Time and money: Exploring enhancements to performance validity research designs

Area of Science:

• Neuropsychology
• Cognitive assessment
• Traumatic Brain Injury (TBI) simulation

Background:

• Understanding factors influencing malingering in neuropsychological evaluations is crucial.
• Traumatic Brain Injury (TBI) simulation studies examine how individuals feign cognitive deficits.
• Previous TBI simulation research primarily used single-session coaching.

Purpose of the Study:

• To investigate the impact of preparation time and financial incentives on TBI simulation.
• To compare a novel TBI simulation design (SIM-IP) with a traditional design (SIM-SC).
• To assess the effectiveness of these modifications in increasing successful simulation rates.

Main Methods:

• Retrospective comparison of two TBI simulator group designs: SIM-SC (standard coaching) and SIM-IP (incentive and preparation time).
• Both groups (n=46 SIM-SC, n=49 SIM-IP) completed an ecologically valid neuropsychological test battery.
• Included widely-used cognitive tests and five common performance validity tests (PVTs).

Main Results:

• SIM-IP group showed significantly worse performance and higher impairment rates on processing speed and executive functioning tests (Trails A and B).
• SIM-IP participants were more likely to avoid detection on one PVT, but effects were small and non-significant.
• No significant increase in successful simulation rates (defined as cognitive impairment with <2 PVT failures) was observed in the SIM-IP group.

Conclusions:

• Preparation time and financial incentives provided limited additional benefit over traditional single-session coaching for TBI simulation.
• The modified design did not lead to meaningfully higher rates of successful simulation or improved avoidance of PVT detection.
• Findings suggest current modifications may not substantially enhance the challenge of detecting simulated TBI in research settings.