Cognitive impairment does not cause invalid performance: analyzing performance patterns among cognitively unimpaired, impaired, and noncredible participants across six performance validity tests

Working Memory, Processing Speed, and Memory Functioning Are Minimally Predictive of Victoria Symptom Validity Test Performance

“…A clinically useful and psychometrically robust PVT is one that is accurate for detecting invalid performance while remaining relatively insensitive to actual cognitive ability(ies) and neurocognitive impairment. Although it has been shown that cognitive impairment does not result in invalid overall performance (i.e., failure on multiple PVTs administered throughout a neuropsychological evaluation; Critchfield et al, 2019), performance on some individual PVTs have been found, to varying degrees, to be adversely affected by bona fide cognitive impairment or more strongly correlated with actual cognitive abilities, such as memory and processing speed (e.g., Bain et al, 2021;Soble et al, 2018;Webber & Soble, 2018), which can limit the utility of these PVTs or necessitate use of different cut-scores in certain clinical populations. While the VSVT's accuracy for detecting invalid performance has been established and replicated (e.g., Grote et al, 2000;Silk-Eglit et al, 2016), current results add to this literature by providing further evidence that actual cognitive abilities have nonsignificant to small effects on VSVT performance across two commonly used indices.…”

“…Of the 123 initial patients, 88 had 0 PVT failures and were retained for analysis, whereas 35 had ≥1 PVT failure (M = 1.46, SD = 0.74) and were excluded. This approach allowed for objective verification of valid performance and confidence that obtained cognitive test scores likely reflect examinees' optimal working memory, speed, and memory abilities, which is critical as invalid performance has been repeatedly shown to result in artificially low neuropsychological test scores (Critchfield et al, 2019;Proto et al, 2014). Inclusion of invalid neuropsychological scores would introduce artifacts into the regression analyses as low scores would no longer necessarily reflect impaired performance and any genuine relationships between the cognitive abilities of interest and VSVT performance would be obscured.…”

“…Because obtaining scores below these cutoffs has been shown to be atypical even for individuals with known neurocognitive disorders when normally motivated, failures on these measures due to cognitive impairment is unlikely, particularly when multiple PVTs are failed (Larrabee, 2014b). For example, Critchfield et al (2019) recently compared performance on a neuropsychological battery, including one embedded and three freestanding PVTs, among patients with valid performance and no cognitive impairment, patients with valid performance and cognitive impairment due to known medical/neurological conditions, and patients with invalid performance in a VA population. While patients with impairment and valid performance and those with invalid performance showed minimal performance differences on cognitive tests, the former averaged <1 PVT failure, whereas the latter averaged 2.40 PVT failures.…”

American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering

“…Single PVT failures can be found in credible patients and, with the exception of performance significantly below chance on a forced choice measure, should not, in isolation, be used to conclude that malingering is present (Victor, Boone, Serpa, Buehler, & Ziegler, 2009). Conversely, multiple PVT failures are not observed in credible populations, even those with cognitive impairment (Critchfield et al, 2019), with the exception of examinees who have well-documented severe functional disability (e.g. dementia) (e.g.…”

Future Directions in Performance Validity Assessment to Optimize Detection of Invalid Neuropsychological Test Performance: Special Issue Introduction

“…Several key empirical findings also have emerged from the rapidly expanding PVT literature base over the past 25 years and currently allow for more precise, refined, and evidence-based assessment of performance validity in neuropsychological evaluations. Among these are establishment of clear benchmarks for classification of invalid neuropsychological test performance (i.e., failure on ≥ 2 independent PVTs; Boone, 2013;Critchfield et al, 2019;Jennette et al, 2021;Larrabee, 2008;Meyers et al, 2014;Rhoads et al, 2021b;Sherman et al, 2020;Webber et al, 2020), elucidation of best practices for validity assessment that includes continuous sampling of validity via administration of multiple freestanding and embedded PVTs throughout neuropsychological evaluations (Boone, 2009;Sweet et al, 2021), and greater empirical support to inform critical clinical decisions related to validity assessment, such as the number and type(s) of PVTs administered (Soble et al, 2020). Perhaps most importantly, the extant PVT literature has continued to firmly establish the psychometric properties and effectiveness of many freestanding and embedded PVTs for detecting performance invalidity across diverse clinical populations with and without cognitive impairment (see Soble et al, 2021b).…”