Embedded assessment of validity using the continuous visual memory test in patients with traumatic brain injury

Retrospective review of a consecutive patient series (n = 115) referred for neuropsychological examinations for traumatic brain injury was undertaken to evaluate an embedded measure of symptom validity for the Continuous Visual Memory Test (CVMT). Performance on the Test of Memory Malingering (TOMM) and Word Memory Test (WMT) was used for classification. Individuals who failed the TOMM or WMT were almost six times more likely to fail the CVMT validity criteria than those who passed the TOMM or WMT. The addition of compensation seeking increased this odds ratio to 9.80. The area under the curve for the latter classification was 0.74. Maximum likelihood ratio optimization of the CVMT validity test cutoff score indicated sensitivity of 0.25 and specificity of 0.99 at a revised cutoff of <12 items. Classification accuracy was 91%. The original cutoff score of <14 items also performed acceptably, with a classification accuracy of 88%. While low sensitivity argues against use in isolation, the proposed measure has utility in conjunction with other established effort measures.