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The emotion word fluency test as an embedded performance validity indicator - Alone and in a multivariate validity

Christopher A Abeare1, Kelly An2, Brad Tyson3

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Existing verbal fluency tests effectively identify noncredible performance. New cutoffs for the Emotion Word Fluency Test (EWFT) show promise but require further validation, with multivariate models outperforming single indicators.

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Area of Science:

  • Neuropsychology
  • Cognitive Assessment
  • Performance Validity

Background:

  • Verbal fluency tests are commonly used in cognitive assessments.
  • Existing performance validity cutoffs for verbal fluency measures (FAS and animals) require cross-validation.
  • A novel measure, the Emotion Word Fluency Test (EWFT), needs established validity indicators.

Purpose of the Study:

  • To cross-validate existing performance validity cutoffs for verbal fluency tests (FAS and animals).
  • To develop and validate new performance validity cutoffs for the Emotion Word Fluency Test (EWFT).
  • To examine the classification accuracy of these tests in healthy and clinical samples.

Main Methods:

  • Two samples were used: 70 cognitively healthy university students and 52 clinical patients.
  • Classification accuracy of verbal fluency tests was assessed against criterion measures.
  • Demographically adjusted T-scores and raw scores were analyzed for specificity and sensitivity.

Main Results:

  • A demographically adjusted T-score ≤31 on the FAS demonstrated high specificity for noncredible responding.
  • Specific cutoffs for the Animals test (T≤29 for students, T≤27 for patients) showed varying sensitivity and high specificity.
  • An EWFT raw score ≤5 was highly specific but insensitive to invalid performance; multiple cutoffs improved specificity.

Conclusions:

  • Existing verbal fluency tests are confirmed as useful embedded validity indicators.
  • Multivariate models for performance validity assessment are superior to single indicators.
  • The clinical utility and limitations of the EWFT as a novel measure are discussed.