Mixed Clinical Sample Research Articles

B - 135 Wisconsin Card Sorting Test 64-Card Computer Version (WCST-64-CV) Failure to Maintain Set (FMS) as an Embedded Performance Validity Indicator in a Mixed Clinical Sample

Abstract Objective The current objective was to determine the sensitivity and specificity of the Wisconsin Card Sorting Test 64-card Computer Version (WCST-64-CV) Failure to Maintain Set (FMS) as an embedded validity indicator. Methods Data were from an archival database of an academic medical center neuropsychology service. Three hundred sixty-eight adult participants completed the WCST-64-CV and Word Memory Test (WMT). Participants were defined as noncredible if all three of their WMT Immediate Recall (IR), Delayed Recall (DR), and Consistency (CNS) scores were 82.5% or below. Participants were defined as credible if all three of IR, DR, and CNS scores were above 82.5%. Forty-seven participants with scores both above and at/below 82.5% were excluded (N = 321). The sample was mean age 45 years (standard deviation [SD] = 17), mean education 13 years (SD = 2), 50% female, and 77% Caucasian. Primary diagnoses were 56.8% epilepsy and 18.1% mild cognitive impairment. No participants had dementia or an acute stroke. Results Twenty-eight participants were noncredible (8.7%) and 293 were credible (91.3%). One hundred sixty-five participants got 0 FMS (51.4%), 95 participants got 1 (29.6%), 41 participants got 2 (12.8%), and 20 participants got 3 or more (6.2%). The lowest cut-off that achieved at least 90% specificity was failure defined as ≥3. The specificity was 93.5% and the sensitivity was 3.5%. A cut-off of ≥2 achieved 80.8% specificity and 17.8% sensitivity. A cut-off of ≥1 achieved 50.8% specificity and 42.8% sensitivity. Conclusions There is no cut-off of WCST-64-CV FMS that achieves adequate specificity and sensitivity as an embedded validity indicator in this mixed clinical sample.

B - 137 Analyzing Completion Time on a Created Forced Choice Trial of the Hopkins Verbal Learning Test – Revised (HVLT-R) to Measure Engagement in a Mixed Clinical Sample

Abstract Objective We created a forced choice recognition trial (FCR) for the HVLT-R, including recording completion time (FCompT), to evaluate the utility of combining completion time with accuracy scores when using performance validity tests (PVTs). Method Participants included 29 clinically referred patients at a large medical center who completed the HVLT-R in addition to multiple free-standing and embedded PVTs including the TOMM, Word Choice Test (WCT), Reliable Digit Span (RDS), and the Dot Counting Test (DCT) as part of a larger battery of neuropsychological tests in an outpatient setting. Data from the sample (M age = 64.79, SD = 13.86; M education = 15.65, SD = 2.47; 62.1% females) were analyzed using correlation and linear regression. Results The HVLT-R FCR trial correlated with the TOMM-10, r(19) = 0.75, p = <0.001, TOMM trial 1, r(17) = 0.75, p = <0.01, the DCT r(12) = −0.71, p = <0.01, and the FCompT, r(29) = −0.72, p = <0.001. The FCompT was correlated with RDS, r(28) = −0.46, p = 0.03, TOMM-10, r(19) = −0.64, p = <0.01, and TOMM trial 1, r(17) = −0.61, p = <0.01. FCompT significantly predicted FCR accuracy b = −0.72, t(29) = −5.41, p < 0.001. Conclusions The HVLT-R FC and FCompT strongly correlated with free-standing and embedded PVTs. Data demonstrates that a longer completion time predicts poorer performance on FCR. Results demonstrate the value of measuring completion time for specific PVTs, in addition to providing support for the addition of a FCR trial to the HVLT-R.

B - 129 Examining the Influence of Age and Other Demographics on Word Choice (WC)

Abstract Objective Performance validity tests (PVTs) often vary by examinee characteristics including age and education among other demographics. Normative data on WC are limited to adults in the 16–69 age range. We examined relationships among demographic variables and WC in a mixed clinical sample. Method Local clinical data were retrospectively examined. Cases with WC and four independent PVTs were included; cases with dementia, intellectual disability or psychosis were excluded yielding a sample (N = 362) in which 61% of participants were female and 44% identified as Hispanic/Latino. Average age and education were 48 and 13 years, respectively. Outcome measures included WC and PVT scores and dichotomous cutoffs. Results WC was associated with age (r = −0.27) but not education. WC scores were significantly different by gender with a small effect (d = 0.39) but not by ethnicity. Using logistic regression with WC as outcome, age, education, and gender were significant predictors. Significantly more males (11%) scored below the WC cutoff than females (5%) in the valid group. Among participants 70 and older, 17% scored below the standard WC cutoff, but only 7% scored below expectation on two or more criterion PVTs. Lowering the WC cutoff resulted in improved specificity in the 70 and older subset: 15% with WC ≤ 40, and 11% with WC ≤ 36. Conclusions WC scores varied by age and gender. The standard WC cutoff showed an elevated false positive rate among adults 70 and older. Consideration might be given to adjusting the cutoff if subsequent research supports these preliminary findings. Further research might also examine relationships among gender, education, and WC.

B - 99 Timely Matters: Processing Speed and Other Cognitive Corelates of Identi-Fi Accuracy and Time to Completion

Abstract Objective The Identi-Fi is a test of visuospatial organization with overall performance represented by the Visual Organization Index (VOI). Though untimed, the Professional Manual indicates administration takes ~10 minutes in the standardization sample. We examined Identi-Fi time of completion (TOC) in a mixed clinical sample and explored whether TOC and VOI are differentially associated with other neuropsychological measures. Method Participants were 240 adults referred for clinical neuropsychological evaluation, 78.3% being aged 60+ (M = 64.50 ± 12.38 years, range = 21–79), male (54.6%), with 14.80 ± 2.89 years of education (range = 7–21). They completed the Identi-Fi and other cognitive tests (WAIS-IV Block Design and Digit Span; Trail Making Test; Boston Naming Test; D-KEFS Color-Word Interference). Correlation and linear regression were used to examine relationships. Results Overall, VOI was low average (M = 85.61 ± 19.00, range = 40–125). TOC was slightly longer (M = 12.92 ± 6.04 minutes, range = 4.07–47.78) than reported in the manual. VOI was correlated with visuoconstruction, confrontation naming, attention, processing speed and executive functions (all p ≤ 0.001), as well as TOC (r = −0.195, p = 0.002) and education (r = 0.136, p = 0.035). TOC was corelated with age (r. = 384, p < 0.001), education (r = 0.141, p = 0.029), processing speed (TMT-A: r = −0.329, p < 0.001; CW1: r = −0.171, p = 0.014), cognitive flexibility (r = −0.230, p = 0.001), and response inhibition (r = −0.269, p < 0.001). TOC was predicted by processing speed (β = −4.986, p = 0.049) even after accounting for age and education. Conclusion TOC may be longer in clinical populations, though this may reflect the older age of this sample. Although time and accuracy on the Identi-Fi correlated with processing speed, accuracy was also associated with other cognitive abilities. Further research into the clinical utility of Identi-Fi TOC is warranted.

B - 145 CVLT-3 Forced Choice Recognition Failure Rate in a Mixed Clinical Population

Abstract Objective The CVLT-3 is a measure of verbal learning and memory used extensively in clinical and research settings that contains an embedded performance validity indicator, a forced choice recognition trial (CVLT-3-FCR). The CVLT-2-FCR was modified for the CVLT-3-FCR, replacing abstract with concrete distractor words. To date, no one has reported independent data on failure rates in clinical populations on the CVLT-3-FCR. Method Participants were 373 patients referred for clinical neuropsychological evaluation who completed the CVLT-3 (Standard form) as part of their evaluation. Mean age was 61.20 (SD = 14.30, range = 20–86), mean education was 15.00 years (SD = 2.87, range = 6–21), 53.1% were male, and 97.6% White. Failure was defined as CVLT-3-FCR score ≤ 14. Results 85.5% of our mixed clinical sample had CVLT-3-FCR score of 16/16, and 7.5% had 15/16. Only 7% (N = 26) scored ≤14, most common primary diagnoses being mild neurocognitive disorder (N = 9) and psychiatric (N = 7), while only four had dementia of any etiology. Those who failed tended to be a little older [pass = 60.82 years (SD = 14.44), fail = 66.38 years (SD = 11.28); p = 0.055) and scored lower for CVLT-3 Total Trials 1–5, short- and long-delay free recall, recognition hits, false positives, and discriminability (all p < 0.001). Conclusions Findings indicate CVLT-3-FCR ≤ 14 is extremely rare in a large mixed clinical sample of adults and older adults, even in subsamples for whom lower scores on PVTs have been suggested (e.g., dementia). While passing the CVLT-3-FCR does not in itself confirm adequate test engagement, failure should raise concern and the need for additional PVTs in one’s assessment.

B - 128 Examining Word Choice (WC) and Test of Memory Malingering Trial 1 (T1) Cutoffs by Ethnicity, Language, and Education

Abstract Objective Optimal cutoffs on performance validity tests can vary by examinee characteristics including ethnicity, language, and education. We examined WC and T1 cutoffs in Hispanic/Latino (H/L) and non-H/L participants with consideration of language and education. Method Local clinical data were retrospectively examined. Cases with WC and T1 data were included if there was no diagnosis of dementia, intellectual disability or psychosis yielding a sample (N = 580) in which 41% of participants identified as H/L and 26% of participants with language data (n = 530) reported bilingualism. Outcome measures included WC and T1 scores and dichotomous cutoffs. Results Education showed significant associations with WC and T1 (r = 0.12–0.20) and varied by ethnicity and bilingualism (pH/L) with a small effect (d = 0.21). No language differences were observed on WC or T1. Logistic regression models predicting dichotomous WC and T1 with education, ethnicity, and language as predictors were significant overall, but ethnicity and language were not significant. Grouping with independent validity indicators, WC false positives (5–6%) did not vary significantly by ethnicity or language; T1 false positives were not significantly different but were slightly higher in H/L and bilingual (14–15%) participants compared to non-H/L and monolingual (9–10%) participants. Conclusions WC and T1 cutoffs from prior research in mixed clinical and forensic samples appear appropriate for use with H/L and bilingual examinees. Lower educational levels remain an area in need of further validity measure research.

The effect of ABM on attentional networks and stress-induced emotional reactivity in a mixed clinical sample with depression: A randomized sham-controlled trial

Research on the efficacy of Attention Bias Modification for depressive symptoms has predominantly yielded unfavorable outcomes. Despite adhering to rigorous conventions in randomized controlled trials, findings from these studies have indicated minimal effect sizes, thereby raising concerns about their limited clinical significance. This may be attributed to the overlapping mechanisms in ABM and the sham comparator, both affecting attentional processes. Participants with a diagnosis of major depressive disorder, with and without comorbid anxiety (N = 101) were randomized to a two-week preregistered randomized trial of ABM compared to sham. Attentional networks were assessed prior to and after the intervention by the Attention Network Task (ANT), and emotional reactivity was assessed in response to a lab-stressor. Irrespective of condition, participants improved their performance on the alerting and executive attentional networks, but not orienting, and stress-induced emotional reactivity was marginally decreased. Changes in attentional networks predicted post-intervention depression scores. It is imperative to reconsider the employment of a sham comparator in the exploration of the clinical efficacy of ABM.

Predictors of psychosocial impairment in a transdiagnostic sample: Unique effects of repetitive negative thinking

BackgroundRepetitive negative thinking (RNT) is a transdiagnostic process involving perseverative, unproductive, and uncontrollable thoughts. Although RNT may impede adaptive psychosocial functioning by prolonging negative mood states, strengthening cognitive biases, and preventing effective problem-solving, the extent to which RNT is associated with risk for poor psychosocial outcomes is unclear. Given that this has clear transdiagnostic treatment implications, the present study aimed to isolate the unique relationship of RNT with social functioning and life satisfaction in a mixed clinical and non-clinical sample. MethodsIn 201 mid-to-later life adult participants (27 with primary diagnoses of bipolar disorder, 84 with major depressive disorder, and 90 healthy volunteers), we measured RNT, social functioning, life satisfaction, trait rumination, DSM-5 diagnoses, depressive symptoms, manic symptoms, cognitive control performance, and global cognitive functioning. ResultsLinear regression models revealed that RNT, but not rumination, was significantly associated with poorer social functioning (β = 0.42 p < .001) and reduced life satisfaction (β = −0.42, p < .001) after controlling for clinical and cognitive covariates. LimitationsLimited demographic diversity, cross-sectional design, self-reporting of outcomes. ConclusionsResults suggest that RNT may confer risk for key psychosocial outcomes during middle to later adulthood, over and above the effects of clinical and cognitive variables and independent of diagnostic status. Findings lend support to the notion of RNT as a transdiagnostic process and suggest that RNT may be an important therapeutic target for adults with poor social functioning and/or reduced life satisfaction.

Intolerance of uncertainty on distress and impairment: The mediating role of repetitive negative thinking.

Repetitive negative thinking and intolerance of uncertainty are risk and maintenance factors for emotional disorders. Although emerging evidence suggests that intolerance of uncertainty predicts increases in distress through repetitive negative thinking, these relationships have yet to be investigated among veterans. The present study examines if repetitive negative thinking mediates the relationships of intolerance of uncertainty with stress, disordered symptoms and impairment among a mixed clinical sample of veterans. Two hundred and forty-four treatment-seeking veterans with diagnoses of major depressive disorder, panic disorder, or posttraumatic stress disorder completed measures of intolerance of uncertainty, repetitive negative thinking, stress, impairment, depression, panic, and posttraumatic stress prior to receiving treatment. Mediation models revealed indirect effects of intolerance of uncertainty through repetitive negative thinking on stress and impairment in the full sample, and on disordered symptoms in subsamples with major depressive disorder and posttraumatic stress disorder. Conversely, intolerance of uncertainty did not have direct or indirect effects on disordered symptoms in a panic disorder subsample. Findings suggest that repetitive negative thinking and intolerance of uncertainty uniquely contribute to stress, impairment, and disordered symptoms, but repetitive negative thinking, may, in part, drive intolerance of uncertainty's contribution to emotional disorders. Interventions for repetitive negative thinking might improve the efficacy of existing transdiagnostic treatment protocols. Cross-sectional data is a limitation of the present study. Prospective designs in civilian samples can better establish the temporality of these relationships and if they are generalizable to the larger population.

Does neuropsychological intraindividual variability index cognitive dysfunction, an invalid presentation, or both? Preliminary findings from a mixed clinical older adult veteran sample

ABSTRACT Introduction Intraindividual variability across a battery of neuropsychological tests (IIV-dispersion) can reflect normal variation in scores or arise from cognitive impairment. An alternate interpretation is IIV-dispersion reflects reduced engagement/invalid test data, although extant research addressing this interpretation is significantly limited. Method We used a sample of 97 older adult (mean age: 69.92), predominantly White (57%) or Black/African American (34%), and predominantly cis-gender male (87%) veterans. Examinees completed a comprehensive neuropsychological battery, including measures of reduced engagement/invalid test data (a symptom validity test [SVT], multiple performance validity tests [PVTs]), as part of a clinical evaluation. IIV-dispersion was indexed using the coefficient of variance (CoV). We tested 1) the relationships of raw scores and “failures” on SVT/PVTs with IIV-dispersion, 2) the relationship between IIV-dispersion and validity/neurocognitive disorder status, and 3) whether IIV-dispersion discriminated the validity/neurocognitive disorder groups using receiver operating characteristic (ROC) curves. Results IIV-dispersion was significantly and independently associated with a selection of PVTs, with small to very large effect sizes. Participants with invalid profiles and cognitively impaired participants with valid profiles exhibited medium to large (d = .55–1.09) elevations in IIV-dispersion compared to cognitively unimpaired participants with valid profiles. A non-significant but small to medium (d = .35–.60) elevation in IIV-dispersion was observed for participants with invalid profiles compared to those with a neurocognitive disorder. IIV-dispersion was largely accurate at differentiating participants without a neurocognitive disorder from invalid participants and those with a neurocognitive disorder (areas under the Curve [AUCs]=.69–.83), while accuracy was low for differentiating invalid participants from those with a neurocognitive disorder (AUCs=.58–.65). Conclusions These preliminary data suggest IIV-dispersion may be sensitive to both neurocognitive disorders and compromised engagement. Clinicians and researchers should exercise due diligence and consider test validity (e.g. PVTs, behavioral signs of engagement) as an alternate explanation prior to interpretation of intraindividual variability as an indicator of cognitive impairment.

Correlates of performance on the Child and Adolescent Memory Profile (ChAMP) in a mixed pediatric sample

ABSTRACT This study aimed to determine some of the factors that influence performance on a comprehensive test of verbal and visual memory in children, the Child and Adolescent Memory Profile (ChAMP) in a mixed clinical sample (n = 178; 56% male, 67% White, median age 12 years). We used hierarchical linear regression analyses with ChAMP standard scores as the dependent variable, and parental education as well as Wechsler Intelligence Scale for Children–Fifth Edition (WISC–V) factor index scores as the independent variables. WISC–V Processing Speed and (to a lesser extent) Working Memory were statistically significant predictors of most ChAMP Index scores. In addition, WISC–V Verbal Comprehension contributed to the model for ChAMP Verbal Memory, and WISC–V Visual Spatial to the model for ChAMP Visual Memory. In each case better performance on the WISC–V was predictive of higher scores on the ChAMP, with large effect sizes. WISC–V variables also mediated the positive effect of parental education on ChAMP scores. We conclude that clinicians should consider performance on measures of speed of processing, working memory, language and visual-spatial skills as potential influences on ChAMP results that may suggest a specific memory deficit.

Effect of processing speed and memory performance on classification accuracy of the dot counting test in a mixed neuropsychiatric sample

ABSTRACT Objective This study examined the impact of impairment in two specific cognitive abilities, processing speed and memory, on Dot Counting Test (DCT) classification accuracy by evaluating performance validity classification accuracy across cognitively unimpaired, single-domain impairment, and multidomain impairment subgroups within a mixed clinical sample. Method Cross-sectional data were analyzed from 348 adult outpatients classified as valid (n = 284) or invalid (n = 64) based on four independent criterion performance validity tests (PVTs). Unimpaired (n = 164), single-domain processing speed impairment (n = 24), single-domain memory impairment (n = 53), and multidomain processing speed and memory impairment (n = 43) clinical subgroups were established among the valid group. Both the traditional DCT E-score and unrounded E-score were examined. Results Overall, the DCT demonstrated acceptable to excellent classification accuracy across the unimpaired (area under the curve [AUC] traditional E-score=.855; unrounded E-score=.855) and single-domain impairment groups (traditional E-score AUCs = .690–.754; unrounded E-score AUCs = .692–747). However, it did not reliably discriminate the multidomain processing speed and memory impairment group from the invalid performers (traditional and unrounded E-scores AUC = .557). Conclusions Findings support the DCT as a non-memory-based freestanding PVT for use with single-domain cognitive impairment, with traditional E-score ≥17 (unrounded E-score ≥16.95) recommended for those with memory impairment and traditional E-score ≥19 (unrounded ≥18.08) with processing speed impairment. Moreover, results replicated previously established optimal cutoffs for unimpaired groups using both the traditional (≥14) and unrounded (≥13.84) E-scores. However, the DCT did not reliably discriminate between invalid performance and multidomain cognitive impairment, indicating caution is warranted when using the DCT with patients suspected of greater cognitive impairment.

Replicating the classification accuracy of the Verbal Paired Associates and Visual Reproduction recognition trials as embedded performance validity tests.

This study was designed to replicate previous research on the clinical utility of the Verbal Paired Associates (VPA) and Visual Reproduction (VR) subtests of the WMS-IV as embedded performance validity tests (PVTs) and perform a critical item (CR) analysis within the VPA recognition trial. Archival data were collected from a mixed clinical sample of 119 adults (MAge = 42.5, MEducation = 13.9). Classification accuracy was computed against psychometrically defined criterion groups based on the outcome of various free-standing and embedded PVTs. Age-corrected scaled scores ≤ 6 were specific (.89-.98) but had variable sensitivity (.36-.64). A VPA recognition cutoff of ≤ 34 produced a good combination of sensitivity (.46-.56) and specificity (.92-.93), as did a VR recognition cutoff of ≤ 4 (.48-.53 sensitivity at .86-.94 specificity). Critical item analysis expanded the VPA's sensitivity by 3.5%-7.0% and specificity by 5%-8%. Negative learning curves (declining output on subsequent encoding trials) were rare but highly specific (.99-1.00) to noncredible responding. Results largely support previous reports on the clinical utility of the VPA and VR as embedded PVTs. Sample-specific fluctuations in their classification accuracy warrant further research into the generalizability of the findings. Critical item analysis offers a cost-effective method for increasing confidence in the interpretation of the VPA recognition trial as a PVT. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cross-validation of the Trail Making Test as a non-memory-based embedded performance validity test among veterans with and without cognitive impairment

ABSTRACT Objective This study cross-validated multiple Trail Making Test (TMT) Parts A and B scores as non-memory-based embedded performance validity tests (PVTs) for detecting invalid neuropsychological performance among veterans with and without cognitive impairment. Method Data were collected from a demographically and diagnostically diverse mixed clinical sample of 100 veterans undergoing outpatient neuropsychological evaluation at a Southwestern VA Medical Center. As part of a larger battery of neuropsychological tests, all veterans completed TMT A and B and four independent criterion PVTs, which were used to classify veterans into valid (n = 75) and invalid (n = 25) groups. Among the valid group 47% (n = 35) were cognitively impaired. Results Among the overall sample, all embedded PVTs derived from TMT A and B raw and demographically corrected T-scores significantly differed between validity groups (ηp2 = .21–.31) with significant areas under the curve (AUCs) of .72–.78 and 32–48% sensitivity (≥91% specificity) at optimal cut-scores. When subdivided by cognitive impairment status (i.e., valid-unimpaired vs. invalid; valid-impaired vs. invalid), all TMT scores yielded significant AUCs of .80–.88 and 56%–72% sensitivity (≥90% specificity) at optimal cut-scores. Among veterans with cognitive impairment, neither TMT A or B raw scores were able to significantly differentiate the invalid from the valid-cognitively impaired group; however, demographically corrected T-scores were able to significantly differentiate groups but had poor classification accuracy (AUCs = .66–.68) and reduced sensitivity of 28%–44% (≥91% specificity). Conclusions Embedded PVTs derived from TMT Parts A and B raw and T-scores were able to accurately differentiate valid from invalid neuropsychological performance among veterans without cognitive impairment; however, the demographically corrected T-scores generally were more robust and consistent with prior studies compared to raw scores. By contrast, TMT embedded PVTs had poor accuracy and low sensitivity among veterans with cognitive impairment, suggesting limited utility as PVTs among populations with cognitive dysfunction.

Parent ratings of children’s daily functioning in a mixed clinical sample

Parent questionnaires pertaining to executive and emotional/behavioral functioning are routinely included in neuropsychological evaluations to complement face-to-face cognitive tests. We evaluated in a clinical sample of 198 6–16 year-old children the degree of overlap and divergence between two common parent rating scales: the Behavior Assessment System for Children—Third Edition (BASC–3) and the Behavior Rating Inventory of Executive Function—Second Edition (BRIEF–2). This sample was 66% male, 70% white, and included both neurological diagnoses (e.g., 33% traumatic brain injury, 12% cerebral palsy) and neurodevelopmental ones (e.g., 10% attention-deficit/hyperactivity disorder). Inter-correlations between composite indices from the respective instruments were moderate (.41–.77). They disagreed about the presence or absence of impairment in 26% of the cases. Cluster analysis revealed four subtypes: Cluster 1 had mild externalizing and executive concerns, Cluster 2 had global emotional/behavioral and executive concerns, Cluster 3 had normal functioning, and Cluster 4 had mild internalizing and executive concerns. Clusters 2 and 3 differed in age and parental education, whereas Clusters 1 and 4 differed in Full Scale IQ. We conclude that BASC–3 and BRIEF–2 provide complementary information about a child’s functioning that can inform treatment of neurobehavioral dysfunction. Elevations as well as patterns of the respective profiles on these instruments may help direct such treatment (e.g., cognitive rehabilitation, behavioral management and/or psychotherapy).

Validity assessment in Eastern Europe: cross-validation of the Dot Counting Test and MODEMM against the TOMM-1 and Rey-15 in a Romanian mixed clinical sample.

This study investigated performance validity in the understudied Romanian clinical population by exploring classification accuracies of the Dot Counting Test (DCT) and the first Romanian performance validity test (PVT) (Memory of Objects and Digits and Evaluation of Memory Malingering/MODEMM) in a heterogeneous clinical sample. We evaluated 54 outpatients (26 females; MAge = 62.02; SDAge = 12.3; MEducation = 2.41, SDEducation = 2.82) with the Test of Memory Malingering 1 (TOMM-1), Rey Fifteen Items Test (Rey-15) (free recall and recognition trials), DCT, MODEMM, and MMSE/MoCA as part of their neuropsychological assessment. Accuracy parameters and base failure rates were computed for the DCT and MODEMM indicators against the TOMM-1 and Rey-15. Two patient groups were constructed according to psychometrically defined credible/noncredible performance (i.e., pass/fail both TOMM-1 and Rey-15). Similar to other cultures, a cutoff of ≥18 on the DCT E score produced the best combination between sensitivity (0.50-0.57) and specificity (≥0.90). MODEMM indicators based on recognition accuracy, inconsistencies, and inclusion false positives generated 0.75-0.86 sensitivities at ≥0.90 specificities. Multivariable models of MODEMM indicators reached perfect sensitivities at ≥0.90 specificities against two PVTs. Patients who failed the TOMM-1 and Rey-15 were significantly more likely to fail the DCT and MODEMM than patients who passed both PVTs. Our results offer proof of concept for the DCT's cross-cultural validity and the applicability of the MODEMM on Romanian clinical examinees, further recommending the use of heterogeneous validity indicators in clinical assessments.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis.

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

79 Concordance Between Theorized Cognitive Profiles, Medical Risk Factors, and Clinical Diagnoses Within Preschool-Aged Children

Objective:Early childhood is recognized as a critical window of rapid cognitive development. Unfortunately, many risk factors for atypical cognitive development may occur during this period, including genetic syndromes, congenital neuroanatomical malformations, pre- or perinatal injury, and neurological and medical disorders. The impact of these risk factors on cognitive functioning may not always map onto patterns typically observed in adults. Limited literature exists on the presentation of cognitive profiles within clinical populations in the preschool developmental period. The present study aimed to evaluate whether discrete a priori cognitive profiles consistent with common neurobehavioral syndromes emerge and are distinguishable on testing in early childhood in a mixed clinical sample. We also aimed to determine if there was a consistent association between known medical risk factors and resultant cognitive profiles.Participants and Methods:Participants included 163 children aged 1-5 years (M=48.5 months, SD=12.8 months) referred for neuropsychological evaluation. The sample was predominantly male (67.5%) and White (72.9%), followed by other/mixed race (11.6%), Black (9.7%), and Latino/Hispanic (5.8%). Cognitive abilities assessed included broad intellectual abilities, verbal abilities, nonverbal abilities, attention, and executive functioning. Continuous test scores were transformed into categorical ranges of performance, with scores classified as “above average,” “average,” “below average,” or “extremely low” to allow for profile classification. Theoretical clinical profiles consistent with common neurobehavioral syndromes were determined a priori by consensus among three authors (JK, AH, LM). Chi square tests of independence were conducted to compare membership across neurobehavioral diagnostic groups, clinical profile groups, and medical groups.Results:Based on cognitive data, 55.2% of the sample (n=90) was classified as Global Developmental Delay/Intellectual Disability, 19.6% (GDD/ID; n=32) was classified asLanguage Disorder, and 18.4% (n=30) was classified as Typical Cognitive Development. 4.3% (n=7) of the sample was classified as Attention-Deficit/Hyperactivity Disorder (ADHD), and 2.5% (n=4) was classified as Nondominant Hemisphere Dysfunction. As hypothesized, cognitive profile group membership was consistent with diagnostic impressions, as actual clinical diagnoses of Language Disorder, ADHD, GDD/ID, or a classification of typical cognitive development were significantly associated with theorized cognitive profile based on test performance alone (x2 (1,20) = 147.29, p &lt; .001). Cognitive profile group membership was also significantly associated with referral source (1,28) = 62.88, p &lt; .001) and the presence of a neurological disorder (1,4) = 14.64, p =.006).Conclusions:Findings support the presence of specific theorized cognitive profiles in preschoolers in a mixed clinical sample. Specifically, GDD/ID, Language Disorder, and typical cognitive development are discrete and consistently distinguishable cognitive profiles in this age range. Early life neurological risk factors are also significantly related to cognitive profile membership, suggesting that these factors may be useful in predicting cognitive development even in very young children. Future work is needed to examine the consistency of these profiles over time and their predictive value in estimating subsequent development, and the possibility of discriminating unique cognitive profiles for specific medical conditions in preschoolers.

16 Validation of the Pillbox Test in a Veteran Sample: A Replication Study.

Objective:Assessment of medication management, an instrumental activity of daily living (IADL), is particularly important among Veterans, who are prescribed an average of 2540 prescriptions per year (Nguyen et al., 2017). The Pillbox Test (PT) is a brief, performance-based measure that was designed as an ecologically valid measure of executive functioning (EF; Zartman, Hilsabeck, Guarnaccia, &amp; Houtz, 2013), the cognitive domain most predictive of successful medication schedule management (Suchy, Ziemnik, Niermeyer, &amp; Brothers, 2020). However, a validation study by Logue, Marceaux, Balldin, and Hilsabeck (2015) found that EF predicted performance on the PT more so than processing speed (PS), but not the language, attention, visuospatial, and memory domains combined. Thus, this project sought to increase generalizability of the latter study by replicating and extending their investigation utilizing a larger set of neuropsychological tests.Participants and Methods:Participants included 176 patients in a mixed clinical sample (5.1% female, 43.2% Black/African American, 55.7% white, Mage = 70.7 years, SDage = 9.3, Medu = 12.6 years, SDedu = 2.6) who completed a comprehensive neuropsychological evaluation in a VA medical center. All participants completed the PT where they had five minutes to organize five pill bottles using a seven-day pillbox according to standardized instructions on the labels. Participants also completed some combination of 26 neuropsychological tests (i.e., participants did not complete every test as evaluations were tailored to disparate referral questions). Correlations between completed tests and number of pillbox errors were evaluated. These tests were then combined into the following six domains: language, visuospatial, working memory (WM), psychomotor/PS, memory, and EF. Hierarchical multiple regression was completed using these domains to predict pillbox errors.Results:Spearman’s correlation coefficients indicated that 25 tests had a weak to moderate relationship with PT total errors (rs = 0.23 -0.51); forward digit span was not significantly related (rs = 0.13). A forced-entry multiple regression was run to predict PT total errors from the six domains. The model accounted for 29% of the variance in PT performance, F(6, 169) = 11.56, p &lt; .001. Of the domains, psychomotor/PS made the greatest contribution, f(169) = 2.73, p = .007, followed by language, f(169) = 2.41, p = .017, and WM, f(169) = 2.15, p = .033. Visuospatial performance and EF did not make significant contributions (ps&gt;.05). Next, two hierarchical multiple regressions were run. Results indicated that EF predicted performance on the PT beyond measures of PS, AR2 = .02, p = .044, but not beyond the combination of all cognitive domains, AR2 = .00, p = .863.Conclusions:Results of this study partially replicated the findings of Logue et al. (2015). Namely, EF predicted PT performance beyond PS, but not other cognitive domains. However, when all predictors were entered into the same model, visuospatial performance did not significantly contribute to the prediction of pillbox errors. These results suggest that providers may benefit from investigating medication management abilities when deficits in PS, WM, and/or language are identified. Further research is needed to better understand which domains best predict PT failure.

78 Utility of the D-KEFS Color Word Interference Test as a Measure of Performance Validity in Adults Referred for a Psychoeducational Evaluation

Objective:Previous investigations have demonstrated the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Color Word Interference Test (CWIT) as an embedded validity indicator in mixed clinical samples and traumatic brain injury. The present study sought to cross-validate previously identified indicators and cutoffs in a sample of adults referred for psychoeducational testing.Participants and Methods:Archival data from 267 students and community members self-referred for a psychoeducational evaluation at a university clinic in the South were analyzed. Referrals included assessment for attention-deficit hyperactivity disorder, specific learning disorder, autism spectrum disorder, or other disorders (e.g., anxiety, depression). Individuals were administered subtests of the D-KEFS including the CWIT and several standalone and embedded performance validity indicators as part of the evaluation. Criterion measures included The b Test, Victoria Symptom Validity Test, Medical Symptom Validity Test, Dot Counting Test, and Reliable Digit Span. Individuals who failed 0 criterion measures were included in the credible group (n = 164) and individuals failing 2 or more criterion measures were included in the non-credible group (n = 31). Because a subset of the sample were seeking external incentives (e.g., accommodations), individuals who failed only 1 of the criterion measures were excluded (n = 72). Indicators of interest included all test conditions examined separately, the inverted Stroop index (i.e., better performance on the interference trial than the word reading or color naming trials), inhibition and inhibition/switching composite, and sum of all conditions.Results:Receiver Operating Characteristics (ROC) curves were significant for all four conditions (p &lt; .001) and the inverted stroop index (p = .032). However, only conditions 2, 3 and 4 met minimal acceptable classification accuracy (AUC = .72 - 81). ROC curves with composite indicators were also significant (p &lt; .001), with all three composite indicators meeting minimal acceptable classification accuracy (AUC = .71- .80). At the previously identified cutoff of age corrected scale score of 6 for all four conditions, specificity was high (.88 -.91), with varying sensitivity (.23 - .45). At the previously identified cutoff of .75 for the inverted stroop index, specificity was high (.87) while sensitivity was low (.19). Composite indicators yielded high specificity (.88 - .99) at previously established cutoffs with sensitivity varying from low to moderate (.19 - .48). Increasing the cutoffs (i.e., requiring higher age corrected scale score to pass) for composite indicators increased sensitivity while still maintaining high specificity. For example, increasing the total score cutoff from 18 to 28 resulted in moderate sensitivity (.26 vs .52) with specificity of .91.Conclusions:While a cutoff of 6 resulted in high specificity for most conditions, the sum of all four conditions exhibited the strongest classification accuracy and appears to be the most robust indicator which is consistent with previous research (Eglit et al., 2019). However, a cutoff of 28 as opposed to 18 may be most appropriate for psychoeducational samples. Overall, the results suggest that the D-KEFS CWIT can function as a measure of performance validity in addition to a measure of processing speed/executive functioning.