Validation of the Repeatable Battery for the Assessment of Neuropsychological Status – Effort Index in a Veteran Sample

Abstract

The RBANS Effort Index (RBANS-EI; Silverberg, Wertheimer, & Fichtenberg, 2007) is an embedded measure of effort within a frequently employed neuropsychological screening battery. While it has been criticized for inadequate specificity in older non-litigating samples (Hook, Marquine, & Hoelzle, 2009; Warren et al., 2010), the RBANS-EI has yet to be investigated in a non-geriatric veteran sample. Archival data were collected from 85 veterans who completed the RBANS and WMT within either a routine neuropsychological evaluation (n = 66) or compensation evaluation (n = 19). At a cutoff of >3 RBANS-EI exhibited strong specificity (.94) yet limited sensitivity (.31) in the prediction of WMT performance. Examination of RBANS-EI component subtests found that List Recognition <17 had strong specificity (.90) and moderate sensitivity (.52) in discriminating WMT performance groups. In contrast, Digit Span performance was comparable between those passing and failing the WMT. Present findings indicate that both the RBANS-EI and List Recognition subtest may be useful in detecting suboptimal effort yet raise questions regarding the Digit Span component of the RBANS-EI.

Using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index to Predict Treatment Group Attendance in Patients with Schizophrenia

“…We found that a more conservative EI cutoff of 4 had greater attendance predictive abilities than a lower cutoff. Given the age and overall levels of cognitive impairment in our sample, using a conservative cutoff which adjusts for these factors seemed clinically appropriate (Young et al, 2012).…”

“…In the original study, a heterogeneous clinical sample was used to identify an appropriate cut-off score for the RBANS EI to detect insufficient effort, then the EI was validated using a sample of genuine versus feigned traumatic brain injury patients (Silverberg et al, 2007). Still a relatively new measure of effort, only six studies have been published examining its reliability and validity (Armistead-Jehle & Hansen, 2011; Duff et al, 2011; Hook, Marquine, & Hoelzle, 2009; O'Mahar et al, 2012; Silverberg et al, 2007; Young, Baughman, & Roper, 2012). These studies conclude (although inconsistently) that scores of 3 or higher are indicative of low effort.…”

“…Scores on each of the two subtests are inversely weighted (i.e., Digit Span raw score between 8 and 16 receives weighted score of 0; Digit Span raw score of 7 receives weighted score of 2) and then summed to create an overall score ranging from 0-12, so that higher EI scores are thought to be reflective of poorer effort. In the original study, a heterogeneous clinical sample was used to identify an appropriate cut-off score for the RBANS EI to detect insufficient effort, then the EI was validated using a sample of genuine versus feigned traumatic brain injury patients (Armistead-Jehle & Hansen, 2011; Duff et al, 2011; Hook, Marquine, & Hoelzle, 2009; O’Mahar et al, 2012; Silverberg et al, 2007; Young, Baughman, & Roper, 2012). Still a relatively new measure of effort, only six studies have been published examining its reliability and validity (Silverberg et al, 2007).…”

Comparison of the Repeatable Battery for the Assessment of Neuropsychological Status Effort Scale and Effort Index in a Dementia Sample

“…When the EI was investigated in a sample of 303 older adult veterans referred for neuropsychological evaluations at a memory disorders clinic, the EI had a sensitivity of 64% and a specificity of 85% when effort classification was determined by the Test of Memory Malingering (Barker, Horner, & Bachman, 2010). Further, the EI showed a specificity of 94% and sensitivity of 31% when compared with the Word Memory Test classifications of effort in a sample of 85 veterans under the age of 65 (Young, Baughman, & Roper, 2012). Armistead-Jehle and Hansen (2011) compared the EI with established stand-alone measures of effort and found the EI had high specificity, but weak sensitivity compared with the Medical Symptom Validity Test (MSVT; Green, 2004), Non-Verbal Medical Symptom Validity Test (Green, 2008), and Test of Memory Malingering (Tombaugh, 1996).…”

Effort in acute traumatic brain injury: Considering more than pass/fail.

“…The RBANS effort index incorrectly classified 31% of medically ill geriatric patients not suspected of having any external incentive to malinger (Hook et al, 2009), but also demonstrated modest sensitivity in a different sample of geriatric patients with suspected underperformance issues (Barker et al, 2010). It has been shown to have modest sensitivity, but strong specificity in service members and veterans (Armistead-Jehle & Hansen, 2011; Young et al, 2012). …”