Comparisons of Five Performance Validity Indices in Bona Fide and Simulated Traumatic Brain Injury

A number of performance validity tests (PVTs) are used to assess memory complaints associated with traumatic brain injury (TBI); however, few studies examine the concordance and predictive accuracy of multiple PVTs, specifically in the context of combined models in known-group designs. The present study compared five widely used PVTs: the Test of Memory Malingering (TOMM), Medical Symptom Validity Test (MSVT), Reliable Digit Span (RDS), Word Choice Test (WCT), and California Verbal Learning Test - Forced Choice (CVLT-FC). Participants were 51 adults with bona fide moderate to severe TBI and 58 demographically comparable healthy adults coached to simulate memory impairment. Classification accuracy of individual PVTs was evaluated using logistic regression and receiver operating characteristic (ROC) curves, examining both the dichotomous cutting scores as recommended by the test publishers and continuous scores for the measures. Results demonstrated nearly equivalent discrimination ability of the TOMM, MSVT, and CVLT-FC as individual predictors, all of which markedly outperformed the WCT and RDS. Models of combined PVTs were examined using Bayesian information criterion statistics, with results demonstrating that diagnostic accuracy showed only small to modest growth when the number of tests was increased beyond two. Considering the clinical and pragmatic issues in deriving a parsimonious assessment battery, these findings suggest that using the TOMM and CVLT in conjunction or the MSVT and CVLT in conjunction maximized predictive accuracy as compared to a single index or an assortment of these widely used measures.