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AbstractObjectiveMethodResultsConclusionsPerformance validity test (PVT) misclassification is an important concern for neuropsychologists. The present study determined whether expanding PVT analysis from 4-PVTs to 8-PVTs could lead to elevated rates of false positive performance validity misclassifications.Retrospective analysis of 443 patients who underwent a fixed neuropsychological test battery in a mixed clinical and forensic setting. Rates of failing two PVTs were compared to those predicted by Monte Carlo simulations when PVT analysis extended from 4-PVTs to 8-PVTs. Indeterminate performers (IDT; n = 42; those who failed two PVTs only after PVT analysis extended from 4-PVTs to 8-PVTs) were compared to a PVT-Fail group (n = 148; those who failed two PVTs in the 4-PVT battery or failed >2 PVTs).Rate of failing two PVTs remained stable when PVT analysis extended from 4- to 8-PVTs (12.9 to 11.9%) and was significantly lower than those predicted by Monte Carlo simulations. Compared to PVT-Fail, the IDT group was significantly younger, had stronger neuropsychological test performance, and demonstrated comparable rates of forensic referral and conditions with known neurocognitive sequelae (e.g. stroke, moderate-to-severe TBI).Monte Carlo simulations significantly overestimated rates of individuals failing two PVTs as PVT battery length doubled. IDT did not differ from PVT-Fail across variables with known PVT effects (e.g. age, referral context, neurologic diagnoses), lowering concern that this group is comprised entirely of false-positive PVT classifications. More research is needed to determine the effect of PVT battery length on validity classification accuracy. [ABSTRACT FROM AUTHOR]

The study examined the effect of preparation time and financial incentives on healthy adults' ability to simulate traumatic brain injury (TBI) during neuropsychological evaluation. A retrospective comparison of two TBI simulator group designs: a traditional design employing a single-session of standard coaching immediately before participation (SIM-SC; n = 46) and a novel design that provided financial incentive and preparation time (SIM-IP; n = 49). Both groups completed an ecologically valid neuropsychological test battery that included widely-used cognitive tests and five common performance validity tests (PVTs). Compared to SIM-SC, SIM-IP performed significantly worse and had higher rates of impairment on tests of processing speed and executive functioning (Trails A and B). SIM-IP were more likely than SIM-SC to avoid detection on one of the PVTs and performed somewhat better on three of the PVTs, but the effects were small and non-significant. SIM-IP did not demonstrate significantly higher rates of successful simulation (i.e., performing impaired on cognitive tests with <2 PVT failures). Overall, the rate of the successful simulation was ∼40% with a liberal criterion, requiring cognitive impairment defined as performance >1 SD below the normative mean. At a more rigorous criterion defining impairment (>1.5 SD below the normative mean), successful simulation approached 35%. Incentive and preparation time appear to add limited incremental effect over traditional, single-session coaching analog studies of TBI simulation. Moreover, these design modifications did not translate to meaningfully higher rates of successful simulation and avoidance of detection by PVTs. [ABSTRACT FROM AUTHOR]

Pupillometry provides information about physiological and psychological processes related to cognitive load, familiarity, and deception, and it is outside of conscious control. This study examined pupillary dilation patterns during a performance validity test (PVT) among adults with true and feigned impairment of traumatic brain injury (TBI). Participants were 214 adults in three groups: adults with bona fide moderate to severe TBI (TBI; n = 51), healthy comparisons instructed to perform their best (HC; n = 72), and healthy adults instructed and incentivized to simulate cognitive impairment due to TBI (SIM; n = 91). The Recognition Memory Test (RMT) was administered in the context of a comprehensive neuropsychological battery. Three pupillary indices were evaluated. Two pure pupil dilation (PD) indices assessed a simple measure of baseline arousal (PD-Baseline) and a nuanced measure of dynamic engagement (PD-Range). A pupillary-behavioral index was also evaluated. Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer). All three indices differed significantly among the groups, with medium-to-large effect sizes. PD-Baseline appeared sensitive to oculomotor dysfunction due to TBI; adults with TBI displayed significantly lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). Dynamic engagement (PD-Range) yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, subgroup analyses indicated that DRI differed significantly for simulators who scored in the invalid range on the RMT (n = 45) versus adults with genuine TBI who scored invalidly (n = 15). The findings support continued research on the application of pupillometry to performance validity assessment: Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity. [ABSTRACT FROM AUTHOR]

Objective This study explored the specificity of four embedded performance validity tests (PVTs) derived from common neuropsychological tasks in a sample of older veterans with verified cognitive decline and whose performance was deemed valid by licensed psychologists. Method Participants were 180 veterans who underwent comprehensive neuropsychological evaluation, were determined to have valid performance following profile analysis/conceptualization, and were diagnosed with mild neurocognitive disorder (i.e. MCI; n  = 64) or major neurocognitive disorder (i.e. Dementia; n =  116). All participants completed at least one of four embedded PVTs: Reliable Digit Span (RDS), California Verbal Learning Test—2nd ed. Short Form (CVLT-II SF) Forced choice, Trails B:A, and Delis-Kaplan Executive Function System (DKEFS) Letter and Category Fluency. Results Adequate specificity (i.e. ≥90%) was achieved at modified cut-scores for all embedded PVTs across MCI and Dementia groups. Trails B:A demonstrated near perfect specificity at its traditional cut-score (Trails B:A < 1.5). RDS ≤ 5 and CVLT-II SF Forced Choice ≤7 led to <10% false positive classification errors across MCI and dementia groups. DKEFS Letter and Category Fluency achieved 90% specificity at extremely low normative cut-scores. Conclusions RDS, Trails B:A, and CVLT-II SF Forced Choice reflect promising embedded PVTs in the context of dementia evaluations. DKEFS Letter and Category Fluency appear too sensitive to genuine neurocognitive decline and, therefore, are inappropriate PVTs in adults with MCI or dementia. Additional research into embedded PVT sensitivity (via known-groups or analogue designs) in MCI and dementia is needed. [ABSTRACT FROM AUTHOR]

Abstract Objective: Chronic Traumatic Encephalopathy (CTE) has received significant media coverage as a major health concern for collision sport athletes and combat veterans. This survey study investigated neuropsychologists’ perspectives of CTE.Methods: Neuropsychologists (N = 325) were contacted via electronic advertisement posted to popular neuropsychology professional listservs and completed a survey regarding their perspectives of: the proposed sequelae of repeated concussions, the strength of the CTE research base, and its media coverage.Results: Most respondents (91%) were at least somewhat familiar with the concept of CTE. Moderate uncertainty was reported (i.e. up to 30%) regarding the effects of repeated concussions. Most felt the research in support of CTE was unreliable (80%) and weak regarding claims that repeated concussions cause CTE (91%), independently cause behavioral/emotional/cognitive dysfunction (86%), or increase the risk for neurodegeneration (79%). Respondents agreed patients are concerned about CTE (92%), concerns are influenced by the media (96%) that presents a biased/alarmist view of CTE (96%), and patient recovery is influenced by their CTE beliefs (82%).Conclusions: There was strong agreement that the media presents an alarmist/biased view of CTE that influences patients concerns and outcomes following concussion. This presentation is incongruent with the perceptions of surveyed neuropsychologists who find the research in support of CTE to be weak and unreliable. More research is needed to determine the potential effects of repeated (sub)concussive events. As public knowledge will continue to be influenced by the media and health care professionals, future research should explore CTE perceptions across other health care disciplines. [ABSTRACT FROM AUTHOR]

Objective: The addition of Sequencing to WAIS-IV Digit Span (DS) brought about new Reliable Digit Span (RDS) indices and an Age-Corrected Scaled Score that includes Sequencing trials. Reports have indicated that these new performance validity tests (PVTs) are superior to the traditional RDS; however, comparisons in the context of known neurocognitive impairment are sparse. This study compared DS-derived PVT classification accuracies in a design that included adults with verified TBI. Methods: Participants included 64 adults with moderate-to-severe TBI (TBI), 51 healthy adults coached to simulate TBI (SIM), and 78 healthy comparisons (HC). Participants completed the WAIS-IV DS subtest in the context of a larger test battery. Results: Kruskal–Wallis tests indicated that all DS indices differed significantly across groups. Post hoc contrasts revealed that only RDS Forward and the traditional RDS differed significantly between SIM and TBI. ROC analyses indicated that RDS variables were comparable predictors of SIM vs. HC; however, the traditional RDS showed the highest sensitivity when approximating 90% specificity for SIM vs. TBI. A greater percentage of TBI scored RDS Sequencing < 1 compared to SIM and HC. Conclusion: In the context of moderate-to-severe TBI, the DS-derived PVTs showed comparable discriminability. However, the Greiffenstein et al. traditional RDS demonstrated the best classification accuracy with respect to specificity/sensitivity balance. This relative superiority may reflect that individuals with verified TBI are more likely to perseverate on prior instructions during DS Sequencing. Findings highlight the importance of including individuals with verified TBI when evaluating and developing PVTs. [ABSTRACT FROM AUTHOR]

The present study tested the incremental utility of response time (RT) on the Warrington Recognition Memory Test – Words (RMT-W) in classifying bona fide versus feigned TBI. Participants were 173 adults: 55 with moderate to severe TBI, 69 healthy comparisons (HC) instructed to perform their best, and 49 healthy adults coached to simulate TBI (SIM). Participants completed a computerized version of the RMT-W in the context of a comprehensive neuropsychological battery. Groups were compared on RT indices including mean RT (overall, correct trials, incorrect trials) and variability, as well as the traditional RMT-W accuracy score. Several RT indices differed significantly across groups, although RMT-W accuracy predicted group membership more strongly than any individual RT index. SIM showed longer average RT than both TBI and HC. RT variability and RT for incorrect trials distinguished SIM-HC but not SIM-TBI comparisons. In general, results for SIM-TBI comparisons were weaker than SIM-HC results. For SIM-HC comparisons, classification accuracy was excellent for all multivariable models incorporating RMT-W accuracy with one of the RT indices. For SIM-TBI comparisons, classification accuracies for multivariable models ranged from acceptable to excellent discriminability. In addition to mean RT and RT on correct trials, the ratio of RT on correct items to incorrect items showed incremental predictive value to accuracy. Findings support the growing body of research supporting the value of combining RT with PVTs in discriminating between verified and feigned TBI. The diagnostic accuracy of the RMT-W can be improved by incorporating RT. [ABSTRACT FROM AUTHOR]

Objective: The present study examined the incremental utility of item-level response time (RT) variables on a traditional performance validity test in distinguishing adults with verified TBI from adults coached to feign neurocognitive impairment. Method: Participants were 45 adults with moderate to severe TBI, 45 healthy adults coached to feign neurocognitive impairment (SIM), and 61 healthy adult comparisons providing full effort (HC). All participants completed a computerized version of the Test of Memory Malingering (TOMM-C) in the context of a larger test battery. RT variables examined along with TOMM-C accuracy scores included mean RTs (Trial 1, Trial 2, correct and incorrect trials) and RT variability indices. Results: Several RT indices differed significantly across the groups. In general, SIM produced longer, more variable RTs than HC and TBI. Of the RT indices, average RT for Trial 1 and 2 were the best predictors of group membership; however, classification accuracies were greatly influenced by the groups being compared. Average RT for Trial 1 and 2 showed excellent discrimination of SIM and HC. All RT indices were less successful in discriminating SIM and TBI. Average RT for Trial 1 and 2 added incremental predictive value to TOMM-C accuracy in distinguishing SIM from TBI. Conclusion: Findings contribute to a limited body of research examining the incremental utility of combining RT with traditional PVTs in distinguishing feigned and bona fide TBI. Findings support the hypothesis that combining RT with TOMM-C accuracy can improve its diagnostic accuracy. Future research with other groups of clinical interest is recommended. [ABSTRACT FROM AUTHOR]