Cross-Validating the Embedded Performance Validity Indicators in the Rey Auditory Verbal Learning Test in Mixed Neuropsychiatric and Attention-Deficit/Hyperactivity Disorder Clinical Samples

• Published in: Psychology & Neuroscience 2023-06, Vol.16 (2), p.125-137
• Main Authors: Tse, Phoebe Ka Yin, Finley, John-Christopher, Frick, Lauren, Guilfoyle, Janna, Brooks, Julia, Khalid, Elmma, Charara, Raghid, Resch, Zachary J., Ulrich, Devin M., Ovsiew, Gabriel P., Soble, Jason R.
• Format: Article
• Language: English
• Subjects: Attention Deficit Disorder with Hyperactivity; Clinical Practice; Cutting Scores; Female; Human; Learning; Male; Neuropsychology; Psychometrics; Test Performance; Test Reliability; Test Validity; Verbal Learning
• ISSN: 1984-3054; 1983-3288
• DOI: 10.1037/pne0000302

Objective: The Rey Auditory Verbal Learning Test (RAVLT) is a common test of learning and memory with established embedded validity indicators (EVIs), including the Effort Score (ES) and Forced Choice (FC) recognition. Currently, the literature lacks a head-to-head comparison of the classification accuracy of ES and FC for detecting invalid test performance. This study aimed to cross-validate ES and FC in two large, diverse, independent samples. Method: This cross-sectional study included a mixed neuropsychiatric (n = 209) and attention-deficit/hyperactivity disorder (ADHD) sample (n = 544). Validity groups were established using multiple criterion performance validity tests (PVTs), resulting in 242 valid/57 invalid and 480 valid/64 invalid performances in the neuropsychiatric and ADHD samples, respectively. Results: ES and FC both demonstrated robust classification accuracy. The optimal ES cut score was significantly higher for the ADHD (≤13; 41% sensitivity/90% specificity) than the neuropsychiatric (≤3; 33% sensitivity/89% specificity) sample. Classification accuracies of FC ranged from weak in the ADHD (area under the curve [AUC] = 0.67) to excellent in the neuropsychiatric (AUC = 0.80) sample. The FC cut score was ≤12 (54% sensitivity/91% specificity) in the neuropsychiatric and ≤14 in the ADHD (41% sensitivity/93% specificity) sample. Both EVIs were significant predictors of validity status when examined in combination. Conclusions: Both the RAVLT-ES and RAVLT-FC were effective as PVTs; however, their relative utility varied by sample such that FC had stronger classification statistics in the neuropsychiatric sample (which included a higher incidence of cognitive impairment and dementia), whereas ES was more robust in the adult ADHD sample. Moreover, considering both EVIs may result in greater accuracy than isolation. Public Significance Statement This study showed that two embedded performance validity indicators in the Rey Auditory Verbal Learning Test, the Effort Score and Forced Choice, are both able to detect invalid test performance across multiple, independent clinical samples; thus, allowing for accurate assessment of verbal learning and memory abilities with minimal additional testing time/burden or associated costs.