The Wechsler scales are some of the most widely used measures of cognitive functioning in neuropsychology, and several measures of effort have been developed utilizing its subtests and index scores. With new or revised tests continually being published and information about effort measures continually being leaked ( Boone, 2009 Horwitz & McCaffrey, 2006 Slick, Sherman, & Iverson, 1999 Victor & Abeles, 2004), there appears to be an ever-growing need for new measures to be developed. The multidimensional approach, however, will necessitate developing additional indicators of effort because there are only a limited number of options at this time to adequately identify suboptimal effort. Thus, not only is it important to use multiple tests throughout the assessment, it is also important to employ a multidimensional approach to optimize response bias detection. As Boone (2009) and Victor and colleagues (2009) point out, however, when using several measures of effort it is important to avoid using highly correlated SVTs due to the limited incremental information this would provide. This assertion has been supported by the literature as several studies show that failing two or more measures of effort significantly increases the ability to identify suboptimal effort while reducing the chance of making a false-positive error ( Larrabee, 2003 Meyers & Volbrecht, 2003 Victor, Boone, Serpa, Buehler, & Ziegler, 2009). Relying on such a method also reduces the ability to assess the nature, severity, and intentionality of the response bias. For example, relying on one SVT administered at the beginning of an evaluation will often be insufficient for detecting response bias. It is not enough to assess effort in a limited capacity ( Boone, 2009 Bush et al., 2005 Heilbronner et al., 2009). As such, utilizing freestanding symptom validity tests (SVTs) and embedded measures of effort is now standard practice within clinical neuropsychology ( AACN, 2007 Bush et al., 2005 Heilbronner et al., 2009). Many non-neurological factors can influence test performance, even when an obvious incentive to perform poorly is unknown. Base rates of 25%–40% are not uncommon in settings such as the Veteran's Administration Healthcare System and medicolegal evaluations ( Armistead-Jehle, 2010 Axelrod & Schutte, 2010 Larrabee, 2003 Mittenberg, Patton, Canyock, & Condit, 2002 Young, Roper, & Sawyer, 2011). Response bias during neuropsychological evaluations is a universal problem encountered by neuropsychologists. Neuropsychological Evaluation, Symptom Validity Testing, Response Bias, Military Veterans Introduction Collectively, present results suggest that Symbol Span can effectively differentiate veterans with multiple failures on established free-standing and embedded SVTs. Similarly, sensitivity was 52% and specificity was 84% when employing a cutoff of <7 for Age-Corrected Scale Score. A raw score cutoff of <14 produced 83% specificity and 50% sensitivity for detection of Poor Effort. 001) than the Good Effort group on the Symbol Span test. 001) and age-corrected scaled scores ( p <. The Poor Effort group had significantly lower raw scores ( p <. Archival data were collected from 136 veterans classified into Poor Effort ( n = 42) and Good Effort ( n = 94) groups based on symptom validity test (SVT) performance. The current study explored whether Symbol Span, a novel Wechsler Memory Scale-fourth edition measure of supraspan visual attention, could be used to discriminate adequate effort from suboptimal effort. Developing embedded indicators of suboptimal effort on objective neurocognitive testing is essential for detecting increasingly sophisticated forms of symptom feigning.
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