Detecting poor effort and malingering with an expanded version of the Auditory Verbal Learning Test (AVLTX): validation with clinical samples.

Three studies describe the development and validation of a new procedure (AVLTX) to detect inadequate effort or malingering by adding 60-min delayed recall/recognition trials and identifying "impaired" memory performances that are highly inconsistent with performances of brain-damaged (BD) individuals. In Study I, AVLTX performances of 25 probable malingerers (PMs) were compared with those of 43BD and 40 psychiatric patients (PSYs). Seven inconsistencies were identified and converted to scaled inconsistency scores, yielding the exaggeration index (EI). Study II reported cross-validation in an independent sample of 34 PM, 70BD and 89 PSY, showing sensitivity of 0.59 and specificities of 0.97 (BD) and 0.92 (PSY). Study III compared the diagnostic accuracy of the EI with two well-established effort assessment paradigms, exemplified by the RMTand DRT (a symptom validity test). The RMT showed excellent sensitivity and poor specificity; the DRT showed poor sensitivity and excellent specificity; the EI showed good sensitivity and excellent specificity. Adding a second delayed trial to list-learning tests can be a time-efficient procedure to detect inadequate effort.