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OBJECTIVE: This study is a cross-validation of the Cognitive Bias Scale (CBS) from the Personality Assessment Inventory (PAI), a ten-item scale designed to assess symptom endorsement associated with performance validity test failure in neuropsychological samples. The study utilized a mixed neuropsychological sample of consecutively referred patients at a large academic medical center in the Midwest. PARTICIPANTS AND METHODS: Participants were 332 patients who completed embedded and free-standing performance validity tests (PVTs) and the PAI. Pass and fail groups were created based on PVT performance to evaluate classification accuracy of the CBS. RESULTS: The results were generally consistent with the initial study for overall classification accuracy, sensitivity, and cut-off score. Consistent with the validation study, CBS had better classification accuracy than the original PAI validity scales and a comparable effect size to that obtained in the original validation publication; however, the Somatic Complaints scale (SOM) and the Conversion subscale (SOM-C) also demonstrated good classification accuracy. The CBS had incremental predictive ability compared to existing PAI scales. CONCLUSIONS: The results supported the CBS, but further research is needed on specific populations. Findings from this present study also suggest the relationship between conversion tendencies and PVT failure may be stronger in some geographic locations or population types (forensic versus clinical patients).

Objective As the COVID-19 pandemic continues, the impact on neuropsychology trainees continues to evolve. This paper describes the results of a survey of neuropsychology trainee (graduate student through postdoctoral resident) perspectives on the COVID-19 pandemic and compares them to a previous survey conducted in Spring 2020. Method The survey used several questions from the 2020 survey and added applicable new questions based on the results of the 2020 survey. The survey was distributed to listservs, training directors, and student organizations in neuropsychology with snowball sampling used. Results Respondents were primarily female (82.4%) and white (63%). The majority of trainees (66%) reported loss of clinical hours. Interestingly, the average training time missed was approximately 3.36 weeks (SD = 9.27). Trainees continue to report that they have experienced increased anxiety, depression, and stress since the beginning of the pandemic; however, compared to a prior survey, rates of increased anxiety/stress remained stable, but more trainees reported increased depression. Approximately 31% of trainees reported that they were differentially impacted by the pandemic due to racial/ethnic background and female trainees were more likely to report increased personal stress, anxiety and depression than their male counterparts. Conclusions Results suggest continued wide-reaching pandemic related impacts on neuropsychology trainees. For example, trainees continue to be concerned about the impact of lost clinical hours on their professional futures. The most notable of the personal impacts included increased rates of mental health concerns and differential impacts on trainees from ethnoracial minority communities. Recommendations are provided to assist trainees in coping with pandemic-related disruptions.

OBJECTIVE. As many as 65% of people with multiple sclerosis (MS) have clinically significant memory impairment, but the nature of this deficit is controversial. Some investigations suggest that an inability to retrieve newly-learned information from memory is prominent, whereas others imply that compromised acquisition accounts for impairment. Prior research has not simultaneously evaluated acquisition and retrieval processes in MS, and fewer have attempted to account for initial acquisition when studying retrieval. The Item Specific Deficit Approach (ISDA: Wright, Woo, Schmitter-Edgecombe, Hinkin, Miller, & Gooding, 2009) offers a method of quantifying acquisition, retrieval, and retention processes, with the latter two mechanisms being adjusted for initial acquisition. To simultaneously quantify acquisition and retrieval abilities, the ISDA was applied to list learning performance in two independent samples of people with MS and corresponding healthy comparison groups. PARTICIPANTS AND METHODS. Study 1 included 85 people with MS and 47 healthy individuals. Study 2 involved a separate sample of 79 people with MS and 22 healthy people. They were administered neuropsychological batteries, and participants with MS were classified as globally impaired or unimpaired. The California Verbal Learning Test-II was administered to assess new-learning in both studies, and responses were scored using the ISDA. RESULTS. Both studies revealed that cognitively impaired people with MS manifest weaknesses involving acquisition and retrieval. Nearly identical effect sizes emerged across samples, with cognitive impairment achieving a medium effect upon acquisition and a large effect upon retrieval. CONCLUSIONS. These findings accord well with previous research showing diminished acquisition and retrieval among people with MS. The results may also reconcile contradictory findings in the extant literature by showing that memory impairment in MS is not exclusively attributable to either acquisition or retrieval. Rather, both processes may manifest across people with MS. The replication across samples with nearly identical effect sizes implies that these effects are reliable and possess external validity. These data hold implications for memory rehabilitation interventions involving people with MS, and suggest that acquisition and retrieval processes should be addressed in treatment.

Long-term cognitive sequelae of COVID-19 have not been extensively studied. This study provides initial results on cognitive outcomes in Post-Acute Sequelae of COVID-19 (PASC).Analyses indicated no mean scores in the Impaired range (2 standard deviations [SD] below normative mean) on objective cognitive testing and a low base rate of Impaired test scores. Higher (20%) base rates of Borderline performance (1-2 SDs below normative mean) were found on some measures. There was also evidence for frequently elevated mean scores on mood measures which correlated with some cognitive measures and the number of Borderline scores per participants.The results were noteworthy for infrequent Impaired scores, and significant correlations between cognition and mood/anxiety measures, but not between cognitive performance and premorbid vascular risk factors, psychiatric diagnoses, or COVID-19 disease severity. Results suggest that psychological distress was prominent in PASC and related to objective cognitive performance, but objective cognitive performance was unrelated to cognitive complaints. Other contributing factors may include fatigue/sleep issues. Neurologically based cognitive deficits were not suggested by the results.

Limited research investigating the long-term psychological and emotional correlates of COVID-19 infection has been completed. The current study begins to address this limitation in patients experiencing Post-Acute Sequelae SARS-CoV-2 (PASC; e.g. "Long COVID").Participants were 43 consecutive neuropsychological outpatients diagnosed with PASC and who completed the Personality Assessment Inventory (PAI). The sample was predominantly female (PAI scales measuring somatic preoccupation and depression had large effect sizes and the highest base rates of scale elevations, with the mean T score at approximately the normative cutoff for clinical significance (T = 70). The Schizophrenia Thought Disorder subscale (SCZ-T) also had a large effect size and high base rate of elevation, likely reflecting cognitive concerns. Scales measuring anxiety had medium effect sizes. The other PAI scales generally had small to negligible effect sizes. There were no significant differences between hospitalized and non-hospitalized participants on the PAI.Overall, PAI scales measuring psychological distress, particularly somatic preoccupation and depression, were the most frequently elevated in the participants. The specific reasons for somatic preoccupation could not be determined in this study. Potential explanations include a vulnerability to distress in Long COVID patients, premorbid somatic preoccupation perhaps motivating these patients to seek clinical attention, or socioenvironmental factors leading some COVID patients to be somatically preoccupied with minor physiological changes and attribute those changes to COVID-19.

The Word Memory Test (WMT) assesses non-credible performance in neuropsychological assessment. To mitigate risk of false positives among patients with severe cognitive dysfunction, the Genuine Memory Impairment Profile was derived. Only a modest number of investigations has evaluated classification accuracy among clinical samples, leaving the GMIP's accuracy largely uncertain. Accordingly, a simulation experiment evaluated the classification accuracy of the GMIP in a group of healthy individuals coached to simulate mild traumatic brain injury (TBI) related memory impairment on the WMT.Eighty healthy individuals were randomly assigned to one of the four experimental groups. One group was provided superficial information concerning TBI symptoms (naïve simulators), another was provided extensive information concerning TBI symptoms (sophisticated simulators), and a third group was provided extensive TBI symptom information and tactics to evade detection by performance validity tests (PVT) (test-coached). An honest responding control group was directed to give their best performance. All participants were administered the California Verbal Learning Test-2 (CVLT-2) and the WMT.Among the TBI simulators, 90% of the test-coached, 95% of the sophisticated simulators, and 100% of the naïve simulators were correctly classified as exaggerating memory impairment on the primary WMT indices. The simulator groups performed worse than the honest responding group on the CVLT-2. Of those who exceeded the WMT cutoffs, 60%, 27%, and 6% of the naïve-, sophisticated-, and test-coached simulators manifested the GMIP profile, respectively.The GMIP is apt to misclassify individuals as having genuine memory impairment, especially if a naïve or unsophisticated effort is made to exert non-credible performance. Indeed, individuals who employ the least sophisticated efforts to exaggerate cognitive impairment appear most likely to manifest the GMIP. The GMIP should be used cautiously to discriminate genuine impairment from non-credible performance, especially among people with mild TBI.

Introduction: This study evaluated symptom endorsement patterns in participants at various stratified performance levels on the Test of Memory Malingering (TOMM). It was hypothesized that the lowes...

Objective: This study describes the derivation and initial validation evidence of a novel Personality Assessment Inventory (PAI) scale designed to be sensitive to cognitive response bias, as defined by poor performance on performance validity tests (PVTs), in the context of neuropsychological assessment. The Cognitive Bias Scale (CBS) is a ten-item scale that was designed to discriminate between neuropsychological patients who passed or failed PVTs. Method: In a sample of 306 consecutive mixed neuropsychological outpatients, the CBS was derived by initially selecting items that significantly discriminated participants who passed and failed two or more PVTs, with further item refinement utilizing Item Response Theory methods. Results: Initial validation evidence suggests the CBS outperforms existing PAI symptom validity tests in predicting failure on two or more PVTs. The CBS showed good ability to discriminate between valid and invalid performance validity (Cohen's d = -0.96), with good classification accuracy (area under the curve = 0.72). Conclusions: Study results suggest the CBS may be useful in detecting cognitive response bias in a mixed neuropsychological outpatient sample; however, cross-validation will be necessary to further establish its utility.

Objective Among patients with brain damage, executive function deficits and impulsivity correspond with propensity to engage in risky behaviors. Less research has addressed this issue in healthy adults, and fewer still have simultaneously evaluated the importance of executive function and impulsive personality. Additionally, most research has focused exclusively on substance use while ignoring other domains of risky behavior such as sexual activity and antisocial practices. Toward this end, we examined the association of risky behaviors with executive function and self-reported impulsivity. Method Healthy undergraduates (n = 56) were administered the Iowa Gambling Task (IGT), Wisconsin Card Sorting Test (WCST), and UPPS-P impulsivity questionnaire. A self-report questionnaire assessed risky sexual activities, drug use, and antisocial behaviors over a 2-month interval. Results After accounting for social desirability and performance effort, multiple regression analyses revealed a robust relationship between executive function and risk-taking. Specifically, WCST performance correlated with risky sexual and substance use behavior, whereas the IGT was uniquely linked with antisocial acts. Trait impulsivity was positively associated with sexual behavior. Conclusions Extending previous research, executive function accounted for more variance in risky behaviors than self-reported impulsivity, but this was mediated by facet of executive function. Decision-making under risk seemed to better account for antisocial acts, whereas perseveration was more strongly linked to sexual activity and substance misuse. These data imply that poor executive function increases the likelihood that healthy young adults will engage in risky and potentially dangerous acts, extending the ecological validity of the WCST and IGT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: This exploratory study examined the classification accuracy of three derived scales aimed at detecting cognitive response bias in neuropsychological samples. The derived scales are composed of existing scales from the Personality Assessment Inventory (PAI). A mixed clinical sample of consecutive outpatients referred for neuropsychological assessment at a large Midwestern academic medical center was utilized. Participants and Methods: Participants included 332 patients who completed study's embedded and free-standing performance validity tests (PVTs) and the PAI. PASS and FAIL groups were created based on PVT performance to evaluate the classification accuracy of the derived scales. Three new scales, Cognitive Bias Scale of Scales 1-3, (CB-SOS1-3) were derived by combining existing scales by either summing the scales together and dividing by the total number of scales summed, or by logistically deriving a variable from the contributions of several scales. Results: All of the newly derived scales significantly differentiated between PASS and FAIL groups. All of the derived SOS scales demonstrated acceptable classification accuracy (i.e. CB-SOS1 AUC = 0.72; CB-SOS2 AUC = 0.73; CB-SOS3 AUC = 0.75). Conclusions: This exploratory study demonstrates that attending to scale-level PAI data may be a promising area of research in improving prediction of PVT failure.

Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS.Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM).Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B.Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.

Objective: To date, very few studies investigating neurocognitive deficits in COVID-19 have been published. This case series addresses cognition in post-COVID-19 patient by describing three patients in acute rehabilitation to inform a model of cognitive sequelae of COVID-19. Methods: Three English-speaking inpatients with severe symptoms and long-term intensive care unit (ICU) treatment are described. All patients had a premorbid history of hypertension and hyperlipidemia and experienced delirium and hypoxemia when hospitalized. Patient 1 is a 62-year-old male with 15 years of education with additional history of obstructive sleep apnea and type 2 diabetes. Patient 2 is a 73-year-old female with 12 years of education with a premorbid medical history of alcohol use disorder and Guillain-Barre syndrome. Patient 3 is a 75-year-old male with 14 years of education. No patients had premorbid psychiatric histories. Results: The three patients demonstrated deficits on formal neuropsychological testing, particularly with encoding and verbal fluency. Memory measures improved with a more structured story memory task compared to a less-structured verbal list-learning task, suggesting executive dysfunction impacted learning. None of the patients demonstrated rapid forgetting of information. Two patients endorsed new depressive and/or anxiety symptoms. Conclusions: The results suggest evidence for neurocognitive deficits after severe COVID-19 infection, particularly in encoding and verbal fluency. These results were interpreted with caution given the limited number of patients and the telephone-based battery. The specific mechanism that caused these cognitive deficits in these individuals remains unclear. A proposed three-stage model of cognitive dysfunction is described to help guide future research.

The development of more sophisticated performance validity measures is important due to concerns with coaching as well as providing clinicians with a greater variety of options when assessing performance validity. Examinees with noncredible performance may find it more difficult to elude detection by PVTs derived from arithmetical summation or logistic regression. The present study evaluated the classification accuracy of several executive functioning (EF) variables as PVTs both individually and when combined into derived variables. The current study evaluated a simple mathematic summation of embedded PVT scores and a logistic regression-based formula based on embedded PVTs from executive function measures. A total of 155 consecutive patients completed neuropsychological evaluation after sustaining a mild traumatic brain injury (MTBI) were studied and were placed into a PVT-PASS (

Performance validity tests (PVTs) and symptom validity tests (SVTs) are often administered during neuropsychological evaluations. Examinees may be coached to avoid detection by measures of response validity. Relatively little research has evaluated whether graduated levels of coaching has differential effects upon PVT and SVT performance. Accordingly, the present experiment evaluated the effect of graduated levels of coaching upon the classification accuracy of commonly used PVTs and SVTs and the currently accepted criterion of failing two or more PVTs or SVTs.Participants simulated symptoms associated with mild traumatic brain injury (TBI). One group was provided superficial information concerning cognitive, emotional, and physical symptoms. Another group was provided detailed information about such symptoms. A third group was provided detailed information about symptoms and guidance how to evade detection by PVTs. These groups were compared to an honest-responding group. Extending prior experiments, stand-alone and embedded PVT measures were administered in addition to SVTs.The three simulator groups were readily identified by PVTs and SVTs, but a meaningful minority of those provided test-taking strategies eluded detection. The Word Memory Test emerged as the most sensitive indicator of simulated mild TBI symptoms. PVTs achieved more sensitive detection of simulated head injury status than SVTs.Individuals coached to modify test-taking performance were marginally more successful in eluding detection by PVTs and SVTs than those coached with respect to TBI symptoms only. When the criterion of failing two or more PVTs or SVTs was applied, only 5% eluded detection.

Psychological assessment is a key activity for psychologists and a foundational element of psychology training, and psychological assessment supervision differs from psychotherapy supervision. The ...

It is our pleasure to announce the winners of the Sixth Annual TCN/AACN Student Project Competition. The competition is open to all students and recent graduates who submit their first-authored man...

OBJECTIVE. As many as 70% of people with multiple sclerosis (MS) have clinically significant cognitive impairment, and most of these individuals exhibit executive dysfunction. Most research concerning executive dysfunction in MS has focused upon non-verbal measures. The Verbal Concept Attainment Test (VCAT) has demonstrated construct validity as an executive function measure in people infected with HIV and in people with focal brain lesions, but its validity among people with MS is unknown. The current study evaluated the VCAT’s criterion, diagnostic, and ecological validity in people with MS. PARTICIPANTS AND METHODS. A comprehensive neuropsychological battery was administered to 44 healthy individuals and 97 people with MS. Based on existing norms, they were classified as impaired or unimpaired, resulting in 65 people with MS categorized as unimpaired and 32 as impaired. They were administered a battery assessing neuropsychological impairment and disability status. RESULTS. The VCAT correlated with most measures of neuropsychological function, but its largest correlations occurred with measures of executive function, working memory, and verbal memory. Regarding classification accuracy, the VCAT achieved satisfactory sensitivity and specificity in identifying neuropsychological impairment in people with MS. The VCAT achieved moderate correlations with measures of disability status. CONCLUSIONS. The data provide evidence for an optimal VCAT cutoff score for establishing neuropsychological impairment in people with MS, and they demonstrate that the VCAT possesses acceptable criterion, diagnostic, and ecological validity. As such, these data support the inclusion of the VCAT in research and clinical practice involving people with MS.

To make valid inferences regarding the meaning of test scores, neuropsychologists must verify that the patient exerted credible performance during the evaluation. Performance validity tests (PVTs) are routinely employed to determine whether test data reflect genuine cognitive ability or response bias (i.e., malingering or noncredible performance) (Martin PK, Schroeder RW, Odland AP. Clin Neuropsychol 29:741–776, 2015; Sharland M, Gfeller J. Arch Clin Neuropsychol 22:213–223, 2007). Historically, most research concerning the application of PVTs has been conducted on populations with clear external incentives, such as individuals with mild traumatic brain injury involved in civil lawsuits (Larrabee GJ. Clin Neuropsychol 17:410–425, 2003; Carone DA, Bush SA (2013) Mild traumatic brain injury: symptom validity assessment and malingering. Springer, New York). However, neuropsychologists commonly administer PVTs in clinical practice, so their use is not restricted to forensic contexts (Bush SS, Ruff RM, Troster AI, Barth JT, Koffler SP, Pliskin NH, Reynolds CR, Silver CH. Arch Clin Neuropsychol 20:419–426, 2005; Heilbronner RL, Sweet JJ, Morgan JE, Larrabee GJ, Millis SR. Clin Neuropsychol 23:1093–1129, 2009). For example, PVTs have been studied for use in pain, psychiatric conditions, intellectually disabled, and pediatric populations (Donders J, Kirkwood MW (2013) Symptom validity assessment with special populations. Carone, Dominic A, Bush, Shane S, Mild traumatic brain injury: symptom validity assessment and malingering (pp 399–410) Xvii, 430 pp, New York, NS: Springer Publishing Co; US, 399–410) in addition to older adults. This chapter will focus on concepts and research relating to PVT use with older adults and illustrate these issues with two contrasting case vignettes.

Objective: To conduct an online survey in order to understand neuropsychology trainees' perspectives during the COVID-19 pandemic and identify pertinent concerns, training gaps, and recommendations.Method: A total of 874 neuropsychology trainees (81% female) completed the 69-item survey. Of the included trainees, 48% were doctoral students, 17% were interns, and 35% were postdoctoral residents (50% of resident respondents were in their first year).Results: The majority of neuropsychology trainees reported some impact of the pandemic on their professional and/or personal life. Overall, the impact did not differ by training level, geographic location, or demographic factors. Trainees' primary professional concerns included uncertainty about the impact of the pandemic on their professional future, loss of clinical hours, and desire for increased and ongoing communication from their leadership. A notable percentage of trainees reported increased personal mental health symptoms (i.e. anxiety/depression; 74%/54%), as well as a number of other personal stressors. Despite the transition to telehealth (mostly interviews/feedback sessions), few trainees have prior training or experience in providing neuropsychological services via phone or video platform. A limited proportion of trainees (approximately 10%) were still seeing patients face-to-face for neuropsychological evaluations during the COVID-19 pandemic as of 14 April 2020.Conclusions: The COVID-19 pandemic is impacting neuropsychological training and the well-being of trainees. This survey highlights the importance of communication with trainees during uncertain times. Based on the survey results, recommendations were developed to assist neuropsychology organizations in developing initiatives to support trainees during the current pandemic and in the future.

Objective: Electroconvulsive therapy (ECT) is associated with positive outcomes for treatment-resistant mood disorders in the short term. However, there is limited research on long-term cognitive or psychological changes beyond 1 year after -ECT. This study evaluated long-term outcomes in cognitive functioning, psychiatric symptoms, and quality of life for individuals who had undergone ECT. Methods: Eligible participants (N = 294) who completed a brief pre-ECT neuropsychological assessment within the last 14 years were recruited for a follow-up evaluation; a limited sample agreed to follow-up testing (n = 34). At follow-up, participants were administered cognitive measures (Repeatable Battery for the Assessment of Neuropsychological Status [RBANS], Wide Range Achievement Test-4 Word Reading, Trail Making Test, Wechsler Adult Intelligence Scale-Fourth Edition Letter Number Sequence and Digit Span, and Controlled Oral Word Association Test), along with emotional functioning measures (Beck Depression Inventory-Second Edition [BDI-II] and Beck Anxiety Inventory) and the World Health Organization Quality of Life-BREF quality of life measure. Follow-up-testing occurred on average (SD) 6.01 (3.5) years after last ECT treatment. Results: At follow-up, a paired t test showed a large and robust reduction in mean BDI-II score. Scores in cognitive domains remained largely unchanged. A trend was observed for a mean reduction in RBANS visual spatial scores. Lower BDI-II scores were significantly associated with higher RBANS scores and improved quality of life. Conclusions: For some ECT patients, memory, cognitive functioning, and decreases in depressive symptoms can remain intact and stable even several years after ECT. However, the selective sampling at follow-up makes these results difficult to generalize to all post-ECT patients. Future research should examine what variables may predict stable cognitive functioning and a decline in psychiatric symptoms after ECT.

Among embedded performance validity tests (PVTs), little research addresses the use of Total Hits and Total False Positives from the California Verbal Learning Test, Second Edition (CVLT-II) in spite of low sensitivity, particularly in psychiatric samples.This study examined the classification accuracy of these two measures in individuals with psychiatric disorders or mild traumatic brain injury (MTBI). These samples were separated into two groups using the criteria of passing all PVTs versus failing 2 or more PVTs. They were also compared to a criterion group of moderate to severe traumatic brain injury (M-STBI) patients who passed all PVTs. The sample included 176 individuals consecutively referred for neuropsychological testing (mean age = 46.31, SD = 15.30; mean education = 13.07, SD = 2.50, 52.3% males; 91.2% Caucasian) who met study criteria.For classification accuracy, Total Hits in the psychiatric group had excellent classification accuracy (Area Under the Curve [AUC] = .82; Sensitivity = .47; Specificity = .90), whereas Total False Positives (AUC = .49) demonstrated poor classification accuracy. The MTBI group had similar results, with Total Hits having excellent classification accuracy (AUC = .88; Sensitivity = .60; Specificity = .90), whereas Total False Positive (AUC = .62) did not.Results provide preliminary support for using Total Hits; however, Total False Positives were ineffective in identifying non-credible patients with psychiatric disorders or MTBI. Total Hits also compared favorably to other embedded CVLT measures.

Performance validity assessment is increasingly considered standard practice in neuropsychological evaluations. The current study extended research on logistically derived performance validity tests (PVTs) by utilizing neuropsychological measures from multiple cognitive domains instead of from a single measure or a single cognitive domain.A logistic-derived PVT was calculated using several measures from multiple cognitive domains, including verbal memory (California Verbal Learning Test-II Trial 5, Total Hits, and False Positives), attention (Brief Test of Attention Total score), and language (Boston Naming Test T-score, and Animal Fluency T-score). Due to its cross-domain nature, the cross-domain logistic-derived embedded PVT was hypothesized to have excellent classification accuracy for non-credible performance. Participants included 224 patients who completed all measures and were moderate to severe traumatic brain injury (STBI) patients (N = 66), possible mild TBI (MTBI-FAIL) patients who failed at least 2 independent PVTs (N = 67), and possible mild TBI patients who passed all PVTs (MTBI-PASS; N = 91). Logistic regression and ROC analyses were conducted on the MTBI-FAIL group and the STBI group.Multivariate analysis of variance indicated that the MTBI-FAIL group was significantly lower on all measures than the MTBI-PASS and the STBI groups. Using logistic regression, CVLT Total Hits, BTA, and the CVLT False Positives best differentiated between the MTBI-FAIL and STBI groups. The logistically derived PVT had excellent classification accuracy (area under the curve [AUC] = .84), with sensitivity at .54 when specificity was set at .90, higher than any individual variable.Findings support the use of this logistical-derived variable as an embedded PVT and support further research with this type of methodology.

No studies to date have investigated the Boston Naming Test (BNT) as an embedded performance validity test (PVT). This study investigated the classification accuracy of the Boston Naming Test (BNT) and the Verbal Fluency Test (FAS and Animal Fluency), as embedded PVTs in a compensation-seeking mild traumatic brain injury (MTBI) sample (N = 57) compared to a non-compensation-seeking moderate-to-severe TBI (STBI) sample (N = 61). Participants in the MTBI sample who failed two or more PVTs were included, as were STBI participants who passed all PVTs. The classification accuracy of the individual tests and a logistically derived combined (LANGPVT) measure were studied. Results showed significant group differences (p.05) on BNT, Animal Fluency, and LANGPVT between the MTBI and STBI groups. However, receiver operating characteristic (ROC) analyses indicated that only LANGPVT had acceptable classification accuracy (area under the curve.70). Setting specificity at approximately .90, the recommended LANGPVT cutoff scores had sensitivity of .26. Results indicated that, similar to other embedded PVTs, these measures had low sensitivity when adequate specificity levels were maintained. However, extremely low scores on these measures are unlikely to occur in non-compensation-seeking, non-language-impaired, STBI cases.

Few studies have evaluated the symptom validity tests (SVTs) within the Personality Assessment Inventory (PAI) in a neuropsychological assessment context. Accordingly, the present study explored the accuracy of PAI SVTs in identifying exaggerated cognitive dysfunction in a mixed sample of outpatients referred for neuropsychological assessment.Participants who failed two or more Performance Validity Tests (PVTs) were classified as having exaggerated cognitive dysfunction (n = 49). Their responses on PAI SVTs were compared to examinees who did not fail PVTs (n = 257).Multivariate analysis of variance indicated the Negative Impression Management (NIM) scale most strongly discriminated between those with exaggerated cognitive dysfunction from honest responders (Cohen's d = .58). Nonetheless, its classification accuracy was low (area under the curve [AUC] = .65). A k-means cluster analysis and a subsequent multinomial logistic regression indicated evidence for two distinct groups of exaggerators. In particular, one group seemed to exaggerate symptoms, whereas another presented in a defensive manner, implying that individuals with positive and NIM biases on the PAI were apt to display invalid performance on PVTs.Findings indicated that exaggerated cognitive dysfunction tends to be present when NIM is very high and that evidence exists for a defensive response style on the PAI in the context of PVT failure.

A nationwide collaborative research network has been developed by the Association of Psychology Training Clinics (APTC) to carry out research with the potential to improve services provided in training clinic settings. Six APTC member clinics participated in this inaugural study. In addition to demonstrating that the APTC research network can recruit clients for participation in multisite research and randomize enrolled participants to conditions effectively across the network, findings from this study also contribute to our growing understanding of the problem of premature termination within psychology training clinics. More specifically, the results confirm earlier single-site reports in the literature that a high rate of premature termination is a common problem within psychology training clinics (multisite M 69.4%) and that the most typical client outcome at the end of treatment is no reliable change in symptomatic distress. Findings indicate that clients’ pretreatment expectations of treatment duration are positively correlated with the number of treatment sessions subsequently attended and are predictive of clients’ symptom severity at termination. However, expectancy education was not associated with a reduction in premature termination. Notably, there is a positive correlation between prior treatment exposure and current, prospective treatment expectations. Implications for training and policy are discussed with future directions for research suggested.

The current study was designed to advance general research investigating the Personality Assessment Inventory (PAI), by examining whether the psychometric properties of the PAI would generalize to a sample differing from the original standardization sample. Specifically, the reliability and factor structure of the PAI were examined in a mixed neuropsychological sample. Reliability full scale coefficients ranged from .72 to .94, and subscale coefficients ranged from .60 to .90. Confirmatory factor analysis (CFA) was conducted to test Morey's original four-factor model (for all 22 PAI scales) and three-factor model (for the 11 clinical scales). CFA results indicated that Morey's original factor solutions were not a good fit. Thus, following Morey's original methodology, principal components analyses (PCA) were conducted on all 22 PAI scales and on the 11 PAI clinical scales and the results indicated evidence for a five-component solution (for all 22 PAI scales) and a two-component solution (for the 11 clinical scales). Overall, while results indicated some relatively subtle differences between the original standardization sample and the current sample, they still supported the notion that the PAI is a reliable and valid measure when used in a neuropsychological sample. This study expands upon the existing literature related to the clinical utility of the PAI in specialized samples.

Cognitive impairment often occurs in people with multiple sclerosis (MS), and dysfunction involving executive function, new learning, and working memory is especially common. Compromised activities of daily living are linked to this cognitive impairment, and people with MS are apt to be unemployed and struggle to manage domestic responsibilities. Financial decision making is an important activity of daily living, and no study has examined whether it is compromised by neuropsychological dysfunction in people with MS.A battery of neuropsychological tests and a measure of financial decision making (Financial Capacity Instrument, FCI: Marson, D. C. 2001. Loss of financial capacity in dementia: Conceptual and empirical approaches. Aging, Neuropsychology, and Cognition, 8, 164-181) were administered to 50 participants (34 patients with MS and 16 cognitively healthy adults). Based on the neuropsychological test results, 14 patients were classified as having cognitive impairment, and 20 had no significant impairment.The impaired MS patients performed significantly worse than unimpaired patients and the healthy comparison group on most financial tasks. The impaired group retained abilities to count money and display adequate financial judgment. Regression analyses showed that measures of mental flexibility and working memory correlated most strongly with performance on the FCI domains across groups.Cognitively impaired patients with MS have degraded financial skills, which are linked to executive function and working memory deficits.

Electrical injury (EI) produces an assortment of consequences for individuals. Survivors perform poorly on measures of attention and mental speed, memory, and emotional functioning. Moreover, sequelae are not always reported immediately following injury and often increase over the months following injury. It remains unclear whether the observed increase in neuropsychological and emotional symptoms over time is attributable to the delayed physical effects of EI or other factors that arise subsequent to injury, such as difficulty adjusting to post-injury limitations.The current study utilized archival data to compare the neuropsychological and emotional complaints of EI survivors at two points during recovery, hypothesizing that Time 1 data would predict participants' outcome at Time 2. Specifically, those with worse neuropsychological performance and greater depressive symptomatology at Time 1 would have worse long-term adjustment to injury and psychological symptomatology.Multiple regression analyses revealed a significant predictive effect of Time 1 neurocognitive performance and depressive symptomatology on Time 2 adjustment to injury, psychological distress, and return to work. Participants with greater depressive symptomatology endorsed during the initial neuropsychological evaluation had substantially more difficulty with overall psychosocial adjustment to electrical injury. Moreover, depressive symptomatology persisted or worsened over the course of recovery.Findings demonstrate that poor outcome 4 years after EI is largely predicated by early emotional sequelae. Early screening and specialized interventions are needed to address psychological symptomatology among EI survivors.

The relationship between validity measures of the Personality Assessment Inventory (PAI; Morey, 1991) and homelessness was investigated in this archival study. Two groups (N = 50) of compensation-seeking adults were included: homeless and domiciled. The purpose of the study was to determine if differences existed between these 2 groups on the validity measures of the PAI to inform the clinical evaluations of the compensation-seeking homeless. Results of independent sample t tests indicated no significant differences between the homeless and domiciled groups on the 4 validity scales and 2 additional indexes of exaggerated responding (Malingering Index [Morey, 1996] and Rogers Discriminant Function [Rogers, Sewell, Morey, & Ustad, 1996]). Results suggested the compensation-seeking homeless have similar elevations on the PAI validity indexes as domiciled groups seeking compensation.

A wide variety of cognitive measures, particularly memory measures, have been studied for their ability to detect suspect effort, or biased responding on neuropsychological assessment instruments. However, visual spatial measures have received less attention. The purpose of this study was to evaluate the classification accuracy of several commonly used visual spatial measures, including the Judgment of Line Orientation Test, the Benton Facial Recognition Test, the Hooper Visual Organization Test, and the Rey Complex Figure Test-Copy and Recognition trials. Participants included 491 consecutive referrals who participated in a comprehensive neuropsychological assessment and met study criteria. Participants were divided into two groups identified as either unbiased responding (UR, N = 415) or biased responding (BR, N = 30) based on their performance on two measures of effort. The remaining participants (N = 46) had discrepant performance on the symptom validity measures and were excluded from further analysis. The groups differed significantly on all measures. Additionally, receiver operating characteristic (ROC) analysis indicated all of the measures had acceptable classification accuracy, but a measure combining scores from all of the measures had excellent classification accuracy. Results indicated that various cut-off scores on the measures could be used depending on the context of the evaluation. Suggested cut-off scores for the measures had sensitivity levels of approximately 32-46%, when specificity was at least 87%. When combined, the measures suggested cut-off scores had sensitivity increase to 57% while maintaining the same level of specificity (87%). The results were discussed in the context of research advocating the use of multiple measures of effort.

This case study describes the relationship between left temporal lobe epilepsy (TLE) and learning disabilities in a 26-year-old male college student. The client developed seizures following an episode of mycoplasma encephalitis at the age of 7. The client underwent a left temporal lobectomy involving resection of the left mesial temporal lobe, amygdala, hippocampus, and part of the brain stem 6 years prior to the current evaluation, in an attempt to address the frequency of the seizures. The surgery was extensive, including neocortical resection extending posterior to the vein of Labbe along the inferior temporal gyrus. The lobectomy reportedly successfully eliminated the seizures and the need for anti-seizure medications, but no neurological or neuropsychological follow-up occurred until 2009 when he was referred by his academic program for an evaluation of learning disabilities. Results of the neuropsychological evaluation indicated significant expressive language functioning deficits, with generally better-preserved receptive language. However, compared to a pre-surgical neuropsychological evaluation there was evidence for subtle to mild improvement in several aspects of cognitive functioning, likely due to seizure elimination and discontinuation of the anti-seizure medication. Nonetheless, his deficits resulted in significant functional impact on his academic abilities, thus implications for academic intervention were discussed.

Little research has examined the relationship between the Personality Assessment Inventory (PAI) and cognitive effort. The current study extends the research on personality assessment and suboptimal cognitive effort by evaluating the relationship between the PAI clinical scales and the Test of Memory Malingering (TOMM) in a neuropsychological population. Utilizing corrections for multiple comparisons, rank-order correlations with the TOMM Trial 2 (T2) and the PAI clinical scales indicated a significant relationship with the SOM (rho = -.26, p.001), with additional scales (SCZ, ANX, and DEP) trending toward significance. Analysis of SOM subscales indicated a significant relationship between SOM-C and T2 as well. To further explore the relationship between SOM and the TOMM, ANOVA results indicated that individuals scoring within normal limits on the SOM had higher mean TOMM scores than those with extremely elevated SOM. Additional analyses indicated that utilizing the cut-off for extreme responding on the SOM scale (T87) had adequate sensitivity (93%) and specificity (76%) in predicting TOMM performance, with a positive predictive power of 54% and a negative predictive power of 97%, resulting in a 91% correct classification rate. Thus, the evidence suggests that extreme scores on SOM should prompt careful evaluation for suboptimal cognitive effort.

Measures of phonemic and semantic verbal fluency, such as FAS and Animal Fluency (Benton, Hamsher, & Sivan, 1989), are often thought to be measures of executive functioning (EF). However, some studies (Henry & Crawford, 2004a , 2004b , 2004c ) have noted there is also a language component to these tasks. The current exploratory factor-analytic study examined the underlying cognitive structure of verbal fluency. Participants were administered language and EF measures, including the Controlled Oral Word Association Test (FAS version), Animal Fluency, Boston Naming Test (BNT), Vocabulary (Wechsler Adult Intelligence Scale-III), Wisconsin Card-Sorting Test (WCST, perseverative responses), and Trail-Making Test-Part B (TMT-B). A 2-factor solution was found with the 1st factor, language, having significant loadings for BNT and Vocabulary, while the second factor was labeled EF because of significant loading from the WCST and TMT-B. Surprisingly, FAS and Animal Fluency loaded exclusively on to the language factor and not EF. The current results do not exclude EF as a determinant of verbal fluency, but they do suggest that language processing is the critical component for this task, even without significant aphasic symptoms. Thus, the results indicated that both letter (phonemic) and category (semantic) fluency are related to language, but the relationship to EF is not supported by the results.

The Neurobehavioral Cognitive Status Examination (NCSE) was developed as a brief neuropsychological screening instrument. To date there has been minimal research investigating the usefulness of the NCSE. The purpose of this study is to analyze the factor structure of the NCSE and investigate the relationship between the NCSE and the Trail Making Test as a criterion measure of cognitive dysfunction in patients with chronic liver disease. Exploratory factor analysis suggests that an attention-based, general cognitive functioning factor is present. Correlational and regression analyses suggest that the Memory and Construction subtests are most strongly related to cognitive dysfunction secondary to hepatic encephalopathy. Finally, preliminary norms for the NCSE are presented utilizing this population. Results suggest that the NCSE is relatively free of age and education effects, is an adequate screen for general cognitive dysfunction, and is a viable alternative to other cognitive screening instrumen...

Many cognitive measures have been studied for their ability to detect suboptimal cognitive effort; however, attention measures have not been extensively researched. The current study evaluated the classification accuracy of commonly used attention/concentration measures, the Brief Test of Attention (BTA), Trail Making Test (TMT), and the Conners' Continuous Performance Test (CPT-II). Participants included 413 consecutive patients who completed a comprehensive neuropsychological evaluation. Participants were separated into two groups, identified as either unbiased responders or biased responders as determined by performance on the TOMM. Based on Mann-Whitney U results, the two groups differed significantly on all attentional measures. Classification accuracy of the BTA (.83), CPT-II omission errors (OE; .76) and TMT B (.75) were acceptable; however, classification accuracy of CPT-II commission errors (CE; .64) and TMT A (.62) were poor. When variables were combined in different combinations, sensitivity did not significantly increase. Results indicated for optimal cut-off scores, sensitivity ranged from 48% to 64% when specificity was at least 85%. Given that sensitivity rates were not adequate, there remains a need to utilize highly sensitive measures in addition to these embedded measures. Results were discussed within the context of research promoting the need for multiple measures of cognitive effort.

This study addressed the relationship between Personality Assessment Inventory (PAI) validity indicators and cognitive effort measures on the Test of Memory Malingering (TOMM). Significant correlations were found between TOMM and some PAI validity scales. Factor analysis results found separate cognitive and personality components, but the Negative Impression Management (NIM) scale, a measure of response bias, had factor loadings on both the cognitive and the personality components. Follow-up hierarchical multiple regression and t-test analysis generally confirmed this result, and found that NIM and the Infrequency (INF) scale have significant relationships with the TOMM. The results indicate that individuals with elevations on the PAI's INF and NIM scales often display decreased cognitive effort on the TOMM. The current results support the hypothesis that personality assessment validity indicators have a modest but significant relationship with poor cognitive effort.