Attention Performance as an Embedded Validity Indicator in the Cognitive Assessment of Early Retirement Claimants

The assessment of performance validity is essential in any neuropsychological evaluation. However, relatively few measures exist that are based on attention performance embedded within routine cognitive tasks. The present study explores the potential value of a computerized attention test, the Cognitrone, as an embedded validity indicator in the neuropsychological assessment of early retirement claimants. Two hundred and sixty-five early retirement claimants were assessed with the Word Memory Test (WMT) and the Cognitrone. WMT scores were used as the independent criterion to determine performance validity. Speed and accuracy measures of the Cognitrone were analyzed in receiver operating characteristics (ROC) to classify group membership. The Cognitrone was sensitive in revealing attention deficits in early retirement claimants. Further, 54% (n = 143) of the individuals showed noncredible cognitive performance, whereas 46% (n = 122) showed credible cognitive performance. Individuals failing the performance validity assessment showed slower (AUC = 79.1%) and more inaccurate (AUC = 79.5%) attention performance than those passing the performance validity assessment. A compound score integrating speed and accuracy revealed incremental value as indicated by AUC = 87.9%. Various cut scores are suggested, resulting in equal rates of 80% sensitivity and specificity (cut score = 1.297) or 69% sensitivity with 90% specificity (cut score = 0.734). The present study supports the sensitivity of the Cognitrone for the assessment of attention deficits in early retirement claimants and its potential value as an embedded validity indicator. Further research on different samples and with multidimensional criteria for determining invalid performance are required before clinical application can be suggested.

Scores in Self-Report Questionnaires Assessing Adult ADHD Can Be Influenced by Negative Response Bias but Are Unrelated to Performance on Executive Function and Attention Tests

Self-report questionnaires are in widespread use in the assessment of adults with suspected attention-deficit and hyperactivity disorder (ADHD). Notwithstanding the high degree of validity, these questionnaires are considered to possess, their stand-alone use in assessment for adult ADHD may result in false-positive diagnoses due to the risk of negative response bias. Most of the self-report questionnaires in typical use are based on the diagnostic systems DSM-5 or ICD-10. From a neuropsychological point of view, however, testing of various executive function abilities and attentional performance is important in the assessment of adult ADHD. The present study (N = 211) found no evidence linking executive function (working memory and inhibitory processes) and attentional performance (processing speed) to the results of a self-report questionnaire, the ADHS-LE. The number of failures on the three symptom or performance validity tests (SVT/PVT) used provided the sole, and significant, explanation for the response behavior reported on the ADHS-LE. Of these three SVT/PVTs (the German version of the Structured Inventory of Malingered Symptomatology, SIMS, the reliable digit span, and the standard deviation of simple reaction time), only the SIMS was found to be a significant predictor variable. In the clinical context of this study, 32.6% of subjects produced at least one invalid SVT/PVT result. The use of a more conservative criterion—failure on at least two of the three SVT/PVTs deemed to be feigning ADHD—reduced the proportion of participants generating invalid values to 5%.

Motor Reaction Times as an Embedded Measure of Performance Validity: a Study with a Sample of Austrian Early Retirement Claimants

Among embedded measures of performance validity, reaction time parameters appear to be less common. However, their potential may be underestimated. In the German-speaking countries, reaction time is often examined using the Alertness subtest of the Test of Attention Performance (TAP). Several previous studies have examined its suitability for validity assessment. The current study was conceived to examine a variety of reaction time parameters of the TAP Alertness subtest with a sample of 266 Austrian civil forensic patients. Classification results from the Word Memory Test (WMT) were used as an external indicator to distinguish between valid and invalid symptom presentations. Results demonstrated that the WMT fail group performed worse in reaction time as well as its intraindividual variation across trials when compared to the WMT pass group. Receiver operating characteristic analyses revealed areas under the curve of .775–.804. Logistic regression models indicated the parameter intraindividual variation of motor reaction time with warning sound as being the best predictor for invalid test performance. Suggested cut scores yielded a sensitivity of .62 and a specificity of .90, or .45 and .95, respectively, when the accepted false-positive rate was set lower. The results encourage the use of the Alertness subtest as an embedded measure of performance validity.

Kriterien zur Bestimmung des Schweregrades einer neuropsychologischen Störung sowie Zuordnungen zur Funktions- und Arbeitsfähigkeit

Zusammenfassung. Im Folgenden wird ein Beurteilungssystem zur Einschätzung des Schweregrades von neuropsychologischen Störungen vorgestellt. Insbesondere umfasst es spezifische Kriterien zur Ermittlung des Schweregrades einer Störung, die wiederum in Beziehung zur Funktions- und Arbeitsfähigkeit eines Patienten oder Versicherten gesetzt werden. Das Beurteilungssystem beruht auf den in der Suva-Tabelle 8 zur Einschätzung der psychischen Folgen einer Hirnverletzung definierten Kriterien. Infolgedessen ist es auch grundsätzlich damit vereinbar, stellt aber aufgrund des Miteinbezugs von neuropsychologischen Testergebnissen in Form von Standardwerten als Beurteilungskriterium sowie verbunden mit den Erläuterungen zu deren Interpretation und Anwendung eine wesentliche Weiterentwicklung dar. Im Gegensatz zur Suva-Tabelle 8 ist das Beurteilungssystem unabhängig vom kausalen Versicherungskontext des UVG. Es kann somit unter anderem auch in Rahmen des IVG und KVG/VVG angewandt werden. In diesem Sinne ist es sowohl unabhängig von der Ätiologie des jeweiligen Beschwerdebildes wie auch unabhängig von der artifiziellen dichotomen Unterscheidung zwischen „organischen“ und „nichtorganischen“ psychischen Störungen. Mit der Erstellung und Publikation dieser neuen Kriterien-Tabelle soll ein Beitrag zur weiteren Verbesserung der Interrater-Reliabilität im Rahmen der Beurteilung des Schweregrades von neuropsychologischen Störungen sowie der Einschätzung der Funktionsfähigkeit geleistet werden. Nicht zuletzt ist das Beurteilungssystem auch kompatibel mit den im DSM-5 festgelegten Kriterien zur Einschätzung des Schweregrades einer neurokognitiven Störung.