This cross-sectional study evaluated eight embedded performance validity tests (PVTs) previously derived from the Rey Auditory Verbal Learning Test (RAVLT), Wechsler Memory Scale–IV–Logical Memory (LM), and Brief Visuospatial Memory Test–Revised (BVMT-R) recognition trials among a single mixed clinical sample of 108 neuropsychiatric patients (83 valid/25 invalid) with ( n = 54) and without ( n = 29) mild neurocognitive disorder. Among the overall sample, all eight recognition PVTs significantly differentiated valid from invalid performance (areas under the curve [AUCs] = .64-.81) with 26% to 44% sensitivity (≥89% specificity) at optimal cut-scores depending on the specific PVT. After subdividing the sample by cognitive impairment status, all eight PVTs continued to reliably identify invalid performance (AUC = .68-.91) with markedly increased sensitivities of 56% to 80% (≥89% specificity) in the unimpaired group. In contrast, among those with mild neurocognitive disorder, RAVLT False Positives and LM became nonsignificant, whereas the other six PVTs remained significant (AUC = .64-.77), albeit with reduced sensitivities of 32% to 44% (≥89% specificity) at optimal cut-scores. Taken together, results cross-validated BVMT-R and most RAVLT recognition indices as effective embedded PVTs for identifying invalid neuropsychological test performance with diverse populations including examinees with and without suspected mild neurocognitive disorder, whereas LM had more limited utility as an embedded PVT, particularly when mild neurocognitive disorder was present.

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A forced-choice (FC) recognition trial was recently developed as an embedded validity indicator for the Rey Auditory Verbal Learning Test (RAVLT), although it has not been replicated outside of the initial validation study. This study cross-validated the RAVLT FC trial for detecting invalid neuropsychological test performance and assessed the degree to which material-specific verbal memory impairment severity impacts its classification accuracy as a performance validity test (PVT). This cross-sectional study included 172 neuropsychiatric patients who completed the RAVLT and 4 independent criterion PVTs, which were used to classify validity groups (134 valid/38 invalid). Overall results showed the RAVLT FC had excellent classification accuracy for detecting invalid performance at a ≤13 cut-score (66% sensitivity/87% specificity). When patients were subdivided by memory impairment status, FC retained excellent classification accuracy among the normal memory and mild memory impairment groups with 66%-82% sensitivity and ≥89% specificity. Accuracy decreased among those with severe memory impairment, but remained significant with a lower, alternative cut-score of ≤11 (37% sensitivity/88% specificity). Findings were consistent with FC trials developed for other memory measures and support the utility of this novel RAVLT FC index for reliably identifying invalid performance, even in the context of significant verbal memory impairment. Public Significance StatementThe Rey Auditory Verbal Learning Test (RAVLT) is a well-validated and commonly used verbal learning/memory test in neuropsychological evaluation. This study demonstrated that a forced-choice recognition trial previously developed as an embedded performance validity test greatly enhances the clinical and research utility of the RAVLT as it accurately detects invalid test performance, even in the context of genuine memory impairment of increasing severity, without contributing to significantly greater evaluation time/burden.

This study cross-validated the dot counting test (DCT) as a performance validity test (PVT) in an adult attention-deficit/hyperactivity disorder (ADHD) clinical population and examined the effect of ADHD subtype and psychiatric comorbidity on accuracy for detecting invalidity. DCT performance was assessed among 210 consecutive adult ADHD referrals who underwent neuropsychological evaluation and were classified into valid ( n = 175) or invalid ( n = 35) groups based on seven independent criterion PVTs. The invalid group had significantly worse DCT performance than the valid group using both the standard and unrounded scoring procedure ([Formula: see text]). Classification accuracy was excellent, with 54.3% sensitivity/92% specificity at optimal cut-scores of ≥14 (rounded) and ≥13.38 (unrounded). Nonsignificant DCT performance differences emerged based on ADHD subtype or the presence/absence of comorbid psychopathology. The DCT functions well as a nonmemory-based PVT in an ethnoracially diverse ADHD population, supporting its clinical utility for detecting invalid neurocognitive performance during ADHD evaluations.

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