Optimal per test cutoff scores and combinations of failure on multiple embedded performance validity tests in detecting performance invalidity in a mixed clinical sample.

We tested the usefulness of six embedded performance validity tests (EPVTs) in identifying performance invalidity in a mixed clinical sample. Using a retrospective design, 181 adults were classified as valid (n = 146) or invalid (n = 35) performance based upon their performance on one of three standalone PVTs (Test of Memory Malingering, Victoria Symptom Validity Test, Dot Counting Test). Multiple cutoffs were identified corresponding to predetermined false positive rates of 0, 5, 10, and 15% for each of six EPVTs. EPVT cutoffs corresponding to the predetermined false positive benchmarks were generally more conservative than currently established scores. Sensitivity was low (.0%-42.9%) for individual EPVTs across these cutoffs and was moderately improved by the combination of multiple EPVT failures. The optimal number of EPVT failures using the 10% false positive rate was ≥ 2. Although the overall classification accuracy of 80.7% and specificity of 89.0% were comparable to prior research, the sensitivity of 45.7% was more modest than previous estimates. Low sensitivities indicate that this combination of EPVTs failed to detect a majority of invalid performers.

Relationship of Sensory Modality to Retention of Episodic Memory.

This study investigated the difference between episodic memory for verbal information presented in an oral format versus equivalent material presented in a written format. The study utilized the Logical Memory subtest of the Wechsler Memory Scales-Fourth Edition and the recently validated Morris Revision-IV Paragraphs. In a sample of 97 normal participants, auditory and visual memory performances were found to be significantly correlated (r = .651, p < .001). Post-hoc analysis revealed a slight though not clinically significant preference for retention in the visual modality. The results demonstrate a high-degree correlation for retention of episodic memory for these two sensory modalities in normal participants.

Effects of severity of dementia on a symptom validity measure.

While prior research has shown symptom validity tests (SVTs) to have clinical utility with cognitively impaired individuals, these studies typically excluded those diagnosed with mild cognitive impairment (MCI) and dementia. The purpose of this study was to determine the utility of an SVT, the Test of Memory Malingering (TOMM), in those with MCI and moderate to severe dementia. Participants included 30 cognitively intact individuals (Control Group), 28 diagnosed with MCI (MCI Group), and 31 diagnosed with moderate to severe dementia (Moderate-Severe Group). The range of Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Standard Scores were then calculated for each group and all participants were administered the TOMM. Analysis of covariance (ANCOVA) revealed no significant differences on TOMM Trail 2 scores between the Control Group and the MCI Group. While all group means were above established cut-off scores, approximately 20% of participants in the Moderate-Severe Group failed the TOMM according to established criteria. Results suggest that the TOMM may be an appropriate test of effort in older adults diagnosed with MCI, but is not recommended for assessing potential malingering in those with at least moderate to severe dementia.

Development of alternate paragraphs for the Logical Memory subtest of the Wechsler Memory Scale-IV.

The purpose of the two studies included in this article was to validate an alternate form, the Morris Revision-Fourth Edition (MR-IV), to the Logical Memory paragraphs of the Wechsler Memory Scale-Fourth Edition (LM-IV) for use when retesting of individuals is desired. Study I demonstrated high correlation with the LM-IV paragraphs. Study II was a replication that again demonstrated high correlation between the original LM-IV and the new MR-IV paragraphs. High interrater reliability also was demonstrated. Consequently, the MR-IV paragraphs can be considered an alternate form to the LM-IV paragraphs. Although other attempts have been made to develop alternate stories, these new paragraphs are the only ones that are equivalent in structure, affective tone, and number of scorable units. They have considerable clinical utility and research potential.