Are Embedded Validity Indices Equivalent to Free-Standing Symptom Validity Tests?

Abstract

Symptom validity assessment is an important part of neuropsychological evaluation. There are currently several free-standing symptom validity tests (SVTs), as well as a number of empirically derived embedded validity indices, that have been developed to assess that an examinee is putting forth an optimal level of effort during testing. The use of embedded validity indices is attractive since they do not increase overall testing time and may also be less vulnerable to coaching. In addition, there are some instances where embedded validity indices are the only tool available to the neuropsychological practitioner for assessing an examinee's level of effort. As with free-standing measures, the sensitivity and specificity of embedded validity indices to suboptimal effort varies. The present study evaluated the diagnostic validity of 17 embedded validity indices by comparing performance on these indices to performance on combinations of free-standing SVTs. Results from the current medico-legal sample revealed that of the embedded validity indices, Reliable Digit Span had the best classification accuracy; however, the findings do not support the use of this embedded validity index in the absence of free-standing SVTs.

Symptom validity in clinical assessments

“…The results showed that Western European neuropsychologists exhib-ited an awareness of the occurrence of non-credible symptom reports in both forensic and clinical assessments. The general estimate of the prevalence of malingering (10% in clinical assessments and 20% in forensic assessments) corresponded broadly to the data from empirical studies (e.g., Kemp et al, 2008;Gervais et al, 2004;Miele et al, 2012;Boone, 2013), although the estimate found in forensic studies was at the lower end of the range found in empirical studies.…”

“…Another striking finding is that less than one of every four respondents stated that they often or always used embedded indicators to determine the validity of the ob-tained test scores. Although research shows that embedded measures are often less sensitive than stand-alone SVTs for the detection of underperformance (e.g., Miele et al, 2012), acceptable sensitivity and specificity rates (84% and 94%, respectively) have been found by Victor, Boone, Serpa, Buehler, and Ziegler (2009) when using a "two-failure rule" (any pairwise failure of two embedded indicators of underperfor-mance). Moreover, embedded measures have certain advantages over stand-alone SVTs.…”

“…SVTs enable neuropsychologists to understand the prevalence of non-credible symptoms in various settings (e.g., injury claims and work-related disability claims) and their impact on standard psychological tests and questionnaires (e.g., Rohling, Green, Allen, & Iverson, 2002;Iverson, 2006;Boone, 2013). It is now widely acknowl-edged that non-credible symptoms occur on a non-trivial scale in forensic assess-ments, with estimates ranging from 25 to 45% depending on the context (i.e., criminal vs. civil litigation), the sample studied, and the SVTs used (e.g., Gervais, Rohling, Green, & Ford, 2004;Van Hout, Schmand, & Wekking, 2006;Chafetz, Prentkowski, & Rao, 2011;Miele, Gunner, Lynch, & McCaffrey, 2012).…”

Identifying Novel Embedded Performance Validity Test Formulas Within the Repeatable Battery for the Assessment of Neuropsychological Status: a Simulation Study

“…Embedded performance validity tests (PVTs) derived from commonly administered neuropsychological measures serve "double duty" in that they function as measures of both neurocognitive ability and noncredible performance Whiteside, Wald, & Busse, 2011). They are helpful in the detection of noncredible performance for reasons of increased costeffectiveness and efficiency by making use of extant materials and added resistance to coaching and detection by examinees (Brennan et al, 2009;Heilbronner et al, 2009;Miele, Gunner, Lynch, & McCaffrey, 2011). Embedded PVTs commonly utilize forced-choice or other memory-related paradigms (Bouman, Hendriks, Schmand, Kessels, & Aldenkamp, 2016;King, Gfeller, & Davis, 1998;Olsen, Schroeder, Heinrichs, & Martin, 2019;Schwartz et al, 2016).…”

Logistic Regression Function for Detection of Suspicious Performance During Baseline Evaluations Using Concussion Vital Signs

“…This approach is a less obvious method of assessing suboptimal effort and is thought to be less susceptible to coaching (Heilbronner et al, 2009). However, embedded measures have also been shown to have higher misclassification rates than standalone PVTs (Miele, Gunner, Lynch, & McCaffrey, 2012).…”