Joint Factor Performance Validity?-Network and Factor Structure of Performance Validity Measures in the Clinical...

Performance validity tests (PVTs) and symptom validity tests (SVTs) are central to evaluating neuropsychological test results in clinical adult ADHD assessments. Although their relationships have been widely examined, the constructs these measures assess remain poorly understood in applied contexts. This study investigates the conceptual similarities and distinctions of performance validity measures, i.e., the Groningen Effort Test (GET), the Medical Symptom Validity Test (MSVT), and the Amsterdam Short-Term Memory (ASTM) test, within a comprehensive diagnostic battery for adult ADHD. The diagnostic battery included symptom self-reports and a continuous performance test (CPT). Network and factor analyses investigated these relationships. A three-factor structure was hypothesized, consisting of (1) performance validity measures, (2) continuous performance measures, and (3) symptom reports (including embedded SVTs). Data from a large clinical referral sample (N = 461) of adults with suspected ADHD were analyzed to explore these constructs. Network analysis revealed that the PVTs did not form a cohesive network with CPT measures. Symptom reports, including embedded SVTs, formed their own cluster, separate from performance-based attention measures. Factor analysis rejected a unified construct of performance validity measures. Regression analysis showed that cognitive deficits, education level, and impulsivity predicted ASTM test performance, whilst the MSVT and GET did not. These findings suggest that PVTs should be interpreted in the context of ADHD assessment, particularly in high-stakes forensic evaluations, where the accuracy of performance evaluation is critical. Future research should explore multidimensional models of performance validity, addressing domain-specific underperformance and individual variability in ADHD evaluations.