Cross validation of the Personality Assessment Inventory (PAI) Cognitive Bias Scale of Scales (CB-SOS) over-reporting indicators in a military sample.

Following the development of the Cognitive Bias Scale (CBS), three other cognitive over-reporting indicators were created. This study cross-validates these new Cognitive Bias Scale of Scales (CB-SOS) measurements in a military sample and contrasts their performance to the CBS. We analyzed data from 288 active-duty soldiers who underwent neuropsychological evaluation. Groups were established based on performance validity testing (PVT) failure. Medium effects (d = .71 to .74) were observed between those passing and failing PVTs. The CB-SOS scales have high specificity (≥.90) but low sensitivity across the suggested cut scores. While all CB-SOS were able to achieve .90, lower scores were typically needed. CBS demonstrated incremental validity beyond CB-SOS-1 and CB-SOS-3; only CB-SOS-2 was incremental beyond CBS. In a military sample, the CB-SOS scales have more limited sensitivity than in its original validation, indicating an area of limited utility despite easier calculation. The CBS performs comparably, if not better, than CB-SOS scales. CB-SOS-2's differences in performance in this study and its initial validation suggest that its psychometric properties may be sample dependent. Given their ease of calculation and relatively high specificity, our study supports the interpretation of elevated CB-SOS scores indicating those who are likely to fail concurrent PVTs.

Evaluating Personality Assessment Inventory Response Patterns in Active-Duty Personnel With Head Injury Using a Latent Class Approach.

OBJECTIVE: Previous research has found that among those with brain injury, individuals have a variety of different potential symptom sets, which will be seen on the Personality Assessment Inventory (PAI). The number of different groups and what they measure have varied depending on the study. METHOD: In active-duty personnel with a remote history of mild traumatic brain injury (n = 384) who were evaluated at a neuropsychology clinic, we used a retrospective database to examine if there are different groups of individuals who have distinct sets of symptoms as measured on the PAI. We examined the potential of distinct groups of respondents by conducting a latent class analysis of the clinical scales. Post hoc testing of group structures was conducted on concurrently administered cognitive testing, performance validity tests, and the PAI subscales. RESULTS: Findings indicate a pattern of broad symptom severity as the most probable reason for multiple groups of respondents, suggesting that there are no distinct symptom sets observed within this population. Pathology levels were the most elevated on internalizing and thought disorder scales across the various class solutions. CONCLUSION: Findings indicate that among active-duty service members with remote brain injury, there are no distinct groups of respondents with different sets of symptom types as has been found in prior work with other neuropsychology samples. We conclude that the groups found are likely a function of general psychopathology present in the population/sample rather than bona fide differences.

Validation of the personality assessment inventory (PAI) cognitive bias (CBS) and cognitive bias scale of scales (CB-SOS) in a post-deployment veteran sample.

Objective: The present study evaluated the function of four cognitive, symptom validity scales on the Personality Assessment Inventory (PAI), the Cognitive Bias Scale (CBS) and the Cognitive Bias Scale of Scales (CB-SOS) 1, 2, and 3 in a sample of Veterans who volunteered for a study of neurocognitive functioning. Method: 371 Veterans (88.1% male, 66.1% White) completed a battery including the Miller Forensic Assessment of Symptoms Test (M-FAST), the Word Memory Test (WMT), and the PAI. Independent samples t-tests compared mean differences on cognitive bias scales between valid and invalid groups on the M-FAST and WMT. Area under the curve (AUC), sensitivity, specificity, and hit rate across various scale point-estimates were used to evaluate classification accuracy of the CBS and CB-SOS scales. Results: Group differences were significant with moderate effect sizes for all cognitive bias scales between the WMT-classified groups (d = .52-.55), and large effect sizes between the M-FAST-classified groups (d = 1.27-1.45). AUC effect sizes were moderate across the WMT-classified groups (.650-.676) and large across M-FAST-classified groups (.816-.854). When specificity was set to .90, sensitivity was higher for M-FAST and the CBS performed the best (sensitivity = .42). Conclusion: The CBS and CB-SOS scales seem to better detect symptom invalidity than performance invalidity in Veterans using cutoff scores similar to those found in prior studies with non-Veterans.

Relationship of Personality Assessment Inventory (PAI) over-reporting scales to performance validity testing in a military neuropsychological sample.

This study evaluated the Personality Assessment Inventory's (PAI) symptom validity-based over-reporting scales with concurrently administered performance validity testing in a sample of active-duty military personnel seen within a neuropsychology clinic. We utilize two measures of performance validity to identify problematic performance validity (pass all/fail any) in 468 participants. Scale means, sensitivity, specificity, predictive value, and risk ratios were contrasted across symptom validity-based over-reporting scales. Results indicate that the Negative Impression Management (NIM), Malingering Index (MAL), and Multiscale Feigning Index (MFI) scales are the best at classifying failed performance validity testing with medium to large effects (d = .61-.73). In general, these scales demonstrated high specificity and low sensitivity. Roger's Discriminant Function (RDF) had negligible group differences and poor classification. The Feigned Adult ADHD index (FAA) performed inconsistently. This study provides support for the use of several PAI over-reporting scales at detecting probable patterns of performance-based invalid responses within a military sample. Military clinicians using NIM, MAL, or MFI are confident that those who elevate these scales at recommended cut scores are likely to fail concurrent performance validity testing. Use of the Feigned Adult FAA and RDF scales is discouraged due to their poor or mixed performance.

Personality Assessment Inventory Cognitive Bias Scale: Validation in a Military Sample.

OBJECTIVE: Recently, in a mixed neuropsychological outpatient sample, a measure of cognitive response bias has been developed for the Personality Assessment Inventory (PAI) called the Cognitive Bias Scale (CBS). This study sought to cross-validate this measure in a military sample. METHOD: Retrospective review of 197 active duty soldiers referred to an Army outpatient clinic for neuropsychological evaluation. Groups were created based on the number of failed performance validity tests (0, 1, or 2-3 performance validity testing [PVT] failures). RESULTS: The magnitude of effect for the 10-item CBS scale was medium-to-large when comparing those with one PVT failure to those with two to three (d = .98) and those with no failures (d = 1.21); however, effects between the 1 and 2-3 PVT failure groups were less pronounced. In 1 and 2-3 PVT failure groups, a score of $\ge$16 had high specificity (.92 and .95, respectively) and low to moderate sensitivity (.20 and .55, respectively). CONCLUSIONS: In a military sample, the CBS demonstrated high specificity with relatively low sensitivity. The measure operated similarly to the original study and the current data supports the CBS to rule in, but not rule out, over-reported cognitive symptoms on the PAI.

Evaluating the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) over-reporting scales in a military neuropsychology clinic.

Introduction: This study examines the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales to detect invalid responding within a sample of active duty United States Army soldiers referred for neuropsychological evaluations.Method: This study examines the relationship between performance validity testing and performance on the MMPI-2-RF over-reporting scales. Specifically, mean differences between those who passed (n = 152; 75.6%) or failed (n = 49; 24.4%) performance validity testing were compared. Receiver operator characteristic analyzes were also conducted to expand available information on the MMPI-2-RF over-reporting sensitivity and specificity in an Army sample.Results: This study has two distinct findings. First, effect size differences between those passing and failing performance validity testing are classified as small to medium in magnitude (ranging from d = . 30/g = .32 on F-r to d = .66/g = .73 on RBS). Second, over-reporting scales have higher specificity and poorer sensitivity. Likewise, performance of the over-reporting scales suggests that those who exceeding recommended cut scores are likely to have failed extra-test performance validity measures.Conclusion: These findings suggest that many who fail external performance measures may be undetected on the MMPI-2-RF over-reporting scales and that those exceeding recommended cut scores are likely to have failed extra-test performance validity testing. Implications for research on, and practice with, the MMPI-2-RF in military populations are discussed.

Performance validity test and neuropsychological assessment battery screening module performances in an active-duty sample with a history of concussion.

The current retrospective investigation sought to replicate previous findings demonstrating the significant impact of performance validity test (PVT) performance and evaluation context on neuropsychological testing. We examined differences on performance validity testing between active-duty service members undergoing neurocognitive screening for concussion who were seen in a clinical context and those who were seen in a disability-seeking context, as well as the overall impact of PVT performance on a neurocognitive screening battery. Overall, 38.2% of the sample failed the Word Memory Test (WMT). Of those involved in a disability evaluation, the failure rate was 51.9%, which was significantly higher than the 36.8% failure rate among those evaluated in a clinical context. The effect size of WMT performance on a cognitive screening measure was also large. The current retrospective analysis served to replicate previous work.

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

The 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.

Comparison of the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index and stand-alone symptom validity tests in a military sample.

The current study sought to report the base rates of Symptom Validity Test (SVT) failure in an active duty military sample as well as to compare the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) to stand-alone measures of symptom validity. SVT failure varied from previous studies and even among different subgroups in the current sample, ranging from 8% to 30%. The RBANS EI demonstrated modest sensitivity in the detection of suboptimal effort when compared with stand-alone SVTs. Although the index appears to add some utility to the detection of suboptimal effort, sole use of the EI as a measure of symptom validity could conceivably result in an unnecessarily high rate of false negatives.