Objective: This study was designed to replicate previous research on critical item analysis within the Word Choice Test (WCT). Method: Archival data were collected from a mixed clinical sample of 119 consecutively referred adults (Mage = 51.7, Meducation = 14.7). The classification accuracy of the WCT was calculated against psychometrically defined criterion groups. Results: Critical item analysis identified an additional 2%–5% of the sample that passed traditional cutoffs as noncredible. Passing critical items after failing traditional cutoffs was associated with weaker independent evidence of invalid performance, alerting the assessor to the elevated risk for false positives. Failing critical items in addition to failing select traditional cutoffs increased overall specificity. Non-White patients were 2.5 to 3.5 times more likely to Fail traditional WCT cutoffs, but select critical item cutoffs limited the risk to 1.5–2. Conclusions: Results confirmed the clinical utility of critical item analysis. Although the improvement in sensitivity was modest, critical items were effective at containing false positive errors in general, and especially in racially diverse patients. Critical item analysis appears to be a cost-effective and equitable method to improve an instrument’s classification accuracy.

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