Assessing Effort: Differentiating Performance and Symptom Validity

Abstract

The current study aimed to clarify the relationship among the constructs involved in neuropsychological assessment, including cognitive performance, symptom self-report, performance validity, and symptom validity. Participants consisted of 120 consecutively evaluated individuals from a veteran's hospital with mixed referral sources. Measures included the Wechsler Adult Intelligence Scale-Fourth Edition Full Scale IQ (WAIS-IV FSIQ), California Verbal Learning Test-Second Edition (CVLT-II), Trail Making Test Part B (TMT-B), Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), WAIS-IV Reliable Digit Span (RDS), Post-traumatic Check List-Military Version (PCL-M), MMPI-2 F scale, MMPI-2 Symptom Validity Scale (FBS), MMPI-2 Response Bias Scale (RBS), and the Postconcussive Symptom Questionnaire (PCSQ). Six different models were tested using confirmatory factor analysis (CFA) to determine the factor model describing the relationships between cognitive performance, symptom self-report, performance validity, and symptom validity. The strongest and most parsimonious model was a three-factor model in which cognitive performance, performance validity, and self-reported symptoms (including both standard and symptom validity measures) were separate factors. The findings suggest failure in one validity domain does not necessarily invalidate the other domain. Thus, performance validity and symptom validity should be evaluated separately.

Postconcussive symptom overreporting in Iraq/Afghanistan Veterans with mild traumatic brain injury

“…However, there was not complete overlap between Veterans who scored above the cutoff on the Validity-10 and those who failed the PVT variable, which supports the use of both PVTs and SVTs when determining validity of assessment in this population because SVT failure and PVT failure are not completely overlapping constructs [21,36].…”

“…VA service connection was also a significant predictor in the model; however, the second model that did not include this variable was also significant. The Validity-10 continued to contribute additional, albeit modest, predictive utility to both models after psychiatric comorbidities and VA service connection were accounted for, providing support for the strong relationship between SVTs and PVTs as well as the incremental predictive utility that accompanies the use of an SVT [36]. This finding is only partially congruent with a study by Armistead-Jehle that found SVT performance was clinically elevated in Veterans with a history of mTBI who failed PVTs but did not significantly predict PVT failure [29].…”

“…However, in Veterans with a history of mTBI only, other SVTs (various subscales of the PAI) did not significantly predict PVT failure, whereas VA service connection and a previous diagnosis of depression did [29]. Thus, there is evidence that PVT failure corresponds to SVTs, but assessing symptom and performance validity separately is still essential as they are not completely overlapping constructs and failure of one type of measure does not necessarily invalidate the other set of measures [36]. The discrepant findings regarding the relationship between PVTs and SVTs may be a result of the use of heterogeneous samples (e.g., all severities of TBI, various neurological disorders), the use of different measures across studies (e.g., PAI vs MMPI-2, Medical Symptom Validity Test [37] vs Test of Memory Malingering (TOMM) [38]), and the use of different methods to assess response bias (e.g., atypical vs infrequent symptom reporting).…”

Assessment of effort in children: A systematic review

“…However, this term tends to be used mostly in reference to the latter (often referred to as effort testing). Some researchers have recently distinguished between performance validity tests (PVTs) and reserve the term "SVTs" for symptom reporting validity measures (Larrabee, 2012;Van Dyke, Millis, Axelrod, & Hanks, 2013). For the purposes of this review, the term "PVT" is used synonymously with effort testing.…”

Neuropsychologists’ ability to predict distorted symptom presentation

“…Since the early nineties, there has been a steady increase in empirical and meta-analytic studies evaluating the diagnostic accuracy of tools designed to identify distorted symptom presentation (e.g., Sweet & Guidotti Breting, 2013). In keeping with the terminology of other authors (Larrabee, 2012;Van Dyke, Millis, Axelrod, & Hanks, 2013), we use response validity tests as an overarching term for these tools. Broadly speaking, there are two types of response validity tests: (a) self-report symptom validity tests (SVTs) that intend to measure overreporting of symptoms, and (b) performance validity tests (PVTs) that assay underperformance on cognitive tests (Greve, Bianchini, & Brewer, 2013).…”