Examination of the relationship between symptom and performance validity measures across referral subtypes.

INTRODUCTION: The extent to which performance validity (PVT) and symptom validity (SVT) tests measure separate constructs is unclear. Prior research using the Minnesota Multiphasic Personality Inventory (MMPI-2 & RF) suggested that PVTs and SVTs are separate but related constructs. However, the relationship between Personality Assessment Inventory (PAI) SVTs and PVTs has not been explored. This study aimed to replicate previous MMPI research using the PAI, exploring the relationship between PVTs and overreporting SVTs across three subsamples, neurodevelopmental (attention deficit-hyperactivity disorder (ADHD)/learning disorder), psychiatric, and mild traumatic brain injury (mTBI). METHODS: Participants included 561 consecutive referrals who completed the Test of Memory Malingering (TOMM) and the PAI. Three subgroups were created based on referral question. The relationship between PAI SVTs and the PVT was evaluated through multiple regression analysis. RESULTS: The results demonstrated the relationship between PAI symptom overreporting SVTs, including Negative Impression Management (NIM), Malingering Index (MAL), and Cognitive Bias Scale (CBS), and PVTs varied by referral subgroup. Specifically, overreporting on CBS but not NIM and MAL significantly predicted poorer PVT performance in the full sample and the mTBI sample. In contrast, none of the overreporting SVTs significantly predicted PVT performance in the ADHD/learning disorder sample but conversely, all SVTs predicted PVT performance in the psychiatric sample. CONCLUSIONS: The results partially replicated prior research comparing SVTs and PVTs and suggested that constructs measured by SVTs and PVTs vary depending upon population. The results support the necessity of both PVTs and SVTs in clinical neuropsychological practice.

Validation of the Personality Assessment Inventory (PAI) scale of scales in a mixed clinical sample.

Objective: This exploratory study examined the classification accuracy of three derived scales aimed at detecting cognitive response bias in neuropsychological samples. The derived scales are composed of existing scales from the Personality Assessment Inventory (PAI). A mixed clinical sample of consecutive outpatients referred for neuropsychological assessment at a large Midwestern academic medical center was utilized. Participants and Methods: Participants included 332 patients who completed study's embedded and free-standing performance validity tests (PVTs) and the PAI. PASS and FAIL groups were created based on PVT performance to evaluate the classification accuracy of the derived scales. Three new scales, Cognitive Bias Scale of Scales 1-3, (CB-SOS1-3) were derived by combining existing scales by either summing the scales together and dividing by the total number of scales summed, or by logistically deriving a variable from the contributions of several scales. Results: All of the newly derived scales significantly differentiated between PASS and FAIL groups. All of the derived SOS scales demonstrated acceptable classification accuracy (i.e. CB-SOS1 AUC = 0.72; CB-SOS2 AUC = 0.73; CB-SOS3 AUC = 0.75). Conclusions: This exploratory study demonstrates that attending to scale-level PAI data may be a promising area of research in improving prediction of PVT failure.

Replication and cross-validation of the personality assessment inventory (PAI) cognitive bias scale (CBS) in a mixed clinical sample.

Objective: This study is a cross-validation of the Cognitive Bias Scale (CBS) from the Personality Assessment Inventory (PAI), a ten-item scale designed to assess symptom endorsement associated with performance validity test failure in neuropsychological samples. The study utilized a mixed neuropsychological sample of consecutively referred patients at a large academic medical center in the Midwest. Participants and Methods: Participants were 332 patients who completed embedded and free-standing performance validity tests (PVTs) and the PAI. Pass and fail groups were created based on PVT performance to evaluate classification accuracy of the CBS. Results: The results were generally consistent with the initial study for overall classification accuracy, sensitivity, and cut-off score. Consistent with the validation study, CBS had better classification accuracy than the original PAI validity scales and a comparable effect size to that obtained in the original validation publication; however, the Somatic Complaints scale (SOM) and the Conversion subscale (SOM-C) also demonstrated good classification accuracy. The CBS had incremental predictive ability compared to existing PAI scales. Conclusions: The results supported the CBS, but further research is needed on specific populations. Findings from this present study also suggest the relationship between conversion tendencies and PVT failure may be stronger in some geographic locations or population types (forensic versus clinical patients).

The ADHD Symptom Infrequency Scale (ASIS): A novel measure designed to detect adult ADHD simulators.

The current project outlines the development of the Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Infrequency Scale (ASIS), a stand-alone measure designed to identify individuals feigning or exaggerating symptoms to receive a diagnosis of ADHD. Over the course of 3 studies, valid data was collected from 402 participants assigned to control, simulator, ADHD diagnosed, or possible undiagnosed ADHD groups. Group assignment was based on self-reported history of ADHD diagnosis including information about the credentials of diagnosing professional and methods used. The ASIS includes an Infrequency Scale (INF) designed to detect rarely reported symptoms of ADHD and several clinical scales designed to measure genuine symptoms. The final version of the ASIS demonstrated high internal consistency for the INF (α = .96) and the ADHD Total scales (α= .96). Convergent validity for the ADHD Total was established through a strong correlation with Barkley Adult ADHD Rating Scale-IV (r = .92). Initial validation of the INF yielded high discriminability between groups (d = 2.76; 95% confidence interval [2.17, 3.36]). The final INF scale demonstrated strong sensitivity (.79-.86) and excellent specificity (.89). Using our study's malingering base rate of 29%, positive and negative predictive values were strong (.71-.79 and .92-.93, respectively). Additional information is provided for a range of base rates. Current results suggest that the ASIS has potential as a reliable and valid measure of ADHD that is sensitive to malingering when compared to a sample of individuals self-reporting a history of ADHD diagnosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).