Objective: The Rey Auditory Verbal Learning Test (RAVLT) is a common test of learning and memory with established embedded validity indicators (EVIs), including the Effort Score (ES) and Forced Choice (FC) recognition. Currently, the literature lacks a head-to-head comparison of the classification accuracy of ES and FC for detecting invalid test performance. This study aimed to cross-validate ES and FC in two large, diverse, independent samples. Method: This cross-sectional study included a mixed neuropsychiatric (n = 209) and attention-deficit/hyperactivity disorder (ADHD) sample (n = 544). Validity groups were established using multiple criterion performance validity tests (PVTs), resulting in 242 valid/57 invalid and 480 valid/64 invalid performances in the neuropsychiatric and ADHD samples, respectively. Results: ES and FC both demonstrated robust classification accuracy. The optimal ES cut score was significantly higher for the ADHD (≤13; 41% sensitivity/90% specificity) than the neuropsychiatric (≤3; 33% sensitivity/89% specificity) sample. Classification accuracies of FC ranged from weak in the ADHD (area under the curve [AUC] = 0.67) to excellent in the neuropsychiatric (AUC = 0.80) sample. The FC cut score was ≤12 (54% sensitivity/91% specificity) in the neuropsychiatric and ≤14 in the ADHD (41% sensitivity/93% specificity) sample. Both EVIs were significant predictors of validity status when examined in combination. Conclusions: Both the RAVLT-ES and RAVLT-FC were effective as PVTs; however, their relative utility varied by sample such that FC had stronger classification statistics in the neuropsychiatric sample (which included a higher incidence of cognitive impairment and dementia), whereas ES was more robust in the adult ADHD sample. Moreover, considering both EVIs may result in greater accuracy than isolation.
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