Performance validity test failure in clinical populations—a systematic review, 2020, Stone et al

Andy · Jul 12, 2020

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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Paywall, https://jnnp.bmj.com/content/early/2020/07/10/jnnp-2020-323776.full
Sci hub, https://sci-hub.tw/10.1136/jnnp-2020-323776

My bolding

Functional disorders

Eleven studies described PVT performance in people with functional disorders, including for the purposes of this review those conditions termed ‘medically unexplained’, somatoform or ‘nonorganic’. Where possible, PVT failure rates were pooled by specific condition. In two studies of individuals with fibromyalgia, 8 (8%) of 104 failed the TOMM.13 14 In three studies of psychogenic non-epileptic seizures (PNES, also called dissociative seizures), 13 (10%) of 132 failed the TOMM.15–17 In two other studies of PNES, 25 (44%) of 57 met criterion A (therefore failed) on the standard WMT.18 19 In two studies of individuals with chronic fatigue syndrome, 374 (25%) of 1526 failed the Amsterdam Short Term Memory Test (scoring <86/100).20 21(online supplementary table 4) Failure rates higher than 25% were reported by Tyson et al in 33 individuals with PNES on RDS (cut-off ≤7), vocabulary–digit span (≥3), forced choice recall on the California Verbal Learning Test (CVLT) (≤15) and the Boston Naming Test.17
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Snow Leopard · Jul 13, 2020

The alternative is to consider the "validity test" themselves may lack specificity.

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Performance validity test failure in clinical populations—a systematic review, 2020, Stone et al

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Performance validity test failure in clinical populations—a systematic review, 2020, Stone et al

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