Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 2020 Sep;91(9):945-952. doi: 10.1136/jnnp-2020-323776. Epub 2020 Jul 10.
Performance validity tests (PVTs) are widely used in attempts to quantify effort and/or detect negative response bias during neuropsychological testing. However, it can be challenging to interpret the meaning of poor PVT performance in a clinical context. Compensation-seeking populations predominate in the PVT literature. We aimed to establish base rates of PVT failure in clinical populations without known external motivation to underperform. We searched MEDLINE, EMBASE and PsycINFO for studies reporting PVT failure rates in adults with defined clinical diagnoses, excluding studies of active or veteran military personnel, forensic populations or studies of participants known to be litigating or seeking disability benefits. Results were summarised by diagnostic group and implications discussed. Our review identified 69 studies, and 45 different PVTs or indices, in clinical populations with intellectual disability, degenerative brain disease, brain injury, psychiatric disorders, functional disorders and epilepsy. Various pass/fail cut-off scores were described. PVT failure was common in all clinical groups described, with failure rates for some groups and tests exceeding 25%. PVT failure is common across a range of clinical conditions, even in the absence of obvious incentive to underperform. Failure rates are no higher in functional disorders than in other clinical conditions. As PVT failure indicates invalidity of other attempted neuropsychological tests, the finding of frequent and unexpected failure in a range of clinical conditions raises important questions about the degree of objectivity afforded to neuropsychological tests in clinical practice and research.
性能有效性测试（PVT）广泛用于量化努力和/或在神经心理测试中检测负面反应偏差。然而，在临床环境中解释 PVT 性能不佳的含义具有挑战性。在 PVT 文献中，寻求补偿的人群占主导地位。我们旨在确定无明显外部动机表现不佳的临床人群中 PVT 失败的基础率。我们在 MEDLINE、EMBASE 和 PsycINFO 中搜索了报告有明确临床诊断的成年人的 PVT 失败率的研究，不包括现役或退伍军人、法医人群或已知正在诉讼或寻求残疾福利的参与者的研究。结果按诊断组进行总结，并讨论了其含义。我们的综述确定了 69 项研究，涉及智力障碍、退行性脑疾病、脑损伤、精神障碍、功能性障碍和癫痫等临床人群中的 45 种不同的 PVT 或指数。描述了各种通过/失败的截止分数。在所有描述的临床组中，PVT 失败都很常见，一些组和测试的失败率超过 25%。即使没有明显的表现不佳的动机，PVT 失败在各种临床情况下也很常见。在功能性障碍中，失败率并不高于其他临床情况。由于 PVT 失败表明其他尝试的神经心理测试无效，因此在一系列临床情况下频繁且意外地发现失败，这对神经心理测试在临床实践和研究中的客观性程度提出了重要问题。
