Investigation of Performance and Symptom Validity Testing in Children Utilizing Control, Simulation, and Clinical Groups
Date of Award
Doctor of Philosophy (PhD)
Hoelzle, James B.
Integral to neuropsychology, assessment relies on valid self-report and credible performance on neuropsychological tests. Symptom exaggeration and misrepresentation of abilities confound interpretation of neuropsychological test data, subsequent diagnosis, and treatment. Measures evaluating performance and symptom validity have been extensively studied in adult populations; however, similar research in child and adolescent populations is limited. In accordance with recommended research methodology, this study utilized a simulation design with community recruited and medical center clinical criterion groups which included 191 children and adolescents (7 to 16 years old). Sensitivity, specificity, and proposed cut-off scores are described for the Victoria Symptom Validity Test, Digit Span Age Corrected Scaled Score, Reliable Digit Span, Reliable Digit Span-Revised, Rey Fifteen Item Test, and Automatized Sequences Task. Novel embedded performance validity indicators for WRAML-2 Verbal Learning were developed, and cut-off scores are proposed for recognition discriminability, d prime, and forced choice measures. Additionally, symptom validity scales from parent- and child-report questionnaires suggested that select parent-report BRIEF and BASC-2 and child-report BASC-2 validity scales distinguished simulators from control and clinical participants. This study meaningfully and substantially adds to the current understanding of objective validity measurement in youth neuropsychological assessment and provides a framework for future development and investigation of youth performance validity tests and youth and parent symptom validity tests.