Holly M. Miskey

Embedded Performance Validity Measures with Postdeployment Veterans: Cross-Validation and Efficiency with Multiple Measures

Embedded validity measures support comprehensive assessment of performance validity. The purpose of this study was to evaluate the accuracy of individual embedded measures and to reduce them to the most efficient combination. The sample included 212 postdeployment veterans (average age = 35 years, average education = 14 years). Thirty embedded measures were initially identified as predictors of Green’s Word Memory Test (WMT) and were derived from the California Verbal Learning Test-Second Edition (CVLT-II), Conners’ Continuous Performance Test-Second Edition (CPT-II), Trail Making Test, Stroop, Wisconsin Card Sorting Test-64, the Wechsler Adult Intelligence Scale-Third Edition Letter-Number Sequencing, Rey Complex Figure Test (RCFT), Brief Visuospatial Memory Test-Revised, and the Finger Tapping Test. Eight nonoverlapping measures with the highest area-under-the-curve (AUC) values were retained for entry into a logistic regression analysis. Embedded measure accuracy was also compared to cutoffs found in the existing literature. Twenty-one percent of the sample failed the WMT. Previously developed cutoffs for individual measures showed poor sensitivity (SN) in the current sample except for the CPT-II (Total Errors, SN = .41). The CVLT-II (Trials 1–5 Total) showed the best overall accuracy (AUC = .80). After redundant measures were statistically eliminated, the model included the RCFT (Recognition True Positives), CPT-II (Total Errors), and CVLT-II (Trials 1–5 Total) and increased overall accuracy compared with the CVLT-II alone (AUC = .87). The combination of just 3 measures from the CPT-II, CVLT-II, and RCFT was the most accurate/efficient in predicting WMT performance.

Auditory Consonant Trigrams: A Psychometric Update†.

The Auditory Consonant Trigrams (ACT) test was developed to evaluate immediate memory in the absence of rehearsal. There are few psychometric studies of the measure and a lack of normative data using samples from the United States or Veterans. ACT data were examined for 184 participants who passed the Word Memory Test, denied a history of moderate to severe traumatic brain injury (TBI), and consented for research purposes only. Reliability and construct validity were examined and normative data developed using a healthy subsample. Cronbachs α for the ACT total score was 0.79. Regression analyses suggested that years of education, estimated premorbid IQ, psychomotor speed, working memory, and impulsivity had the strongest relationships with performance on the ACT. Performance was unrelated to posttraumatic stress disorder and remote mild TBI, but the presence of major depressive disorder was associated with lower total scores. These results demonstrate the ACT has adequate psychometric properties.

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology

Objective: Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans. Method: Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25). Results: There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses. Conclusions: This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.

Neurological Symptoms in US Government Personnel in Cuba

plausible cause-of-death codes varied widely among counties, highlighting the potential for differential effects by location. In this study, we used redistribution methods2,3 to reassign deaths from insufficiently specific or implausible cause-of-death codes to likely underlying cause-of-death codes. This approach should mitigate the effect of this particular type of misclassification on spatial patterns in cause-specific mortality.

Evaluating the motor slowing hypothesis of depression

The purpose of this study was to evaluate the hypothesis that processing speed deficits are the primary cognitive deficits in those with depression, consistent with the motor slowing hypothesis. Participants (n=223) were research volunteers who served in the US military since September 11, 2001, and denied a history of significant brain injuries. Depression was measured using a structured interview, the Personality Assessment Inventory (PAI), and the Beck Depression Inventory-II (BDI-II). Outcomes included performance on 10 processing speed variables. Invalid performance/report accounted for significant variance for 8 of 10 processing speed measures. There was not a consistent pattern of slowed processing speed in those with current depressive diagnoses compared to those without. However, depression symptom burden per the PAI Depression scale was significant for 7 of 10 processing speed tests. Only non-dominant fine motor dexterity was significantly slower in those with high versus low burden using BDI-II quartiles. Thus, the motor slowing hypothesis was supported, but only for depression burden and not diagnostic status or high versus low categorical classification. These results underscore the importance of validity assessment and consideration of how one measures psychiatric constructs when evaluating relations among symptoms and cognition.

Word Memory Test Performance Across Cognitive Domains, Psychiatric Presentations, and Mild Traumatic Brain Injury

Objective The current study addressed two aims: (i) determine how Word Memory Test (WMT) performance relates to test performance across numerous cognitive domains and (ii) evaluate how current psychiatric disorders or mild traumatic brain injury (mTBI) history affects performance on the WMT after excluding participants with poor symptom validity. Method Participants were 235 Iraq and Afghanistan-era veterans (Mage = 35.5) who completed a comprehensive neuropsychological battery. Participants were divided into two groups based on WMT performance (Pass = 193, Fail = 42). Tests were grouped into cognitive domains and an average z-score was calculated for each domain. Results Significant differences were found between those who passed and those who failed the WMT on the memory, attention, executive function, and motor output domain z-scores. WMT failure was associated with a larger performance decrement in the memory domain than the sensation or visuospatial-construction domains. Participants with a current psychiatric diagnosis or mTBI history were significantly more likely to fail the WMT, even after removing participants with poor symptom validity. Conclusions Results suggest that the WMT is most appropriate for assessing validity in the domains of attention, executive function, motor output and memory, with little relationship to performance in domains of sensation or visuospatial-construction. Comprehensive cognitive batteries would benefit from inclusion of additional performance validity tests in these domains. Additionally, symptom validity did not explain higher rates of WMT failure in individuals with a current psychiatric diagnosis or mTBI history. Further research is needed to better understand how these conditions may affect WMT performance.

Neuropsychological assessment of a veteran with a large arachnoid cyst

ABSTRACT Arachnoid cysts are benign, congenital masses that are believed to form when the arachnoid membrane splits or is duplicated and the resulting space fills with fluid. Despite their potentially alarming appearance on brain imaging, congenital cysts discovered in adulthood are usually silent and do not result in functional impairment. A left-handed male veteran with mild memory complaints was discovered to have a large (16.4 cm × 7.7 cm), left-sided arachnoid cyst. Magnetic resonance imaging (MRI) revealed significant displacement of brain structures including the hippocampus, Sylvan fissure, and splenium. Viewing brain MRI images in only 1 plane was misleading and could have erroneously resulted in assuming some structures were absent. Viewing multiple planes of section revealed significant structural displacement and provided a better 3-dimensional conceptualization of an abnormal brain. A clinical interview indicated excellent premorbid functioning, and neuropsychological test results were within the normal range with the exception of mildly impaired scores on tests reliant on processing speed and lower-than-expected visual memory scores. Results were consistent with previous research noting retained verbal abilities and low-average visual skills. Low-average and mildly impaired scores were potentially secondary to microvascular changes, slowed visual scanning, psychiatric conditions, and testing base rates.

RBANS Validity Indices: a Systematic Review and Meta-Analysis

Neuropsychology practice organizations have highlighted the need for thorough evaluation of performance validity as part of the neuropsychological assessment process. Embedded validity indices are derived from existing measures and expand the scope of validity assessment. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief instrument that quickly allows a clinician to assess a variety of cognitive domains. The RBANS also contains multiple embedded validity indicators. The purpose of this study was to synthesize the utility of those indicators to assess performance validity. A systematic search was completed, resulting in 11 studies for synthesis and 10 for meta-analysis. Data were synthesized on four indices and three subtests across samples of civilians, service members, and veterans. Sufficient data for meta-analysis were only available for the Effort Index, and related analyses indicated optimal cutoff scores of ≥1 (AUC = .86) and ≥ 3 (AUC = .85). However, outliers and heterogeneity were present indicating the importance of age and evaluation context. Overall, embedded validity indicators have shown adequate diagnostic accuracy across a variety of populations. Recommendations for interpreting these measures and future studies are provided.

Cognitive Symptoms in US Government Personnel in Cuba: The mending is worse than the hole

Sergio Della Sala , Robert D. McIntosh , Roberto Cubelli , Jason A. Kacmarski , Holly M. Miskey d and Robert D. Shura d a Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK b Department of Psychology and Cognitive Sciences, University of Trento, Rovereto, Italy c Health Psychology Section, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA d Mental Health & Behavioral Science Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, NC, USA

Symptom and performance validity with veterans assessed for attention-deficit/hyperactivity disorder (ADHD).

Little is known about attention-deficit/hyperactivity disorder (ADHD) in veterans. Practice standards recommend the use of both symptom and performance validity measures in any assessment, and there are salient external incentives associated with ADHD evaluation (stimulant medication access and academic accommodations). The purpose of this study was to evaluate symptom and performance validity measures in a clinical sample of veterans presenting for specialty ADHD evaluation. Patients without a history of a neurocognitive disorder and for whom data were available on all measures (n = 114) completed a clinical interview structured on DSM–5 ADHD symptoms, the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF), and the Test of Memory Malingering Trial 1 (TOMM1) as part of a standardized ADHD diagnostic evaluation. Veterans meeting criteria for ADHD were not more likely to overreport symptoms on the MMPI-2-RF nor to fail TOMM1 (score ⩽ 41) compared with those who did not meet criteria. Those who overreported symptoms did not endorse significantly more ADHD symptoms; however, those who failed TOMM1 did report significantly more ADHD symptoms (g = 0.90). In the total sample, 19.3% failed TOMM1, 44.7% overreported on the MMPI-2-RF, and 8.8% produced both an overreported MMPI-2-RF and invalid TOMM1. F-r had the highest correlation to TOMM1 scores (r = −.30). These results underscore the importance of assessing both symptom and performance validity in a clinical ADHD evaluation with veterans. In contrast to certain other conditions (e.g., mild traumatic brain injury), ADHD as a diagnosis is not related to higher rates of invalid report/performance in veterans.