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Performance validity test failure in clinical populations-a systematic review.

Laura McWhirter1, Craig W Ritchie2, Jon Stone2

  • 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK laura.mcwhirter@ed.ac.uk.

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Performance validity tests (PVTs) are frequently failed by patients with clinical conditions, even without external motivation. This suggests neuropsychological test objectivity may be limited in clinical practice and research.

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Area of Science:

  • Neuropsychology
  • Clinical Psychology

Background:

  • Performance validity tests (PVTs) are crucial for assessing effort and detecting response bias in neuropsychological evaluations.
  • Interpreting poor PVT performance in clinical settings is complex, especially given the prevalence of compensation-seeking groups in research.

Purpose of the Study:

  • To determine baseline rates of PVT failure in clinical populations without clear external incentives to underperform.
  • To investigate PVT failure rates across diverse clinical diagnoses.

Main Methods:

  • Systematic literature search of MEDLINE, EMBASE, and PsycINFO for studies reporting PVT failure rates in adults with clinical diagnoses.
  • Exclusion of military, forensic, and disability-seeking populations.
  • Summarization of results by diagnostic group.

Main Results:

  • Sixty-nine studies and 45 PVTs/indices were identified across clinical groups including intellectual disability, neurodegenerative diseases, brain injury, psychiatric disorders, functional disorders, and epilepsy.
  • PVT failure was common across all investigated clinical groups, with some exceeding 25% failure rates.
  • Failure rates for functional disorders were comparable to other clinical conditions.

Conclusions:

  • PVT failure is prevalent in various clinical conditions, irrespective of apparent motivation to underperform.
  • The high rate of unexpected PVT failure questions the objectivity of neuropsychological tests in clinical research and practice.
  • Findings highlight the need for careful interpretation of PVT results in diverse patient populations.