The Limits of the Complex Ideational Material As an Embedded Performance Validity Test – a Case Report

Abstract

ABSTRACT Objective This paper describes a clinical case illustrating the limitations of the Complex Ideational Material (CIM) as an embedded performance validity test (PVT). Method A comprehensive neuropsychological battery was administered to a 19-year-old male to evaluate the residual effects of a motor vehicle collision. Results The patient passed all free-standing PVTs and the majority of embedded validity indicators. Failing the CIM (≤9) in the context of long-standing, documented deficits in semantic processing and following the difficulty gradient inherent in the task (i.e. all errors occurred on later items) likely represents a false positive. Conclusions Future research on CIM as PVT should include an item-level analysis in addition to the overall score to reduce the risk of misidentifying bona fide deficits as non-credible responding. More broadly, genuine impairment and invalid performance may be psychometrically indistinguishable in individual embedded PVTs. Failures on embedded validity cutoffs should be interpreted in the context of the patient’s clinical history. Routinely administering a comprehensive battery of neuropsychological tests can aid the interpretation of isolated atypical scores.