Performance and symptom validity indicators among children undergoing cognitive surveillance following treatment for craniopharyngioma

Background

Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to neuropsychological evaluations, helping ensure findings reflect true abilities or concerns. It is unclear how PVTs and SVTs perform in children who received radiotherapy for brain tumors. Accordingly, we investigated the rate of noncredible performance on validity indicators as well as associations with fatigue and lower intellectual functioning.

Methods

Embedded PVTs and SVTs were investigated in 98 patients with pediatric craniopharyngioma undergoing proton radiotherapy (PRT). The contribution of fatigue, sleepiness, and lower intellectual functioning to embedded PVT performance was examined. Further, we investigated PVTs and SVTs in relation to cognitive performance at pre-PRT baseline and change over time.

Results

SVTs on parent measures were not an area of concern. PVTs identified 0-31% of the cohort as demonstrating possible noncredible performance at baseline, with stable findings 1 year following PRT. Reliable digit span (RDS) noted the highest PVT failure rate; RDS has been criticized for false positives in pediatric populations, especially children with neurological impairment. Objective sleepiness was strongly associated with PVT failure, stressing need to consider arousal level when interpreting cognitive performance in children with craniopharyngioma. Lower intellectual functioning also needs to be considered when interpreting task engagement indices as it was strongly associated with PVT failure.

Conclusions

Embedded PVTs should be used with caution in pediatric craniopharyngioma patients who have received PRT. Future research should investigate different cut-off scores and validity indicator combinations to best differentiate noncredible performance due to task engagement versus variable arousal and/or lower intellectual functioning.

New Child and Adolescent Memory Profile Embedded Performance Validity Test

OBJECTIVE

It is essential to interpret performance validity tests (PVTs) that are well-established and have strong psychometrics. This study evaluated the Child and Adolescent Memory Profile (ChAMP) Validity Indicator (VI) using a pediatric sample with traumatic brain injury (TBI).

METHOD

A cross-sectional sample of N = 110 youth (mean age = 15.1 years, standard deviation [SD] = 2.4 range = 8-18) on average 32.7 weeks (SD = 40.9) post TBI (71.8% mild/concussion; 3.6% complicated mild; 24.6% moderate-to-severe) were administered the ChAMP and two stand-alone PVTs. Criterion for valid performance was scores above cutoffs on both PVTs; criterion for invalid performance was scores below cutoffs on both PVTs. Classification statistics were used to evaluate the existing ChAMP VI and establish a new VI cutoff score if needed.

RESULTS

There were no significant differences in demographics or time since injury between those deemed valid (n = 96) or invalid (n = 14), but all ChAMP scores were significantly lower in those deemed invalid. The original ChAMP VI cutoff score was highly specific (no false positives) but also highly insensitive (sensitivity [SN] = .07, specificity [SP] = 1.0). Based on area under the curve (AUC) analysis (0.94), a new cutoff score was established using the sum of scaled scores (VI-SS). A ChAMP VI-SS score of 32 or lower achieved strong SN (86%) and SP (92%). Using a 15% base rate, positive predictive value was 64% and negative predictive value was 97%.

CONCLUSIONS

The originally proposed ChAMP VI has insufficient SN in pediatric TBI. However, this study yields a promising new ChAMP VI-SS, with classification metrics that exceed any other current embedded PVT in pediatrics.

The Impact of Learning and Memory on Performance Validity Tests in a Mixed Clinical Pediatric Population

OBJECTIVE

This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample.

METHOD

Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children's Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included.

RESULTS

Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%-26%). Verbal learning/memory performance accounted for 5%-16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group.

CONCLUSIONS

Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP's embedded validity measure was most strongly impacted by learning/memory performance.

Age, education and gender effects on Wisconsin card sorting test: standardization, reliability and validity in healthy Argentinian adults

The Wisconsin Card Sorting Test (WCST) is a widely used neuropsychological assessment of executive functioning. The aim of this study was to provide norm values and analyze the psychometric properties of WCST in healthy Argentinian adults aged from 18 to 89 years old (N = 235). Descriptive statistics are reported as means, standard deviations and percentiles, with the effects of age, education and gender being investigated by ANOVA, and with the effect sizes being calculated. The psychometrics were studied using the WCST structure, reliability, convergent validity, and discriminant validity, and WCST norms adjusted for age and educational level are proposed. This instrument is a reliable and valid tool for the assessment of executive functions. However, as the age- and educational-related effects were demonstrated, these characteristics need to be considered before interpreting WCST scores. Regarding gender, no differences were found. Our results expand the geographical and sociocultural applicability of WCST.