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Embedded measures of performance validity using verbal fluency tests in a clinical sample.

Michael A Sugarman1, Bradley N Axelrod

  • 1a Department of Psychology , John D. Dingell Veterans' Affairs Medical Hospital.

Applied Neuropsychology. Adult
|August 26, 2014
PubMed
Summary

Verbal fluency tests effectively identify poor effort during neuropsychological evaluations. Specific measures like the Animals test and combined models show high accuracy in detecting invalid performance, aiding clinical assessments.

Keywords:
COWATeffortlogistic regressionmalingering

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Area of Science:

  • Neuropsychology
  • Cognitive Psychology
  • Psychometrics

Background:

  • Performance validity tests (PVTs) are crucial in neuropsychological evaluations to detect invalid responses.
  • Verbal fluency measures are widely used cognitive tests, but their utility as performance validity indicators requires further investigation.

Purpose of the Study:

  • To assess the effectiveness of verbal fluency measures (Controlled Oral Word Association Test and Animals) as indicators of performance validity in a clinical neuropsychological setting.
  • To determine the sensitivity and specificity of these measures in distinguishing between credible and poor effort groups.

Main Methods:

  • Clinically referred participants (n=623) were divided into credible performance (n=431) and poor effort (n=192) groups based on PVT results.
  • All participants completed the Controlled Oral Word Association Test (COWAT) and Animals verbal fluency tests.
  • Logistic regression models were used to evaluate the classification accuracy of verbal fluency scores.

Main Results:

  • Animals verbal fluency scores demonstrated 90% specificity and over 40% sensitivity in detecting poor effort.
  • COWAT scores showed lower sensitivity compared to the Animals test.
  • Combined verbal fluency measures (FAS and Animals) in logistic regression models achieved 90% specificity and over 44% sensitivity for group classification.

Conclusions:

  • Verbal fluency measures, particularly the Animals test and combined models, can adequately detect poor effort in neuropsychological evaluations.
  • Suggested cut points and logistic regression models are provided to optimize the detection of invalid performance in clinical practice.