A-77 Validity Testing with Youth Populations: D-KEFS Trail Making Test Conditions 4:2 Ratio as an Embedded Validity Indicator

Abstract

Abstract Objective The Trail Making Test B:A ratio is an embedded validity indicator (EVI) for neuropsychological assessment (NA; Ruffolo, Guilmette, & Willis, 2000). Recent literature supports D-KEFS Trail Making Test Conditions 4:2 (analogous to B:A) ratio (D-KEFS 4:2) as an EVI (Erdodi et al., 2018). The present study sought to assess the utility of D-KEFS 4:2 as an EVI for youth populations, using the Test of Memory Malingering (TOMM) to operationalize effort. Method 102 children (81.2% male, Mage = 11.88) completed a NA, including D-KEFS 4:2 and TOMM. Receiver operator characteristics (ROC) curve analysis calculating Area Under the Curve (AUC) determined whether D-KEFS 4:2 accurately categorized participants’ effort (represented by TOMM performance). Results D-KEFS 4:2 (cut-off = 1.60: Erdodi et al., 2018) produced sensitivity of 9.09% and specificity of 91.25% in predicting TOMM performance on Trial 1 (TOMM1; AUC = 0.488) and 0.00% and 91.09% in predicting Trial 2 (TOMM2; AUC = 0.772). As a TOMM2 cut-off of 49 is suggested as more sensitive to inadequate effort, another analysis showed D-KEFS 4:2 yielded sensitivity of 33.33% and specificity of 91.92% (AUC = 0.710) in predicting TOMM2 performance with the more conservative cutoff. Conclusions This study suggests that D-KEFS 4:2 is an adequate EVI in predicting suboptimal effort when operationalized by TOMM performance, particularly when more conservative TOMM cutoffs are used. D-KEFS 4:2 detected true effortful performance with excellent specificity but exhibited poor detection of suboptimal performance. As a result, D-KEFS 4:2 has utility as an EVI in youth populations, but should not be used independently.