Bridging the Gap Between Neurocognitive Processing Theory and Performance Validity Assessment among the Cognitively Impaired: A Review and Methodological Approach

Abstract

Bigler (2012) and Larrabee (2012) recently addressed the state of the science surrounding performance validity tests (PVTs) in a dialogue highlighting evidence for the valid and increased use of PVTs, but also for unresolved problems. Specifically, Bigler criticized the lack of guidance from neurocognitive processing theory in the PVT literature. For example, individual PVTs have applied the simultaneous forced-choice methodology using a variety of test characteristics (e.g., word vs. picture stimuli) with known neurocognitive processing implications (e.g., the "picture superiority effect"). However, the influence of such variations on classification accuracy has been inadequately evaluated, particularly among cognitively impaired individuals. The current review places the PVT literature in the context of neurocognitive processing theory, and identifies potential methodological factors to account for the significant variability we identified in classification accuracy across current PVTs. We subsequently evaluated the utility of a well-known cognitive manipulation to provide a Clinical Analogue Methodology (CAM), that is, to alter the PVT performance of healthy individuals to be similar to that of a cognitively impaired group. Initial support was found, suggesting the CAM may be useful alongside other approaches (analogue malingering methodology) for the systematic evaluation of PVTs, particularly the influence of specific neurocognitive processing components on performance.

Flipping the Script: Measuring Both Performance Validity and Cognitive Ability with the Forced Choice Recognition Trial of the RCFT

“…Although EVIs have tended to exhibit inferior signal detection relative to traditional PVTs ( Lau et al., 2017 ) and they have sometimes been criticized for conflating ability and effort ( Bigler, 2012 ; Leighton et al., 2014 ), their advantages have included (a) cost-effectiveness; (b) reduced mental stamina demands for young or medically/emotionally fragile examinees ( Lichtenstein et al., 2017 ); and (d) an inconspicuousness that made them more difficult for examinees to detect ( An et al., 2019 ; Berger et al., 2019 ) and, therefore, more resistant to coaching ( Brennan et al., 2009 ; Erdal, 2004 ; Lippa, 2018 ; Weinborn et al., 2012 ). Of equal importance, EVIs protect assessors from the appearance of a confirmation bias when PVT use seems to have been motivated by clinician expectations of examinee malingering ( Boone, 2013 ).…”

Identifying Feigned Cognitive Impairment: Investigating the Utility of Diffusion Model Analyses

“…More specifically, the field has focused on clinical utility, neglecting the theoretical aspects related to the feigning of cognitive impairment. The latter include, among others, uncovering cognitive processes underlying the phenomenon and sources for borderline performance in PVTs (Bigler, 2012;Eglit et al, 2017;Leighton et al, 2014). This may hinder progress in the field, including the theory-driven development of novel PVTs.…”

“…However, we have little understanding of these cognitive processes, or of those involved in performing FCRM-PVTs in general. As will be elaborated, RT measures have the potential to clarify these cognitive processes, a potential that should be pursued considering the overly utilitarian focus of the field up-to-date (Bigler, 2012;Eglit et al, 2017;Leighton et al, 2014).…”

Neuroimaging as a biomarker in symptom validity and performance validity testing

“…Proponents of the universal use of SVT/PVT measures as omnibus indicators of validity have not thoroughly explored the cognitive neuroscience of SVT/PVT functioning (see critical review by Leighton et al 2014). Since all SVT/PVT measures engage some aspect of test taking and cognitive processing, before universal conclusions about the merits of SVT/ PVT findings are adopted and neuropsychological test findings deemed valid or invalid, it seems appropriate to understand the cognitive neuroscience of SVT/PVT measures and what relevant neuroimaging findings may add to understanding SVT/PVT results.…”

“…As such, in this review a case study approach will be taken because the most important decision involves the individual. 1 Likewise, as pointed out by Leighton et al (2014) in their review of the field, there has been no theory underlying neurocognitive processing of SVT/PVT stimuli and task conditions within the SVT/PVT literature other than they are simple and purportedly easy to perform. The current review develops a potential neurobiological and substrate neuroanatomical model of brain regions and connectivity essential for SVT/PVT task performance.…”