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).

Personal Characteristics Associated with Ecological Momentary Assessment Compliance in Adult Cochlear Implant Candidates and Users.

BACKGROUND: Ecological momentary assessment (EMA) often places high physical and mental burden on research participants compared with retrospective self-reports. The high burden could result in noncompliance with the EMA sampling scheme protocol. It has been a concern that certain types of participants could be more likely to have low compliance, such as those who have severe hearing loss and poor speech recognition performance, are employed, are not familiar with technologies used to implement EMA (e.g., smartphones), and have poorer cognitive abilities. Noncompliance dependent on personal characteristics could negatively impact the generalizability of EMA research. PURPOSE: This article aims to determine personal characteristics associated with EMA compliance in a group of adult cochlear implant (CI) candidates and users. RESEARCH DESIGN: An observational study. STUDY SAMPLE: Fifty-eight adults who were either scheduled to received CIs or were experienced CI users completed the study. DATA COLLECTION AND ANALYSIS: Participants conducted smartphone-based EMA designed to assess an individual's daily auditory ecology for 1 week. EMA compliance was quantified using two metrics: the number of completed surveys and the response rate to the notification delivered by the EMA app. Personal characteristics (i.e., predictors) included age, gender, CI status (candidate or user), employment status (employed or not employed), smartphone ownership, speech recognition performance, social network size, level of depressive symptoms, and neurocognitive abilities. A word recognition test, questionnaires, and a test battery of neurocognitive assessments were used to measure the predictors. We used negative binomial regression and logistic mixed models to determine the factors associated with the number of completed surveys and the response rate, respectively. We hypothesized that, for example, employed participants with poorer speech recognition performance would have lower compliance. RESULTS: Contrary to the hypothesis, word recognition score was negatively associated with the number of completed surveys (p = 0.022). Holding all other variables constant, a 10-point (i.e., 10%) word recognition score decrease was associated with an 11% increase in the number of completed surveys. For the response rate, employment status was the only significant predictor (p < 0.0001). Consistent with our hypothesis, the odds of responding to EMA notifications for those who are not employed are 82% higher than the odds for those who are employed. No other studied personal characteristic was associated with compliance. CONCLUSION: For CI candidates and users, EMA compliance could be affected by personal characteristics such as speech recognition performance and employment status. Because (1) participants with poorer speech recognition performance do not necessarily have lower compliance and (2) most personal characteristics investigated in the present study (e.g., age, gender, smartphone ownership, and neurocognitive abilities) do not predict compliance, a wide range of participants could successfully conduct smartphone-based EMA.

Stratified performance on the Test of Memory Malingering (TOMM) is associated with differential responding on the Personality Assessment Inventory (PAI).

Introduction: This study evaluated symptom endorsement patterns in participants at various stratified performance levels on the Test of Memory Malingering (TOMM). It was hypothesized that the lowest stratum (chance performance and below) would have the most pathological (i.e., elevated item endorsement) responding on the Personality Assessment Inventory (PAI) validity and clinical scales. This study was primarily a replication of previous work with emphasis on the PAI scales and consideration of varying degrees of performance on TOMM Trial 2.Methods: Participants were 760 (54% female, 85.4% Caucasian, mean age = 42.01 (SD = 15.89), mean education = 13.55 (SD = 2.35)) consecutively referred neuropsychological outpatients who completed the TOMM and PAI. Participants were placed in one of 5 stratified TOMM Trial 2 performance level groups (High Pass, Low Pass, High Fail, Low Fail, and Chance). No significant differences were found between the demographic variables except for referral source, which was overrepresented in the Chance group relative to the other groups.Results: Due to the highly skewed nature of TOMM Trial 2, Spearman rank order correlations were calculated for the 5 stratified levels of TOMM performance and all the main PAI scales. The NIM, SOM, DEP, ANX, SCZ and SUI scales had significant correlations, so a series of One-way ANOVAs were calculated to examine these scales at different TOMM stratified performance levels. Results indicated that the Chance group had the highest level of responding on all scales, with NIM, SOM, DEP, SCZ and SUI having mean elevations above the clinical cutoff (T = 70).Conclusions: Results were consistent with previous pass-fail PVT research, but extended earlier research to provide evidence that Chance performance group had more pathological PAI responding. The results provide preliminary evidence to support the notion that patients who fail PVTs at different levels do not have the same characteristics.

Classification accuracy of individual and combined executive functioning embedded performance validity measures in mild traumatic brain injury.

The development of more sophisticated performance validity measures is important due to concerns with coaching as well as providing clinicians with a greater variety of options when assessing performance validity. Examinees with noncredible performance may find it more difficult to elude detection by PVTs derived from arithmetical summation or logistic regression. The present study evaluated the classification accuracy of several executive functioning (EF) variables as PVTs both individually and when combined into derived variables. The current study evaluated a simple mathematic summation of embedded PVT scores and a logistic regression-based formula based on embedded PVTs from executive function measures. A total of 155 consecutive patients completed neuropsychological evaluation after sustaining a mild traumatic brain injury (MTBI) were studied and were placed into a PVT-PASS (N = 95, mean age = 44.9, SD = 12.55, mean education = 13.45, SD = 2.23, 38% male, 97% Caucasian) or PVT-FAIL group (N = 60, mean age = 44.1, SD = 15.47, mean education = 13.05, SD = 2.58, 55% male, 92% Caucasian). Trail Making Test B, Wisconsin Card Sorting Test, and Stroop Color Word Test were summed and also used in logistic regression to predict whether patients had credible performance. Both the mathematical summation and the logistic regression methods achieved excellent classification accuracy (summation AUC = .79; logistic regression AUC = .82) with higher sensitivity than individual PVTs.

Vast Differences in Psychotropic Prescription Rates, But Not Outcomes, for Obese Adolescents in Immersion Treatment across Geographical Regions.

BACKGROUND: Pediatric obesity is recognized as a worldwide epidemic. Treatment of this problem has proven difficult, but many promising interventions exist, including immersion treatment. The purpose of this study is to examine the potential influence of psychotropic medications on immersion treatment outcomes in a real-world treatment setting. METHODS: This study examines the prescription rates of psychotropic medications and treatment process and outcomes of 642 adolescents in ten different cognitive behavioral therapeutic immersion weight-loss camps in the United States and in the United Kingdom. RESULTS: The US participants received psychotropic medications at drastically varying rates by geographical location and overall at almost ten times the rate of UK participants. Those taking psychotropic medications engaged in treatment and decreased percentage overweight at similar rates as their nonmedicated peers. The medication group reported higher initial and final rates of distress, but both groups improved their moods during camp and exhibited smaller differences in mood ratings by the end of camp. CONCLUSIONS: Significantly higher prescription rates of psychotropic medication, especially evident comparing the United States to the United Kingdom, were unrelated to immersion obesity treatment process and outcomes for youth. Immersion treatment for obese adolescents appears effective regardless of psychotropic medication status of the participant. This finding supports the use of cognitive behavioral immersion treatments for adolescent obesity and leads to several possible conclusions and directions for future study.

"I see inspiration everywhere": potential keys to nurturing healthy obsessions by very successful young weight controllers.

BACKGROUND: The Healthy Obsession Model posits that committed weight controllers develop preoccupations with the planning and execution of target behaviors to reach healthy goals. We expected that successful weight controllers, more so than unsuccessful weight controllers, would report more elaborate definitions of their healthy obsessions, negative reactions to lapses, and constructive responses to high-risk situations. We also expected to find differential sources of commitment between losers and gainers, including a greater emphasis on emotional and experiential consequences by losers, as documented in the authors' 2012 study. METHODS: Sixteen adolescent participants who had completed cognitive-behavior therapy immersion treatment for obesity at least 1 year before the interviews (8 successful and 8 unsuccessful weight controllers) completed in-depth interviews based on the Scanlan Collaborative Interview Method. A qualitative analysis followed in which two coders identified themes within the interviews. RESULTS: Reliable coding of the interviews produced results that supported the hypothesis that highly successful weight controllers nurture strong healthy obsessions. Successful weight controllers also reported using significantly more helpful motivators than did unsuccessful weight controllers. In addition, these adolescent weight controllers seemed motivated by some of the same factors that elite athletes identified in the Sport Commitment Model. CONCLUSIONS: Clinical implications include focusing weight loss interventions on nurturing healthy obsessions in general and, more specifically, on helping weight controllers use more diverse sources of commitment.