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82 Single Errors on Trial 1 of the Test of Memory Malingering may be Indicative of Invalid Performance on Neuropsychological Measures in a Sample of Youth Athletes
- Daniel Baldini, Talamahe’a A. Tupou, Julius Flowers, Ashlynn Steinbaugh, Bradley R. Forbes, Michael Ellis-Stockley, Rachel Murley, Rayna B. Hirst
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 755-756
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Objective:
The Test of Memory Malingering (TOMM) is a performance validity test (PVT) that aims to assess whether participants are giving adequate effort to perform well on tasks of memory performance (Tombaugh, 1996). Other PVTs, specifically the Forced Choice Recognition Trial in the California Verbal Learning Test, have shown that even single errors may indicate invalid performance (Erdodi et al., 2018). Finally, youth are often understudied in the PVT literature, and athletes are at increased risk of invalid performance on baseline testing due to many wanting to return to play following concussion (Erdal, 2012). Therefore, the objective of the current study is to examine whether single errors on TOMM Trial 1 are indicative of lower, and possibly invalid, cognitive performance in a youth sample, given that cognitive performance declines with even small decreases in effort (Green, 2007).
Participants and Methods:Healthy youth athletes (n=174) aged 8-16 years (M=12.07) completed the TOMM as well as other neuropsychological measures during baseline neuropsychological evaluation in a clinical research program for sports concussion. Independent samples t-tests compared youth athletes who scored 49 points on the TOMM (n=28) to youth athletes who scored a perfect 50 (n=50) across several groupings of neuropsychological measures. Participants who scored less than 49 or who didn’t complete the TOMM were excluded from the analyses.
Results:Participants scoring 50/50 on TOMM Trial 1 scored significantly higher on Stroop Color Naming task (p=0.036), Verbal Learning Delayed task from the second edition of the Wide Range Assessment of Learning and Memory (WRAML-2, p=0.018), and Letter Number Sequencing task from the Weschler Intelligence Scale for Children (WISC-IV, p=0.025), relative to participants scoring 49/50. Though not statistically significant, results also showed a trend toward participants scoring 50/50 scoring higher on nearly every test in the battery.
Conclusions:Participants with a single error on TOMM Trial 1, as compared to participants with a perfect score, performed significantly worse on a processing speed task, a verbal learning task, and a working memory task as part of a comprehensive neuropsychological battery. The single-error group also trended toward scoring lower on nearly all of the remaining attention, processing speed, perceptual ability, memory, and executive functioning tasks in the battery. The results could lead to a more liberal interpretation of TOMM scores, given that the trend towards lower performance may be due to putting forth significantly less effort. These results point to the need for a similar comparison of the TOMM in a larger sample size, as greater power may reveal even more significant differences in performance. Findings also emphasize the importance of viewing performance validity on a continuum rather than as a dichotomous pass/fail. Understanding the TOMM and how single errors may be indicative of poorer performance in a youth sample could help to reframe the way PVT results are interpreted in clinical and forensic settings.
15 Construct Validity of the Stroop Interference task in Youth and the Contribution of Effort
- Julius H Flowers, Ashlynn Steinbaugh, Bradley Forbes, Tarah Talamahe’a, Lillian Vang, Daniel Baldini, Rayna Hirst
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 892-893
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Objective:
Previous literature has studied the cognitive processes that contribute to performance on the Stroop interference condition in adults and found that the Stroop task performance (i.e., color-word interference) is comprised of multiple cognitive skills, including speed of visual search, working memory, and conflict monitoring (Perianez et al. 2020). However, the relationship of these cognitive processes to Stroop interference in youth remains understudied. Moreover, no studies have examined the contribution of effort measurement to the interference condition in healthy youth.
Participants and Methods:Golden Stroop Test interference performance was examined in healthy youth athletes (n=174) aged 8-16 years (mean age=12.07) who participated in a baseline neuropsychological evaluation as part of a clinical research program on sports concussion. Predictor variables included speed of visual search, working memory, processing speed, verbal fluency effort (i.e., validity tests), visuospatial abilities, visual processing, and executive functioning skills such as cognitive flexibility and reasoning.
Results:Speed of visual search as measured by Trail Making Test visual scanning time (p<0.00), and effort as measured by Reliable Digit Span and Trail Making Test ratio (p=0.03; p<0.00, respectively) significantly contributed to Stroop interference performance in healthy youth. We provided three validity measures; however, only those requiring higher-order cognitive processes predicted Stroop performance: Reliable Digit Span (p=0.03) and the Trail Making Test ratio (p<0.00). The standalone validity measure (TOMM) was not a significant predictor of Stroop performance (p>0.05).
Conclusions:In contrast to adults, working memory and processing speed did not significantly predict Stroop performance, while visual search speed did predict Stroop interference. Furthermore, two embedded validity indicator (EVI) measures predicted Stroop interference, in contrast to a standalone validity measure requiring lower cognitive processes, which did not predict Stroop performance. Therefore, EVI’s that include an executive functioning component may not accurately represent effort in youth, perhaps due to their less developed executive functioning relative to adults (Lezak et al., 2012; Shanmugan & Satterthwaite, 2017). Overall, understanding the cognitive processes contributing to Stroop performance in healthy youth will allow clinicians to better detect deficits in those cognitive processes and understand how they may impact Stroop performance. This would lead to a better understanding of executive functioning and the accurate measurement of effort in healthy youth.
79 The Clinical Utility of Reliable Digit Span in Predicting Effort on the TOMM in Youth with a History of a Concussion
- Ashlynn Steinbaugh, Rachel Murley, Bradley R Forbes, Daniel Baldini, Talamahe’a A Tupou, Julius Flowers, Rayna B Hirst
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 753-754
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- Article
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Objective:
Performance validity testing (PVT) is important in neuropsychological evaluations to ensure accurate interpretation of performance. While research shows children pass PVTs with adult cut-offs, PVTs are more commonly used with adults (Lippa, 2018). The Test of Memory Malingering (TOMM), a standalone PVT, is commonly used with adults and children (DeRight & Carone, 2015). The Reliable Digit Span (RDS), an embedded PVT derived from the Digit Span subtest of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children-4th Edition, WISC-IV; Wechsler, 2003), is less commonly used with children (DeRight & Carone, 2015). RDS cut-off scores are associated with an increased rate of false positives in children, indicating mixed results regarding the clinical utility in pediatric populations (Welsh et al., 2012). Research shows that youth with a history of concussion (HOC) may demonstrate suboptimal effort for many reasons (e.g., external incentives, boredom, pressure), thus highlighting the need to investigate the utility of PVTs in this population (Araujo et al., 2014; DeRight & Carone, 2015). The present study aimed to examine the clinical utility of RDS in detecting poor effort on the TOMM in youth athletes with a HOC.
Participants and Methods:Participants included 174 youth athletes aged 8 to 18 (20.1% female; 42.5% people of color (POC)) who completed a baseline neuropsychological battery that included the TOMM and WISC-IV Digit Span. Of the sample, 29 youth athletes reported a HOC (13.8% female; 37.9 POC). RDS was calculated for each Digit Span administration, and sensitivity (SN) and specificity (SP) were calculated for RDS when invalid performance was operationalized by a more stringent cut-off score of <49 to increase the SN of the TOMM Trial 1 (Stenclik et al., 2013). Receiver operator characteristics (ROC) curve analysis determined whether RDS performance accurately predicted participants’ performance on the TOMM.
Results:The ROC curve analysis resulted in an area under the curve (AUC) of just 0.427 for RDS. A cut-off score of <7 (as suggested by Kirkwood et al. (2011)) for RDS results in 100% SN, 8.3% SP, 5% positive predictive validity (PPV), and 95% negative predictive validity (NPV). However, a cut-off score of <9 for RDS results in 75% SN, 15% SP, 25% PPV, and 75% NPV.
Conclusions:Little research shows the utility of different PVTs predicting children’s performance on other PVTs, despite evidence that children with a HOC are vulnerable to variable or insufficient effort (Araujo et al., 2014; DeRight & Carone, 2015). In a sample of 29 youth athletes with a HOC, RDS predicted TOMM performance at rates worse than chance. While RDS has advantages as an embedded PVT, its limited ability to predict performance on a standalone PVT suggests interpreting with great caution. These findings highlight the importance of implementing multiple PVTs throughout testing to ensure accurate findings and interpretations, particularly in youth with a HOC. The small sample size is a limitation that possibly impacted the ability of RDS to predict TOMM performance. Further research is needed to understand the utility of RDS as a predictor of PVT performance in different populations. Replication of these findings with a larger sample size is needed to provide confirmatory evidence of poor predictive performance of the RDS.