Performance validity measures in clinical patients with aphasia

Bodner, Thomas; Merten, Thomas; Benke, Thomas

doi:10.1080/13803395.2019.1579783

Cited by 29 publications

(14 citation statements)

References 47 publications

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“…This was despite there being a much higher proportion of severely injured cases, a lower proportion of outpatient assessments, and much greater cultural diversity in the current sample, which attests to the robustness of this finding within the brain injury rehabilitation setting. It is also in line with the base rates reported in many smaller studies of other clinical groups, including stroke (Bodner et al, 2019), Korsakoff's syndrome (Oudman et al, 2020), Huntington's disease (Sieck et al, 2012), mild cognitive impairment (Walter et al, 2014), and HIV (Paul et al, 2017).…”

Section: Discussionsupporting

confidence: 89%

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis

Gates

Metcalf

Sabaz

et al. 2022

J Int Neuropsychol Soc

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Objectives: To determine base rates of invalid performance on the Test of Memory Malingering (TOMM) in patients with traumatic brain injury (TBI) undertaking rehabilitation who were referred for clinical assessment, and the factors contributing to TOMM failure. Methods: Retrospective file review of consecutive TBI referrals for neuropsychological assessment over seven years. TOMM failure was conventionally defined as performance <45/50 on Trial 2 or Retention Trial. Demographic, injury, financial compensation, occupational, and medical variables were collected. Results: Four hundred and ninety one TBI cases (Median age = 40 years [IQR = 26–52], 79% male, 82% severe TBI) were identified. Overall, 48 cases (9.78%) failed the TOMM. Logistic regression analyses revealed that use of an interpreter during the assessment (adjusted odds ratio [aOR] = 8.25, 95%CI = 3.96–17.18), outpatient setting (aOR = 4.80, 95%CI = 1.87–12.31) and post-injury psychological distress (aOR = 2.77, 95%CI = 1.35–5.70) were significant multivariate predictors of TOMM failure. The TOMM failure rate for interpreter cases was 49% (21/43) in the outpatient setting vs. 7% (2/30) in the inpatient setting. By comparison, 9% (21/230) of non-interpreter outpatient cases failed the TOMM vs. 2% (4/188) of inpatient cases. Conclusions: TOMM failure very rarely occurs in clinical assessment of TBI patients in the inpatient rehabilitation setting. It is more common in the outpatient setting, particularly in non-English-speaking people requiring an interpreter. The findings reinforce the importance of routinely administering stand-alone performance validity tests in assessments of clinical TBI populations, particularly in outpatient settings, to ensure that neuropsychological test results can be interpreted with a high degree of confidence.

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Section: Discussionsupporting

confidence: 89%

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis

Gates

Metcalf

Sabaz

et al. 2022

J Int Neuropsychol Soc

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“…31 A study reporting validity test performance after stroke with initial aphasia found low failure rates on the (standard, pictorial) TOMM measures (7% (1/15 failing trial 2 and 0 failing the retention trial, but high failure rates on the Rey 15-item, RDS (<7) and reliable spatial span (60%, 73% and 40% respectively)). 32 One study described a single case of surgical removal of medial temporal lobe structures, and another described three cases of bilateral hippocampal atrophy after anoxic brain injury; none of these four individuals failed the WMT. 33 34 Oudman et al reported that 2 (10%) of 20 individuals with Korsakoff Amnesia failed the second trial of the TOMM.…”

Section: Acquired Brain Injurymentioning

confidence: 99%

Performance validity test failure in clinical populations—a systematic review

McWhirter

Ritchie

Stone

et al. 2020

J Neurol Neurosurg Psychiatry

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Performance validity tests (PVTs) are widely used in attempts to quantify effort and/or detect negative response bias during neuropsychological testing. However, it can be challenging to interpret the meaning of poor PVT performance in a clinical context. Compensation-seeking populations predominate in the PVT literature. We aimed to establish base rates of PVT failure in clinical populations without known external motivation to underperform. We searched MEDLINE, EMBASE and PsycINFO for studies reporting PVT failure rates in adults with defined clinical diagnoses, excluding studies of active or veteran military personnel, forensic populations or studies of participants known to be litigating or seeking disability benefits. Results were summarised by diagnostic group and implications discussed. Our review identified 69 studies, and 45 different PVTs or indices, in clinical populations with intellectual disability, degenerative brain disease, brain injury, psychiatric disorders, functional disorders and epilepsy. Various pass/fail cut-off scores were described. PVT failure was common in all clinical groups described, with failure rates for some groups and tests exceeding 25%. PVT failure is common across a range of clinical conditions, even in the absence of obvious incentive to underperform. Failure rates are no higher in functional disorders than in other clinical conditions. As PVT failure indicates invalidity of other attempted neuropsychological tests, the finding of frequent and unexpected failure in a range of clinical conditions raises important questions about the degree of objectivity afforded to neuropsychological tests in clinical practice and research.

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“…Adults with TBI versus simulators. As in prior research (Bodner, Merten, & Benke, 2019;Davis, 2018;Kanser et al, 2019), indexes that showed powerful ability to discriminate between healthy adults and TBI simulators in the typical analogue design were considerably less powerful in the ecologically valid challenge of discriminating the groups of greatest clinical interest: TBI simulators and those with verified TBI. Oculomotor behaviors partly under conscious control (i.e., purposefully looking at the background instead of at the response options) no longer reliably distinguished groups, suggesting that TBI simulators were able to adequately feign some aspects of inattention/cognitive inefficiency common to adults with verified TBI.…”

Section: Discussionmentioning

confidence: 68%

Detecting feigned traumatic brain injury with eye tracking during a test of performance validity.

Kanser¹,

Bashem²,

Patrick³

et al. 2020

Neuropsychology

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Objective: Eye-tracking is a promising technology to enhance assessment of performance validity. Research has established that ocular behaviors are reliable biomarkers of (un)conscious cognitive processes, and they have distinguished deceptive from honest responding in experimental paradigms. This study examined the incremental utility of eye-tracking on a clinical performance validity test (PVT) in distinguishing adults with verified TBI from adults coached to feign cognitive impairment. Method: Participants were 49 adults with moderate-to-severe TBI (TBI), 47 healthy adults coached to simulate TBI (SIM), and 67 healthy comparisons providing full effort (HC). A PVT linked to eye-tracking was completed in the context of a full neuropsychological battery. Results: Kruskal-Wallis tests revealed that eye-tracking indices did not differ among the groups during presentation of stimulus items but did differ during forced-choice trials. Compared to TBI and HC, SIM had significantly more transitions, fixations, and time spent looking at correct and incorrect response options. Logistic regressions and ROC curve analyses showed that accuracy was the best predictor of SIM versus HC. For SIM versus TBI, eye-tracking indices exceeded accuracy in distinguishing the groups. Eye-tracking added incremental predictive value to accuracy for both SIM-HC and SIM-TBI discriminations. Conclusion: Eye-tracking indicated that persons feigning TBI showed multiple signs of greater cognitive effort than persons with verified TBI and healthy comparisons. In the comparison of greatest interest (SIM vs. TBI) eye-tracking best predicted group status and yielded excellent discrimination when combined with accuracy. Eye-tracking may be an important complement to traditional accuracy scores on PVTs.

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Performance validity measures in clinical patients with aphasia

Cited by 29 publications

References 47 publications

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis

What are the predictors of TOMM failure in clinical TBI populations? A retrospective analysis

Performance validity test failure in clinical populations—a systematic review

Detecting feigned traumatic brain injury with eye tracking during a test of performance validity.

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