Effort Test Failure: Toward a Predictive Model

Abstract

Predictors of effort test failure were examined in an archival sample of 555 traumatically brain-injured (TBI) adults. Logistic regression models were used to examine whether compensation-seeking, injury-related, psychological, demographic, and cultural factors predicted effort test failure (ETF). ETF was significantly associated with compensation-seeking (OR = 3.51, 95% CI [1.25, 9.79]), low education (OR:. 83 [.74, . 94]), self-reported mood disorder (OR: 5.53 [3.10, 9.85]), exaggerated displays of behavior (OR: 5.84 [2.15, 15.84]), psychotic illness (OR: 12.86 [3.21, 51.44]), being foreign-born (OR: 5.10 [2.35, 11.06]), having sustained a workplace accident (OR: 4.60 [2.40, 8.81]), and mild traumatic brain injury severity compared with very severe traumatic brain injury severity (OR: 0.37 [0.13, 0.995]). ETF was associated with a broader range of statistical predictors than has previously been identified and the relative importance of psychological and behavioral predictors of ETF was evident in the logistic regression model. Variables that might potentially extend the model of ETF are identified for future research efforts.

Examination of Performance Validity Test Failure in Relation to Number of Tests Administered

“…An important distinction between the present study and that of Dean et al is that none of the participants in the current sample met criteria for intellectual disability even among the subset of participants who reported a history of grade retention and special education. Other research has specifically examined demographic characteristics including educational level and PVT failure (Webb et al, 2012). The current findings appear consistent with data reported by Webb et al in that lower educational level was associated with greater likelihood of PVT failure.…”

“…Turning to other predictors of PVT failure, the current findings regarding educational level may be interpreted as similar to other research examining demographic characteristics in relation to PVT data (e.g., Dean et al, 2008;Webb, Batchelor, Meares, Taylor, & Marsh, 2012). Dean and colleagues reported increased PVT failure rates in a sample stratified by IQ with the lowest IQ group failing the majority of administered PVTs.…”

Are Verbal Intelligence Subtests and Reading Measures Immune to Non-Credible Effort?

“…From that standpoint, we note that the VCI difference across groups of 11.8 standard score points reflects a reliable difference that is of interpretive significance pertaining to performance validity. Finally, our study was consistent with prior studies in showing a statistically significant difference across effort groups in educational level (Babikian, Boone, Lu, & Arnold, 2006;Greve, Etherton, Bianchini, & Curtis, 2009;Webb, Batchelor, Taylor, Meares, & Marsh, 2012) with those passing PVTs having one more year of education than those failing two or more PVTs. However, when correcting for educational level, those significant group differences in test scores persisted.…”

Symptom validity in clinical assessments

“…Other studies, however, did find an association between validity test failure and financial incentives in clinical samples (Webb et al, 2012;Johnson-Greene et al, 2013). Im-portantly, several other factors have been found to be related to validity test failure, such as self-reported mood, exaggerated displays of behavior, and a diagnosis of psy-chotic illness (Webb et al, 2012). Although the operationalization of external incen-tives in our study has several limitations (see below), these findings at a minimum suggest that SVT failure in clinical samples is not restricted to those patients who might have obvious financial benefits.…”

“…Similarly, a recent study with a sample of patients with psychogenic non-epileptic seizures failed to find an association be-tween financial incentives and validity test failure (Williamson et al, 2012). Other studies, however, did find an association between validity test failure and financial incentives in clinical samples (Webb et al, 2012;Johnson-Greene et al, 2013). Im-portantly, several other factors have been found to be related to validity test failure, such as self-reported mood, exaggerated displays of behavior, and a diagnosis of psy-chotic illness (Webb et al, 2012).…”