The Rey AVLT Serial Position Effect: A Useful Indicator of Symptom Exaggeration?

Abstract

This investigation explored the usefulness of serial position patterns during word recall on the Rey Auditory Verbal Learning Test (RAVLT; Rey, 1964) as an indicator of poor effort. Significantly better recall for early (primacy) and recent (recency) material defines the serial position effect (SPE; Rundus, 1971). The SPE on the RAVLT was examined in four groups: normal controls (NC), symptom-coached simulators (SC), test-coached simulators (TC), and a group of moderate to severe subacute traumatic brain injury (TBI) patients. Normal control participants and TBI patients demonstrated the expected SPE. Only the SC simulators clearly suppressed the primacy effect. The SPE appears neither sensitive nor specific enough to be used independently of more sensitive symptom validity tests in the detection of suboptimal effort. It may be especially problematic when used with clients presenting with sophisticated styles of exaggeration and in settings with lower base rates of compromised effort.

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

“…Consistent with previous reports (Suhr, 2002; Sullivan et al, 2002; Powell et al, 2004), primacy/recency ratios were abnormal ( p < 0.05) in 60% of the simulated malingerers and 20% of the abnormal controls.…”

“…Consistent with prior studies (Suhr, 2002; Powell et al, 2004; Gavett and Horwitz, 2012; Egli et al, 2014), we found strong primacy and recency effects on initial list presentations (A1 and B) that diminished with learning. Recency effects were absent on recall, consistent with suggestions that recency effects depend on access to a short-term buffer that is overwritten by the presentation of competing lists (Davelaar et al, 2005).…”

Estimating the Diagnostic Value of the Trail Making Test for Suboptimal Effort in Acquired Brain Injury Rehabilitation Patients

“…For example, several investigators have explored the utility of Trail Making Test (TMT; Reitan & Wolfson, 1992) scores as indicators of suboptimal effort in patient and non-patient populations (Goebel, 1983;Horton & Roberts, 2002;Iverson, Lange, Green, & Frazen, 2002;O'Bryant, Hilsabeck, Fisher, & McCaffrey, INTRODUCTION Although symptom validity tests may represent a ''gold standard'' for assessing effort or task engagement during neuropsychological evaluations (Vickery, Berry, Hanlon, Harris, & Orey, 2001), clinicians continue to utilize multiple sources of information when rendering decisions about patient effort (Mittenberg, Patton, Canyock, & Condit, 2002;Slick, Tan, Strauss, & Hultsch, 2004). Indicators derived from standardized neuropsychological instruments represent one additional source of data to inform decisions about the validity of test results (e.g., Axelrod, Barlow, & Paradee, 2009;Mittenberg, Azrin, Millsaps, & Heilbronner, 1993;Powell, Gfeller, Oliveri, Stanton, & Hendricks, 2004;Suhr, 2002). For example, several investigators have explored the utility of Trail Making Test (TMT; Reitan & Wolfson, 1992) scores as indicators of suboptimal effort in patient and non-patient populations (Goebel, 1983;Horton & Roberts, 2002;Iverson, Lange, Green, & Frazen, 2002;O'Bryant, Hilsabeck, Fisher, & McCaffrey, 2003;Roberts & Horton, 2003;Ruffolo, Guilmette, & Willis, 2000;Trueblood & Schmidt, 1993).…”

“…Indicators derived from standardized neuropsychological instruments represent one additional source of data to inform decisions about the validity of test results (e.g., Axelrod, Barlow, & Paradee, 2009;Mittenberg, Azrin, Millsaps, & Heilbronner, 1993;Powell, Gfeller, Oliveri, Stanton, & Hendricks, 2004;Suhr, 2002). For example, several investigators have explored the utility of Trail Making Test (TMT; Reitan & Wolfson, 1992) scores as indicators of suboptimal effort in patient and non-patient populations (Goebel, 1983;Horton & Roberts, 2002;Iverson, Lange, Green, & Frazen, 2002;O'Bryant, Hilsabeck, Fisher, & McCaffrey, INTRODUCTION Although symptom validity tests may represent a ''gold standard'' for assessing effort or task engagement during neuropsychological evaluations (Vickery, Berry, Hanlon, Harris, & Orey, 2001), clinicians continue to utilize multiple sources of information when rendering decisions about patient effort (Mittenberg, Patton, Canyock, & Condit, 2002;Slick, Tan, Strauss, & Hultsch, 2004).…”

Memory factors in Rey AVLT: Implications for early staging of cognitive decline

“…The first two factors are already discussed at length in the literature (see, e.g. Powell et al ., ; Winters & Ward, ). The current study gives statistical evidence for these factors, which were found across all the trials of the test.…”