Comprehensive Analysis of MMPI-2-RF Symptom Validity Scales and Performance Validity Test Relationships in a Diverse Mixed Neuropsychiatric Setting

Abstract

The utility of symptom (SVT) and performance (PVT) validity tests has been independently established in neuropsychological evaluations, yet research on the relationship between these two types of validity indices is limited to circumscribed populations and measures. This study examined the relationship between SVTs on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and PVTs in a mixed neuropsychiatric setting. This cross-sectional study included data from 181 diagnostically and demographically diverse patients with neuropsychiatric conditions referred for outpatient clinical neuropsychological evaluation at an academic medical center. All patients were administered a uniform neuropsychological battery, including the MMPI-2-RF and five PVTs (i.e., Dot Counting Test; Medical Symptom Validity Test; Reliable Digit Span; Test of Memory Malingering-Trial 1; Word Choice Test). Nonsignificant associations emerged between SVT and PVT performance. Although the Response Bias Scale was most predictive of PVT performance, MMPI-2-RF SVTs generally had low classification accuracy for predicting PVT performance. Neuropsychological test performance was related to MMPI-2-RF SVT status only when overreporting elevations were at extreme scores. The current study further supports that SVTs and PVTs measure unique and dissociable constructs among diverse patients with neuropsychiatric conditions, consistent with literature from other clinical contexts. Therefore, objective evidence of symptom overreporting on MMPI-2-RF SVTs cannot be interpreted as definitively indicating invalid performance on tests of neurocognitive abilities. As such, clinicians should include both SVTs and PVTs as part of a comprehensive neuropsychological evaluation as they provide unique information regarding performance and symptom validity.

The ecological validity of the IOP-29: A follow-up study using the MMPI-2-RF and the SIMS as criterion variables.

“…The other criterion groups study, that is, Holcomb et al (2023), assessed the ecological validity of the IOP-29 by focusing on performance validity rather than symptom validity, using two PVTs as criterion variables. Thus, because symptom validity and performance validity are related but certainly not overly redundant constructs (De Boer et al, 2023; Giromini, Viglione, et al, 2020; Larrabee, 2012; Sabelli et al, 2021), additional research on the ecological validity of the IOP-29 using SVT-based criteria was deemed necessary.…”

Cognitive Underperformance in a Mixed Neuropsychiatric Sample at Diagnostic Evaluation of Adult ADHD

“…Current guidelines recommend that a thorough credibility assessment of a neuropsychological evaluation should utilize both SVTs and PVTs, as they seem to provide largely unique information regarding the credibility of symptom responses and test performance [30,31]. SVTs as indicators of symptom overreporting and PVTs as indicators of underperformance seem to represent distinct constructs, as concluded from studies utilizing factor analytic techniques [13,32,33].…”

“…The strength of the association between measures of symptom and performance validity in previous research appears to vary depending on population, assessment context, and applied measures. In neuropsychiatric patients undergoing clinical evaluation of adult ADHD, PVTs and SVTs have been shown to be rather dissociable [30,97,98], whereas more concordance has been shown in disability claimants [99]. Giromini et al [100] brought forward several explanations that may explain this inconsistency in the findings on the SVTs/PVTs relationship, including the relatively few validated SVTs compared to PVTs, differences in optimal SVTs cut scores across populations, differences in agreed standards for determining invalidity (i.e., ≥2 independent PVT failures but no similar standards agreed on SVTs application, yet), and PVTs being generally evaluated as a more unitary underlying construct compared to SVTs.…”