Time and money: Exploring enhancements to performance validity research designs

• Published in: Applied neuropsychology. Adult Vol. 31; no. 3; pp. 256 - 263
• Main Authors: Kanser, Robert J., Rapport, Lisa J., Hanks, Robin A., Patrick, Sarah D.
• Format: Journal Article
• Language: English
• Published: United States Routledge 03-05-2024
• Subjects: Adult; Brain Injuries, Traumatic - diagnosis; Cognitive Dysfunction - diagnosis; Humans; Malingering; Malingering - diagnosis; Malingering - psychology; Neuropsychological Tests; performance validity; Reproducibility of Results; Research Design; Retrospective Studies; traumatic brain injury; traumatic brain injury; performance validity; Malingering
• ISSN: 2327-9095; 2327-9109
• DOI: 10.1080/23279095.2021.2019740

The study examined the effect of preparation time and financial incentives on healthy adults' ability to simulate traumatic brain injury (TBI) during neuropsychological evaluation.
A retrospective comparison of two TBI simulator group designs: a traditional design employing a single-session of standard coaching immediately before participation (SIM-SC; n = 46) and a novel design that provided financial incentive and preparation time (SIM-IP; n = 49). Both groups completed an ecologically valid neuropsychological test battery that included widely-used cognitive tests and five common performance validity tests (PVTs).
Compared to SIM-SC, SIM-IP performed significantly worse and had higher rates of impairment on tests of processing speed and executive functioning (Trails A and B). SIM-IP were more likely than SIM-SC to avoid detection on one of the PVTs and performed somewhat better on three of the PVTs, but the effects were small and non-significant. SIM-IP did not demonstrate significantly higher rates of successful simulation (i.e., performing impaired on cognitive tests with <2 PVT failures). Overall, the rate of the successful simulation was ∼40% with a liberal criterion, requiring cognitive impairment defined as performance >1 SD below the normative mean. At a more rigorous criterion defining impairment (>1.5 SD below the normative mean), successful simulation approached 35%.
Incentive and preparation time appear to add limited incremental effect over traditional, single-session coaching analog studies of TBI simulation. Moreover, these design modifications did not translate to meaningfully higher rates of successful simulation and avoidance of detection by PVTs.