Performance and symptom validity testing in neuropsychological assessments in Australia: a survey of practises and beliefs

Objective: Validity test failures within neuropsychological assessments are common. This study aimed to assess current practise. Method: Australian psychologists completed an online survey evaluating their approach to validity issues. Results: There were 102 participants (75% female, mean age 41.68 (11.72), 88% clinical neuropsychologists or registrars, 35% conducting 10+ assessments in medico-legal settings, 88% conducting 10+ assessments in clinical settings). Performance validity tests were used by most clinicians in a medico-legal setting, but in less than 50% of assessments in clinical settings. Symptom validity tests were used significantly more frequently in medico-legal settings as compared to clinical settings. Less objective methods (e.g., qualitative observation) were more frequently used to evaluate validity in clinical settings. Conclusions: Overall, validity testing in Australia is not consistent with published North American guidelines or practise trends. In Australia, psychologists practising in clinical settings appear to be relying on subjective judgements more frequently than on objective test findings. Australian guidelines that reflect recent research findings regarding validity test failure rates in clinical settings are required. The most frequently cited reason for not including validity tests was insufficient time, so future research should continue to examine time-efficient ways of incorporating validity testing. What is already known about this topic: (1) Performance validity and symptom validity test failure occur in both medico-legal and clinical settings. (2) Professional guidelines for validity testing published by professional bodies in North America emphasise the importance of validity tests in medico-legal and other settings. (3) Validity test use varies between countries, with high rates in North America but lower rates in Europe and New Zealand. What this paper adds: (1) Based on North American guidelines, performance validity tests are used less frequently than recommended in clinical settings in Australia, whilst symptom validity tests are used less frequently than recommended in both clinical and medico-legal settings. (2) Lack of time is the biggest barrier to incorporating validity tests into neuropsychological assessments; more time-efficient validity testing methods would help redress this issue. (3) There is an urgent need for Australian guidelines for validity testing in neuropsychological assessments.

Automated summary

This study found inconsistencies in the use of validity testing in Australia, with clinicians in clinical settings relying more on subjective judgements than objective test findings. Lack of time was cited as the main barrier to incorporating validity tests, indicating a need for more time-efficient methods. Australian guidelines for validity testing in neuropsychological assessments are urgently needed to address validity test failure rates in clinical settings.