Official Position of the American Academy of Clinical Neuropsychology Social Security Administration Policy on Validity Testing: Guidance and Recommendations for Change.

UNLABELLED: The milestone publication by Slick, Sherman, and Iverson (1999) of criteria for determining malingered neurocognitive dysfunction led to extensive research on validity testing. Position statements by the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology (AACN) recommended routine validity testing in neuropsychological evaluations. Despite this widespread scientific and professional support, the Social Security Administration (SSA) continued to discourage validity testing, a stance that led to a congressional initiative for SSA to reevaluate their position. In response, SSA commissioned the Institute of Medicine (IOM) to evaluate the science concerning the validation of psychological testing. The IOM concluded that validity assessment was necessary in psychological and neuropsychological examinations (IOM, 2015 ). OBJECTIVE: The AACN sought to provide independent expert guidance and recommendations concerning the use of validity testing in disability determinations. METHOD: A panel of contributors to the science of validity testing and its application to the disability process was charged with describing why the disability process for SSA needs improvement, and indicating the necessity for validity testing in disability exams. RESULTS: This work showed how the determination of malingering is a probability proposition, described how different types of validity tests are appropriate, provided evidence concerning non-credible findings in children and low-functioning individuals, and discussed the appropriate evaluation of pain disorders typically seen outside of mental consultations. CONCLUSIONS: A scientific plan for validity assessment that additionally protects test security is needed in disability determinations and in research on classification accuracy of disability decisions.

Latent structure of the Wisconsin Card Sorting Test in a clinical sample.

The aims of this study were to: (a) examine the consistency of the published Wisconsin Card Sorting Test (WCST) factor structures; (b) determine the factor structure of the WCST in a large, heterogeneous sample; and (c) compare the WCST factor analytically with other neuropsychological procedures. Two WCST factors (concept formation/perseveration and Failure-to-Maintain-Set [FMS]) were consistently reported in the literature. Our analysis of data from 473 clinical cases replicated the two factors previously reported and revealed a third on which nonperseverative errors (NPE) was the sole salient variable. This pattern was maintained in three of four diagnostically distinct subgroups. These factors are potentially clinically meaningful, with each seeming to reflect one of three qualitatively different performance styles. In the construct validation factor analysis, WCST scores loaded independently of other neuropsychological variables, indicating that the WCST contributes uniquely to neuropsychological evaluation. Nevertheless, despite the rational interpretation of the factors, the cognitive processes underlying WCST performance remain poorly understood. Future directions for the application of these factor analytic findings are discussed.

The Wisconsin Card Sorting Test in stroke rehabilitation: factor structure and relationship to outcome.

The present study attempted to replicate the findings of previous factor analytic studies of the Wisconsin Card Sorting Test (WCST) in a homogeneous sample of patients suffering recent cerebrovascular accidents and being treated in a comprehensive inpatient physical rehabilitation program. In addition this study examined the relationship of the WCST to standard measures of functional ability used in many rehabilitation programs. The results confirmed the previously reported three-factor structure and replicated past findings concerning the test's construct validity. A small but significant relationship was noted between the WCST and functional status, though the WCST did not make a unique contribution to the prediction of functional status at discharge. This study highlights the similarities and differences in WCST factor structure in a stroke sample compared to a more general neurological sample and raises questions about the utility of the WCST in stroke rehabilitation.

Symptom validity testing: a critical review.

This paper provides a comprehensive review of the published literature on symptom validity tests (SVT) and, with the accompanying tables, serves as a reference to assist in their selection, interpretation, and defense. Because malingering is inherently an applied problem that frequently arises in a medico-legal context, the use of SVTs must meet certain standards. Thus, a number of methodological and theoretical weaknesses of SVT research which limit the use of SVTs as clinical tools and sources of evidence are highlighted. These criticisms incorporate recommendations which must be addressed if conclusions based on SVT data are to meet the increasingly rigorous standards for the admissibility of scientific evidence.

Interrater reliability of three clock drawing test scoring systems.

This study demonstrates the reliability of 3 Clock Drawing Test (CDT) scoring systems when applied to the protocols of stroke patients. The sample included 20 randomly selected sets of both freehand and predrawn circle versions ofthe CDT completed by patients undergoing comprehensive stroke rehabilitation. The protocols were scored independently by 2 raters using each of 3 published scoring systems (Freedman et al., 1994; Libon, Malamut, Swenson, Sands, & Cloud, 1996; Rouleau, Salmon, Butters, Kennedy, & McGuire, 1992). Interrater agreement and intrarater consistency were measured using the intraclass correlation coefficient (ICC). The results demonstrate that the raters used comparable criteria for each score (high interrater reliability) and that each applied similar scoring criteria throughout the set of protocols (high intrarater consistency). Scores related to the overall contour of the clockface tended to have lower ICCs. Reliability coefficients were comparable for both CDT versions. The results provide evidence for the accurate and consistent scoring of the CDT in stroke.

Construct validity and predictive value of the Hooper Visual Organization Test in stroke rehabilitation.

The Hooper Visual Organization Test (HVOT; Hooper, 1958) is a commonly used measure of visual perceptual function. However, serious questions have recently been raised about its construct validity (i.e., the role of object naming). This study further examined the HVOT's construct validity and began exploring its contribution to outcome prediction in stroke rehabilitation. Participants were 101 rehabilitation inpatients suffering from recent cerebrovascular accidents. Each participant was administered the HVOT as part of a comprehensive neuropsychological evaluation. Wechsler Adult Intelligence Scale-Revised (Wechsler, 1981) Object Assembly, Picture Completion, and Cognistat Naming were significantly and uniquely correlated with the HVOT and accounted for about 45% of its variance. The HVOT's value in outcome prediction was examined by correlating HVOT with admission and discharge Functional Independence Measure (FIM; Granger & Hamilton, 1990; Hamilton, Granger, Sherwin, Zielezny, & Tashman, 1987) scores. While correlating weakly with some FIM domains, when admission FIM was controlled, the relation between HVOT and discharge FIM became nonsignificant. Implications of these data for the HVOT's clinical utility are discussed.

Classification accuracy of the portland digit recognition test in traumatic brain injury.

This study examined the classification accuracy of the Portland Digit Recognition Test (PDRT) in traumatic brain injury (TBI). It differs from past studies in assigning patients to malingering and control groups on the basis of compensation-seeking status and the presence of external markers for malingering. Sensitivity and Specificity were.77 and 1.00, respectively. Past research comparing compensation-seekers to noncompensation-seekers reported Sensitivities of.33 or lower (Specificity is always high). This study demonstrates that past research has seriously underestimated the Sensitivity of the PDRT and raises questions about the true Sensitivity of other malingering techniques as well.