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The purpose of this study was to evaluate multiple embedded performance validity indicators within the Digits Forward and Digits Backward subtests of the Neuropsychological Assessment Battery (NAB), including Reliable Digit Span (RDS), as no published papers have examined embedded digit span validity indicators within these subtests of the NAB. Retrospective archival chart review was conducted at an outpatient neuropsychology clinic. Participants were 92 adults (ages 19−68) who completed NAB Digits Forward and Digits Backward, and the Word Choice Test (WCT). Receiver operating characteristic (ROC) curves, t-tests, and sensitivity and specificity analyses were conducted. Analyses showed that RDS demonstrated acceptable classification accuracy between those who passed the WCT and those who did not. The area under the curve (AUC) value for RDS was 0.702; however, AUC values for all other digit span indices were unacceptably low. The optimal cutoff for RDS was identified (<8). RDS for the NAB appears to be an adequate indicator of performance validity; however, considering the very small number of participants who were invalid on the WCT (n = 15), as well as the utilization of only one stand-alone PVT to classify validity status, these findings are preliminary and in need of replication. [ABSTRACT FROM AUTHOR]

Objective: The clinical utility of continuous performance tests (CPTs) among adults with attention-deficit/hyperactivity disorder (ADHD) has increasingly been brought under question. Therefore, the objective of this study was to systematically review the literature to investigate the clinical utility of various commercially available CPTs, including the Conner's Continuous Performance Test (CCPT), Test of Variables of Attention (TOVA), Gordon Diagnostic System (GDS), and Integrated Visual and Auditory Continuous Performance Test (IVA) in the adult ADHD population. Methods: This systematic review followed the a priori PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles were gathered from PsycINFO, PsycARTICLES, Academic Search Complete, and Google Scholar on 11 April 2022. Sixty-nine articles were included in the final review. Risk of bias was assessed using the National Institute of Health Quality Assessment Took for Observational Cohort and Cross-Sectional Studies. Results: Most articles demonstrated high risk of bias, and there was substantial heterogeneity across studies. Overall, the reviewed CPTs appeared to have limited diagnostic utility and classification accuracy. Although many studies showed differing scores between adults with ADHD and comparison groups, findings were not consistent. Characteristics of CPT performances among adults with ADHD were mixed, with little consistency and no evidence of a clear profile of performances; however, CCPT commission errors appeared to have the most utility when used a treatment or experimental outcome measure, compared to other CCPT scores. Conclusion: Overall, CPTs should not be used in isolation as a diagnostic test but may be beneficial when used as a component of a comprehensive assessment. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to determine base rates of response bias in veterans and service members (SM) referred specifically for attention-deficit/hyperactivity disorder (ADHD) evaluation. Method Observational study of various performance validity tests (PVTs) and symptom validity tests (SVTs) in a sample of SMs (n  = 94) and veterans (n  = 504) referred for clinical evaluation of ADHD. Results SVT and PVT failure rates were similar between the samples, but they were lower than previous Veterans Affairs (VA) and SM studies that were not exclusive to ADHD evaluations. Invalid reporting across all SVT scales on the Minnesota Multiphasic Personality Inventory and Personality Assessment Inventory was relatively uncommon, with rates of invalid scores falling at less than 7%. In both samples, free-standing PVTs were failed at about 22%. Conclusions Although the base rates of PVT and SVT failures in ADHD-specific evaluations were lower than previously published data on non-ADHD-specific evaluations in veterans and SMs, the current study continues to support the inclusion of these measures. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to evaluate the classification accuracy and resistance to coaching of the Inventory of Problems-29 (IOP-29) and the IOP-Memory (IOP-M) with a Spanish sample of patients diagnosed with mild traumatic brain injury (mTBI) and healthy participants instructed to feign. Method: Using a simulation design, 37 outpatients with mTBI (clinical control group) and 213 non-clinical instructed feigners under several coaching conditions completed the Spanish versions of the IOP-29, IOP-M, Structured Inventory of Malingered Symptomatology, and Rivermead Post Concussion Symptoms Questionnaire. Results: The IOP-29 discriminated well between clinical patients and instructed feigners, with an excellent classification accuracy for the recommended cutoff score (FDS ≥.50; sensitivity = 87.10% for coached group and 89.09% for uncoached; specificity = 95.12%). The IOP-M also showed an excellent classification accuracy (cutoff ≤ 29; sensitivity = 87.27% for coached group and 93.55% for uncoached; specificity = 97.56%). Both instruments proved to be resistant to symptom information coaching and performance warnings. Conclusions: The results confirm that both of the IOP measures offer a similarly valid but different perspective compared to SIMS when assessing the credibility of symptoms of mTBI. The encouraging findings indicate that both tests are a valuable addition to the symptom validity practices of forensic professionals. Additional research in multiple contexts and with diverse conditions is warranted. [ABSTRACT FROM AUTHOR]

Objective Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. Method Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. Results After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist–Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. Conclusions Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary. [ABSTRACT FROM AUTHOR]

Objective: The present study evaluated the function of four cognitive, symptom validity scales on the Personality Assessment Inventory (PAI), the Cognitive Bias Scale (CBS) and the Cognitive Bias Scale of Scales (CB-SOS) 1, 2, and 3 in a sample of Veterans who volunteered for a study of neurocognitive functioning. Method: 371 Veterans (88.1% male, 66.1% White) completed a battery including the Miller Forensic Assessment of Symptoms Test (M-FAST), the Word Memory Test (WMT), and the PAI. Independent samples t-tests compared mean differences on cognitive bias scales between valid and invalid groups on the M-FAST and WMT. Area under the curve (AUC), sensitivity, specificity, and hit rate across various scale point-estimates were used to evaluate classification accuracy of the CBS and CB-SOS scales. Results: Group differences were significant with moderate effect sizes for all cognitive bias scales between the WMT-classified groups (d =.52–.55), and large effect sizes between the M-FAST-classified groups (d = 1.27–1.45). AUC effect sizes were moderate across the WMT-classified groups (.650–.676) and large across M-FAST-classified groups (.816–.854). When specificity was set to.90, sensitivity was higher for M-FAST and the CBS performed the best (sensitivity =.42). Conclusion: The CBS and CB-SOS scales seem to better detect symptom invalidity than performance invalidity in Veterans using cutoff scores similar to those found in prior studies with non-Veterans. [ABSTRACT FROM AUTHOR]

The use of symptom validity tests (SVTs) is standard practice in psychodiagnostic assessments. Embedded measures are indices within self‐report measures. To date, no embedded SVTs have been identified in the Posttraumatic Stress Disorder Checklist for DSM‐5 (PCL‐5). This research aimed to develop and validate PCL‐5 SVTs in two samples of veterans. Participants completed one of two prospective research studies that included cognitive and psychological tests. Participants in Study 1 were veterans (N = 464) who served following the September 11, 2001, terrorist attacks; participants in Study 2 were veterans or service members (N = 338) who had been deployed to Iraq and/or Afghanistan. Both studies included the PCL‐5 and the Structured Inventory of Malingered Symptomatology (SIMS), the latter of which served as the criterion for identifying PCL‐5 SVTs. For Study 1, two separate SVTs were developed: the PCL‐5 Symptom Severity scale (PSS), based on the PCL‐5 total score, and the PCL‐5 Rare Items scale (PRI), based on PCL‐5 items infrequently endorsed at the highest item ratings. At the most conservative SIMS cutoff score, the PSS achieved excellent discrimination for both the Study 1, AUC =.840, and Study 2 samples, AUC =.858, with specific cutoff scores of ≥ 51 and ≥ 56 maximizing sensitivity while maintaining a specificity of.90. The PRI achieved good discrimination, AUCs =.760 and.726, respectively, with a cutoff score of 2 or higher indicated by both studies. The results of these two studies provide provisional support for these two embedded SVTs in the PCL‐5. [ABSTRACT FROM AUTHOR]

The purpose of this exploratory study was to evaluate the potential value of comparing specific attachments to posttraumatic stress disorder (PTSD) symptomatology in combat veterans with a new measure of attachments. A case series of 22 combat veterans in a Veterans Affairs Medical Center clinic completed PTSD Checklist - Military Version (PCL-M), Trauma Symptom Inventory - 2nd Edition, and the Attachment and Clinical Issues Questionnaire (ACIQ) as part of a pilot study for a larger project. Descriptive statistics and Pearson correlations were used to examine the data. Although there were significant negative correlations between self-rated PTSD symptoms and avoidant (r = -0.44) and ambivalent (r = -0.55) attachment scores towards their mothers, suggesting a novel type of enmeshment, positive correlations were found between PTSD symptoms and avoidant partner attachments scores (r = 0.47). There were no significant correlations between the attachment scales to father and PTSD symptoms. The ACIQ Ambivalent Partner scale was only related to TSI-2 scales Intrusive Experiences (r = -0.44) and Defensive Avoidance (r = -0.44). An exploratory regression model using attachment variables identified from correlations and predicting PCL scores was significant (R.sup.2 = 0.48); however, only Avoidant Partner scale contributed significant variance ([beta] = 0.42, p = 0.024). The potency of the partner scale suggests a potential target for future research and intervention. These data point to new questions to be explored with larger samples and more sophisticated statistical techniques, and further highlighting the complexity of attachment and PTSD., Author(s): Robert D. Shura [sup.1] [sup.2] , Billy J. Rutherford [sup.3] , April Fugett [sup.4] , Marc A. Lindberg [sup.4] Author Affiliations: (1) Mid-Atlantic Mental Illness Research, Education, and Clinical [...]

Introduction: The present study evaluates the complex relationships between symptom burden, validity, and cognition in a sample of Iraq and Afghanistan veterans to identify key characteristic symptoms and validity measures driving cognitive performance. We hypothesized that symptom and performance validity would account for poorer outcomes on cognitive performance beyond psychological symptoms. Methods: Veterans (n = 226) completed a cognitive test battery, Personality Assessment Inventory (PAI), Word Memory Test (WMT), and Miller Forensic Assessment Symptom Test (M-FAST). Partial least squares structural equation modeling (PLS-SEM) modeled the fully-adjusted relationships among PAI subscales, validity, and cognitive performance. Results: 23.45% of participants failed validity indices (19.9% WMT; 7.1% M-FAST). PLS-SEM indicated PAI subscales were not directly associated with performance or symptom validity measures, and there were no direct effects between validity performance and cognitive performance. Several PAI subscales were directly associated with measures of verbal abstraction, visual processing, and verbal learning and memory. Conclusion: Contrary to hypotheses, symptom and performance validity did not account for poorer outcomes on cognitive performance beyond symptom burden in the PLS-SEM model. Results highlight the association between psychiatric symptoms and cognitive performance beyond validity status. [ABSTRACT FROM AUTHOR]

Objective Clarify procedures to correctly score Test of Premorbid Functioning (TOPF) and assess the accuracy of TOPF scores in the estimation of premorbid intellectual functioning. Method In this cross-sectional study, post-9/11 veterans (N  = 233, 84.12% male) completed the TOPF, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), and performance validity measures. Results All TOPF scores were significantly correlated with WAIS-IV FSIQ scores (range r  = 0.56–.73). The degree of discrepancy between TOPF scores and FSIQ varied with 10%–17% of TOPF scores deviating from FSIQ scores by one SD or more. Conclusions Proper TOPF scoring procedures are presented. The TOPF Actual and Predicted scores were related to FSIQ. However, a higher percentage of Actual and Predicted scores were discrepant from FSIQ compared with the other three TOPF estimates, arguing against their use as independent premorbid estimates. Use of the TOPF as was designed is recommended. [ABSTRACT FROM AUTHOR]