Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Victoria, Australia.
Arch Clin Neuropsychol. 2022 Nov 21;37(8):1662-1687. doi: 10.1093/arclin/acac039.
This study examined the relative contribution of performance and symptom validity in litigating adults with traumatic brain injury (TBI), as a function of TBI severity, and examined the relationship between self-reported emotional symptoms and cognitive tests scores while controlling for validity test performance.
Participants underwent neuropsychological assessment between January 2012 and June 2021 in the context of compensation-seeking claims related to a TBI. All participants completed a cognitive test battery, the Personality Assessment Inventory (including symptom validity tests; SVTs), and multiple performance validity tests (PVTs). Data analyses included independent t-tests, one-way ANOVAs, correlation analyses, and hierarchical multiple regression.
A total of 370 participants were included. Atypical PVT and SVT performance were associated with poorer cognitive test performance and higher emotional symptom report, irrespective of TBI severity. PVTs and SVTs had an additive effect on cognitive test performance for uncomplicated mTBI, but less so for more severe TBI. The relationship between emotional symptoms and cognitive test performance diminished substantially when validity test performance was controlled, and validity test performance had a substantially larger impact than emotional symptoms on cognitive test performance.
Validity test performance has a significant impact on the neuropsychological profiles of people with TBI, irrespective of TBI severity, and plays a significant role in the relationship between emotional symptoms and cognitive test performance. Adequate validity testing should be incorporated into every neuropsychological assessment, and associations between emotional symptoms and cognitive outcomes that do not consider validity testing should be interpreted with extreme caution.
本研究考察了在与创伤性脑损伤（TBI）相关的诉讼中，成人的表现和症状效度对 TBI 严重程度的相对贡献，并在控制有效性测试表现的情况下，考察了自我报告的情绪症状与认知测试分数之间的关系。
2012 年 1 月至 2021 年 6 月期间，参与者在与 TBI 相关的赔偿诉求的背景下接受了神经心理学评估。所有参与者都完成了认知测试组合、人格评估量表（包括症状效度测试；SVTs）和多项表现有效性测试（PVTs）。数据分析包括独立样本 t 检验、单因素方差分析、相关分析和分层多元回归。
共纳入 370 名参与者。无论 TBI 严重程度如何，不典型的 PVT 和 SVT 表现与较差的认知测试表现和较高的情绪症状报告相关。PVTs 和 SVTs 对无并发症 mTBI 的认知测试表现有累加效应，但对更严重的 TBI 则影响较小。当控制有效性测试表现时，情绪症状与认知测试表现之间的关系显著减弱，而有效性测试表现对认知测试表现的影响明显大于情绪症状。
有效性测试表现对 TBI 患者的神经心理学特征有显著影响，与 TBI 严重程度无关，并且在情绪症状与认知测试表现之间的关系中起着重要作用。在每一次神经心理学评估中都应纳入充分的有效性测试，并且在不考虑有效性测试的情况下，情绪症状与认知结果之间的关联应谨慎解释。
