The Stroop test as a measure of performance validity in adults clinically referred for neuropsychological assessment.

This study was designed to develop performance validity indicators embedded within the Delis-Kaplan Executive Function Systems (D-KEFS) version of the Stroop task. Archival data from a mixed clinical sample of 132 patients (50% male; MAge = 43.4; MEducation = 14.1) clinically referred for neuropsychological assessment were analyzed. Criterion measures included the Warrington Recognition Memory Test-Words and 2 composites based on several independent validity indicators. An age-corrected scaled score ≤6 on any of the 4 trials reliably differentiated psychometrically defined credible and noncredible response sets with high specificity (.87-.94) and variable sensitivity (.34-.71). An inverted Stroop effect was less sensitive (.14-.29), but comparably specific (.85-90) to invalid performance. Aggregating the newly developed D-KEFS Stroop validity indicators further improved classification accuracy. Failing the validity cutoffs was unrelated to self-reported depression or anxiety. However, it was associated with elevated somatic symptom report. In addition to processing speed and executive function, the D-KEFS version of the Stroop task can function as a measure of performance validity. A multivariate approach to performance validity assessment is generally superior to univariate models. (PsycINFO Database Record

A Single Error Is One Too Many: The Forced Choice Recognition Trial of the CVLT-II as a Measure of Performance Validity in Adults with TBI.

OBJECTIVE: The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test-Second Edition (CVLT-II) was designed to serve as a performance validity test (PVT). The present study was designed to compare the classification accuracy of a more liberal alternative (≤15) to the de facto FCR cutoff (≤14). METHOD: The classification accuracy of the two cutoffs was computed in reference to psychometrically defined invalid performance, across various criterion measures, in a sample of 104 adults with TBI clinically referred for neuropsychological assessment. RESULTS: The FCR was highly predictive (AUC: .71-.83) of Pass/Fail status on reference PVTs, but unrelated to performance on measures known to be sensitive to TBI. On average, FCR ≤15 correctly identified an additional 6% of invalid response sets compared to FCR ≤14, while maintaining .92 specificity. Patients who failed the FCR reported higher levels of emotional distress. CONCLUSIONS: Results suggest that even a single error on the FCR is a reliable indicator of invalid responding. Further research is needed to investigate the clinical significance of the relationship between failing the FCR and level of self-reported psychiatric symptoms.

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.

Neuropsychological performance of youth with secondary attention-deficit/hyperactivity disorder 6- and 12-months after traumatic brain injury.

The present study compared executive dysfunction among children with attention-deficit/hyperactivity disorder (ADHD) after traumatic brain injury (TBI), also called secondary ADHD (S-ADHD), pre-injury ADHD and children with TBI only (i.e., no ADHD). Youth aged 6-16 years admitted for TBI to five trauma centers were enrolled (n=177) and evaluated with a semi-structured psychiatric interview scheduled on three occasions (within 2 weeks of TBI, i.e., baseline assessment for pre-injury status; 6-months and 12-months post-TBI). This permitted the determination of 6- and 12-month post-injury classifications of membership in three mutually exclusive groups (S-ADHD; pre-injury ADHD; TBI-only). Several executive control measures were administered. Unremitted S-ADHD was present in 17/141 (12%) children at the 6-month assessment, and in 14/125 (11%) children at 12-months post-injury. The study found that children with S-ADHD exhibited deficient working memory, attention, and psychomotor speed as compared to children with pre-injury ADHD. Furthermore, the children with S-ADHD and the children with TBI-only were impaired compared to the children with pre-injury ADHD with regard to planning. No group differences related to response inhibition emerged. Age, but not injury severity, gender, or adaptive functioning was related to executive function outcome. Neuropsychological sequelae distinguish among children who develop S-ADHD following TBI and those with TBI only. Moreover, there appears to be a different pattern of executive control performance in those who develop S-ADHD than in children with pre-injury ADHD suggesting that differences exist in the underlying neural mechanisms that define each disorder, underscoring the need to identify targeted treatment interventions.