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.
Embedded validity indicators (EVIs) derived from motor tests have received less empirical attention than those derived from tests of other neuropsychological abilities, particularly memory. Preliminary evidence suggests that the Grooved Pegboard Test (GPB) may function as an EVI, but existing studies were largely conducted using simulators and population samples without cognitive impairment. In this study we aimed to evaluate the GPB’s classification accuracy as an EVI among a mixed clinical neuropsychiatric sample with and without cognitive impairment. This cross-sectional study comprised 223 patients clinically referred for neuropsychological testing. GPB raw and T-scores for both dominant and nondominant hands were examined as EVIs. A known-groups design, based on ≤1 failure on a battery of validated, independent criterion PVTs, showed that GPB performance differed significantly by validity group. Within the valid group, receiver operating characteristic curve analyses revealed that only the dominant hand raw score displayed acceptable classification accuracy for detecting invalid performance (area under curve [AUC] = .72), with an optimal cut-score of ≥106 seconds (33% sensitivity/88% specificity). All other scores had marginally lower classification accuracy (AUCs = .65–.68) for differentiating valid from invalid performers. Therefore, the GPB demonstrated limited utility as an EVI in a clinical sample containing patients with bona fide cognitive impairment.
This study examined the utility of dichotomous versus dimensional scores across two measures of social determinants of health (SDOH) regarding their associations with cognitive performance and psychiatric symptoms in a mixed clinical sample of 215 adults referred for neuropsychological evaluation ( Mage = 43.91, 53.5% male, 44.2% non-Hispanic White). Both dimensional and dichotomous health literacy scores accounted for substantial variance in all cognitive outcomes assessed, whereas dimensional and dichotomous adverse childhood experience scores were significantly associated with psychiatric symptoms. Tests of differences between correlated correlations indicated that correlations with cognitive and psychiatric outcomes were not significantly different across dimensional versus dichotomous scores, suggesting that these operationalizations of SDOH roughly equivalently characterize risk of poorer cognitive performance and increased psychiatric symptoms. Results highlight the necessity of measuring multiple SDOH, as different SDOH appear to be differentially associated with cognitive performance versus psychiatric symptoms. Furthermore, results suggest that clinicians can use cut-scores when characterizing patients’ risk of poor cognitive or psychiatric outcomes based on SDOH.
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