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Cross-validation of verbal fluency measures as embedded performance validity tests in a clinical sample
Keith Johnson1,2, Lee Ashendorf2
1Department of Psychology, Rusk Institute of Rehabilitation Medicine, NYU Langone Medical Center, New York City, NY, USA.
Applied Neuropsychology. Adult
|July 18, 2026
Summary
Verbal fluency tests like the Controlled Oral Word Association Test (COWAT-FAS) and Animal Naming effectively identify non-credible performance in veterans undergoing neuropsychological evaluation. These tests serve as efficient, non-memory-based performance validity tests (PVTs).
Area of Science:
- Neuropsychology
- Clinical Psychology
- Cognitive Neuroscience
Background:
- Neuropsychological evaluations are crucial for diagnosing conditions like mild TBI and ADHD in military veterans.
- Performance validity tests (PVTs) are essential to ensure the reliability of assessment results.
- Embedded PVTs, integrated within standard cognitive tests, offer efficient methods for detecting invalid performance.
Purpose of the Study:
- To evaluate the effectiveness of the Controlled Oral Word Association Test (COWAT-FAS) and Animal Naming as embedded PVTs.
- To determine the classification accuracy of these verbal fluency measures in distinguishing credible from non-credible participants.
- To identify optimal scoring methods for these PVTs in a veteran population.
Main Methods:
- A mixed clinical sample of 165 military veterans, referred for neuropsychological evaluation due to mild TBI or suspected ADHD, was studied.
- Participants were classified as credible (0 PVT failures) or non-credible (≥2 PVT failures) based on established PVT criteria.
- Classification accuracy was assessed using raw scores, demographically adjusted T-scores, and logistic regression models for COWAT-FAS and Animal Naming.
Main Results:
- Both COWAT-FAS and Animal Naming significantly differentiated between credible and non-credible groups.
- Optimal classification accuracy was achieved using COWAT-FAS raw scores, both independently and within a logistic regression model.
- These verbal fluency measures demonstrated efficiency as embedded, non-memory-based PVTs.
Conclusions:
- Verbal fluency measures, particularly the COWAT-FAS, are effective embedded PVTs for use in neuropsychological evaluations of military veterans.
- These findings support the utility of non-memory-based tests for assessing performance validity in clinical settings.
- The study highlights the practical application of verbal fluency tasks in ensuring the integrity of neuropsychological data.
