Detection of Insufficient Effort Using the Advanced Clinical Solutions for the Wechsler Memory Scale, Fourth Edition

Abstract

This study investigated the ability of the Wechsler Memory Scale-4th Edition (WMS-IV) and the Advanced Clinical Solutions (ACS) package including the new Word Choice test (WCT) to distinguish poor performance due to intentional response bias among simulators of traumatic brain injury (TBI) from poor performance due to actual TBI. Participants were 45 survivors of moderate to severe TBI and 39 healthy adult coached to simulate TBI. Logistic regression indicated that a five-variable model containing all the ACS variables and a single-variable model using only the WCT were statistically reliable. Comparing predictive accuracy of each model found that adding the WCT to the ACS increased predictive accuracy. Diagnostic efficiency for the full ACS model was considered "excellent" according to interpretive guidelines.

Indicators of suboptimal performance embedded in the Wechsler Memory Scale–Fourth Edition (WMS–IV)

“…B. Miller et al, 2011;Young et al, 2012), but lower than the AUC value of 0.95 that was found for the WMS-IV ACS package (including the WMS-IV recognition tasks, the Word Choice Test and reliable digit span: J. B.…”

“…B. Miller et al (2011) included healthy adults coached to feign cognitive impairment, which is similar to our design, these were only compared to patients with traumatic brain injury. This design differs from our study that recruited mixed-etiology neurological patients.…”

“…B. Miller et al (2011) also included the newly developed Word Choice Test as part of the optional Advanced Clinical Solutions package for the WMS-IV, which is not available in the Netherlands, which may partly explain the discrepancy in findings. However, this cannot fully explain the differences between our and their study results, as the recognition tasks are equivalent.…”

“…So far, only two studies found promising results for the WMS-IV ACS package as an effective tool for detection of suboptimal performance (Holdnack & Drozdick, 2009;J. B. Miller et al, 2011).…”

“…First, we selected the visual working memory tasks Spatial Addition (SA) and Symbol Span (SSP), as working memory tests were previously found to be sensitive in other WMS studies (Lange et al, 2006;Young et al, 2012). Secondly, we selected the recognition tasks LM-Rec, VPARec, DE-Rec, and VR-Rec, because these subtests were already shown to be sensitive in previous research using the WMS-IV (Holdnack & Drozdick, 2009;J. B. Miller et al, 2011).…”