Performance Validity Testing in Patients with Substance Abuse in Addiction Care

Area of Science:

• Neuropsychology
• Addiction Medicine
• Cognitive Assessment

Background:

• Substance use disorder (SUD) is linked to cognitive impairments affecting treatment outcomes.
• Neuropsychological testing is vital for identifying these deficits, but performance validity data is scarce.
• Performance validity testing (PVT) assesses the reliability of neuropsychological test results.

Purpose of the Study:

• To determine the prevalence of poor performance validity in SUD inpatients using different PVTs.
• To evaluate the agreement between various PVTs in detecting invalid performance.
• To examine the association between PVT results and overall cognitive function.

Main Methods:

• Retrospective analysis of 172 SUD inpatients (2017-2024).
• Evaluation of three PVTs: Visual Association Test-Extended (VAT-E), Amsterdam Short-Term Memory test (ASTM), and WAIS-IV Digit Span Age-Corrected Scaled Score (DS ACSS).
• Calculation of failure rates, inter-PVT agreement (κ), and correlations with the Montreal Cognitive Assessment (MoCA).

Main Results:

• Substantial variation in failure rates across PVTs (1.3% to 36%).
• Low agreement between PVTs (κ = 0.019–0.397) and minimal correlations among their scores.
• Weak to moderate positive correlations between PVTs and MoCA scores (ρ = -0.024–0.403).

Conclusions:

• Different PVTs may assess distinct constructs, leading to varied failure rates.
• ASTM may be too difficult, and DS ACSS failures might indicate lower intelligence, not necessarily invalid performance.
• Careful selection of PVTs is crucial in addiction settings to prevent misclassification and ensure valid neuropsychological assessments.