Therapeutic assessment and the art of feedback: A model for integrating evidence-based assessment and therapy techniques in neurological rehabilitation.

BACKGROUND: Therapeutic assessment involves the integration of evidence-based approaches and humanistic principles, and there is empirical support for the use of this approach in the context of neuropsychological assessment broadly. OBJECTIVE: We propose that therapeutic assessment (TA) and collaborative therapeutic neuropsychological assessment (CTNA) principles are appropriate and effective for application within a neurological rehabilitation population specifically. METHODS: We review TA and CTNA principles and propose a model for their application to a neurological rehabilitation population, with an emphasis on describing the strengths of the collaborative approach, guidelines and principles for maximizing the efficacy of feedback, and transitioning the patient into psychotherapy services to further address their personal goals. A case example of a neurologically injured individual engaged in CTNA and subsequent intervention is shared to highlight the principles discussed. RESULTS AND CONCLUSION: The proposed model and case study demonstrate the clinical utility of TA and CTNA principles with a neurological rehabilitation population.

Impact of criterion measures on the classification accuracy of TOMM-1.

This study was designed to examine the effect of various criterion measures on the classification accuracy of Trial 1 of the Test of Memory Malingering (TOMM-1), a free-standing performance validity test (PVT). Archival data were collected from a case sequence of 91 (M Age = 42.2 years; M Education = 12.7) patients clinically referred for neuropsychological assessment. Trials 2 and Retention of the TOMM, the Word Choice Test, and three validity composites were used as criterion PVTs. Classification accuracy varied systematically as a function of criterion PVT. TOMM-1 ≤ 43 emerged as the optimal cutoff, resulting in a wide range of sensitivity (.47-1.00), with perfect overall specificity. Failing the TOMM-1 was unrelated to age, education or gender, but was associated with elevated self-reported depression. Results support the utility of TOMM-1 as an independent, free-standing, single-trial PVT. Consistent with previous reports, the choice of criterion measure influences parameter estimates of the PVT being calibrated. The methodological implications of modality specificity to PVT research and clinical/forensic practice should be considered when evaluating cutoffs or interpreting scores in the failing range.

A comparison of the MMPI-2-RF and PAI overreporting indicators in a civil forensic sample with emphasis on the Response Bias Scale (RBS) and the Cognitive Bias Scale (CBS).

The Cognitive Bias Scale (CBS; Gaasedelen, Whiteside, Altmaier, Welch, & Basso, 2019) was developed as a Personality Assessment Inventory (PAI) indicator of poor performance on Performance Validity Tests (PVTs) in a neuropsychological context. The current study aimed to investigate the effectiveness of the CBS in a forensic disability sample through a series of analyses by comparing it to other PAI validity scales and the Minnesota Multiphasic Personality Inventory (MMPI)-2-RF overreporting scales with an emphasis on the Response Bias Scale (RBS), which guided the development of the CBS. The participants in this study were drawn from an archival dataset containing 588 consecutive civil disability claimants. Findings showed the RBS and the CBS yielded similar patterns of negative correlations to PVTs, with RBS effect sizes being somewhat larger in most comparisons. Results of ANOVAs showed that the RBS produced the largest effect sizes in distinguishing between incentive only versus probable/definite malingered neurocognitive dysfunction (MND) groups, followed by the CBS. Estimates of sensitivity and specificity were comparable between the RBS and CBS at liberal cut scores, but the RBS was more specific to detecting Probable/Definite MND at more conservative cutoffs. Hierarchical logistic regression analyses showed that RBS accounted for 6% variance over CBS in the probable/definite MND classification, whereas the CBS accounted for 2% variance beyond the RBS. Overall, the results of this study support the utility of the CBS as the most effective PAI validity scale for detecting MND in a civil disability sample, and the RBS generally outperformed the CBS to some degree in all analyses. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Wisconsin Card Sorting Test embedded validity indicators developed for adults can be extended to children.

Past studies have examined the ability of the Wisconsin Card Sorting Test (WCST) to discriminate valid from invalid performance in adults using both individual embedded validity indicators (EVIs) and multivariate approaches. This study is designed to investigate whether the two most stable of these indicators-failures to maintain set (FMS) and the logistical regression equation S-BLRE-can be extended to pediatric populations. The classification accuracy for FMS and S-BLRE was examined in a mixed clinical sample of 226 children aged 7 to 17 years (64.6% male, MAge = 13.6 years) against a combination of established performance validity tests (PVTs). The results show that at adult cutoffs, FMS and S-BLRE produce an unacceptably high failure rate (33.2% and 45.6%) and low specificity (.55-.72), but an upward adjustment in cutoffs significantly improves classification accuracy. Defining Pass as <2 and Fail as ≥4 on FMS results in consistently good specificity (.89-.92) but low and variable sensitivity (.00-.33). Similarly, cutting the S-BLRE distribution at 3.68 produces good specificity (.90-.92) but variable sensitivity (.06-.38). Passing or failing FMS or S-BLRE is unrelated to age, gender and IQ. The data from this study suggest that in a pediatric sample, adjusted cutoffs on the FMS and S-BLRE ensure good specificity, but with low or variable sensitivity. Thus, they should not be used in isolation to determine the credibility of a response set. At the same time, they can make valuable contributions to pediatric neuropsychology by providing empirically-supported, expedient and cost-effective indicators to enhance performance validity assessment.

Utility of critical items within the Recognition Memory Test and Word Choice Test.

This study was designed to examine the clinical utility of critical items within the Recognition Memory Test (RMT) and the Word Choice Test (WCT). Archival data were collected from a mixed clinical sample of 202 patients clinically referred for neuropsychological testing (54.5% male; mean age = 45.3 years; mean level of education = 13.9 years). The credibility of a given response set was psychometrically defined using three separate composite measures, each of which was based on multiple independent performance validity indicators. Critical items improved the classification accuracy of both tests. They increased sensitivity by correctly identifying an additional 2-17% of the invalid response sets that passed the traditional cutoffs based on total score. They also increased specificity by providing additional evidence of noncredible performance in response sets that failed the total score cutoff. The combination of failing the traditional cutoff, but passing critical items was associated with increased risk of misclassifying the response set as invalid. Critical item analysis enhances the diagnostic power of both the RMT and WCT. Given that critical items require no additional test material or administration time, but help reduce both false positive and false negative errors, they represent a versatile, valuable, and time- and cost-effective supplement to performance validity assessment.

A single error is one too many: Examining alternative cutoffs on Trial 2 of the TOMM.

OBJECTIVE: This study investigated the potential of alternative, more liberal cutoffs on Trial 2 of the Test of Memory Malingering (TOMM) to improve classification accuracy relative to the standard cutoffs (≤44). METHOD: The sample consisted of 152 patients (49.3% male) with psychiatric conditions (PSY) and traumatic brain injury (TBI) referred for neuropsychological assessment in a medico-legal setting (MAge = 44.4, MEducation = 11.9 years). Classification accuracy for various TOMM Trial 2 cutoffs was computed against three criterion measures. RESULTS: Patients with TBI failed TOMM Trial 2 cutoffs at higher rates than patients with PSY. Trial 2 ≤49 achieved acceptable combinations of sensitivity (0.38-0.67) and specificity (0.89-0.96) in all but one comparison group. Trial 2 ≤48 improved specificity (0.94-0.98) with minimal loss in sensitivity. The standard cutoff (≤44) disproportionally traded sensitivity (0.15-0.50) for specificity (0.96-1.00). CONCLUSIONS: One error on TOMM Trial 2 constitutes sufficient evidence to question the credibility of a response set. However, the confidence in classifying a score as invalid continues to increase with each additional error. Even at the most liberal conceivable cutoff (≤49), the TOMM detected only about half of the patients who failed other criterion measures. Therefore, it should never be used in isolation to determine performance validity.

[Formula: see text]Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children.

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.

Embedded validity indicators in Conners' CPT-II: Do adult cutoffs work the same way in children?

In previous research, several subscales of Conners' CPT-II were found to be useful as performance validity tests (PVTs) when administered to adults with traumatic brain injury (TBI). Furthermore, invalid response sets were associated with inflated scores on several CPT-II scales. The present study proposed to investigate whether these findings would replicate in a pediatric sample. The analyses were based on archival data from 15 children with TBI. The Omissions, Hit RT, Perseverations, and Hit RT BC scales proved effective at differentiating valid and invalid response sets. However, Commission errors were unrelated to scores on PVTs. A composite measure based on these four scores was a superior and more stable validity indicator than individual scales. Two or more T-scores >65 on any of these scales resulted in acceptable overall specificity (.86-1.00) and variable sensitivity (.00-1.00). Scores on CPT-II scales were generally higher among those who failed the reference PVTs. Results suggest that embedded CPT-II validity indices developed in adult TBI samples function similarly in children with TBI, with some notable exceptions. Although the use of adult PVT cutoffs in pediatric assessment is a common practice, and broadly supported by the present findings, there remains a clear need for the independent empirical validation of adult PVTs in children.