The Rey Auditory Verbal Learning Test forced-choice recognition task: Base-rate data and norms

Abstract

The present study describes a novel Forced-Choice Response (FCR) index for detecting poor effort on the Rey Auditory Verbal Learning Test (RAVLT). This retrospective study analyzes the performance of 4 groups on the new index: clinically referred patients with suspected dementia, forensic patients identified as not exhibiting adequate effort on other measures of response bias, students who simulated poor effort, and a large normative sample collected in the Gulf State of Oman. Using sensitivity and specificity analyses, the study shows that much like the California Verbal Learning Test-Second Edition FCR index, the RAVLT FCR index misses a proportion of individuals with inadequate effort (low sensitivity), but those who fail this measure are highly likely to be exhibiting poor effort (high specificity). The limitations and benefits of utilizing the RAVLT FCR index in clinical practice are discussed.

Cross-validation of a forced-choice validity indicator to enhance the clinical utility of the Rey Auditory Verbal Learning Test.

“…Continuous assessment of performance validity testing is a critical component of a neuropsychological evaluation (Boone, 2009), with embedded measures allowing for efficient validity assessment without increasing evaluation cost, time, or burden. This study aimed to cross-validate the Poreh et al (2016) RAVLT FC trial in a large, diverse sample and to determine whether this novel embedded PVT can be effectively utilized to detect invalid neuropsychological test performance in the context of increasing verbal memory impairment. Results indicated that this FC paradigm had excellent accuracy for identifying performance invalidity among patients with no and mild memory impairment with 66%-82% sensitivity and ≥89% specificity at respective cut-scores of ≤14 and ≤13.…”

“…In its standard iteration, examinees are presented with a list of 15 unrelated words (List A) across 5 learning trials, followed by a distractor list (List B), immediate (Trial 6) and delayed (Trial 7) recall trials, and a recognition trial. The Poreh et al (2016) FC trial consists of 15 target words paired with 15 concrete-noun foils and yields a total score calculated by summing the number of correct responses; FC stimuli are provided in the original study. It was administered immediately after completion of the recognition trial.…”

“…More recently, efforts have led to the development of a forcedchoice (FC) recognition trial as an embedded PVT to assess for invalid RAVLT test performance, similar to FC trials on other memory tests [e.g., California Verbal Learning Test (Delis et al, 2000(Delis et al, , 2017]. Notably, Poreh et al (2016) developed an FC trial in which all 15 RAVLT words were paired with concrete-noun distractor items. In its initial validation, the authors examined FC performance among older patients with suspected dementia on the brief cognitive measure (i.e., Saint Louis University Mental Status Exam; Tariq et al 2006) and forensic referrals with invalid performance on independent criterion PVTs.…”

“…Although this novel RAVLT FC paradigm appears promising, its current utility is limited by a lack of independent cross-validation studies to determine if the accuracy and associated sensitivity and specificity values found in the initial development studies can be replicated in other diverse populations. Therefore, the objective of this study was to cross-validate the Poreh et al (2016) RAVLT FC trial among a large, mixed clinical neuropsychiatric sample with independently verified valid/invalid test performance to determine its accuracy for detecting performance invalidity. This study also examined the effect of increasing memory impairment severity on FC performance to ascertain whether this novel embedded PVT retains its ability to identify invalid neuropsychological test performance in the context of increasing memory impairment severity, given that initial validation suggested it could reliably differentiate patients with suspected dementia from invalid performers (Poreh et al, 2016).…”

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

“…In recent decades EVI research has proliferated. A popular method of EVI development has been to add a FCR trial to existing memory tests, such as the California Verbal Learning Test (Delis et al, 2000), California Verbal Learning Test -Children's Version (Lichtenstein et al, 2017;2018); Rey Auditory Verbal Learning Test (Poreh et al, 2016), and Hopkins Verbal Learning Test (Abeare, Hurtubise et al, 2020;Cutler et al, 2021). Following this trend, introduced an FCR trial to the Rey Complex Figure Test (RCFT); this RCFT FCR was placed 10 minutes after the end of the standard administration protocol.…”