Nonverbal Medical Symptom Validity Test Research Articles

76 Cross-Cultural Utility of Performance Validity Indicators in a Community Sample from Kampala, Uganda

Objective:Empirical support for inclusion of performance validity testing (PVTs) in neuropsychological assessment continues to grow (Sweet et al., 2021). However, considerable validation is still needed to understand the impact of culturally mediated factors on the reliability of current, commonly used PVTs to accurately classify effort among various cultural groups. This study sought to contribute to the literature by examining the utility of several PVTs in a non-clinical, community-dwelling sample in Kampala, Uganda.Participants and Methods:Participants included 52 residents (25 Female, 27 Male) who were born between 1953-2003 from the Wabigalo community of central Kampala. Individuals were recruited by community leaders and volunteered to participate. All 52 participants were administered the Dot Counting Test (DCT; Boone et al., 2002), Test of Memory Malingering (TOMM; Tombaugh, 1997), and Rey 15-Item Memorization Test (Rey 15; Lezak, 1995). Twenty-five participants also completed Green’s Non-Verbal Medical Symptom Validity Test (NV-MSVT; Green, 2006). Data from three participants was excluded due to suspected memory concerns. Instructions for all tests were translated into Luganda by a professional translator with experience in Luganda and were administered by Luganda-speaking individuals.Results:Using test manual-derived cut scores, 71.4% (n = 35) participants scored in the invalid range on the DCT, 10.2% (n = 5) produced total combined scores in the invalid range on Rey 15, 6.1% (n = 3) failed TOMM Trial 2, and one participant (4.3%) exceeded cut-offs on Green’s NV-MSVT.Conclusions:In this non-clinical sample, manual cutoffs for DCT contributed to a high type-1 error rate. These findings suggest that culturally mediated factors may contribute to differences in engagement or performance on DCT. Future studies should explore these factors and continue to examine the utility of widely used tests in diverse samples.

Grooved Pegboard adds incremental value over memory-apparent performance validity tests in predicting psychiatric symptom report

The present study evaluated whether Grooved Pegboard (GPB), when used as a performance validity test (PVT), can incrementally predict psychiatric symptom report elevations beyond memory-apparent PVTs. Participants (N = 111) were military personnel and were predominantly White (84%), male (76%), with a mean age of 43 (SD = 12) and having on average 16 years of education (SD = 2). Individuals with disorders potentially compromising motor dexterity were excluded. Participants were administered GPB, three memory-apparent PVTs (Medical Symptom Validity Test, Non-Verbal Medical Symptom Validity Test, Reliable Digit Span), and a symptom validity test (Personality Assessment Inventory Negative Impression Management [NIM]). Results from the three memory-apparent PVTs were entered into a model for predicting NIM, where failure of two or more PVTs was categorized as evidence of non-credible responding. Hierarchical regression revealed that non-dominant hand GPB T-score incrementally predicted NIM beyond memory-apparent PVTs (F(2,108) = 16.30, p < .001; R2 change = .05, β = −0.24, p < .01). In a second hierarchical regression, GPB performance was dichotomized into pass or fail, using T-score cutoffs (≤29 for either hand, ≤31 for both). Non-dominant hand GPB again predicted NIM beyond memory-apparent PVTs (F(2,108) = 18.75, p <.001; R2 change = .08, β = −0.28, p < .001). Results indicated that noncredible/failing GPB performance adds incremental value over memory-apparent PVTs in predicting psychiatric symptom report.

Validation of grooved pegboard cutoffs as an additional embedded measure of performance validity

Objective Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand ( 29) or both hands ( 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). Method Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as “passing” or “failing” the GPBviaErdodi’s proposed criteria. “Failures” on the MSVT, NV-MSVT, and RDS were based on conventional recommendations. Results Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.’s initial findings. Conclusion These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of ­performance validity.

The Development and Validation of the Embedded Validity Indicator for the Neuropsychological Assessment Battery.

The purpose of this study was to develop and validate an embedded measure of performance validity within the Neuropsychological Assessment Battery (NAB). This study involved a retrospective chart review at an outpatient neuropsychology clinic. Participants were 183 adults (ages 18-70) who completed the attention and memory modules of the NAB, as well as the Word Choice Test, Green's Medical Symptom Validity Test (MSVT), and Green's Non-Verbal MSVT, as part of a clinical neuropsychological assessment (n=147) or as part of a forensic neuropsychological evaluation (n=36). Replicating methodology utilized by Silverberg etal. (2007) for the development of the Effort Index within the Repeatable Battery for the Assessment of Neuropsychological Status, an Embedded Validity Indictor (EVI) for the NAB was developed in the present study based on Digits Forward and List Learning Long Delayed Forced-Choice Recognition (list recognition) subtests. Receiver operating characteristic curve analyses indicated the newly developed NAB EVI was able to significantly differentiate between valid and invalid status on stand-alone performance-validity tests, with area under the curve values ranging from 0.797 to 0.977. Optimal cutoffs for medical, forensic, and mixed samples were identified. The newly developed NAB EVI shows promise as an embedded performance validity measure; however, due to moderate sensitivity, it should be used in combination with stand-alone performance validity tests to detect invalid performance.

A-224 Clinical Utility of Grooved Pegboard as an Additional Embedded Measure of Performance Validity

Abstract Objective Previously, the Grooved Pegboard Test (GPB) has shown potential as an embedded measure of performance validity (PVT) using a T-score cutoff for either hand (≤ 29) or both hands (≤ 31). This study sought to validate these cutoffs with established PVTs (Medical Symptom Validity Test [MSVT], Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). Method Subjects (N = 190) were primarily Caucasian (85%) and male (81%). Average age and education were 41 (SD = 11.62) and 16 years (SD = 2.35), respectively. Participants were stratified as GPB “pass or fail” based on previously proposed cutoff criteria. MSVT, NV-MSVT, and RDS were also dichotomized as pass or fail based on manual or conventional recommendations. Results Chi-Square analyses revealed significant associations between GPB “fails” for both hands and MSVT, NV-MSVT, and RDS (χ2 (1, n = 190) ranging from 5.80 to 15.98, Phi ranging from .18 to .29, p ranging from &amp;lt; .05 to &amp;lt; .0001). Similar findings were observed for dominant hand “fails”; however, non-dominant hand was only related to the MSVT. Sensitivity and specificity values from the GPB measures ranged from .47 to .58 and from .89 to .92, respectively. Positive and negative predictive power ranged from .38 to .45 and .93 to .94, respectively. Conclusion These data demonstrate the relative utility of the GPB as an embedded PVT. In particular, dominant and both hand cutoffs are likely to be more clinically useful in determining sub-optimal performance. However, as sensitivity is relatively low, this measure should not be employed as the sole PVT administered.

Validation of the Test of Memory Malingering in a Clinical Population from Singapore

The present research aims to establish the predictive validity of the Test of Memory Malingering (TOMM) in a Singaporean sample with mood and psychotic disorders. Its clinical utility was compared against other performance validity tests: Dot Counting Test (DCT), Rey 15-Item Memory Test II (Rey II), Medical Symptom Validity Test (MSVT), Nonverbal Medical Symptom Validity Test (NV-MSVT), Word Memory Test (WMT) and Victoria Symptom Validity Test (VSVT). Findings revealed that TOMM, MSVT, NV-MSVT, WMT and VSVT preserved the ability to distinguish between Clinical participants' simulation groups, and TOMM outperformed all tests except NVMSVT. Overall, findings supported continued use of TOMM.

The Impact of Self-Efficacy and Health Locus of Control on Performance Validity Testing.

Recent research has examined potential influences to performance validity testing beyond intentional feigning. The current study sought to examine the hypothesized relationships of two psychological constructs (self-efficacy and health locus of control) with performance validity testing (PVT). Retrospective review of 158 mild traumatic brain injury (mTBI) cases referred to an Army outpatient clinic for neuropsychological evaluation. The mTBI cases were classified according to passing or failing the Medical Symptom Validity Test (MSVT) or Non-Verbal Medical Symptom Validity Test (NV-MSVT). Group comparisons were performed utilizing one-way ANOVA to evaluate the differences between the PVT-Pass and PVT-Fail groups on self-efficacy (MMPI-2-RF Inefficacy scale) and locus of control (Multi-Dimensional Health Locus of Control). There was no relationship between self-efficacy or health locus of control and passing/failing PVTs. Further research is warranted to explore potential influences on PVT performance, which we conceptualize as analogous to experimental nuisance variables that may be amenable to intervention.

Introduction to special issue on effort testing in children and adolescents

This manuscript reviews the past history of effort testing in children and adolescents. Results in children and adults are briefly described on tests such as the Word Memory Test (WMT), the Medical Symptom Validity Test (MSVT), the Nonverbal Medical Symptom Validity Test (NV-MSVT) and Test of Memory Malingering (TOMM). Articles in the Special Issue are also briefly described.

Noncredible effort on the Nonverbal-Medical Symptom Validity Test (NV-MSVT): Impact on cognitive performance in pediatric mild traumatic brain injury

This study examined failure rates on the Nonverbal-Medical Symptom Validity Test (NV-MSVT) and its impact on cognitive performance in a sample of youths with mild traumatic brain injury (mTBI). Participants were 184 children and adolescents who presented to a multidisciplinary concussion clinic for a targeted neuropsychological evaluation. Performance Validity Tests (PVTs) were a part of the standard battery, including the NV-MSVT. Twenty-eight participants (15.2%) failed the NV-MSVT, none of whom displayed a genuine memory impairment profile (GMIP). Participants who failed the NV-MSVT performed significantly worse than those who passed the NV-MSVT on measures of IQ, memory, and immediate attention/working memory. There was no significant difference between groups on processing speed, sustained attention, cognitive flexibility, or sight word reading level. Aside from a slight difference in age, NV-MSVT failure was not impacted by demographic variables (sex, race), premorbid risk factors (pre-injury ADHD, learning disabilities, psychiatric diagnoses or treatment, developmental delays, or prior special education), injury-related variables (time since injury, positive neuroimaging findings, post-traumatic amnesia, number of prior mTBIs, etc.) or post-mTBI anxiety/depression. That said, participants who failed NV-MSVT endorsed significantly more severe postconcussive symptoms. These findings support the use of the NV-MSVT in neuropsychological evaluation of children and adolescents with mTBI.

Self-efficacy and Performance Validity Testing in Active Duty Service Members

Abstract Objective The base rate of performance validity test (PVT) failure in the military has been relatively well established and averages approximately 33% in clinical and 50% in disability samples, respectively. Secondary gain is an omnipresent concern; however, frank malingering may not account for all cases of PVT failure. As a result, other psychological and social factors potentially associated with PVT failure have been suggested and include nocebo effect, diagnosis threat, perceived injustice, and loss aversion. Self-efficacy has been associated with a range of medical and psychological conditions and outcomes. It was hypothesized that self-efficacy would be among the psychosocial factors impacting PVT failure. Method A retrospective review of 263 US Service Members administered the MMPI-2-RF and the Medical Symptom Validity Test (MSVT) and/or the Non-Verbal MSVT (NV-MSVT) in the context of neuropsychological assessments was conducted. Results Correlations between the MMPI-2-RF Inefficacy sub-scale (NFC) and MSVT and NV-MSVT were not statistically significant (r = -0.10, p = .12 &amp; r = -.04, p = .53, respectively). Moreover, the Inefficacy sub-scale did not significantly differ as a function of PVT performance (non-significant t-tests) and effect sizes were low (Cohen’s d of .22 [MSVT] and .11 [NV-MSVT]). Conclusions Contrary to initial expectations, the current data failed to demonstrate a reliable relationship between self-efficacy and PVT performances. While various psychosocial variables have been associated with performance validity testing, it appears that self-efficacy is not.

Factor Analysis of the MSVT, NV-MSVT, and RBANS Memory Subtests.

The current investigation sought to define the relationship between established performance validity tests and measures of memory via a factor analytic strategy first published by Heyanka, Thaler, Linck, Pastorek, Miller, Romesser, & Sim (2015). A Factor analytic approach to the validation of the Word Memory Test and Test of Memory Malingering as measures of effort and not memory. Archives of Clinical Neuropsychology, 30, 369-376. The full range of Medical Symptom Validity Test (MSVT) and Non-Verbal Medical Symptom Validity Test (NV-MSVT) subtests were factor analyzed with the memory scales of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a sample of 346 service members with a history of concussion. A two-factor solution was extracted with the MSVT and NV-MSVT effort and paired associate subtests loading on one factor and the RBANS subtests loading on a second factor. Results support the conclusion that the effort subtests of the MSVT and NV-MSVT tap a different construct from established memory measures.

Clinical utility of the memory complaints inventory to detect invalid test performance

Objective: This investigation was designed to examine the classification statistics of Memory Complaints Inventory (MCI) scores relative to the Medical Symptom Validity Test (MSVT) and the Non-Verbal Medical Symptom Validity Test (NV-MSVT), as well as various validity scales on the Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory-2 Restructured Form(MMPI-2-RF). Method: The sample consisted of 339 active duty service members with a history of concussion who completed performance validity tests (PVTs), symptom validity tests (SVTs), and the MCI. Results: Those who failed the MSVT and NV-MSVT had significantly higher scores across all MCI scales. In addition, those who scored above specified cut scores on the evaluated PAI and MMPI-2-RF validity scales also had significantly higher MCI scale scores. Receiver operator characteristics analysis demonstrated acceptable area under the curve (AUC) across the evaluated SVTs for the mean of all MCI subtests with values ranging from (.77 to .86), with comparable findings for PVTs (MSVT AUC = .75; NV-MSVT AUC = .72). Conclusions: In general the MCI scales demonstrated better classification statistics relative to SVTs vs. PVTs, which is consistent with the nature of the MCI as a self-report instrument.

The role of performance validity tests in the assessment of cognitive functioning after military concussion: A replication and extension

ABSTRACTThe current investigation is a replication and extension of a previously published study by Cooper, Vanderploeg, Armistead-Jehle, Lewis, and Bowles (2014) demonstrating that performance validity test scores accounted for more variance in cognitive testing among service members with a history of concussion than did demographic variables, etiology of and time since injury, and symptom severity. The present study included a sample of 142 active-duty service members evaluated following a suspected or confirmed history of mild traumatic brain injury. Participants completed a battery of neuropsychological measures that included scales of performance and symptom validity (specifically the Medical Symptom Validity Test, Nonverbal Medical Symptom Validity Test, and Personality Assessment Inventory). Among the factors considered in the current study, performance validity test results accounted for the most variance in cognitive test scores, above demographic, concussion history, symptom validity, and psychological distress variables. Performance validity test results were modestly related to symptom validity as measured by the Personality Assessment Inventory Negative Impression Management scale. In sum, the current results replicated the original Cooper et al. study and highlight the importance of including performance validity tests as part of neurocognitive evaluation, even in clinical contexts, within this population.

Results From Three Performance Validity Tests in Children With Intellectual Disability

If we wish to conclude that failure on a performance validity test (PVT) is a false positive for poor effort, we must have evidence that the person is truly incapable of passing the test because of cognitive impairment. We must show that they have a diagnostic condition that is sufficient to account fully for failure on that test. The purpose of the current study was to evaluate the performance of children with a primary diagnosis of intellectual disability (ID) on the Word Memory Test (WMT), the Medical Symptom Validity Test (MSVT), and the Nonverbal Medical Symptom Validity Test (Green, 2003, 2004, 2008b; Green & Astner, 1995). If a Full-Scale IQ (FSIQ) less than 70 could account for failure on these tests in adults, then children with ID would also fail them. In fact, the children with ID in the current study did not fail the WMT or MSVT as long as they had at least a Grade 3 reading level. Also, the children with ID did not fail these tests any more often than did children of significantly higher intelligence. The data suggest that an FSIQ in the range of 48 to 70 is not sufficient to explain failure on these PVTs by children or adults.

Rates of Effort Test Failure in Children With ADHD: An Exploratory Study

The present study assessed performance on symptom validity tests (SVTs) and various cognitive-processing measures to evaluate the impact of having attention-deficit hyperactivity disorder (ADHD) on SVT performance using a clinical sample of 73 children aged 7 to 18 years old who had a previous diagnosis of ADHD. Cognitive impairment associated with ADHD may lead these individuals to perform poorly on what are considered to be relatively easy but boring SVTs. Few clients in this sample returned a score pattern on the Word Memory Test, Medical Symptom Validity Test, or Nonverbal Medical Symptom Validity Test that would have classified them as having invested poor effort; the Computerized Assessment of Response Bias returned higher rates of failure. In the absence of a lifelong history of severe attention and impulse control problems, and especially where secondary gains exist for obtaining a diagnosis, clinicians should interpret low scores on these SVTs as indicating low effort or noncredible performance as opposed to failure due to the symptoms of ADHD.

Discriminating Among ADHD Alone, ADHD With a Comorbid Psychological Disorder, and Feigned ADHD in a College Sample

Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. Because ADHD is thought to have accompanying conditions at rates of 50% and higher, it is important to determine if the additional psychological disorders might compromise the accuracy of feigning detection measures. The present study extended the findings of Jasinski et al. (2011) to examine the efficacy of various measures in the context of feigned versus genuine ADHD with comorbid psychological disorders in undergraduate students. Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).

The Detection of Feigned Impairment Using the WMT, MSVT, and NV-MSVT

The current study sought to evaluate the sensitivity of the Word Memory Test, Medical Symptom Validity Test, and the Nonverbal Medical Symptom Validity Test (NV-MSVT) in a group of 50 well-educated individuals asked to simulate dementia. With use of the Genuine Memory Impairment Profile as operationalized by the Advanced Interpretation Program, sensitivities for single measures and the measures in combination ranged from 54% to 98% in the detection of suboptimal effort. Overall, the NV-MSVT appeared the most sensitive to feigned memory impairment in this sample.

Welcoming a Paradigm Shift in Occupational Therapy: Symptom Validity Measures and Cognitive Assessment

Until now, occupational therapists have been limited in their ability to access methods designed to ensure that formal cognitive and psychosocial testing results were valid. These standardized symptom validity tests (SVTs) are now considered mandatory during neuropsychological testing, particularly within a medical-legal context. The purpose of this study was to evaluate the use of symptom validity testing by occupational therapists involved in a medical-legal setting and to determine whether data obtained are in keeping with findings from other professions. Thirty-six consecutive medical-legal clients were administered the Nonverbal Medical Symptom Validity Test, the Medical Symptom Validity Test, or both during the course of standardized testing. Test administration revealed a failure rate on SVTs of 48%, indicating other occupational therapy formal cognitive or psychosocial test results within those assessments were invalid. These findings are in keeping with a vast international body of research on use of symptom validity measures. We recommend implementation of symptom validity measures in all cognitive and psychosocial test situations.

The Effects of Coaching on the Verbal and Nonverbal Medical Symptom Validity Tests

Evaluation of resistance to coaching is an important step in the validation of symptom validity tests (SVTs) for clinical use in neuropsychological evaluations. In the present study coaching effects were evaluated for two recently developed SVTs, the Medical Symptom Validity Test (MSVT) and Nonverbal Medical Symptom Validity Test (NVMSVT) as compared with a well-validated existing SVT, the Test of Memory Malingering (TOMM). This study used a simulation design that included 103 healthy younger study volunteers who were randomly assigned into one of four conditions: Symptom Coaching, Test Coaching, Combined Coaching, or Best Effort Control. Specificity for all SVTs was excellent (96–100%). Test Coaching, either alone or combined with Symptom Coaching, was more effective than Symptom Coaching alone in producing raw scores suggestive of “better” effort for all SVTs. However, there were only modest declines in the obtained sensitivity, which remained above 80% for all SVTs. These results provide empirical support for the classification accuracy of the MSVT and NVMSVT, even when challenged with combined coaching interventions. However, further validation using known-groups designs and clinical samples is needed.

Using Symptom Validity Tests to Detect Malingered ADHD in College Students

Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.