Mixed Clinical Sample Research Articles

Examining the cross-cultural validity of the test of memory malingering and the Rey 15-item test

Objective This study was designed to investigate the cross-cultural validity of two freestanding performance validity tests (PVTs), the Test of Memory Malingering – Trial 1 (TOMM-1) and the Rey Fifteen Item Test (Rey-15) in Romanian-speaking patients. Methods The TOMM-1 and Rey-15 free recall (FR) and the combination score incorporating the recognition trial (COMB) were administered to a mixed clinical sample of 61 adults referred for cognitive evaluation, 24 of whom had external incentives to appear impaired. Average scores on PVTs were compared between the two groups. Classification accuracies were computed using one PVT against another. Results Patients with identifiable external incentives to appear impaired produced significantly lower scores and more errors on validity indicators. The largest effect sizes emerged on TOMM-1 (Cohen’s d = 1.00–1.19). TOMM-1 was a significant predictor of the Rey-15 COMB ≤20 (AUC = .80; .38 sensitivity; .89 specificity at a cutoff of ≤39). Similarly, both Rey-15 indicators were significant predictors of TOMM-1 at ≤39 as the criterion (AUCs = .73–.76; .33 sensitivity; .89–.90 specificity). Conclusion Results offer a proof of concept for the cross-cultural validity of the TOMM-1 and Rey-15 in a Romanian clinical sample.

Mentalizing Mediates the Association between Narcissism and Psychotherapeutic Treatment Outcome in a Mixed Clinical Sample

Introduction: Pathological narcissism has been a challenge for the success of psychological treatment, whereas mentalizing has turned out to be an important mechanism of change in psychotherapy. This study focused on the classic narcissistic self (CNS) (i.e., narcissistic grandiosity) as predictor of the outcome. It further investigated whether mentalizing mediates this relation. Methods: A mixed clinical sample of 205 patients was investigated. The CNS scale of the Narcissism Inventory and the Mentalization Questionnaire was used to measure the features of narcissistic grandiosity and the capacity to mentalize, respectively. The symptom outcome was assessed with the Hamburg Modules for the Assessment of Psychosocial Health. Results: Contrary to our expectations, we did not find a direct association between narcissistic grandiosity and a decrease in symptoms. However, mentalizing was found to mediate the association between the CNS as well as between the narcissistic furor and outcome. Conclusion: Our results confirm the ambiguity concerning the clinical significance of narcissistic grandiosity. However, in order to improve the treatment outcome in patients with narcissistic features, especially narcissistic furor, individualized treatment plans might consider introducing interventions that enhance the capacity to mentalize.

Integration of standardized brain volumetric and neuropsychological assessment data: Conceptual background and preliminary data

<h3>Introduction</h3> NeuroQuant (NQ) is the first FDA-approved medical software to automate and standardize the analysis of brain MRI volumetrics. Such measurements may hold significant value in diagnostic settings by reducing the subjectivity of neuroradiological interpretations. However, NQ reports currently lack any accompanying clinical interpretation, thus limiting its clinical utility. Therefore, identifying reliable cognitive correlates of NQ volumetric data is an important target of investigation in order to enhance clinical applicability. Using NQ data in this way may be particularly valuable within comprehensive assessments aimed at characterizing age-related changes in neuropsychological functioning – one of the overarching aims of our broader though still nascent NQ research program. This poster will provide a conceptual and methodological overview of our NQ program, including a proposed investigation into how volumetric measurements in certain medial-temporal subregions, namely hippocampus, parahippocampus, and entorhinal cortex, predict specific auditory-verbal and visuospatial memory processes commonly assessed in clinical evaluations (i.e., encoding, retrieval, and storage/retention). Though all three regions are heavily intertwined in the processing of memory, previous research suggest these regions may be differentially involved in particular memory processes. However, this has not been examined using standardized volumetric measurements. We present results from a preliminary correlational analysis focused on the association between NQ data from those medial temporal regions and different levels of just auditory memory function in a small, mixed older adult clinical sample. We expect all three brain regions to be differentially associated with the encoding, retrieval, and storage levels of auditory memory. This particular question has been prioritized given its potential value in enhancing dementia/memory assessments, specifically for Alzheimer's disease (AD). Understanding the associations between key brain structures and different types of memory function will aid in the development of more robust and multi-faceted AD diagnostic protocols that incorporate NQ data. <h3>Methods</h3> Subjects are comprised of a mixed clinical sample of older adults who have undergone both neuropsychological testing and structural brain MRI+NQ as part of a comprehensive clinical evaluation in the McLean Hospital Memory Disorders Assessment Clinic. We will apply linear mixed effects models to investigate the association between NQ-derived volumetric measurements in three medial temporal regions across both hemispheres (hippocampus, parahippocampus, and entorhinal cortex) and different levels of verbal and visuospatial memory function (encoding/registration, retrieval, and storage/retention) measured by the California Verbal Learning Test (CVLT-II), Logical Memory (LM), and Rey Complex Figure Test (RCFT). For the current preliminary analysis, however, we present a more narrowly focused bivariate correlational analysis (Spearman rank-order) of CVLT-II data in a small subset of patients (N=6), with NQ data being aggregated across hemispheres. Analyses were performed using R (version 4.1.1). <h3>Results</h3> Six patients (5 female) ranged in age from 72 to 83 years, with an average of 15.5 ± 3.5 years of education. Patients had a mix of major depressive disorder, generalized anxiety disorder, bipolar II disorder, and mild/major neurocognitive diagnoses, with all but 1 patient having comorbid diagnoses. There was a positive correlation between CVLT-II long delay free recall – a measure of memory retrieval – and total entorhinal cortex volume that trended towards significance (ρ=0.79, <i>p</i>=0.059). There were no other significant correlations (all <i>p</i> > 0.1). <h3>Conclusions</h3> The marginally significant correlation between CVLT-II long delay free recall and entorhinal cortex volume suggests this region may be more strongly related to delayed retrieval compared to other memory processes. However, with such a small subject size, these findings must be viewed as highly preliminary and interpreted accordingly. Nonetheless, they support our plan to pursue more sophisticated analyses using linear mixed effects models once more data are available. Validating the associations between structural memory hubs and cognitive function with cutting-edge NQ imaging software lays the groundwork for future projects implementing NQ as a standard of practice in the clinical assessment of age-related cognitive disorders. Additional planned research questions will also be discussed, such as examining associations between cognitive data from commonly used neuropsychological tests and NQ volumetrics in specific connectivity hubs that are critical to broader neural network function. <h3>This research was funded by</h3> Unfunded.

Optimal per test cutoff scores and combinations of failure on multiple embedded performance validity tests in detecting performance invalidity in a mixed clinical sample

We tested the usefulness of six embedded performance validity tests (EPVTs) in identifying performance invalidity in a mixed clinical sample. Using a retrospective design, 181 adults were classified as valid (n = 146) or invalid (n = 35) performance based upon their performance on one of three standalone PVTs (Test of Memory Malingering, Victoria Symptom Validity Test, Dot Counting Test). Multiple cutoffs were identified corresponding to predetermined false positive rates of 0, 5, 10, and 15% for each of six EPVTs. EPVT cutoffs corresponding to the predetermined false positive benchmarks were generally more conservative than currently established scores. Sensitivity was low (.0%–42.9%) for individual EPVTs across these cutoffs and was moderately improved by the combination of multiple EPVT failures. The optimal number of EPVT failures using the 10% false positive rate was ≥ 2. Although the overall classification accuracy of 80.7% and specificity of 89.0% were comparable to prior research, the sensitivity of 45.7% was more modest than previous estimates. Low sensitivities indicate that this combination of EPVTs failed to detect a majority of invalid performers.

A-193 Effects of Sex on Concussion-Related Symptom Reporting in a Diverse Adult Clinical Sample Using the Texas Postconcussion Symptom Inventory

Abstract Objective Concussion symptoms are non-specific and various symptom inventories are influenced by sex, even in the absence of injury. The Texas Postconcussion Symptom Inventory (TPSI) is a new 66-item concussion-related symptom measure with three empirically-derived indices (Cognitive, Neuropsychiatric, and Somatic). We evaluated if symptom reporting on the TPSI related to sex in a large, mixed clinical sample. Methods A diverse clinical sample (N = 319, ages 17–92, M = 48.75), including patients with seizure disorders, dementias, and head injuries, completed the TPSI. Symptom reporting profiles between females (55%) and males (45%) were compared using profile analysis with age as a covariate. Results Although females (M = 20.62, 95% CI [18.91, 22.26]) and males (M = 19.14, 95% CI [17.32, 21.04]) endorsed higher scores on the Cognitive index (Possible Range = 0–52), no significant differences on symptom reporting patterns were seen between the groups on the Cognitive (p = 0.24) or Neuropsychiatric (p = 0.56) Indices. However, a significant difference was found on the Somatic index (Possible Range = 0–34), with females (M = 13.06, 95% CI [11.99, 13.94]) reporting higher scores [t(318) = 2.78, p &amp;lt; 0.01, partial η2 = 0.02] than males (M = 10.98, 95% CI [10.01, 12.17]). Conclusions In this preliminary study, results indicated sex differences in reporting concussion-associated symptoms on the TPSI across a variety of clinical conditions. Similar to prior studies, females reported more somatic symptoms yet were similar in their reports of Cognitive and Neuropsychiatric symptoms. Because baseline data is rarely available when evaluating concussions in clinical settings, future research aims are to develop normative data stratified by sex and investigate the utility of the TPSI within a concussion cohort.

Psychometric Properties of the German Version of the Children’s Rejection Sensitivity Questionnaire (CRSQ)

Rejection Sensitivity (RS) is defined as the disposition to anxiously expect, readily perceive, and overreact to social rejection cues. Aim of the two studies presented in this paper was to develop and administer an instrument to assess RS in a German sample of healthy (pre)adolescents as well as in a clinical sample. The English Children’s Rejection Sensitivity Questionnaire (CRSQ) was translated, adapted, and presented to a non-clinical sample (N = 128) (Study I) to identify psychometric properties of the instrument. In Study II, the resulting questionnaire was completed by a mixed clinical sample (N = 50). Differences in results between samples, and the relation between rejection sensitivity and mental distress were investigated. The resulting German version of the questionnaire CRSQ (German: Fragebogen zur Zurückweisungsempfindlichkeit für Kinder und Jugendliche, FZE-K) showed good psychometric properties. Differences between samples provide insight into the diversity of the construct “rejection sensitivity”.

Critical Item Analysis Enhances the Classification Accuracy of the Logical Memory Recognition Trial as a Performance Validity Indicator

ABSTRACT Objective : Replicate previous research on Logical Memory Recognition (LM Recog ) and perform a critical item analysis. Method : Performance validity was psychometrically operationalized in a mixed clinical sample of 213 adults. Classification of the LM Recog and nine critical items (CR-9) was computed. Results : LM Recog ≤20 produced a good combination of sensitivity (.30-.35) and specificity (.89-.90). CR-9 ≥5 and ≥6 had comparable classification accuracy. CR-9 ≥5 increased sensitivity by 4% over LM Recog ≤20; CR-9 ≥6 increased specificity by 6–8% over LM Recog ≤20; CR-9 ≥7 increased specificity by 8–15%. Conclusions : Critical item analysis enhances the classification accuracy of the optimal LM Recog cutoff (≤20).

The Impact of Learning and Memory on Performance Validity Tests in a Mixed Clinical Pediatric Population.

This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample. Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children's Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included. Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%-26%). Verbal learning/memory performance accounted for 5%-16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group. Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP's embedded validity measure was most strongly impacted by learning/memory performance.

Psychometric implications of failure on one performance validity test: a cross-validation study to inform criterion group definition

ABSTRACT Introduction: Research to date has supported the use of multiple performance validity tests (PVTs) for determining validity status in clinical settings. However, the implications of including versus excluding patients failing one PVT remains a source of debate, and methodological guidelines for PVT research are lacking. This study evaluated three validity classification approaches (i.e. 0 vs. ≥2, 0–1 vs. ≥2, and 0 vs. ≥1 PVT failures) using three reference standards (i.e. criterion PVT groupings) to recommend approaches best suited to establishing validity groups in PVT research methodology. Method: A mixed clinical sample of 157 patients was administered freestanding (Medical Symptom Validity Test, Dot Counting Test, Test of Memory Malingering, Word Choice Test), and embedded PVTs (Reliable Digit Span, RAVLT Effort Score, Stroop Word Reading, BVMT-R Recognition Discrimination) during outpatient neuropsychological evaluation. Three reference standards (i.e. two freestanding and three embedded PVTs from the above list) were created. Rey 15-Item Test and RAVLT Forced Choice were used solely as outcome measures in addition to two freestanding PVTs not employed in the reference standard. Receiver operating characteristic curve analyses evaluated classification accuracy using the three validity classification approaches for each reference standard. Results: When patients failing only one PVT were excluded or classified as valid, classification accuracy ranged from acceptable to excellent. However, classification accuracy was poor to acceptable when patients failing one PVT were classified as invalid. Sensitivity/specificity across two of the validity classification approaches (0 vs. ≥2; 0–1 vs. ≥2) remained reasonably stable. Conclusions: These results reflect that both inclusion and exclusion of patients failing one PVT are acceptable approaches to PVT research methodology and the choice of method likely depends on the study rationale. However, including such patients in the invalid group yields unacceptably poor classification accuracy across a number of psychometrically robust outcome measures and therefore is not recommended.

Concordance Between Standard and Abbreviated Administrations of the Test of Memory Malingering: Implications for Streamlining Performance Validity Assessment

This cross-sectional study examined abbreviated Test of Memory Malingering (TOMM) indices, including Trial 1 (T1) and errors on the first ten items of T1 (TOMMe10), and their respective concordance to assess whether the administration of Trial 2 (T2) provides incremental value. Pass/fail concordance between TOMMe10, T1, and T2 was examined among a diverse mixed clinical sample of 414 neuropsychiatric patients. Of those who failed TOMMe10 or T1, 74% and 77%, respectively, went on to fail T2. For those failing TOMMe10 and T1, 82% failed T2. For those failing T1, 0% passed T2 if T1 was below 30, 13% passed T2 if T1 was 30–34, and 33% passed T2 if T1 was 35–39. Further, 60% of those who failed T1 with scores below 40 also failed two or more independent performance validity tests (PVTs). Using currently accepted practice standards of two or more independent PVT failures as indicative of invalid performance, 93% of those with T1 scores below 30, 80% of those with T1 scores of 30–34, 70% of those with T1 scores of 35–39, and 41% of those with T1 scores of 40–41 failed at least one other independent PVT and, thereby, would be classified clinically as demonstrating invalid neuropsychological test performance. Collectively, results indicated TOMM T2 administration is unnecessary with T1 scores below 35 or above 41. Patients with T1 scores of 35–41 had relatively lower rates of invalid performance on T2, although the implications of potential T1/T2 discrepancies for overall validity status remain unclear.

Boston Naming Test: Lose the Noose.

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation. Participants included a mixed clinical sample of 762 adults, ages 18-88years, seen for neuropsychological evaluation at one of five sites within the USA. Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance. Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Semi-structured interview for personality functioning DSM-5 (STiP-5.1): Psychometric evaluation of the Czech version.

The DSM-5 Alternative Model for Personality Disorders introduced a dimensional perspective on personality disorders and their assessment by measuring personality functioning in the following domains: Identity, Self-Direction, Empathy, and Intimacy. This study provides a replication of the psychometric evaluation of the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1) within a mixed clinical sample and a community sample. The sample consisted of 188 adults: 86 participants from the general population and 102 people from a mixed clinical sample. All participants completed the STiP-5.1 and Level of Personality Functioning Scale-Brief Form (LPFS-BF 2.0). Results showed good internal consistency (McDonald's ω = 0.89-0.94) and promising convergent validity (correlations with LPFS-BF 2.0 above 0.6) of the STiP-5.1. Its scores differentiated participants within the community sample from those in the mixed clinical sample with large effect sizes (rrb = 0.77-0.88). Moreover, the impairment in personality functioning was more pronounced in people with personality disorders than in other psychiatric disorders (medium effect size, rrb = 0.46-0.57), supporting the notion of a continuum of personality functioning impairment. The STiP-5.1 therefore offers an instrument with satisfactory psychometric properties for the assessment of personality functioning both for research and clinical practice.

Assessment of differential neurocognitive performance based on the number of performance validity tests failures: A cross-validation study across multiple mixed clinical samples

Objective: This cross-sectional study examined the effect of number of Performance Validity Test (PVT) failures on neuropsychological test performance among a demographically diverse Veteran (VA) sample (n = 76) and academic medical sample (AMC; n = 128). A secondary goal was to investigate the psychometric implications of including versus excluding those with one PVT failure when cross-validating a series of embedded PVTs. Method: All patients completed the same six criterion PVTs, with the AMC sample completing three additional embedded PVTs. Neurocognitive test performance differences were examined based on number of PVT failures (0, 1, 2+) for both samples, and effect of number of criterion failures on embedded PVT performance was analyzed among the AMC sample. Results: Both groups with 0 or 1 PVT failures performed better than those with ≥2 PVT failures across most cognitive tests. There were nonsignificant differences between those with 0 or 1 PVT failures except for one test in the AMC sample. Receiver operator characteristic curve analyses found no differences in optimal cut score based on number of PVT failures when retaining/excluding one PVT failure. Conclusion: Findings support the use of ≥2 PVT failures as indicative of performance invalidity. These findings strongly support including those with one PVT failure with those with zero PVT failures in diagnostic accuracy studies, given that their inclusion reflects actual clinical practice, does not reduce sample sizes, and does not artificially deflate neurocognitive test results or inflate PVT classification accuracy statistics.

Validation of the Personality Assessment Inventory (PAI) scale of scales in a mixed clinical sample

Objective: This exploratory study examined the classification accuracy of three derived scales aimed at detecting cognitive response bias in neuropsychological samples. The derived scales are composed of existing scales from the Personality Assessment Inventory (PAI). A mixed clinical sample of consecutive outpatients referred for neuropsychological assessment at a large Midwestern academic medical center was utilized. Participants and Methods: Participants included 332 patients who completed study’s embedded and free-standing performance validity tests (PVTs) and the PAI. PASS and FAIL groups were created based on PVT performance to evaluate the classification accuracy of the derived scales. Three new scales, Cognitive Bias Scale of Scales 1–3, (CB-SOS1-3) were derived by combining existing scales by either summing the scales together and dividing by the total number of scales summed, or by logistically deriving a variable from the contributions of several scales. Results: All of the newly derived scales significantly differentiated between PASS and FAIL groups. All of the derived SOS scales demonstrated acceptable classification accuracy (i.e. CB-SOS1 AUC = 0.72; CB-SOS2 AUC = 0.73; CB-SOS3 AUC = 0.75). Conclusions: This exploratory study demonstrates that attending to scale-level PAI data may be a promising area of research in improving prediction of PVT failure.

Examining the Relationship Between CPAP Adherence and Attention/executive functioning Among OSA-Diagnosed Older Adults

<h3>Introduction</h3> BACKGROUND: Obstructive sleep apnea (OSA) is a treatable respiratory condition that becomes more prevalent with age. The extant literature suggests OSA is associated with domain-general cognitive dysfunction, though attention/executive skills may be disproportionately affected (Stranks & Crowe, 2016). Meta-analytic data further suggest that treatment with continuous positive airway pressure (CPAP) can result in small to medium improvements in executive function (Olaithe & Bucks, 2013). However, the relationship between CPAP adherence and executive dysfunction <i>in older adults</i> is less clear – an important target of investigation given mounting evidence demonstrating a link between OSA and age-related cognitive decline, including Alzheimer's disease (Mullins et al., 2020). Accordingly, the current study examined the relationship between self-reported CPAP adherence and attention/executive function, namely basic attention span and executive control, in a mixed clinical sample of older adults with OSA. <h3>Methods</h3> METHODS: Data were obtained from the McLean Hospital Neuropsychology Data Repository, which is a comprehensive, archival dataset comprised of patients who completed a neuropsychological evaluation as part of routine clinical care. The current study examined a transdiagnostic subset of older adults aged 50+ years with OSA. Data were analyzed using univariate general linear models, with self-reported CPAP adherence (i.e., no CPAP vs full/partial adherence) as a fixed factor, performance on each condition of the WAIS-IV Digit Span task as outcome variables, and age as a covariate. <h3>Results</h3> RESULTS: Of the sample used (N=52), 52% were either fully or partially CPAP compliant (n=27), whereas 48% were entirely non-compliant (n=25). Significant performance differences (p<.05) were observed on the digit span backwards task (p=.025), with the full/partial CPAP adherence group (M=53.07, SD=10.183) performing better than the no CPAP (M=47.44, SD=6.764) group. <h3>Conclusions</h3> DISCUSSION: These results suggest that at least some degree of CPAP treatment adherence amongst OSA-diagnosed older adults may improve working memory cognitive processes, compared to non-compliancy. <h3>Limitations</h3> Further research should consider methods for accurately quantifying OSA severity and CPAP treatment (i.e., partial versus full compliancy), distinguishing OSA diagnosis/treatment between different age demographics (i.e., middle adults versus older adults), determining possible relationships between time of diagnosis and initiating treatment/non-treatment, and controlling for co-occurring variables that impact sleep and cognitive functioning (i.e., medication side effects, comorbid vascular and respiratory conditions, psychiatric comorbidities). Future studies should also consider examining larger, age-specific OSA populations, with a more extensive examination of neurocognitive functioning across domains that have been suggested to be strongly influenced by working memory processes (e.g., attention, learning/memory, executive functioning). <h3>Funding</h3> N/A

Replication and cross-validation of the personality assessment inventory (PAI) cognitive bias scale (CBS) in a mixed clinical sample

Objective: This study is a cross-validation of the Cognitive Bias Scale (CBS) from the Personality Assessment Inventory (PAI), a ten-item scale designed to assess symptom endorsement associated with performance validity test failure in neuropsychological samples. The study utilized a mixed neuropsychological sample of consecutively referred patients at a large academic medical center in the Midwest. Participants and Methods:Participants were 332 patients who completed embedded and free-standing performance validity tests (PVTs) and the PAI. Pass and fail groups were created based on PVT performance to evaluate classification accuracy of the CBS. Results: The results were generally consistent with the initial study for overall classification accuracy, sensitivity, and cut-off score. Consistent with the validation study, CBS had better classification accuracy than the original PAI validity scales and a comparable effect size to that obtained in the original validation publication; however, the Somatic Complaints scale (SOM) and the Conversion subscale (SOM-C) also demonstrated good classification accuracy. The CBS had incremental predictive ability compared to existing PAI scales. Conclusions: The results supported the CBS, but further research is needed on specific populations. Findings from this present study also suggest the relationship between conversion tendencies and PVT failure may be stronger in some geographic locations or population types (forensic versus clinical patients).

Validity of In-Home Teleneuropsychological Testing in the Wake of COVID-19.

ObjectiveTeleneuropsychology (TNP) has been shown to be a valid assessment method compared with in-person neuropsychological evaluations. Interest in delivering TNP directly to patients’ homes has arisen in response to the coronavirus disease 2019 (COVID-19) pandemic. However, prior research has typically involved patients tested in clinical settings, and the validity of in-home TNP testing has not yet been established. The present study aims to explore the validity and clinical utility of in-home TNP testing in a mixed clinical sample in the wake of COVID-19.MethodsTest profiles for 111 in-home TNP patients were retrospectively compared with 120 patients who completed in-person evaluations. The TNP test battery consisted of tests measuring attention/processing speed, verbal memory, naming, verbal fluency, and visuoconstruction. TNP scores of cognitively normal (CN) patients were compared with patients with neurocognitive disorders (NCD), and score profiles were examined among suspected diagnostic groups of Alzheimer’s disease (AD), Parkinson’s disease (PD), and vascular disease (VaD).ResultsTNP test scores did not significantly differ from in-person testing across all tests except the Hopkins Verbal Learning Test-Revised Discrimination Index. Within the TNP group, significant differences between the CN and NCD groups were found for all tests, and the memory and semantic fluency tests yielded large effect sizes (d ≥ 0.8). Score profiles among the AD, PD, and VaD groups were explored.ConclusionsThese findings support the validity of in-home TNP testing compared with in-person neuropsychological testing. Practice considerations, limitations, and future directions are discussed.

The path to dissociative experiences: A direct comparison of different etiological models.

Severe dissociation is trauma-related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma-based (e.g., depression, anxiety disorders, and obsessive-compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop-out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between- and within-subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N=98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly-traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

Every second counts: A comparison of four dot counting test scoring procedures for detecting invalid neuropsychological test performance.

Although performance validity tests (PVTs) are an integral element of neuropsychological assessment, most PVTs have historically been restricted to the memory domain. The Dot Counting Test (DCT) is a nonmemory PVT shown to reliably identify invalid performance. Although several traditional and abbreviated scoring methods have been derived, no study to date has directly compared the available scoring approaches within a single sample. This cross-sectional study cross-validated 4 different DCT scoring approaches, including the traditional rounded E-score proposed within the manual, an unrounded E-score, and 2 abbreviated scoring procedures based on 4- and 6-card versions (DCT-4 and DCT-6, respectively) in a diverse mixed clinical neuropsychiatric sample (N = 132). Validity groups were established by 5 independent criterion PVTs (102 valid and 30 invalid). Receiver operating characteristic curve analyses yielded significant areas under the curve (AUCs = .84-.86) for the overall sample, with sensitivities of 50%-67% at ≥ 89% specificity. The DCT scores had outstanding classification accuracy (AUCs ≥ .92; sensitivities = 80%-83%) in the unimpaired group and excellent classification accuracy in the impaired group (AUCs = .79-.81; sensitivities = 43%-60%). Whereas negligible differences emerged between the 4 scoring methods for the cognitively intact group, the DCT-4 showed notably stronger psychometric properties among the overall sample in general and the mild cognitive impairment group in particular. Results corroborate previous findings suggesting that the DCT is a robust PVT, regardless of the employed scoring procedure, and replicate support for the abbreviated DCT-4 as the recommended validity indicator. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mean response latency indices on the Victoria Symptom Validity Test do not contribute meaningful predictive value over accuracy scores for detecting invalid performance

The utility of the Victoria Symptom Validity Test (VSVT) as a performance validity test (PVT) has been primarily established using response accuracy scores. However, the degree to which response latency may contribute to accurate classification of performance invalidity over and above accuracy scores remains understudied. Therefore, this study investigated whether combining VSVT accuracy and response latency scores would increase predictive utility beyond use of accuracy scores alone. Data from a mixed clinical sample of 163 patients, who were administered the VSVT as part of a larger neuropsychological battery, were analyzed. At least four independent criterion PVTs were used to establish validity groups (121 valid/42 invalid). Logistic regression models examining each difficulty level revealed that all VSVT measures were useful in classifying validity groups, both independently and when combined. Individual predictor classification accuracy ranged from 77.9 to 81.6%, indicating acceptable to excellent discriminability across the validity indices. The results of this study support the value of both accuracy and latency scores on the VSVT to identify performance invalidity, although the accuracy scores had superior classification statistics compared to response latency, and mean latency indices provided no unique benefit for classification accuracy beyond dimensional accuracy scores alone.