Clinical utility of the Conners’ Continuous Performance Test-II to detect poor effort in U.S. Military personnel following traumatic brain injury.

Abstract

The purpose of this study is to examine the clinical utility of the Conners' Continuous Performance Test (CPT-II) as an embedded marker of poor effort in military personnel undergoing neuropsychological evaluations following traumatic brain injury. Participants were 158 U.S. military service members divided into 3 groups on the basis of brain injury severity and performance (pass/fail) on 2 symptom validity tests: Mild Traumatic Brain Injury (MTBI)-Pass (n = 87), MTBI-Fail (n = 42), and severe traumatic brain injury (STBI)-Pass (n = 29). The MTBI-Fail group performed worse on the majority of CPT-II measures compared with both the MTBI-Pass and STBI-Pass groups. When comparing the MTBI-Fail group and MTBI-Pass groups, the most accurate measure for identifying poor effort was the Commission T score. When selected measures were combined (i.e., Omissions, Commissions, and Perseverations), there was a very small increase in sensitivity (from .26 to .29). When comparing the MTBI-Fail group and STBI-Pass groups, the most accurate measure for identifying poor effort was the Omission and Commissions T score. When selected measures were combined, sensitivity again increased (from .24 to .45). Overall, these results suggest that individual CPT-II measures can be useful for identifying people who are suspected of providing poor effort from those who have provided adequate effort. However, due to low sensitivity and modest negative predictive power values, this measure cannot be used in isolation to detect poor effort, and is largely useful as a test to "rule in," not "rule out" poor effort.

Adolescent maturation of the relationship between cortical gyrification and cognitive ability

“…In current study, dependent variables included errors of Omission (sustained attention), Commission (inhibitory control), motor response Variability, and the d’ signal detection parameter (detectability). These variables of the CPT-II have been commonly used in many previous studies (Busse and Whiteside, 2012; Fasmer et al, 2016; Hervey et al, 2006; Hurks et al, 2005; Lange et al, 2013; Lucke et al, 2015). Raw scores were used instead of norm-referenced scores because we planned to include age and sex into all study analyses to statistically account for variance related to these factors.…”

Evaluating cognitive effort in a randomized controlled trial

“…Upon application of the criteria proposed by Lange et al (2013), 53 participants (88%) were found to provide consistent effort (good effort group: GEG) while seven participants (12%) were identified as providing poor effort (poor effort group: PEG) at baseline. Number of perseverative errors was the most sensitive indicator for identifying the PEG (Figure 1).…”

“…Finally, the cutoffs for identifying “poor effort” from the CPT‐2 measures, as well most all other embedded and formal effort measures, strongly favor specificity over sensitivity. In the mTBI study from which are cutoffs were derived, sensitivity was 0.41 with specificity of 1.00; in other words, while only 41% of those who gave poor effort were identified with these cutoffs, there were no “false positives” cases (Lange et al , ). In an RCT, placing greater weight on sensitivity over specificity gives individual participants the benefit of uncertainty, and allows investigators to retain more data points.…”

“…Combined errors of omission and reaction time variability provided modest sensitivity (0.44) and excellent specificity (0.97). A similar study with mild TBI was performed by Lange et al (). Cutoffs previously identified by Ord et al () resulted in unacceptably low sensitivity (0.14).…”

Traumatic Brain Injury: Guidance in a Forensic Context from Outcome, Dose–Response, and Response Bias Research

“…A slightly different pattern with the same take‐home message has been observed on a common measure of sustained visual attention. This measure was sensitive to the effects of effort only; that is, for both civilian and military populations with obvious secondary gain incentives, poor effort significantly diminished performance, but TBI severity did not (Lange et al, ; Ord et al, ).…”