method This study utilized archival data from 93 patients (mean age  = 14.56 and SD  = 2.01) with a history of concussion who were assessed at ~5–6 weeks post-injury (mean days  = 40.27 and SD  = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. Results The overall pass rate on Trial 1 was 70% (mean  = 46.04 and SD  = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. Conclusions This study highlights the importance of utilizing PVTs when evaluating concussion recovery. [ABSTRACT FROM AUTHOR]

Objective To increase sensitivity of the Test of Memory Malingering (TOMM), adjustments have been proposed, including adding consistency indices. The Invalid Forgetting Frequency Index (IFFI) is the most recently developed consistency index. While strong classification accuracy rates were originally reported, it currently lacks cross-validation. Method A sample of 184 outpatients was utilized. Valid performers passed all criterion performance validity tests (PVTs) and invalid performers failed two or more PVTs. Classification accuracy statistics were calculated. Results AUC for the IFFI was 0.80, demonstrating adequate discrimination between valid and invalid groups. A score of 3 or more inconsistent responses resulted in sensitivity and specificity rates of 63% and 92%, respectively. Conclusions This is the first article to cross-validate the IFFI. In both the original IFFI study and the current study, the same cut-off was found to maintain at least 90% specificity while producing higher sensitivity rates than those achieved by traditional TOMM indices. [ABSTRACT FROM AUTHOR]

Objective Performance validity research has emphasized the need for briefer measures and, more recently, abbreviated versions of established free-standing tests to minimize neuropsychological evaluation costs/time burden. This study examined the accuracy of multiple abbreviated versions of the Dot Counting Test ("quick" DCT) for detecting invalid performance in isolation and in combination with the Test of Memory Malingering Trial 1 (TOMMT1). Method Data from a mixed clinical sample of 107 veterans (80 valid/27 invalid per independent validity measures and structured criteria) were included in this cross-sectional study; 47% of valid participants were cognitively impaired. Sensitivities/specificities of various 6- and 4-card DCT combinations were calculated and compared to the full, 12-card DCT. Combined models with the most accurate 6- and 4-card combinations and TOMMT1 were then examined. Results Receiver operator characteristic curve analyses were significant for all 6- and 4-card DCT combinations with areas under the curve of.868–.897. The best 6-card combination (cards, 1-3-5-8-11-12) had 56% sensitivity/90% specificity (E-score cut-off, ≥14.5), and the best 4-card combination (cards, 3-4-8-11) had 63% sensitivity/94% specificity (cut-off, ≥16.75). The full DCT had 70% sensitivity/90% specificity (cut-off, ≥16.00). Logistic regression revealed 95% classification accuracy when 6-card or 4-card "quick" combinations were combined with TOMMT1, with the DCT combinations and TOMMT1 both emerging as significant predictors. Conclusions Abbreviated DCT versions utilizing 6- and 4-card combinations yielded comparable sensitivity/specificity as the full DCT. When these "quick" DCT combinations were further combined with an abbreviated memory-based performance validity test (i.e. TOMMT1), overall classification accuracy for identifying invalid performance was 95%. [ABSTRACT FROM AUTHOR]

Objective This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Method A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics. Results Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96–0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68–0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses. Conclusions The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545–561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field. Method: The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms. Results: The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment. Conclusions: The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented. [ABSTRACT FROM AUTHOR]

Objective: The Test of Memory Malingering (TOMM) is commonly used by neuropsychologists (Sharland, M. J., & Gfeller, J. D. (2007). A survey of neuropsychologists' beliefs and practices with respect to the assessment of effort. Archives of Clinical Neuropsychology, 22 (2), 213–223); however there is variable research regarding its use in low intelligence and epileptic populations (Hill, S. K., Ryan, L. M., Kennedy, C. H., & Malamut, B. L. (2003). The relationship between measures of declarative memory and the Test of Memory Malingering in patients with and without temporal lobe dysfunction. Journal of Forensic Neuropsychology, 3 (3), 1–18; Hurley, K. E., & Deal, W. P. (2006). Assessment instruments measuring malingering used with individuals who have mental retardation: Potential problems and issues. Mental Retardation, 44 (2), 112–119; Simon, M. J. (2007). Performance of mentally retarded forensic patients on the Test of Memory Malingering. Journal of Clinical Psychology, 63 (4), 339–344). The present study evaluates whether the standard TOMM cutoffs are resistant to low estimated IQ (≤80) in a clinical sample of patients with intractable epilepsy. A second aim is to decipher possible relationships between the TOMM and memory performance. Methods: Retrospective data analysis was conducted between 2010 and 2019 on 42 adults with intractable epilepsy who completed a comprehensive neuropsychological evaluation as part of screening procedures for epilepsy surgery. IQ estimates and TOMM were administered to all participants. Some were also administered memory- and mood-related measures. Results: Traditional TOMM cutoffs demonstrated excellent specificity with only one participant scoring below the cutoff score on the Retention Trial, but not on Trial 2. The TOMM significantly correlated with several scores on various memory tests. Conclusions: The TOMM may be appropriate for use in low intellectually functioning populations with intractable epilepsy given the excellent specificity seen in this study. Future studies may seek to better understand the relationship between TOMM and memory performance in other low-functioning populations. [ABSTRACT FROM AUTHOR]

Objective: The Test of Memory Malingering (TOMM) is widely used to assess performance validity. To improve efficiency, we investigated whether abbreviated administration (i.e., only the first 25 items of Trial 1 [T1]) is possible when effort is very strong (≥49/50 on T1 or T2). Method: We collected TOMM scores of 501 consecutive adult patients ranging in cognitive status who underwent standard neuropsychological evaluation at Mayo Clinic, Rochester, MN. Results: Receiver Operating Characteristic (ROC) analysis showed excellent area under the curve (AUC) (0.94; CI95% [0.92, 0.97]) and a cutoff of 25/25 had 100% specificity for identifying strong performance. Of the 224 patients who obtained a perfect score on the first 25 items, 197 (88%) obtained ≥49 on T1 and the remaining patients (n = 27) obtained ≥49 on T2. Conclusion: A perfect score on the first 25 items of the TOMM predicted overall strong performance 100% of the time, supporting abbreviated administration in select cases in a general outpatient clinical setting. [ABSTRACT FROM AUTHOR]

Objective The main objectives of this study were to determine how accurately the embedded invalidity indicators (EIIs) identify purposeful underperformers on the baseline Immediate Post-concussion Assessment and Cognitive Test (ImPACT); and to assess the effectiveness of each individual EII. Methods A randomized controlled trial was conducted in which all participants completed a baseline ImPACT assessment. Participants were randomized into a control or purposeful underperformance (sandbagging) group. The primary outcomes measured were the number of participants identified as invalid (via any EII), as well as the ability of each individual EII to detect purposeful sandbagging. Additionally, participants mean raw composite scores and percentiles were evaluated. Results Seventy-seven participants completed the study (control n = 37, sandbag n = 40.) None of the participants in the control group, and 50% of the purposeful sandbaggers were identified as invalid via the current EIIs. Of the five EIIs, three were unable to identify more than 15% of purposeful sandbaggers. The best performing EIIs were Word Memory and Three Letters, identifying 40% and 35% of purposeful sandbaggers, respectively. Sixty- five percent of the purposeful sandbaggers had at least one composite score ≤1st percentile. Using a composite score ≤1st percentile as potential marker of invalidity would have accurately identified more purposeful sandbaggers than all existing EIIs combined. Conclusion Half of purposeful sandbaggers were not identified by ImPACT's current EIIs. Multiple EIIs were only able to identify <15% of purposeful underperformers, suggesting that reevaluation and/or recalibration of EII cutoffs may be appropriate. [ABSTRACT FROM AUTHOR]

Objective Evaluate the effectiveness of Rey 15-item plus recognition data in a large neuropsychological sample. Method Rey 15-item plus recognition scores were compared in credible (n = 138) and noncredible (n = 353) neuropsychology referrals. Results Noncredible patients scored significantly worse than credible patients on all Rey 15-item plus recognition scores. When cut-offs were selected to maintain at least 89.9% specificity, cut-offs could be made more stringent, with the highest sensitivity found for recognition correct (cut-off ≤11; 62.6% sensitivity) and the combination score (recall + recognition – false positives; cut-off ≤22; 60.6% sensitivity), followed by recall correct (cut-off ≤11; 49.3% sensitivity), and recognition false positive errors (≥3; 17.9% sensitivity). A cut-off of ≥4 applied to a summed qualitative error score for the recall trial resulted in 19.4% sensitivity. Approximately 10% of credible subjects failed either recall correct or recognition correct, whereas two-thirds of noncredible patients (67.7%) showed this pattern. Thirteen percent of credible patients failed either recall correct, recognition correct, or the recall qualitative error score, whereas nearly 70% of noncredible patients failed at least one of the three. Some individual qualitative recognition errors had low false positive rates (<2%) indicating that their presence was virtually pathognomonic for noncredible performance. Older age (>50) and IQ < 80 were associated with increased false positive rates in credible patients. Conclusions Data on a larger sample than that available in the 2002 validation study show that Rey 15-item plus recognition cut-offs can be made more stringent, and thereby detect up to 70% of noncredible test takers, but the test should be used cautiously in older individuals and in individuals with lowered IQ. [ABSTRACT FROM AUTHOR]

Objective The Test of Memory Malingering (TOMM) is among the most widely used performance validity tests (PVTs) in neuropsychology. Despite abundant support documenting its sensitivity and specificity in the detection of invalid performance, most research has occurred among English-speaking, North-American samples. Studies conducted with Spanish-speaking samples in Latin America found associations between education and TOMM performance, though more mixed results in the United States with Hispanic/Latino samples have emerged due to the challenges that bilingualism, acculturation, and heterogeneity of the population pose to an already challenging area of measurement. Due to the pivotal role that PVTs play in clinical diagnoses and legal cases, it is critical that studies begin to broaden their scope and examine their variables cross-culturally. This study investigated the effects of age, education, and cognitive impairment on TOMM Trial 2 performance in a first-generation, monolingual Spanish speaking, Latino sample. Participants and Method The sample consisted of 26 first-generation Latino adults, 14 women and 12 men, Mean age = 57.11 (SD = 11.99); Mean education = 7.69 years (SD = 4.14), who underwent outpatient neuropsychological evaluation that included administration of the TOMM. 4 with invalid performances were excluded. Of the remaining 26, 9 were cognitively intact and 17 met criteria for a neurocognitive disorder. Results A combined linear regression analysis showed that age, education, and cognitive impairment status did not account for a significant portion of the variance in TOMM Trial 2 scores (R2 = 1.70; p =.283). Similarly, analysis of variance (ANOVA) found no significant differences between impaired (M = 46.68; SD = 5.78) and unimpaired (M = 46.50; SD = 6.09) patients (p =.942). Conclusions Results suggested that age, level of education, or cognitive impairment do not have a significant effect on TOMM Trial 2 performance in a sample of first-generation Latinos. [ABSTRACT FROM AUTHOR]

Objective Functional impairment associated with Neurocognitive Disorder is often claimed in medico-legal settings after mild Traumatic Brain Injury (mTBI). This case–control study examined self-reported functional impairment and the plausibility of chronic disability claims following uncomplicated mTBI. Method Independent Medical Evaluations included a battery of performance and symptom validity tests, along with self-reports of physical or emotional complaints and functional impairment. Slick and colleagues' (Slick, D. J. Sherman, E. M. & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13 , 545–561.) criteria ruled out probable malingering in 21 mTBI cases without psychiatric comorbidity and their self-reports were compared to those of seven non-malingering cases with a psychiatric comorbidity, 17 who were probable malingerers, and 31 orthopedic pain sufferers. Coherence Analysis of medical documentation corroborated assignment of mTBI cases to non-malingering versus probable malingering groups. Results Probable malingerers reported more postconcussion symptoms than non-malingerers (d = 0.79) but they did not differ significantly on tests of neurocognitive performance. Probable malingerers and orthopedic pain patients gave significantly higher ratings of functional impairment (d = 1.28 and 1.26) than non-malingerers. Orthopedic pain patients reported more disability due to pain than non-malingerers (d = 1.03), but pain catastrophizing was rated more highly by the probable malingerers (d = 1.21) as well as by the orthopedic pain patients (d = 0.98). The non-malingerers reported lower emotional distress than the other three groups, but only the probable malingerers reported elevated depression symptoms compared to the non-malingerers (d = 1.01). Conclusions The combined evaluation of performance validity, function, and coherence analysis would appear to enhance the difficult clinical evaluation of postconcussion symptoms in the medical-legal setting. [ABSTRACT FROM AUTHOR]

Objective The Personal Problems Questionnaire (PPQ) is a measure designed to assess acquired cognitive, emotional, and physical complaints. The present study sought to develop a normative database to allow clinicians and researchers to assess self-reported complaints among people with disabilities, and evaluate the response consistency and validity of their self-report. Method 404 community-dwelling participants (n 200 males, 204 females) completed the PPQ, as well as an acquired brain injury (ABI) group (n 59), mainly following stroke and traumatic brain injuries, and seen for clinical (i.e. non-forensic) evaluations. Multiple regression analyses were conducted to derive norms from the healthy community sample taking into account age, gender, and educational level. Results Normative T scores and cut-off points for the Clinical and Validity scales were derived, respectively, and used to assess the responses of the ABI group. The results indicated that the ABI group showed good response consistency and elevated scores on the Clinical scales, indicating that the PPQ is likely to be useful in detecting acquired disabilities. On the other hand, scores on the Validity scales were not elevated, indicating that the measures were unaffected by the ABI participants' cognitive difficulties. Conclusions The PPQ provides a comprehensive assessment of complaints and response validity and the present study provides further data to assist with its use and interpretation. [ABSTRACT FROM AUTHOR]

Background Development of an embedded performance validity test (PVT) is desired for visual memory tests. The goal of this study was to derive an embedded PVT for the Child and Adolescent Memory Profile (ChAMP) Objects visual memory subtest in youth with mild traumatic brain injury (MTBI). Methods Children and adolescents (N = 91; mean age = 14.9 years, SD = 2.2, range = 8–18) on average 25.2 weeks (SD = 15.4) post-MTBI were administered ChAMP Objects. Two stand-alone PVTs (Test of Memory Malingering and Medical Symptom Validity Test) were administered, which allowed for grouping into valid (zero failed stand-alone PVTs) and invalid (both stand-alone PVTs failed). Cutoff scores for invalid performance on ChAMP Objects and Objects Delayed were established using failure on two PVTs as the criterion. Results One in five youth (n = 19) failed both PVTs. Invalid performance was not associated with demographics or time since injury, but was significantly correlated with both ChAMP Objects (r =.53, p <.001) and Objects Delayed (r = −.63, p <.001). Area under the curve suggested adequate discrimination by Objects (.87) and excellent discrimination by Objects Delayed (.91). A cutoff scaled score of 5 or less on ChAMP Objects provided sensitivity of 58% for detecting invalid performance with 96% sensitivity. A cutoff scaled score of 5 or less on ChAMP Objects Delayed achieved sensitivity of 63% and specificity of 96%. Interpreting the two embedded PVTs simultaneously improved sensitivity to 79% with 93% specificity. Conclusion This study yields promising new embedded PVTs for the ChAMP Objects subtest with strong sensitivity and specificity for detecting invalid performance in youth with MTBI. [ABSTRACT FROM AUTHOR]

Objective Assessment of performance validity is a necessary component of any neuropsychological evaluation. Prior research has shown that cutoff scores of ≤6 or ≤7 on Reliable Digit Span (RDS) can detect suboptimal effort across numerous adult clinical populations; however, these scores have not been validated for that purpose in an adult epilepsy population. This investigation aims to determine whether these previously established RDS cutoff scores could detect suboptimal effort in adults with epilepsy. Method Sixty-three clinically referred adults with a diagnosis of epilepsy or suspected seizures were administered the Digit Span subtest of the Wechsler Adult Intelligence Scale (WAIS-III or WAIS-IV). Most participants (98%) passed Trial 2 of the Test of Memory Malingering (TOMM), achieving a score of ≥45. Results Previously established cutoff scores of ≤6 and ≤7 on RDS yielded a specificity rate of 85% and 77% respectively. Findings also revealed that RDS scores were positively related to attention and intellectual functioning. Given the less than ideal specificity rate associated with each of these cutoff scores, together with their strong association to cognitive factors, secondary analyses were conducted to identify more optimal cutoff scores. Preliminary results suggest that an RDS cutoff score of ≤4 may be more appropriate in a clinically referred adult epilepsy population with a low average IQ or lower. Conclusions Preliminary findings indicate that cutoff scores of ≤6 and ≤7 on RDS are not appropriate in adults with epilepsy, especially in individuals with low average IQ or below. [ABSTRACT FROM AUTHOR]

Objective: This study involved the calculation of multivariate base rates for the NIH Toolbox Emotion Battery (NIHTB-EB) for the Spanish-speaking normative sample, stratifying by sociocultural variables. Method: Participants were 224 Spanish-speaking adults from the NIHTB norming study (M = 42.2 years-old, SD = 16.3; 40.2% Male; 100% Hispanic/Latinx). Frequencies of obtaining one or more "potentially problematic" emotion scores (i.e., either T60, depending on scale orientation) were calculated with stratifications by gender, education, country of birth and education, bilingualism, and household income. The NIHTB-EB includes 17 scales measuring negative affect, social satisfaction, and psychological well-being. Results: When interpreting all 17 scales, 59.8% of participants had one or more potentially problematic score(s). Only education was related to problematic score frequencies (p < 0.014, phi = 0.19). Adults with less than high school education (68.4%) had the highest frequency scores compared to adults with a high school diploma (42.3%) or greater education (54.5%). Although non-significant, bilingual adults (66.7%) tended to have more potentially problematic scores than monolingual adults (56.8%; p = 0.16, phi = 0.09) and higher income (49.0%) was related to more potentially problematic scores than lower income (63.8%; p = 0.07, phi = 0.14). Conclusions: Most Spanish-speaking adults obtained one or more potentially problematic NIHTB-EB scores, with more emotional difficulties associated with less education and modestly associated with lower socioeconomic status and bilingualism. Future research may explore how these variables interact with emotional health among Spanish-speaking Hispanic/Latinx adults. [ABSTRACT FROM AUTHOR]

Objective: To examine relationships between Posttraumatic Stress Disorder (PTSD) symptom severity and performance on the Test of Memory Malingering (TOMM) trials in veterans without a diagnosis of neurocognitive disorder. Method: A sample of 47 clinically-referred veterans (80.9% male; Mage = 57.47, SD = 14.83; Medu = 13.91, SD = 2.5) who did not meet criteria for a neurocognitive disorder completed the PTSD Checklist for DSM-5 (PCL-5) and the TOMM. Primary diagnoses included PTSD (48.9%), no diagnosis (23.4%), and depression (19.1%). A cutoff of 45 was used for each trial; 47 completed Trial 1 (TOMM-T1), 17 completed Trial 2 (TOMM-T2), and 10 completed Retention Trial (TOMM-Ret). Nine participants (19.1%) failed the TOMM. Analyses included Pearson correlation, Spearman correlation, and independent-samples t-tests. Age was negatively correlated with PCL-5 and positively correlated with TOMM-T1; therefore, relevant partial correlations were conducted. Results: TOMM-T1 demonstrated a moderate, negative correlation with PCL-5, rs(45) = −0.469, p < 0.001, 95%CI(−0.688,-0.248). A moderate non-significant correlation was found between TOMM-T2 and PCL-5, rs(15) = −0.405, p = 0.053, 95%CI(−0.775,0.014). PCL-5 and TOMM-Ret were not correlated. Controlling for age, the correlation between PCL-5 and TOMM-T1 remained significant (rs[44] = −0.426, p = 0.002). Those who passed TOMM (M = 38.45, SD = 16.48) had significantly lower PCL-5 scores compared to those who failed (M = 57.67, SD = 13.83), t(45) = −3.231, p = 0.001, Cohen's D = 16.04. Conclusions: Among veterans, PTSD symptom severity was related to TOMM scores and/or failure. Findings highlight a need to consider the role PTSD symptoms may play in neuropsychological assessment. Findings further support recommendations for trauma-focused treatment before formal neuropsychological testing, as psychiatric symptoms may interfere with obtaining a valid assessment of cognition. [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy of the Validity Indicator Profile (VIP) and Word Memory Test (WMT) in a criminal forensic population. Method Potential participants included 225 male evaluees from a maximum-security Federal prison referred for neuropsychological evaluation for either forensic purposes or for suspected neurocognitive dysfunction as part of a medical evaluation. Examinees were included in the analysis if administered the VIP (Verbal, Nonverbal, or both tests) and WMT along with at least two other freestanding PVTs; 74 satisfied these criteria. Participants were then categorized as having probable Malingered Neurocognitive Dysfunction (+MND) if they failed at least two freestanding validity indicators, negative for MND (−MND) if they passed all indicators, and Possible MND (pMND) if they failed one indicator. Results Groups were very demographically similar. There were significant differences in WMT scores and distribution of VIP profiles across groups. Whether using traditional or investigative cut scores, and whether using the WMT with or without consideration of a GMIP profile, the WMT demonstrated superior sensitivity and specificity on nearly every comparison. Conclusions The VIP, when interpreted in the traditional fashion, and the WMT with GMIP, both had more than adequate psychometric properties when used with criminal forensic evaluees, strengthening the body of literature supporting their use for these types of evaluations. Counting a positive on either of the VIP subtests as an indication of +MND improves the psychometric properties of the VIP slightly, although the WMT had the better overall classification accuracy. [ABSTRACT FROM AUTHOR]

Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been shown to be an effective screener for detecting neurocognitive impairments in English speaking forensic psychiatric inpatients, but no studies have examined whether the RBANS would have the same utility among monolingual Spanish speaking inpatients. This study sought to examine RBANS performance, as well as risk factors (i.e., educational, neurological, and medical) influencing RBANS performance, in that particular population. Method: The present study examined archival data collected from monolingual Spanish speaking inpatients (n = 34; mean age = 48.71, SD = 11.99; 85.3% men; 93.5% with Schizophrenia Spectrum Disorder). All participants must have RBANS data, and must not have a diagnosis of malingering or major neurocognitive disorder. Medical records of eligible participants were examined. Results: Our findings indicated that most participants (75.8%) performed in the impaired range for the RBANS Total Index; however, the frequency of impaired performances varied on more specific RBANS indices (42.4%-72.7% of the participants). Although neurological and medical risk factors were not associated with RBANS Total Index performance (all p's = .26-.82), years of education appeared to be inversely associated with RBANS Total Index score (all p's = .04-.07). Conclusions: These findings can serve as the first step in helping to define "normative" cognition among Spanish speaking forensic psychiatric inpatients. Such findings can reduce the likelihood of over-pathologizing performance and increase the likelihood that treatment goals will be better tailored to the patient's cognitive ability. [ABSTRACT FROM AUTHOR]

Objective: This study tested whether patients who were given a handout based on deterrence theory, immediately prior to evaluation, would provide invalid data less frequently than patients who were simply given an informational handout. Method: All outpatients seen for clinical evaluation in a VA Neuropsychology Clinic were randomly given one of the two handouts immediately prior to evaluation. The "Intervention" handout emphasized the importance of trying one's hardest, explicitly listed consequences of valid and invalid responding and asked patients to sign and initial it. The "Control" handout provided general information about neuropsychological evaluation. Examiners were blinded to condition. Patients were excluded from analyses if they were diagnosed with major neurocognitive disorder or could not read the handout. Medical Symptom Validity Test (MSVT) was used to determine performance validity. Results: Groups did not differ on age, education, or litigation status. For the entire sample (N = 251), there was no effect of handout on passing versus failing MSVT. However, among patients who were seeking disability benefits at the time of evaluation (n = 70), the Intervention handout was associated with lower frequency of failing MSVT than the Control handout. Conclusions: This brief, theory-based, cost-free intervention was associated with lower frequency of invalid data among patients seeking disability benefits at the time of clinical evaluation. We suggest methodological modifications that might produce a more potent intervention that could be effective with additional subsets of patients. [ABSTRACT FROM AUTHOR]

Objective: This research examined cutoff scores for MMPI-2 and MMPI-2-RF validity scales specifically developed to assess non-credible reporting of cognitive and/or somatic symptoms. The validity scales examined included the Response Bias Scale (RBS), the Symptom Validity Scales (FBS, FBS-r), Infrequent Somatic Responses scale (Fs), and the Henry–Heilbronner Indexes (HHI, HHI-r). Method: Cutoffs were developed by comparing a psychometrically defined non-malingering group with three psychometrically defined malingering groups (probable, probable to definite, and definite malingering) and a group that combined all malingering groups. The participants in this research were drawn from a military sample consisting largely of patients with traumatic brain injury (mostly mild traumatic brain injury). Results: Specificities for cutoffs of at least 0.90 are provided. Sensitivities, predictive values, and likelihood ratios are also provided. Conclusions: RBS had the largest mean effect size (d) when the malingering groups were compared to the non-malingering group (d range = 1.23–1.58). [ABSTRACT FROM AUTHOR]

Objective: The current investigation sought to define the relationship between established performance validity tests and measures of memory via a factor analytic strategy first published by Heyanka, Thaler, Linck, Pastorek, Miller, Romesser, & Sim (2015). A Factor analytic approach to the validation of theWord Memory Test and Test of Memory Malingering as measures of effort and not memory. Archives of Clinical Neuropsychology, 30, 369-376. Method: The full range of Medical Symptom Validity Test (MSVT) and Non-Verbal Medical Symptom Validity Test (NV-MSVT) subtests were factor analyzed with the memory scales of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a sample of 346 service members with a history of concussion. Results: A two-factor solution was extracted with the MSVT and NV-MSVT effort and paired associate subtests loading on one factor and the RBANS subtests loading on a second factor. Conclusions: Results support the conclusion that the effort subtests of the MSVT and NV-MSVT tap a different construct from established memory measures. [ABSTRACT FROM AUTHOR]

Objective. Attention deficit/hyperactivity disorder (ADHD) can be easily presented in a non-credible manner, through non-credible report ofADHDsymptoms and/or by non-credible performance on neuropsychological tests. While most studies have focused on detection of non-credible performance using performance validity tests, there are few studies examining the ability to detect noncredible report ofADHD symptoms. We provide further validation data for a recently developed measure of non-credibleADHD symptom report, the Conner's Adult ADHD Rating Scales (CAARS) Infrequency Index (CII). Method. Using archival data from 86 adults referred for concerns aboutADHD, weexamined the accuracy of the CII in detecting extreme scores on the CAARS and invalid reporting on validity indices of the Minnesota Multiphasic Personality Inventory-2 Restructured Format (MMPI-2-RF).We also examined the accuracy of the CII in detecting non-credible performance on standalone and embedded performance validity tests. Results. The CII was 52% sensitive to extreme scores on CAARS DSM symptom subscales (with 97% specificity) and 20%- 36% sensitive to invalid responding onMMPI-2-RF validity scales (with near 90% specificity), providing further evidence for the interpretation of the CII as an indicator of non-credibleADHDsymptomreport. However, the CII detected only18%of individuals who failed a standalone performance validity test (WordMemory Test), with 87.8% specificity, and was not accurate in detecting non-credible performance using embedded digit span cutoffs. Conclusions. Future studies should continue to examine howbest to assess for non-credible symptom report inADHDreferrals. [ABSTRACT FROM AUTHOR]

Objective. This research examined cutoff scores for the Effort Index (EI), an embeddedmeasure of performance validity, for the Repeatable Battery for the Assessment of Neuropsychological Status. EI cutoffs were explored for an active-dutymilitary sample composed mostly of patients with traumatic brain injury. Method. Four psychometrically defined malingering groups including a definite malingering, probable to definite malingering, probable malingering, and a combined group were formed based on the number of validity tests failed. Results. Excellent specificities (0.97 or greater) were found for all cutoffs examined (EI ≥ 1 to EI ≥ 3). Excellent sensitivities (0.80 to 0.89) were also found for the definite malingering group. Sensitivities were 0.49 or below for the other groups. Positive and negative predictive values and likelihood ratios indicated that the cutoffs for EI were much stronger for ruling-in than ruling-out malingering. Analyses indicated the validity tests used to form the malingering groups were uncorrelated, which serves to enhance the validity of the formation of the malingering groups. Conclusions. Cutoffs were similar to other research using samples composed predominantly of head-injured individuals. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated RBS and FBS-r to identify non-credible reporters of cognitive symptoms, but the extent that these scales might be influenced by true neurocognitive dysfunction has not been previously studied. The present study examined the relationship between these cognitive validity scales and neurocognitive performance across seven domains of cognitive functioning, both before and after controlling forPVTstatus in 120 individuals referred for neuropsychological evaluations.Variance in RBS, but not FBS-r,was significantly accounted for by neurocognitive test performance across most cognitive domains. After controlling for PVT status, however, relationships between neurocognitive test performance and validity scales were no longer significant for RBS, and remained non-significant for FBS-r. Additionally, PVT failure accounted for a significant proportion of the variance in both RBS and FBS-r. Results support both the convergent and discriminant validity of RBS and FBS-r. As neither scale was impacted by true neurocognitive dysfunction, these findings provide further support for the use of RBS and FBS-r in neuropsychological evaluations. [ABSTRACT FROM AUTHOR]

Compared with the amount of neuropsychological literature surrounding response bias in civil litigation, there is little regarding criminal cases. This study adds to the criminal forensic neuropsychological literature by comparing the Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) in a criminal forensic setting utilizing a criterion-groups design. Subjects were classified into two groups based on their performance on at least two other freestanding performance validity tests. The WMT demonstrated good sensitivity (95.1%) but poor specificity (68.4%) when Genuine Memory Impaired Profiles (GMIPs) were not considered. Inclusion of GMIPs reduced the sensitivity to 56.1% but increased the specificity to 94.7%. The TOMM evidenced better sensitivity but poorer specificity than the WMT with GMIPs. Conjoint use of the tests was also considered. Receiver operating characteristics and other classification statistics for each measure are presented. Results support the use of these measures in a criminal forensic population. [ABSTRACT FROM AUTHOR]

The current study examined two embedded response bias measures in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Effort Index (EI) and Effort Scale (ES), in relation to Malingered Neurocognitive Dysfunction criteria. We examined 105 individuals undergoing compensation-seeking disability evaluations. The results suggest the EI adequately differentiates the Probable/Definite Malingering group from the Incentive Only and Possible Malingering groups, while the ES does not, which is most likely representative of the current sample of disability litigants rather than its intended population of patients with amnesia. Classification accuracy statistics suggest that while the EI may not be an appropriate stand-alone measure in detecting neurocognitive malingering, it shows utility as a complementary or screening measure in forensic settings. [ABSTRACT FROM AUTHOR]

This examination of four embedded validity indices for the Repeated Battery for the Assessment of Neuropsychological Status (RBANS) explores the potential utility of integrating cognitive and self-reported depressive measures. Examined indices include the proposed RBANS Performance Validity Index (RBANS PVI) and the Charleston Revised Index of Effort for the RBANS (CRIER). The CRIER represented the novel integration of cognitive test performance and depression self-report information. The sample included 234 patients without dementia who could be identified as having demonstrated either valid or invalid responding, based on standardized criteria. Sensitivity and specificity for invalid responding varied widely, with the CRIER emerging as the best all-around index (sensitivity = 0.84, specificity = 0.90, AUC = 0.94). Findings support the use of embedded response validity indices, and suggest that the integration of cognitive and self-report depression data may optimize detection of invalid responding among older Veterans. [ABSTRACT FROM AUTHOR]

The ability of both the non-credible score of the Rey Auditory Verbal Learning Test (RAVLT NC) and the recognition score of the RAVLT (RAVLT Recog) to predict credible versus non-credible neuropsychological test performance was examined. Credible versus non-credible group membership was determined according to diagnostic criteria with consideration of performance on two stand-alone performance validity tests. Findings from this retrospective data analysis of outpatients seen for neuropsychological testing within a Veterans Affairs Medical Center (N = 175) showed that RAVLT Recog demonstrated better classification accuracy than RAVLT NC in predicting credible versus non-credible neuropsychological test performance. Specifically, an RAVLT Recog cutoff of ≤9 resulted in reasonable sensitivity (48%) and acceptable specificity (91%) in predicting non-credible neuropsychological test performance. Implications for clinical practice are discussed. Note: The views contained here within are those of the authors and not representative of the institutions with which they are associated. [ABSTRACT FROM PUBLISHER]

The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310–319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841–854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190–195). We explored failure rates on these effort measures in a non-litigatingmixed dementia sample (N = 145). Failure rate on the EIwas high (48%) and associatedwith dementia severity. In contrast, failure on the ESwas 14% but differed based on type of dementia. ES failure was low(4%) when dementiawas due toAlzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations. [ABSTRACT FROM AUTHOR]

Objective: With the proliferation of telehealth and online neuropsychological assessment, a question is raised to whether the results of such measures are comparable to those used in person. Thus, this study aimed to compare the performance of an online adaptation of the Portland Digit Recognition Test (PDRT) at detecting simulators of traumatic brain injury (TBI) to that of the in-person PDRT when TBI patients are utilized. Methods: 400 participants were randomly assigned to the simulated malingerers' or the control group and completed an online adaptation of the PDRT. The malingerers' group was instructed to perform as if they have a TBI. Sensitivity and specificity using the suggest cutoff score for the online PDRT were compared to in-person PDRT scores from published studies using the original suggested cutoffs. Results: ROC analysis of online PDRT scores used during this study demonstrated a sensitivity of 94% and specificity of 95%. When compared to in-person studies that used samples of TBI patients (e.g. Greve and Bianchini, 2006; Greve et al. 2008; Bianchini et al. 2001), the online version of the PDRT consistently had higher sensitivity but not higher specificity. Conclusions: This study has helped demonstrate the validity of an online version of the PDRT for detection of malingering. When compared to the sensitivity and specificity of in-person PDRT scores, the online version consistently had higher sensitivity and lower specificity. Additional research and comparisons are needed to further validate the online version of the PDRT for malingering detection. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of malingering following a personal injury is estimated to be more than 50% (Resnick, 1997). Thus, it is imperative to have malingering measures that are well-validated (Janaski et al. 2011). Ideally, malingering tests should have high sensitivity and specificity (Trevethan, 2017). The Tri-Choice Naming and Response Bias Measure (N-Tri) is a novel malingering test aimed at being less susceptible to coaching than existing tests. This study aimed to validate the N-Tri for detection of coached malingerers. Methods: 282 neurotypical participants completed an online version of the N-Tri. The N-Tri consists of three blocks: a naming block, a study and forced-choice block, and a delayed forced-choice block. Participants were randomly assigned to either the coached simulators' group or the control group. The coached group was instructed to perform as if they have a traumatic brain injury (TBI) and received a test-taking strategy. Results: ROC curves were used to determine optimal cutoff values, which were chosen based off Youden's index (Youden, 1950). Block 1 had a sensitivity of 92% and a specificity of 99%. Block 2 had a sensitivity of 95% and a specificity of 98%. Block 3 had a sensitivity of 96% and a specificity of 97%. Total score had a sensitivity of 97% and a specificity of 97%. Conclusions: This study demonstrated that all blocks and total score of a novel malingering test, the N-Tri, were able to distinguish between coached malingerers and controls with high levels of sensitivity and specificity. Further research that utilizes patients with documented memory deficits are proposed. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of malingering following a personal injury is estimated to range from 1% (Hickling et al. 1999) to more than 50% (Resnick, 1997). Thus, it is imperative to have malingering measures that are well-validated (Janaski et al. 2011). Additionally, with the proliferation of telehealth and online neuropsychological assessment, a question is raised to whether the results of such measures are comparable to those used in person. Therefore, this study aimed to validate an online adaptation of the PDRT for detection of coached malingerers. Methods: 282 participants were randomly assigned to the coached malingerers' or control group and completed an online adaptation of the Portland Digit Recognition Test (PDRT). The coached malingerers' group was instructed to perform as if they have a TBI and received a test-taking strategy. Sensitivity for the online PDRT were compared to in-person PDRT scores from published simulation studies (e.g. Rose et al. 1998; Gustad and Suhr, 2001). Results: The online adaptation of the PDRT demonstrated a sensitivity of 94% when detecting coached malingerers. When compared to coached malingering detection rates of 47% and 25% from Rose et al. (1998) and Gustad and Suhr (2001), respectively, the online PDRT adaptation consistently had higher sensitivity. Conclusions: These results helped demonstrate the validity of an online version of the PDRT for detection of coached malingering. When compared to the sensitivity of in-person PDRT scores, the online adaptation had higher sensitivity. Additional research and comparisons are needed to further validate the online version of the PDRT for detection of coached malingering. [ABSTRACT FROM AUTHOR]