Faculty Bibliography

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).

The Victoria Symptom Validity Test (VSVT) is a performance validity test (PVT) with over two decades of empirical backing, although methodological limitations within the extant literature restrict its clinical and research generalizability. Chief among these constraints includes limited consensus on the most accurate index within the VSVT and the most appropriate cut-scores within each VSVT validity index. The current systematic review synthesizes existing VSVT validation studies and provides additional cross-validation in an independent sample using a known-groups design. We completed a systematic search of the literature, identifying 17 peer-reviewed studies for synthesis (7 simulation designs, 7 differential prevalence designs, and 3 known-groups designs). The independent cross-validation sample consisted of 200 mixed clinical neuropsychiatric patients referred for outpatient neuropsychological evaluation. Across all indices, Total item accuracy produced the strongest psychometric properties at an optimal cut-score of ≤ 40 (62% sensitivity/88% specificity). However, ROC curve analyses for all VSVT indices yielded statistically significant areas under the curve (AUCs; .73-81), suggestive of moderate classification accuracy. Cut-scores derived using the independent cross-validation sample converged with some previous findings supporting cut-scores of ≤ 22 for Easy item accuracy and ≤ 40 for Total item accuracy, although divergent findings were noted for Difficult item accuracy. Overall, VSVT validity indicators have adequate diagnostic accuracy across populations, with the current study providing additional support for its use as a psychometrically sound PVT in clinical settings. However, caution is recommended among patients with certain verified clinical conditions (e.g., dementia) and those with pronounced working memory deficits due to concerns for increased risk of false positives.

Thorough assessment of performance validity has become an established standard of practice in neuropsychological assessment. While there has been a large focus on the development and cross-validation of embedded performance validity tests (PVTs) in recent years, new freestanding PVTs have also been developed, including the Word Choice Test (WCT) as part of the Advanced Clinical Solutions Effort System. And, while the WCT's general utility for identifying invalid performance has been demonstrated in the ensuing decade since its initial publication, optimal cut-scores and associated psychometric properties have varied widely across studies. This study sought to synthesize the existing diagnostic accuracy literature regarding the WCT via a systematic review and to conduct a meta-analysis to determine the performance validity cut-score that best maximizes sensitivity while maintaining acceptable specificity. A systematic search of the literature resulted in 14 studies for synthesis, with eight of those available for meta-analysis. Meta-analytic results revealed an optimal cut-score of ≤ 42 with 54% sensitivity and 93% specificity for identifying invalid neuropsychological test performance. Collectively, the WCT demonstrated adequate diagnostic accuracy as a PVT across a variety of populations. Recommendations for future studies are also provided.

This study evaluated multiple previously-identified Continuous Performance Test-Third Edition (CPT-3) scores as embedded validity indicators (EVIs) among 201 adults undergoing neuropsychological evaluation for Attention-Deficit/Hyperactivity Disorder (ADHD) divided into valid (n = 169) and invalid (n = 32) groups based on seven criterion measures. Although 6/10 CPT-3 scores accurately detected invalidity, only two reached minimally acceptable classification accuracy of ≥0.70. The remaining four had unacceptably low accuracy (AUCs = 0.62-0.69) with 0.19-0.41 sensitivity at ≥0.90 specificity. Composite scores did not provide better classification accuracy than individual CPT-3 scores. In sum, CPT-3 individual and composite scores generally are not accurate PVTs among adults undergoing clinical evaluation for ADHD.

This cross-sectional study evaluated eight embedded performance validity tests (PVTs) previously derived from the Rey Auditory Verbal Learning Test (RAVLT), Wechsler Memory Scale-IV-Logical Memory (LM), and Brief Visuospatial Memory Test-Revised (BVMT-R) recognition trials among a single mixed clinical sample of 108 neuropsychiatric patients (83 valid/25 invalid) with (n = 54) and without (n = 29) mild neurocognitive disorder. Among the overall sample, all eight recognition PVTs significantly differentiated valid from invalid performance (areas under the curve [AUCs] = .64-.81) with 26% to 44% sensitivity (≥89% specificity) at optimal cut-scores depending on the specific PVT. After subdividing the sample by cognitive impairment status, all eight PVTs continued to reliably identify invalid performance (AUC = .68-.91) with markedly increased sensitivities of 56% to 80% (≥89% specificity) in the unimpaired group. In contrast, among those with mild neurocognitive disorder, RAVLT False Positives and LM became nonsignificant, whereas the other six PVTs remained significant (AUC = .64-.77), albeit with reduced sensitivities of 32% to 44% (≥89% specificity) at optimal cut-scores. Taken together, results cross-validated BVMT-R and most RAVLT recognition indices as effective embedded PVTs for identifying invalid neuropsychological test performance with diverse populations including examinees with and without suspected mild neurocognitive disorder, whereas LM had more limited utility as an embedded PVT, particularly when mild neurocognitive disorder was present.

OBJECTIVE:High intelligence (IQ) adults with attention-deficit/hyperactivity disorder (ADHD) often perform better on neuropsychological tests relative to average IQ adults with ADHD, despite commensurate functional impairment. This study compared adults with ADHD and high versus average IQ on the Rey Auditory Verbal Learning Test (RAVLT) to specifically assess this proposed masking effect of IQ on verbal learning/memory performance among those undergoing neuropsychological evaluation. METHOD/METHODS:RAVLT performance between patients with ADHD and average versus high Test of Premorbid Function-estimated IQ were compared. Latent growth curve modeling (LGCM) evaluated learning acquisition across trials. RESULTS:RAVLT total learning, immediate, and delayed free recall performances were significantly better in the high IQ relative to the average IQ group. LGCM showed similar quadradic growth trajectories for both IQ groups. Both groups reported equivalent symptom severity and functional complaints in childhood and adulthood. CONCLUSIONS:Adults with ADHD and high IQ performed normally on a verbal learning/memory test compared to adults with average IQ, who scored 0.5-1.0 standard deviations below the mean. These results suggest a masking of performance-based memory deficits in the context of higher IQ in adults with ADHD, supporting growing evidence that higher IQ masks neurocognitive deficits during the assessment of adults with ADHD.

Objectives Stroke and post-stroke complications are associated with high morbidity, mortality, and cost. Our objective was to examine healthcare utilization and hospice enrollment for stroke patients at the end of life. Materials and methods The 2014 Nationwide Readmissions Database is a national database of > 14 million admissions. We used validated ICD-9 codes to identify fatal ischemic stroke, summarized demographics and hospitalization characteristics, and examined healthcare use within 30 days before fatal stroke admission. We used de-identified 2014 Medicare hospice data to identify stroke and non-stroke patients admitted to hospice. Results Among IS admissions in 2014 (n = 472,969), 22652 (4.8%) had in-hospital death. 28.2% with fatal IS had two or more hospitalizations in 2014. Among those with fatal IS admission, 13.0% were admitted with cerebrovascular disease within 30 days of fatal IS admission. Half of stroke patients discharged to hospice from the Medicare dataset were hospitalized with cerebrovascular disease within the thirty days prior to hospice enrollment. Within the study year, 6.9% of hospice enrollees had one or more emergency room visits, 31.7% had one or more inpatient encounters, and 5.2% had one or more nursing facility encounters (compared to 21.4%, 70.6%, and 27.2% respectively in the 30-day period prior to enrollment). Conclusions High rates of readmission prior to fatal stroke may indicate opportunity for improvement in acute stroke management, secondary prevention, and palliative care involvement as encouraged by AHA/ASA guidelines. For patients who are expected to survive 6 months or less, hospice may offer goal-concordant services for patients and caregivers who desire comfort-focused care.