Phillip K. Martin

[Formula: see text]Neuropsychologists' Validity Testing Beliefs and Practices: A Survey of North American Professionals.

Objective: The current study investigated changes in neuropsychologists’ validity testing beliefs and practices since publication of the last North American survey targeting these issues in 2007 and explored emerging issues in validity testing that had not been previously addressed in the professional survey literature. Methods: Licensed North American neuropsychologists (n = 316), who primarily evaluate adults, were surveyed in regard to the following topics: (1) comparison of objective validity testing, qualitative data, and clinical judgment; (2) approaches to validity test administration; (3) formal communication in cases of suspected malingering; (4) reporting of validity test results; (5) suspected causes of invalidity; (6) integration of stand-alone, embedded, and symptom-report validity measures; (7) multiple performance validity test interpretation; (8) research practices; and (9) popularity of specific validity instruments. Results: Overall, findings from the current survey indicated that all but a small minority of respondents routinely utilize validity testing in their examinations. Furthermore, nearly all neuropsychologists surveyed believed formal validity testing to be mandatory in forensic evaluations and at least desirable in clinical evaluations. While results indicated general agreement among neuropsychologists across many aspects of validity testing, responses regarding some facets of validity test implementation, interpretation, and reporting were more variable. Validity testing utilization generally did not differ according to level of forensic involvement but did vary in respect to respondent literature consumption. Conclusions: Study findings differ significantly from past professional surveys and indicate an increased utilization of validity testing, suggesting a pronounced paradigm shift in neuropsychology validity testing beliefs and practices.

Expert beliefs and practices regarding neuropsychological validity testing

Abstract Objective: The current study investigated expert beliefs and practices as they relate to neuropsychological validity testing. Methods: North American neuropsychologists with expertise in neuropsychological validity testing (n = 24) were surveyed on numerous items related to validity testing. Results were analyzed and compared to findings from a prior expert survey and a recent survey of a general sample of neuropsychological practitioners. Results: Responses varied among experts on some items, indicating that experts have differences of opinion and practice regarding certain validity testing topics. However, expert opinion converged on a number of topics central to validity testing, particularly those highlighting the need for and importance of validity testing in neuropsychological assessment. Notably, expert responses on these topics often agreed with responses obtained from a prior expert sample and a general sample of neuropsychological practitioners. Conclusions: The results allow practitioners to see the range of validity testing beliefs and practices among current experts. Especially in those areas where consensus emerged, the results provide a way for practitioners to determine if their practices are consistent with those of their expert colleagues.

Does True Neurocognitive Dysfunction Contribute to Minnesota Multiphasic Personality Inventory-2nd Edition-Restructured Form Cognitive Validity Scale Scores?

Previous research has demonstrated RBS and FBS-r to identify non-credible reporters of cognitive symptoms, but the extent that these scales might be influenced by true neurocognitive dysfunction has not been previously studied. The present study examined the relationship between these cognitive validity scales and neurocognitive performance across seven domains of cognitive functioning, both before and after controlling for PVT status in 120 individuals referred for neuropsychological evaluations. Variance in RBS, but not FBS-r, was significantly accounted for by neurocognitive test performance across most cognitive domains. After controlling for PVT status, however, relationships between neurocognitive test performance and validity scales were no longer significant for RBS, and remained non-significant for FBS-r. Additionally, PVT failure accounted for a significant proportion of the variance in both RBS and FBS-r. Results support both the convergent and discriminant validity of RBS and FBS-r. As neither scale was impacted by true neurocognitive dysfunction, these findings provide further support for the use of RBS and FBS-r in neuropsychological evaluations.

Rates of Abnormally Low TOPF Word Reading Scores in Individuals Failing Versus Passing Performance Validity Testing.

The present study examined the impact of performance validity test (PVT) failure on the Test of Premorbid Functioning (TOPF) in a sample of 252 neuropsychological patients. Word reading performance differed significantly according to PVT failure status, and number of PVTs failed accounted for 7.4% of the variance in word reading performance, even after controlling for education. Furthermore, individuals failing ≥2 PVTs were twice as likely as individuals passing all PVTs (33% vs. 16%) to have abnormally low obtained word reading scores relative to demographically predicted scores when using a normative base rate of 10% to define abnormality. When compared with standardization study clinical groups, those failing ≥2 PVTs were twice as likely as patients with moderate to severe traumatic brain injury and as likely as patients with Alzheimer’s dementia to obtain abnormally low TOPF word reading scores. Findings indicate that TOPF word reading based estimates of premorbid functioning should not be interpreted in individuals invalidating cognitive testing.

Research methods in performance validity testing studies: criterion grouping approach impacts study outcomes

Abstract Objective: Performance validity test (PVT) research studies commonly utilize a known-groups design, but the criterion grouping approaches within the design vary greatly from one study to another. At the present time, it is unclear as to what degree different criterion grouping approaches might impact PVT classification accuracy statistics. Method: To analyze this, the authors used three different criterion grouping approaches to examine how classification accuracy statistics of a PVT (Word Choice Test; WCT) would differ. The three criterion grouping approaches included: (1) failure of 2+ PVTs versus failure of 0 PVTs, (2) failure of 2+ PVTs versus failure of 0–1 PVT, and (3) failure of a stand-alone PVT versus passing of a stand-alone PVT (Test of Memory Malingering). Results: When setting specificity at ≥.90, WCT cutoff scores ranged from 41 to 44 and associated sensitivity values ranged from .64 to .88, depending on the criterion grouping approach that was utilized. Conclusions: When using a stand-alone PVT to define criterion group status, classification accuracy rates of the WCT were higher than expected, likely due to strong correlations between the reference PVT and the WCT. This held true even when considering evidence that this grouping approach results in higher rates of criterion group misclassification. Conversely, when using criterion grouping approaches that utilized failure of 2+ PVTs, accuracy rates were more consistent with expectations. These findings demonstrate that criterion grouping approaches can impact PVT classification accuracy rates and resultant cutoff scores. Strengths, weaknesses, and practical implications of each of the criterion grouping approaches are discussed.

A tale of two norms: the impact of normative sample selection criteria on standardized scores in older adults

Abstract Objective: Normative sample composition can vary notably as a function of exclusionary criteria in older adult samples given that typical medical conditions of exclusion become more prevalent with age. Older adult norms may consist of typically aging or healthy aging individuals according to the stringency of the exclusion criteria, a difference illustrated when comparing two normative samples for the RBANS: the original standardization sample and the Oklahoma sample. Methods: The current study examined the clinical impact of norm selection in older adults by analyzing impairment classification rates for 105 older adult behavioral health inpatients. Rates of impaired performance (scaled score ≤4 or its normalized equivalent) were compared across RBANS subtests using standardization sample vs. Oklahoma sample normative data in patients aged 70–79 (n = 57) and 80–89 (n = 48). Results: Across most RBANS subtests, utilization of the original standardization sample vs. Oklahoma sample norms resulted in a greater proportion of individuals classified as impaired. These findings occurred across both age groups and persevered when holding constant the sample normalization process. Overall, use of the standardization sample vs. Oklahoma sample normative data were 1–11 times more likely to indicate impairment, with one of the more notable differences seen on the Coding subtest in the 80–89 sample (65% vs. 8% labeled as impaired). Conclusions: Sample composition and exclusionary criteria require consideration when selecting an appropriate normative sample against which to compare older adult test performance. Salient differences between typically aging vs. healthy aging older adult norms are discussed.

Excessive decline from premorbid functioning: detecting performance invalidity with the WAIS-IV and demographic predictions

Abstract Objective: Excessive Decline from Premorbid Functioning (EDPF) is presented as a construct and defined as a discrepancy between predicted premorbid ability and current test performance that is so atypical of individuals with true neurocognitive impairment that it is likely the product of performance invalidity. New embedded PVTs (EDPF-FSIQ, EDPF-VW, and EDPF-PP) were derived by comparing scores from the WAIS-IV to TOPF demographically predicted premorbid estimates and then examined for classification accuracy. Participants and methods: After excluding for dementia, intellectual disability, and left-sided stroke, participants (n = 230) were grouped according to number of PVTs failed. ROC analyses were conducted to determine the accuracy of EDPF indices in classifying patients as failing 0 or ≥2 PVTs within both a mixed neuropsychological outpatient sample and according to specific diagnostic criterion groups. Results: Significant group differences emerged for all EDPF indices (p < .001). EDPF-FSIQ resulted in an AUC of .837, classifying patients with 56% sensitivity at ≥90% specificity, and EDPF-VW resulted in an AUC of .850, classifying patients with 61% sensitivity at ≥90% specificity. Accuracy remained high across diagnostic groups (i.e. neurocognitive, moderate/severe TBI, and psychiatric) for EDPF-VW and EDPF-FSIQ, whereas specificity declined for EDPF-PP in patients with mixed neurocognitive disorders. Overall, classification accuracy rates exceeded those of Reliable Digit Span. Conclusions: Both EDPF-FSIQ and EDPF-VW demonstrated excellent discrimination between patients providing valid versus invalid test performance. Unique advantages of EDPF validity measures include incorporation of demographic estimates of premorbid ability and examination of performances on multiple tests spanning different cognitive domains.

Selection of Normative Group Affects Rates of Mild Cognitive Impairment in Parkinson's Disease: Normative Data and Rates of MCI in PD

Objective: The objective of this study was to examine the impact of different methods of standardizing cognitive data in the Parkinsons Progression Marker Initiative.

An Individualized Music-Based Intervention for Acute Neuropsychiatric Symptoms in Hospitalized Older Adults With Cognitive Impairment: A Prospective, Controlled, Nonrandomized Trial:

Background: Neuropsychiatric symptoms are common features of dementia, and these occur in three fourths of patients on psychogeriatric inpatient units. These symptoms have traditionally been treated with pharmacological agents, but many medications are as likely to harm patients with dementia as to help them. As a result, nonpharmacological interventions are increasingly being investigated as ways to reduce these symptoms. Objective: The current study evaluated the impact of an individualized music-based intervention on agitation, negative mood, positive mood, compliance with care, need for one-on-one nursing staff intervention, and need for PRN medication. Method: Participants in this study were older adults who were admitted to a geriatric behavioral inpatient unit for acute agitation or behavioral disturbance. Twenty patients were in a treatment as usual group and 21 were in the individualized music group. Results: Agitation, negative mood, and positive mood all benefited from the music-based intervention, with resulting large effect sizes. Resisting care level also significantly benefited from the intervention, with a resulting medium effect size. Conclusion: These findings indicate that an easily implemented and reproducible music-based intervention, which is well tolerated and without adverse side effects, can be an effective way to reduce neuropsychiatric symptoms associated with dementia on a hospital unit.

Examination of optimal embedded PVTs within the BVMT-R in an outpatient clinical sample

Abstract Objective: This study investigated whether indices within the Brief Visuospatial Memory Test – Revised (BVMT-R) could function as embedded performance validity measures in an outpatient clinical sample. Method: A sample of 138 neuropsychological outpatients was utilized; approximately 45% had a known or suspected external incentive. Patients were determined to be valid performers if they passed all criterion performance validity tests (PVTs) and determined to be invalid performers if they failed two or more PVTs. BVMT-R indices met criteria for optimal embedded PVTs if they were not significantly correlated with genuine cognitive dysfunction and if they adequately differentiated the validly from invalidly performing patient groups. Classification accuracy statistics for the indices were then calculated. Supplementary analyses were also calculated for a separate dementia sample. Results: Recognition Hits and Recognition Discrimination were identified as two optimal embedded PVTs for patients without dementia. Recognition Hits showed a sensitivity rate of 41% and a specificity rate of 95%. Recognition Discrimination showed a sensitivity rate of 54% and a specificity rate of 93%. Conclusion: Embedded BVMT-R PVTs are discussed in relation to previous research findings, which were obtained from veteran samples. Recognition Hits and Recognition Discrimination are now validated in a non-veteran clinical sample.