The Bay Area Verbal Learning Test (BAVLT): Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

Abstract

Verbal learning tests (VLTs) are widely used to evaluate memory deficits in neuropsychiatric and developmental disorders. However, their validity has been called into question by studies showing significant differences in VLT scores obtained by different examiners. Here we describe the computerized Bay Area Verbal Learning Test (BAVLT), which minimizes inter-examiner differences by incorporating digital list presentation and automated scoring. In the 10-min BAVLT, a 12-word list is presented on three acquisition trials, followed by a distractor list, immediate recall of the first list, and, after a 30-min delay, delayed recall and recognition. In Experiment 1, we analyzed the performance of 195 participants ranging in age from 18 to 82 years. Acquisition trials showed strong primacy and recency effects, with scores improving over repetitions, particularly for mid-list words. Inter-word intervals (IWIs) increased with successive words recalled. Omnibus scores (summed over all trials except recognition) were influenced by age, education, and sex (women outperformed men). In Experiment 2, we examined BAVLT test-retest reliability in 29 participants tested with different word lists at weekly intervals. High intraclass correlation coefficients were seen for omnibus and acquisition scores, IWIs, and a categorization index reflecting semantic reorganization. Experiment 3 examined the performance of Experiment 2 participants when feigning symptoms of traumatic brain injury. Although 37% of simulated malingerers showed abnormal (p < 0.05) omnibus z-scores, z-score cutoffs were ineffective in discriminating abnormal malingerers from control participants with abnormal scores. In contrast, four malingering indices (recognition scores, primacy/recency effects, learning rate across acquisition trials, and IWIs) discriminated the two groups with 80% sensitivity and 80% specificity. Experiment 4 examined the performance of a small group of patients with mild or severe TBI. Overall, both patient groups performed within the normal range, although significant performance deficits were seen in some patients. The BAVLT improves the speed and replicability of verbal learning assessments while providing comprehensive measures of retrieval timing, semantic organization, and primacy/recency effects that clarify the nature of performance.

The Dyad-Adaptive Paced Auditory Serial Addition Test (DA-PASAT): Normative data and the effects of repeated testing, simulated malingering, and traumatic brain injury

“…Significant elevations in minSOA z-scores were observed in the small sTBI patient group, similar to the results of previous studies using the standard PASAT [ 84 , 85 ] and the adjusting PASAT [ 31 ]. Patients with abnormal performance generally showed normal RTs and abnormal dyad ratios, consistent with deficits in working memory reported in this patient group [ 44 , 58 , 59 ].…”

“…The DA-PASAT was the twentieth test in the California Cognitive Assessment Battery (CCAB). Each CCAB test session included the following computerized tests and questionnaires: finger tapping [ 51 , 57 ], simple reaction time [ 39 , 41 ], Stroop, digit span forward and backward [ 45 , 58 ], verbal list learning [ 59 ], verbal fluency [ 44 ], visuospatial span [ 43 , 60 ], trail making [ 61 ], vocabulary, design fluency [ 62 ], the Wechsler Test of Adult Reading (WTAR), choice reaction time [ 39 , 42 ], risk and loss avoidance, delay discounting, the DA-PASAT, the Cognitive Failures Questionnaire (CFQ) and the Posttraumatic Stress Disorder Checklist (PCL) [ 63 ], and a locally developed traumatic brain injury (TBI) questionnaire.…”

Computerized Analysis of Verbal Fluency: Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

“…Thus, while malingerers produced abnormal correct-word scores, they did so in a manner that failed to match the characteristics of non-malingering subjects with abnormal scores. In other neuropsychological tests, ancillary performance measures have shown utility in distinguishing simulated malingerers and controls with abnormal scores [75, 78, 81, 99, 100]. Thus, while malingerers may produce criterion scores in the abnormal range they do so in different manner from subjects with intrinsically limited processing abilities.…”

Traumatic brain injury and malingering: A systematic review.

“…The Test of Memory Malingering (TOMM) was the most commonly used, administered in five studies (Bashem et al, 2014; Fuermaier et al, 2020; Kanser et al, 2019; Neal et al, 2019; Vickery et al, 2004). Besides studies using TOMM, 12 other studies applied instruments focused explicitly on memory, namely, the Medical SVT (Bashem et al, 2014), the Reliable Digit Span (RDS; Bashem et al, 2014; Strauss et al, 2002), the Word Choice Test (Bashem et al, 2014), the California Verbal Learning Test–Forced Choice (Bashem et al, 2014), the Weschler Memory Scale–Revised (Bernard et al, 1993; Mittenberg et al, 1993), the Portland Digit Recognition Test (PDRT; Ju & Varney, 2000), the Warrington Recognition Memory Test (RMT) of Words (Kanser et al, 2020), the Forced-Choice Graphics Memory Test (Liu et al, 2016), the revised version of the Hiscock Digit Memory Test (Slick et al, 1994), the Word Memory Test (Stevens & Merten, 2010), the Victoria SVT (Strauss et al, 2002), the Letter Memory Test (Vickery et al, 2001), the Digit Memory Test (Vickery et al, 2001), the Multidigit Memory Test (Hayes et al, 1995), the Digit Span Test (Hayes et al, 1995), Warrington RMT (Cato et al, 2002); Dot Couting Test (Cato et al, 2002); Rey Fifteen-Item Test (Cato et al, 2002); Hiscock Forced Choice Procedure (Cato et al, 2002); a computerized spatial span task (Woods et al, 2016b), and the Bay Area Verbal Learning Test (BAVLT; Woods et al, 2017). As a mean to measure feigning of TBI-related neuropsychological deficits, a total of 11 studies resorted to instruments used for the assessment of executive functions or other cognitive domains, namely, the Wisconsin Card Sorting Test (WCST; Bernard et al, 1996), the Trail Making Test (Ruffolo et al, 2000; Woods, Wyma, et al, 2015), versions of the Dot Counting Test (DCT; Hayes et al, 1995; Strauss et al, 2002), the Booklet Category Test (CT; Tenhula & Sweet, 1996), a simple reaction time paradigm (Woods et al, 2015a), a choice reaction time paradigm (Woods et al, 2015b), verbal fluency tasks (Woods et al, 2016a), the Dyad-Adaptive Paced Auditory Serial Addition Test (Woods et al, 2018), the Cognitive Behavioral Drivers Inventory (Ray et al, 1997), and a computerized measure of finger tapping (Hubel et al, 2013).…”

“…The two last studies focused on verbal learning (Woods et al, 2017) and processing speed and executive functioning (Woods et al, 2018) using computerized versions of the BAVLT and of the Dyad-Adaptative Paced Auditory Serial Addition Test. Malingerers exhibited poorer performance ( M = 20.04, SD = 5.44) than mild TBI patients ( M = 21.88, SD = 4.90) but performed better than severe patients ( M = 17.25, SD = 4.27) on the total acquisition score of BAVLT.…”