A Single Error Is One Too Many: The Forced Choice Recognition Trial of the CVLT-II as a Measure of Performance Validity in Adults with TBI.

OBJECTIVE: The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test-Second Edition (CVLT-II) was designed to serve as a performance validity test (PVT). The present study was designed to compare the classification accuracy of a more liberal alternative (≤15) to the de facto FCR cutoff (≤14). METHOD: The classification accuracy of the two cutoffs was computed in reference to psychometrically defined invalid performance, across various criterion measures, in a sample of 104 adults with TBI clinically referred for neuropsychological assessment. RESULTS: The FCR was highly predictive (AUC: .71-.83) of Pass/Fail status on reference PVTs, but unrelated to performance on measures known to be sensitive to TBI. On average, FCR ≤15 correctly identified an additional 6% of invalid response sets compared to FCR ≤14, while maintaining .92 specificity. Patients who failed the FCR reported higher levels of emotional distress. CONCLUSIONS: Results suggest that even a single error on the FCR is a reliable indicator of invalid responding. Further research is needed to investigate the clinical significance of the relationship between failing the FCR and level of self-reported psychiatric symptoms.

Utility of critical items within the Recognition Memory Test and Word Choice Test.

This study was designed to examine the clinical utility of critical items within the Recognition Memory Test (RMT) and the Word Choice Test (WCT). Archival data were collected from a mixed clinical sample of 202 patients clinically referred for neuropsychological testing (54.5% male; mean age = 45.3 years; mean level of education = 13.9 years). The credibility of a given response set was psychometrically defined using three separate composite measures, each of which was based on multiple independent performance validity indicators. Critical items improved the classification accuracy of both tests. They increased sensitivity by correctly identifying an additional 2-17% of the invalid response sets that passed the traditional cutoffs based on total score. They also increased specificity by providing additional evidence of noncredible performance in response sets that failed the total score cutoff. The combination of failing the traditional cutoff, but passing critical items was associated with increased risk of misclassifying the response set as invalid. Critical item analysis enhances the diagnostic power of both the RMT and WCT. Given that critical items require no additional test material or administration time, but help reduce both false positive and false negative errors, they represent a versatile, valuable, and time- and cost-effective supplement to performance validity assessment.