Two Views of Invalid Response Set and Malingering Attributions in Forensic Assessment: Credibility and Non-Credibility.

Performance and Symptom Validity Testing as a Function of Medical Board Evaluation in U.S. Military Service Members with a History of Mild Traumatic Brain Injury.

Objective: Validity test failures within neuropsychological assessments are common. This study aimed to assess current practise. Method: Australian psychologists completed an online survey evaluating their approach to validity issues. Results: There were 102 participants (75% female, mean age 41.68 (11.72), 88% clinical neuropsychologists or registrars, 35% conducting 10+ assessments in medico-legal settings, 88% conducting 10+ assessments in clinical settings). Performance validity tests were used by most clinicians in a medico-legal setting, but in less than 50% of assessments in clinical settings. Symptom validity tests were used significantly more frequently in medico-legal settings as compared to clinical settings. Less objective methods (e.g., qualitative observation) were more frequently used to evaluate validity in clinical settings. Conclusions: Overall, validity testing in Australia is not consistent with published North American guidelines or practise trends. In Australia, psychologists practising in clinical settings appear to be relying on subjective judgements more frequently than on objective test findings. Australian guidelines that reflect recent research findings regarding validity test failure rates in clinical settings are required. The most frequently cited reason for not including validity tests was insufficient time, so future research should continue to examine time-efficient ways of incorporating validity testing. Key Points What is already known about this topic: (1) Performance validity and symptom validity test failure occur in both medico-legal and clinical settings. (2) Professional guidelines for validity testing published by professional bodies in North America emphasise the importance of validity tests in medico-legal and other settings. (3) Validity test use varies between countries, with high rates in North America but lower rates in Europe and New Zealand. What this paper adds: (1) Based on North American guidelines, performance validity tests are used less frequently than recommended in clinical settings in Australia, whilst symptom validity tests are used less frequently than recommended in both clinical and medico-legal settings. (2) Lack of time is the biggest barrier to incorporating validity tests into neuropsychological assessments; more time-efficient validity testing methods would help redress this issue. (3) There is an urgent need for Australian guidelines for validity testing in neuropsychological assessments.

Relative Utility of Performance and Symptom Validity Tests.

The concepts underlying performance validity tests (PVTs) change in focus and, also, the research in their use in forensic neuropsychological assessment is burgeoning. First, we review definitions, testing, and counting procedures. As well, ethics related to assessment have changed, in addition to admissibility laws for court. Next, we examine test construction, and provide a pertinent example of a recently developed PVT, the Inventory of Problems-Memory (IOP-M). In terms of recent empirical PVT research, we enumerate 15 themes that organize the field. There are five themes on foundations, five on extensions, and five on applications. They include: (a) for foundations: PVT validation, PVT fail base rate, PVT cut scores, creating new tests, and embedded PVTs; (b) for extensions, novel PVT approaches, advanced PVT technologies, remote PVTs, demographic research and limitations, and multivariate approaches; and (c) for other applications, clinical applications, students, psychological injuries, extreme conditions, and combinations with symptom validity tests (SVTs). The ongoing research on PVTs support their use in forensic neuropsychological assessment. In determining whether malingering or related attributions has taken place, the assessor needs to consider the full examinee profile; PVT data speak only to invalid response set.

Objective Research examining performance (PVTs) and symptom (SVTs) validity tests has largely included freestanding SVTs or SVTs included in lengthy personality inventories, whereas few studies have assessed this relationship using embedded SVTs. This study investigated the concordance between newly developed embedded SVTs derived from the Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory and performance validity status. Methods A mixed clinical sample of 420 adult medical and neuropsychiatric patients referred for outpatient neuropsychological evaluation at an urban academic medical center. Performance validity status was determined by the Dot Counting Test, Medical Symptom Validity Test, WAIS-IV Reliable Digit Span, and Test of Memory Malingering-Trial 1. Symptom validity status was determined by SVTs validated from the BDI-II and BAI total scores. Results BDI-II and BAI SVTs were moderately correlated (r=.69), whereas weak correlations emerged between these embedded SVT and PVTs (r=.09–.22). Patients with invalid performance on PVTs had significantly higher elevations rates on the BDI-II (2.5x) and BAI (2x) SVTs. However, neither the BDI-II nor BAI SVTs, as well as a combined BDI-II/BAI composite score accurately differentiated invalid from valid performance validity status (AUCs=.573–.583). Results essentially replicated after supplementary analyses excluding those with 1 PVT failure. Conclusions Results align with previous research showing that that PVTs and newly-developed embedded SVTs in the BDI-II and BAI assess non-redundant constructs and should both be routinely included in neuropsychological evaluations. In short, performance invalidity does not necessarily convey noncredible symptom reporting and vice versa.

A-183 Base Rates of Performance and Symptom Validity Test Failures in Active Duty and Veteran Samples Referred for Attention-Deficit/Hyperactivity Disorder Evaluation

In forensic evaluations, offenders may exaggerate psychiatric or cognitive symptoms to influence legal outcomes. Symptom validity tests (SVTs) and performance validity tests (PVTs) are commonly used to detect such noncredible responses. This study aimed to (1) investigate whether symptom validity and performance validity represent distinct constructs, and (2) explore whether offenders who display noncredible symptom reporting are also likely to demonstrate invalid test performance, and vice versa. Seventy pre-trial defendants in Thailand were assessed using the Thai version of the Symptom Validity Test (SVT-Th, SVT) to evaluate symptom credibility, and the Test of Memory Malingering (TOMM, PVT) to assess cognitive performance validity. Results indicated that SVT-Th total scores were not significantly correlated with TOMM scores across all trials. Furthermore, no significant associations were found when applying the established cutoff scores (SVT-Th ≥ 79; TOMM ≤ 44). These findings suggest that symptom validity and performance validity reflect separate constructs, and that noncredible responding in one domain does not necessarily imply invalidity in the other.

Recently, the dichotomy between performance validity tests (PVT) and symptom validity tests (SVT) has been suggested to differentiate between invalid performance and invalid self-report, respectively. PVTs are typically used to identify malingered cognitive impairment, while SVTs identify malingered psychological or somatic symptoms. It is assumed that people can malinger different types of problems, but the impact of modes of reporting invalidly has been largely unexplored. A mixed neurological sample (n = 130) was tested with the Test of Memory Malingering, the Forced Recognition part of the California Verbal Learning Test, and the self-report Structured Inventory of Malingered Symptoms (SIMS). Confirmatory factor analyses testing both method- and content-based factor models found best fit for the method-based division. Regression analyses of other self-rating and performance-based tests provided further support for the importance of type of methods used to collect information. While acknowledging the types of symptoms malingered, the clinician is advised also to consider how information is gathered by using both PVTs and SVTs. SIMS is a good candidate for a stand-alone SVT, although the utility of the Low Intelligence subscale is questionable as a validity measure.

Background Performance validity (PV) and symptom validity (SV) tests assess biased responding that impact scores on neuropsychological tests. The extent to which PV and SV represent overlapping or unique constructs remains incompletely defined, especially among psychiatric patients in a non-forensic setting. The current study investigated this question using confirmatory factor analysis. Method Eighty-two inpatients with mood disorders were administered the Word Memory Test, and its primary indices formed a latent variable of PV. From the Minnesota Multiphasic Personality Inventory-2 the Fake Bad Scale (FBS), Response Bias Scale (RBS), and Henry-Heilbronner Index (HHI) were employed as a latent SV variable. Two models of the relationship between PV and SV were compared. One freely estimated the shared variance between SV and PV latent constructs. The other assumed the relationship between SV and PV was homogeneous, and covariance was fixed to 1.0. Results In the freely estimated model, covariance between PV and SV was −0.18, and model fit was excellent (CFI = 0.098; TLI = 0.096; SRMR = 0.08). For the fixed model, the RBS, HHI, and FBS achieved low loadings on the SV construct, and model fit was poor (CFI = 0.66; TLI = 0.43; SRMR = 0.42). Conclusions PV as indexed by the WMT and SV measured by the MMPI-2 are not overlapping constructs among inpatients with mood disorders. These data imply that PV and SV represent distinct constructs in this population. Implications for practice are discussed.

The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation.

Subjective cognitive complaints are common among patients presenting for evaluation of attention-deficit/hyperactivity disorder (ADHD). Despite these complaints, research overwhelmingly suggests that reported cognitive deficits do not align with objective neurocognitive performance. This study explored the relationship between subjective cognitive complaints, objective neuropsychological functioning, and performance and symptom validity testing in adult patients referred for evaluation due to concern about ADHD. The sample consisted of 523 adult referrals who underwent comprehensive evaluation for concern about ADHD and to characterize cognitive strengths and weaknesses. Four hundred patients were diagnosed with ADHD, and 123 did not meet the diagnostic criteria for ADHD. Patients were dichotomized to form nonelevated (n=134) and elevated (n=389) cognitive complaint groups, which were compared on objective neurocognitive performance, report of ADHD-specific symptoms, and performance validity tests. Significant differences were identified between the elevated and nonelevated cognitive complaints groups in performance validity tests and ADHD symptom reporting; however, clinical differences were not identified on objective neurocognitive measures. Consistent with the results of previously published research, subjective cognitive complaints did not align with objective neurocognitive deficits in a sample of adult ADHD referrals. Elevated cognitive complaints were associated with higher rates of performance validity failure and invalid ADHD-specific symptom reporting. These findings highlight the importance of assessing cognitive complaints using symptom report inventories and cognitive tests that include objective validity indices.

Objective: 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. Method: 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. Results: 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. Conclusions: 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.

To evaluate the relationships among performance validity, symptom validity, symptom self-report, and objective cognitive testing. Combat Veterans (N = 338) completed a neurocognitive assessment battery and several self-report symptom measures assessing depression, posttraumatic stress disorder (PTSD) symptoms, sleep quality, pain interference, and neurobehavioral complaints. All participants also completed two performance validity tests (PVTs) and one stand-alone symptom validity test (SVT) along with two embedded SVTs. Results of an exploratory factor analysis revealed a three-factor solution: performance validity, cognitive performance, and symptom report (SVTs loaded on the third factor). Results of t tests demonstrated that participants who failed PVTs displayed significantly more severe symptoms and significantly worse performance on most measures of neurocognitive functioning compared to those who passed. Participants who failed a stand-alone SVT also reported significantly more severe symptomatology on all symptom report measures, but the pattern of cognitive performance differed based on the selected SVT cutoff. Multiple linear regressions revealed that both SVT and PVT failure explained unique variance in symptom report, but only PVT failure significantly predicted cognitive performance. Performance and symptom validity tests measure distinct but related constructs. SVTs and PVTs are significantly related to both cognitive performance and symptom report; however, the relationship between symptom validity and symptom report is strongest. SVTs are also differentially related to cognitive performance and symptom report based on the utilized cutoff score. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Performance validity tests (PVTs) and symptom validity tests (SVTs) detect inaccuracies in examinee-completed measures, though methods for assessing the accuracy of informant reports-which may be inaccurate due to examinee deception, motivation for external incentives (e.g., disability payments), or attempts to validate examinee experiences-remain underexplored. We used a sample of 72 veteran-informant dyads undergoing evaluation of possible epilepsy-related neurocognitive disorder to assess the association between examinee response invalidity (i.e., performance and/or symptom invalidity) and informant report measures. Examinees completed PVTs, SVTs, cognitive, and self-report measures. Informants completed measures on examinee functioning and their own caregiver burden. Performance invalidity was defined as failure on two or more PVTs. Symptom invalidity for psychopathology symptom reports (SVT-P) and cognitive/somatic symptom reports (SVT-CS) were separately defined via above-threshold scores on two or more SVT criterion. Independent samples t tests demonstrated the associations of the PVT, SVT-CS, and SVT-P groups with informant-report measures. Informants for examinees with performance invalidity reported worse functioning in the examinee than informants for examinees in the valid performance group (medium-large effect sizes). Symptom validity status (for both SVT-CS and SVT-P) was meaningfully but less strongly related to informant-reported examinee functioning (small-medium effect sizes). Neither performance nor symptom invalidity was meaningfully related to informant-reported caregiver burden (negligible effect sizes). Informant reports for examinees with response invalidity should be interpreted with caution. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to neuropsychological evaluations, helping ensure findings reflect true abilities or concerns. It is unclear how PVTs and SVTs perform in children who received radiotherapy for brain tumors. Accordingly, we investigated the rate of noncredible performance on validity indicators as well as associations with fatigue and lower intellectual functioning. Embedded PVTs and SVTs were investigated in 98 patients with pediatric craniopharyngioma undergoing proton radiotherapy (PRT). The contribution of fatigue, sleepiness, and lower intellectual functioning to embedded PVT performance was examined. Further, we investigated PVTs and SVTs in relation to cognitive performance at pre-PRT baseline and change over time. SVTs on parent measures were not an area of concern. PVTs identified 0-31% of the cohort as demonstrating possible noncredible performance at baseline, with stable findings 1 year following PRT. Reliable digit span (RDS) noted the highest PVT failure rate; RDS has been criticized for false positives in pediatric populations, especially children with neurological impairment. Objective sleepiness was strongly associated with PVT failure, stressing need to consider arousal level when interpreting cognitive performance in children with craniopharyngioma. Lower intellectual functioning also needs to be considered when interpreting task engagement indices as it was strongly associated with PVT failure. Embedded PVTs should be used with caution in pediatric craniopharyngioma patients who have received PRT. Future research should investigate different cut-off scores and validity indicator combinations to best differentiate noncredible performance due to task engagement versus variable arousal and/or lower intellectual functioning.