The Development and Validation of the Embedded Validity Indicator for the Neuropsychological Assessment Battery

Abstract

Abstract Objective The purpose of this study was to develop and validate an embedded measure of performance validity within the Neuropsychological Assessment Battery (NAB). Method This study involved a retrospective chart review at an outpatient neuropsychology clinic. Participants were 183 adults (ages 18–70) who completed the attention and memory modules of the NAB, as well as the Word Choice Test, Green’s Medical Symptom Validity Test (MSVT), and Green’s Non-Verbal MSVT, as part of a clinical neuropsychological assessment (n = 147) or as part of a forensic neuropsychological evaluation (n = 36). Replicating methodology utilized by Silverberg et al. (2007) for the development of the Effort Index within the Repeatable Battery for the Assessment of Neuropsychological Status, an Embedded Validity Indictor (EVI) for the NAB was developed in the present study based on Digits Forward and List Learning Long Delayed Forced-Choice Recognition (list recognition) subtests. Results Receiver operating characteristic curve analyses indicated the newly developed NAB EVI was able to significantly differentiate between valid and invalid status on stand-alone performance-validity tests, with area under the curve values ranging from 0.797 to 0.977. Optimal cutoffs for medical, forensic, and mixed samples were identified. Conclusions The newly developed NAB EVI shows promise as an embedded performance validity measure; however, due to moderate sensitivity, it should be used in combination with stand-alone performance validity tests to detect invalid performance.