Rapid automatized naming (RAN) assesses pre-literacy and could be useful for assessing the effects of HIV infection on the development of literacy. Many children with HIV live in sub-Saharan Africa, but the RAN has not been well-studied there. Cultural differences in when children learn color names and in how they prioritize between accuracy and speed can affect RAN results. Typically, RAN and other cognitive functions (e.g., general intelligence, processing speed, working memory, attention) are strongly related. Our goal is to examine how RAN performance relates to neurocognitive function in sub-Saharan Africa and whether RAN performance could reveal the effect of HIV on pre-literacy. The current study examines the relationship between RAN performance and cognitive variables in both children living with HIV (CLWH) and healthy controls in Tanzania.

486 children (ages 3-8) were administered RAN Color and Object tasks as part of a larger longitudinal study in Dar es Salaam, Tanzania. All participants were also administered the Leiter International Performance Scale - 3rd Edition (Leiter-3), a test of nonverbal intelligence and general cognitive function. Binomial logistic regression examined the likelihood of completing a RAN task and included age, Leiter-3 composite standard scores, and HIV status. Multiple linear regression using the same predictors assessed factors associated with RAN completion time in children who completed the tests. SES and education were not included in the model specifications because they were not correlated with any RAN measures.

Only 40% of children could complete the RAN Color task, while 88% completed the Object task. Logistic regression models showed that age (p<0.001), Leiter-3 Nonverbal IQ (p<0.01), and Processing Speed (p<0.001) composite scores were all unique predictors of whether children would complete the RAN Color task. Age (p <0.001) and Nonverbal IQ (p<0.001) were predictors of completing of the RAN Object task. Of those who could complete the RAN Color task, multiple linear regression demonstrated that age (p<0.01), Leiter-3 Nonverbal IQ (p=0.01) and Processing Speed (p=0.001) composites predicted completion time, with the model accounting for 25% of the variance. For the RAN Object task, multiple linear regression indicated age (p<0.001), Leiter-3 Processing Speed (p=0.01) and Nonverbal Memory (p=0.01) composites, and living with HIV (p=0.01), predicted completion time, with the model accounting for 42% of the variance.

Completion rates for RAN Color and Object tasks were low but improved with age. Consistent with brain maturation, increasing age and processing speed improved completion time, regardless of the RAN task. General cognitive ability predicted RAN Color performance, and Nonverbal Memory (encompassing attention, working memory, and retrieval) and HIV status additionally predicted RAN Object performance. Results extend research indicating RAN is distinct yet multifactorial, relying on various neurocognitive functions working together. Additionally, the relationship of HIV to RAN Object performance implies an overlap between the neurocognitive functions inherent in RAN and the neurocognitive weaknesses often reported in CLWH. These findings suggest cognitive vulnerabilities in CLWH may extend to literacy skills in sub-Saharan Africa, which requires further study.

Research has established the importance of early identification and intervention for children with developmental disorders and delays. In striving toward earlier recognition and treatment of developmental concerns, it is crucial to have a universal system to monitor infant and toddler development over time. This system should comprehensively assess the desired areas of development, be based on normative data from large samples, and have strong psychometric properties. While a few developmental monitoring tools are currently in use, they lack many of the aforementioned qualities. The current study reports on the cross-sectional psychometric properties of PediaTrac, which is a novel caregiver-report measure of infant and toddler development. Specifically, this study focuses on psychometric properties of PediaTrac’s social/communication/cognition (SCG) domain during the first 9 months of life.

The current sample included 571 caregiver-infant dyads recruited into term (n=331) and preterm (n=240) groups. Participants were from the PediaTrac multisite, longitudinal study and were socioeconomically (41.9% below median income) and racially (33.6% Black, 47.6% White, 11.0% multiracial/other) diverse. Data included caregiver reports of infant development from the SCG domain of PediaTrac at 5 sampling periods (newborn, 2, 4, 6, and 9 months). Item response theory (IRT) graded response modeling was used to estimate theta, an index of the latent trait, social/communication/cognition. Exploratory factor analysis (EFA) was used to further examine the underlying structure of the SCG domain.

Mean theta values could be reliably estimated at all time periods and followed a linear trend consistent with development. At 9 months, theta values were statistically different between the term and preterm groups, indicating that term infants demonstrated more advanced SCG abilities. Item parameters (discrimination and difficulty) could be modeled at each time period across the range of ability. Reliability of the SCG domain ranged from 0.97 to 0.99. Results of the EFA suggested a two-factor solution (affect/emotional expression, social responsiveness) at the newborn period accounting for 43% of the variance, a three-factor solution (affect/emotional expression, social responsiveness, imitation/emerging communication) at the 2-, 4-, and 6-month periods accounting for 43%, 34%, and 34% of the variance, respectively, and a four-factor solution (affect expression, social responsiveness, imitation/communication, nonverbal/gestural communication) at the 9-month period accounting for 34% of the variance.

The PediaTrac SCG domain has strong psychometric properties, including reliability estimates higher than other existing caregiver-report measures of SCG abilities. EFA analyses demonstrated that the structure of affect/emotional expression and social responsiveness remains relatively stable and may reflect affective and regulatory aspects of temperament. Conversely, the quality and type of communication continually develops and becomes more differentiated throughout the time periods of interest. Notably, parents appear to be capable of observing and reliably reporting on their infants’ abilities in these areas. The use of a universal screening tool developed with rigorous psychometric methods, such as PediaTrac, could transform the way that clinicians identify infants in need of early intervention.

Children with unilateral hearing loss (UHL) have difficulty hearing in noisy environments and localizing sounds, impacting learning and social opportunities across contexts. Using a visible device like a cochlear implant (CI) may improve functioning but can also create psychological risk. Audiological measures alone are insufficient for predicting social, emotional, educational, adaptive, and quality-of-life post-operative outcomes, which are highly variable in this population and can also be impacted by a secondary diagnosis. Extending beyond audition to consider the “whole child” through neuropsychological evaluation may produce a sharper picture of potential outcomes, with or without surgical/audiological intervention. Given recent FDA approval for CI in children with UHL, more are receiving this elective surgery despite difficulties predicting who will experience significant benefit. Here we describe neuropsychological profiles of children with UHL who underwent CI candidacy evaluation at a tertiary pediatric hospital.

During pre-operative clinical care, CI candidates completed targeted neuropsychological evaluation to identify patient- and family-level factors that could impact CI use and outcomes from surgery. Cognitive, language, attention/executive, visuoperceptual/visuomotor, academic, adaptive, and emotional/behavioral functioning were assessed. Evaluations integrated history, observations, caregiver report forms, and performance-based test data.

18 individuals were evaluated (age 7-months to 16-years). Most had left-sided UHL (67%) and were male (61%). Known hearing loss etiologies were congenital cytomegalovirus (n=5), enlarged vestibular aqueduct (n=1), traumatic brain injury (n=1), meningitis (n=1), cholesteatoma (n=1), neurofibromatosis type 1 (n=1), and Waardenburg syndrome (n=1). Indices of general cognitive ability were generally low average to average. Patterns of cognitive impairment were not restricted to language-based tasks (e.g., Beery VMI-6 range 56-109, M=89.42, SD=16.27). Standardized parent ratings of everyday executive functioning, social/emotional/behavioral functioning, and adaptive skills were collected. Eight (44%) had a behavioral health diagnosis: Attention Deficit Hyperactivity Disorder (n=2), Global Developmental Delay (n=2), Unspecified Neurodevelopmental Disorder (n=2), Autism Spectrum Disorder (n=1), and Depression (n=1). Thirteen (72%) received or will receive a CI, of whom 38% had a behavioral health diagnosis. Average Area Deprivation Index (a marker of socio-economic status) was lower for individuals who ultimately received CIs (M=18%tile) compared to those who did not (M=25%tile).

There may be increased rates of neurodevelopmental/psychological conditions among children with UHL, especially when the etiology involves the central nervous system. Albeit preliminary, results align with findings from bilateral hearing loss samples. Findings highlight the importance of routine neuropsychological screening in children with UHL and close interdisciplinary collaboration for optimal outcomes. Socio-economic disparities among those who do and do not receive CI need further exploration as those who did not receive CIs tended to be from less resourced neighborhoods. Additional research is warranted to understand the full range of risk and protective factors for children with UHL and how these relate to outcomes for those who opt for cochlear implantation.

Standardized assessment measures can provide data to inform a diagnosis of Autism Spectrum Disorder (ASD). Most measures assessing ASD characteristics rely on some degree of behavioral response to sound (e.g., responding to name, demonstrating listening response), and are often not appropriate for use with children who are Deaf and Hard of Hearing (DHH), especially with individuals who use signed languages. Few studies have reported on the Behavioral Assessment System for Children, Third Edition (BASC-3) for DHH children, and we aim to describe BASC-3 profiles in children with ASD who are DHH.

Participants include eight DHH patients diagnosed with ASD through interdisciplinary team evaluations by developmental-behavioral pediatricians, speech-language pathologists, and neuropsychologists with expertise in DHH child development. Demographics include a mean age of 6.17 years, and 62.5% were Male. Self-reported racial distribution was 75% White, 12.5% Black and 12.5% declined to answer. Average Area Deprivation Index (marker of socioeconomic status) was 32.13%tile. As a part of the evaluation, parents rated their children using the BASC-3. Languages include spoken English (75%) and American Sign Language (25%). Relevant co-occurring

neurodevelopmental/psychological diagnoses include Global Developmental Delay (n=1), Moderate Intellectual Disability (n=1), and Depression (n=1). Types of hearing loss include sensorineural (75%), conductive (12.5%), and mixed (12.5%). Three participants had different degrees of bilateral hearing loss in each ear: mild sloping-severe, moderate rising-mild (n=1), profound, moderate rising-normal level (n=1), and profound, moderate (n=1). Four participants had the same level of hearing loss in both ears: moderate-moderately severe (n=1), moderately severe-severe (n=1), severe-profound (n=1), and profound (n=1). One child had a unilateral moderate hearing loss. Technology utilized: unilateral hearing aid (n=2), bilateral hearing aids (n=2), unilateral cochlear implant (n=1), bilateral cochlear implants (n=2), and bimodal technology (n=1). BASC-3 scales of interest in this study were the developmental social disorders scale (DSD), Autism probability index (AUI), clinical scales, and adaptive scales. BASC-3 scores were standardized using General Combined norms and means were plotted.

BASC-3 mean scores on clinical scales were elevated (T>60) on Atypicality (M=71), Hyperactivity (M=63), Withdrawal (M=63), and Attention Problems (M=65) in children with ASD who are DHH in this sample. BASC-3 mean scores on adaptive scales were below threshold (T<40) on Social Skills (M=37), Functional Communication (M=39), and overall Adaptive Skills (M=39). DSD scores were in the at-risk (T>60<70) range for 2 out of 8 cases and clinically significant (T>70) for 5 out of 8 cases.

The AUI was clinically significant for 2 out of the 3 cases within the age range for reporting AUI data.

In this preliminary sample of DHH children with a confirmed diagnosis of ASD by comprehensive specialized interdisciplinary clinical evaluations, parent ratings on the BASC-3 were consistent with what is known about BASC-3 profiles in hearing children diagnosed with ASD. Our findings suggest it may be helpful to review the DSD, AUI, clinical scales, and adaptive skills scales profiles when assessing DHH children at risk for ASD. Further research, including a larger sample size and assessment of language differences among participants, is necessary.

The Rey Osterreith Complex Figure (ROCF) is a neuropsychological task used to measure visual-motor integration, visual memory, and executive functioning (EF) in autistic youth. The ROCF is a valued clinical tool because it provides an insight into the way an individual approaches and organizes complex visual stimuli. The constructs measured by the ROCF such as planning, organization, and working memory are highly relevant for research in, but the standardized procedures for scoring the ROCF can be challenging to implement in large scale clinical trials due to complex and lengthy scoring rubrics. We present preliminary data on an adaptation to an existing scoring system that provides quantifiable scores, can be implemented with reliability, and reduces scoring time.

Data was taken from two large-scale clinical trials focusing on EF in autistic youth. All participants completed the ROCF following standard administration guidelines. The research team reviewed commonly used scoring systems and determined that the Boston Qualitative Scoring System (BQSS) was the best fit due to its strengths in measuring EF, the process-related variables generated, and the available normative data. Initially, the BQSS full scoring system was used, which resulted in comprehensive scores but was not feasible due to the time required (approximately 1-1.5 hours per figure for research assistants to complete scoring). Then, the BQSS short form was used, which was successful at solving the timing problem, but resulted in greater subjectivity in the scores impacting the team’s ability to become reliable. Independent reliability could not be calculated for this version because of the large number of discrepancies among scorers which included 2 neuropsychologists and 4 research assistants. A novel checklist was then developed that combined aspects of both scoring systems to help promote objectivity and reliability. In combination with this checklist the team created weekly check in meetings where challenging figures could be brought to discuss. Independent reliability was calculated amongst all research assistant team members (n=4) for the short form and novel checklist. Reliability was calculated based on (1) if the drawing qualified for being brought to the whole team and (2) individual scores on the checklist.

Independent reliability was calculated for 10 figures scored utilizing the novel checklist by a team of 4 trained research assistants. All scorers were able to achieve 80% reliability with a high average (80-86%). Study team members reported that scoring took less time taking on average 30-45 minutes per figure.

Inter-rater reliability was strong on the checklist the study team created, indicating its potential as a useful adaptation to the BQSS scoring system that reduces time demands, making the tool feasible for use in large-scale clinical research studies with initially positive reliability factors. The checklist was easy to use, required little training and could be completed quickly. Future research should continue to examine the reliability of the checklist and the time it takes to complete. Additionally, the ROCF should be studied more broadly in research and examined as a potential outcome measure for large scale research studies.

Sentence repetition (SR) task performance is related to various cognitive abilities and not just learning and memory, as is commonly considered (e.g., Baron, 2018). Bartlett (2018) was the first to examine the associations among SR performance and other cognitive abilities within a single study, using a normative sample. Bartlett (2018) found that SR performance was predicted by language, auditory verbal working memory, processing speed, and nonverbal cognitive ability of which only language abilities and auditory verbal memory significantly added to the prediction. However, no study to date has examined the associations between SR and other cognitive abilities in a clinical sample of school-aged children. The present study sought to determine the extent to which language, working memory, nonverbal abilities (visuospatial processing and fluid reasoning), and processing speed predict children’s SR in a clinical sample.

Children 6 to 14 years of age (N = 191; 65% males) were included in the present study. Participants were drawn from two separate archival data populations of children referred for neuropsychological assessment in southwestern Ontario. SR scores were obtained from performance on Benton’s (1965) sentence repetition task. Language, working memory, fluid reasoning, visual perception, and processing speed were measured with Index scores from the Wechsler Intelligence Scale for Children (5th edition). The association of each of these cognitive domains with SR was determined by multiple linear regression. The effects of age and sex on SR were also examined (N = 226; 64% males).

A multiple linear regression model including the five independent variables significantly predicted SR performance, F(5, 185) = 30.306, p < .001., adj. R2 = .435. Only language and working memory added significantly to the prediction, p < .05. A mediation analysis demonstrated that processing speed indirectly predicted SR performance through working memory, b=.0241, [95% BCa [CI .0132, .0355]. A moderate positive correlation was found between age and SR performance, r(226) = .416, p < .001. Sex was unrelated to SR performance.

The findings from this study are consistent with other studies indicating that SR taps multiple cognitive abilities. In a large and representative clinical sample of children referred for assessment due to academic or other learning difficulties, language plays as significant a role in SR performance as does auditory verbal attention and working memory. An advantage of the present study was the use of clinically relevant summary measures of cognitive domains associated with intelligence testing.

This study aimed to explore the possibility of using the Figure Weights subtest of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) as an embedded validity test (EVT).

We conducted a retrospective cohort study of patients seen in the Johns Hopkins All Children’s Hospital (JHACH) Neuropsychology program between 2015 and 2019. Patient age ranged from 6-15 years (median age 11 years). All patients were administered the WISC-V as a portion of their neuropsychological evaluation. The sample included 75 patients who were generally male (63%), White (77%), English dominant (97%), and right-handed (81%).

Effort determination based on RDS identified more patients as having invalid effort. Clinicians identified only 7% of patients with invalid effort; whereas, 16% of patients with invalid effort were identified using the WISC-V RDS. Although patients having valid effort generally performed better on all WISC-V subtests, no significant differences between groups were found. Over 90% of patients were able to get items 1-10 correct on the WISC-V Figure Weights subtest regardless of their effort determination. WISC-V Figure Weights item analysis showed participants in the invalid group sometimes answered more difficult questions correctly while failing easier items which supports inconsistent effort. Further statistical analyses, including discriminant validity tests, were unable to be completed given the study was underpowered due to significant disparity between effort groups.

This study shows support for WISC-V Figure Weights subtest items 1-10 as an embedded EVT given these items were sufficiently easy to pass regardless of whether participant gave valid or invalid effort. As this is an exploratory study, results will need to be replicated in other pediatric samples. Additionally, the discriminant ability of the WISC-V Figure Weights subtest EVT will need to be further investigated.

The Children’s Communication Checklist-Second Edition (CCC-2) is a rating scale designed to assess domains of communication skills with emphasis on pragmatics (Bishop, 2006). The CCC comprises 10 subtests addressing various aspects of oral communication skills: Speech, Syntax, Semantics, Coherence, Initiation, Scripted Language, Context, Nonverbal Communication, Social Relations, and Interests. In a study conducted on the original CCC, Geurts et al. (2004) found that when compared to normal controls, pragmatic difficulties occurred in children with either high functioning autism (HFA) or ADHD. Since the initial version of the CCC, no study has examined whether the revised version can differentiate children with HFA, ADHD, and LD, the purpose of the present study. Focus was on derived factors of the structure/content of language and the pragmatics of language.

Forty-one participants grouped according to diagnosis were drawn from two archival data pools, one adapted from a previous study conducted by Casey and Scott (2016) and the other from a set of anonymized patients from a neuropsychological clinic. Fourteen participants met clinical criteria for autism (Mage = 11.95), 12 participants met criteria for ADHD without co-morbid disorders (Mage = 9.5), and 15 participants met criteria for a learning disability involving reading, writing, math, or some combination (Mage = 10.13). Group-specific descriptive statistics were computed for the participants’ age, full scale intelligence quotient (IQ), and General Communication Composite (GCC). Two factor scores were computed, one composed of the subtests that constitute the structure/content aspects of language (Speech, Syntax, Semantics, and Coherence) and one composed of the pragmatic aspects of language (Initiation, Nonverbal Communication, Social Relations, and Interests), an area of particular weakness in HFA. Independent samples ANOVAs were conducted on both factor scores to determine whether the CCC-2 could differentiate the three groups. Post-hoc comparisons were planned for the subtests comprising the factor(s) that differentiated the groups.

Participants in the ADHD (M = 9.45, SD = 2.45) group were significantly younger than those in the HFA group (M = 11.95, SD = 2.24) and LD group (M = 10.13, SD = 2.58), the latter two not differing significantly. The groups did not differ significantly on IQ, nor on the structure/content factor. On the pragmatic factor, the LD group (M = 10.18, SD = 9.91) had significantly higher scores than the ADHD group (M = 7.79, SD = 6.54), which in turn, had significantly higher scores than the HFA group (M = 5.48, SD = 8.26), F(2, 38) = 17.81, p < .01. Within this composite, the same pattern was shown on Nonverbal Communication, F(2, 38) = 9.29, p < .01, and Interests, F(2, 38) = 17.81, p < .01.

Compared to children with an academically-based learning disability, children with ADHD and HFA demonstrated pragmatic difficulties on the CCC-2. Although there was overlap between the pragmatic language characteristics of children with ADHD and children with HFA, the CCC-2 demonstrated utility in distinguishing the two disorders on certain aspects of communication skills, suggesting that it is a useful tool in differential diagnosis.

Empirical support for inclusion of performance validity testing (PVTs) in neuropsychological assessment continues to grow (Sweet et al., 2021). However, considerable validation is still needed to understand the impact of culturally mediated factors on the reliability of current, commonly used PVTs to accurately classify effort among various cultural groups. This study sought to contribute to the literature by examining the utility of several PVTs in a non-clinical, community-dwelling sample in Kampala, Uganda.

Participants included 52 residents (25 Female, 27 Male) who were born between 1953-2003 from the Wabigalo community of central Kampala. Individuals were recruited by community leaders and volunteered to participate. All 52 participants were administered the Dot Counting Test (DCT; Boone et al., 2002), Test of Memory Malingering (TOMM; Tombaugh, 1997), and Rey 15-Item Memorization Test (Rey 15; Lezak, 1995). Twenty-five participants also completed Green’s Non-Verbal Medical Symptom Validity Test (NV-MSVT; Green, 2006). Data from three participants was excluded due to suspected memory concerns. Instructions for all tests were translated into Luganda by a professional translator with experience in Luganda and were administered by Luganda-speaking individuals.

Using test manual-derived cut scores, 71.4% (n = 35) participants scored in the invalid range on the DCT, 10.2% (n = 5) produced total combined scores in the invalid range on Rey 15, 6.1% (n = 3) failed TOMM Trial 2, and one participant (4.3%) exceeded cut-offs on Green’s NV-MSVT.

In this non-clinical sample, manual cutoffs for DCT contributed to a high type-1 error rate. These findings suggest that culturally mediated factors may contribute to differences in engagement or performance on DCT. Future studies should explore these factors and continue to examine the utility of widely used tests in diverse samples.

We developed the Shell Game Task (SGT) as a novel Performance Validity Test (PVT). While most PVTs use a forced-choice paradigm with “memory” as the primary domain being assessed, the SGT is a face-valid measure of attention and working memory. We explored the accuracy of the SGT to detect noncredible performance using a simulatordesign study.

Ninety-four university students were randomly assigned to either best effort (CON) (n=49) or simulating traumatic brain injury (TBI) (SIM) (n=45) conditions. Participants completed a full battery of neuropsychological tests to simulate an actual evaluation, including the Test of Memory Malingering (TOMM) and the SGT. The SGT involves three cups and a red ball shown on the screen. Participants watch as the ball is placed under one of the three cups. Cups are then shuffled. Participants are asked to track the cup that contains the ball and correctly identify its location. We created two difficulty levels (easy vs hard, 20 trials each) by changing the number of times the cups were shuffled. Participants were given feedback (correct vs incorrect) after each trial. At the conclusion of the study, participants were asked about adherence to study directions they were given.

Participants with missing data (CON=1; SIM=2) or who reported non-adherence to study directions (CON=2; SIM=1) were removed from analyses. Twenty-five percent in SIM and 0% in CON failed TOMM

Trial 2 (<45) suggesting adequate manipulation of groups. Groups were not different in age, gender, ethnicity, or education (all p’s>.05). There were 9 participants in each group with concussion/TBI history. TBI history was not significantly related to performance on the SGT in either group, although participants with TBI history tended to do better. Average performances on TOMM Trial 1 (36.62 vs 47.91, p<.001) and TOMM Trial 2 (37.50 vs 49.71, p<.001) were significantly lower in the SIM group. Performance on SGT was also significantly lower in the SIM group across SGT Total Correct (20.17 vs 24.65 of 40, p=.008), SGT Easy (10.60 vs 13.52 of 20, p=.002), and SGT Hard (9.57 vs 11.13 of 20, p=.068). Mixed ANOVA showed a trend towards significant group by SGT difficulty interaction (F(1,86)=3.41, p=.052, np2=.043). There was steeper decline in performance on SGT Hard compared to SGT Easy for CON. ROC analyses suggested adequate but not ideal sensitivity/specificity: scores <8 on SGT Easy (sensitivity=26%; false positive=11%), <7 on SGT Hard (sensitivity=26%; false positive=7%), and <15 on SGT Total (sensitivity=24%; false positive=9%).

These preliminary data indicate the SGT may be able to detect malingered TBI. However, additional development of this measure is necessary. Further refinement of difficulty level may improve sensitivity/specificity (e.g., CON mean performance for SGT Easy trails was 13.52, suggesting the items may be too difficult). This study was limited to an online administration due to COVID, which could have affected results; future studies should test inperson administration of the SGT. In addition, performance in clinical control groups (larger samples of individuals with mild TBI, ADHD) should be tested to better determine specificity for these preliminary cutoffs.

Previous investigations have demonstrated the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Color Word Interference Test (CWIT) as an embedded validity indicator in mixed clinical samples and traumatic brain injury. The present study sought to cross-validate previously identified indicators and cutoffs in a sample of adults referred for psychoeducational testing.

Archival data from 267 students and community members self-referred for a psychoeducational evaluation at a university clinic in the South were analyzed. Referrals included assessment for attention-deficit hyperactivity disorder, specific learning disorder, autism spectrum disorder, or other disorders (e.g., anxiety, depression). Individuals were administered subtests of the D-KEFS including the CWIT and several standalone and embedded performance validity indicators as part of the evaluation. Criterion measures included The b Test, Victoria Symptom Validity Test, Medical Symptom Validity Test, Dot Counting Test, and Reliable Digit Span. Individuals who failed 0 criterion measures were included in the credible group (n = 164) and individuals failing 2 or more criterion measures were included in the non-credible group (n = 31). Because a subset of the sample were seeking external incentives (e.g., accommodations), individuals who failed only 1 of the criterion measures were excluded (n = 72). Indicators of interest included all test conditions examined separately, the inverted Stroop index (i.e., better performance on the interference trial than the word reading or color naming trials), inhibition and inhibition/switching composite, and sum of all conditions.

Receiver Operating Characteristics (ROC) curves were significant for all four conditions (p < .001) and the inverted stroop index (p = .032). However, only conditions 2, 3 and 4 met minimal acceptable classification accuracy (AUC = .72 - 81). ROC curves with composite indicators were also significant (p < .001), with all three composite indicators meeting minimal acceptable classification accuracy (AUC = .71- .80). At the previously identified cutoff of age corrected scale score of 6 for all four conditions, specificity was high (.88 -.91), with varying sensitivity (.23 - .45). At the previously identified cutoff of .75 for the inverted stroop index, specificity was high (.87) while sensitivity was low (.19). Composite indicators yielded high specificity (.88 - .99) at previously established cutoffs with sensitivity varying from low to moderate (.19 - .48). Increasing the cutoffs (i.e., requiring higher age corrected scale score to pass) for composite indicators increased sensitivity while still maintaining high specificity. For example, increasing the total score cutoff from 18 to 28 resulted in moderate sensitivity (.26 vs .52) with specificity of .91.

While a cutoff of 6 resulted in high specificity for most conditions, the sum of all four conditions exhibited the strongest classification accuracy and appears to be the most robust indicator which is consistent with previous research (Eglit et al., 2019). However, a cutoff of 28 as opposed to 18 may be most appropriate for psychoeducational samples. Overall, the results suggest that the D-KEFS CWIT can function as a measure of performance validity in addition to a measure of processing speed/executive functioning.

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 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.

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.

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.

This retrospective study compared base rates of failure on a series of standalone and embedded performance validity tests (PVTs) in a sample of Spanish-speaking forensic litigants and explored the impact of demographic factors on PVT performance.

62 Spanish-speaking participants involved in litigation (primarily for work-related mTBI) underwent outpatient neuropsychological evaluation. Country of origin spanned South American (56.5%), Caribbean (22.5%), Central American (16.1%), North American (3.2%), and Spanish (1.6%) regions. Of this sample, 56 completed the Test of Memory Malingering (TOMM), 45 completed the Rey Fifteen Item Test (RFIT), and 49 completed the Dot Counting Test (DCT). Embedded validity measures, Reliable Digit Span (RDS) and the WHO-Auditory Verbal Learning Test (WHO-AVLT) were completed by 32 and 48 participants, respectively.

Effects of age (M=42.4, SD=11.72) and region of origin did not significantly impact overall performance on any measure. Mean scores across all standalone PVTs were below cutoffs, which have been previously suggested for use with Spanish-speaking populations (TOMM <40, RFIT total <21, DCT e-score >18). Overall base rates of failure were as follows: 52.5% TOMM (T1 M= 37.5, SD=10.7; T2 M=35.1, SD=10.6), 64.9% RFIT (M=17.8, SD=7.8) 57.6% DCT (M=18.3, SD=8.8), 51.1% RDS (M=6.1, SD=1.6), 29.4% WHO-AVLT (M=10.7, SD=3.9. Years of education (M=9.98, 3.96) was significantly correlated with RFIT total score (r(43) = .48, p<.01) and DCT e-score (r(47) = -.34, p<.05. When stratified by level of education (0-6, 7-11, and 12+), a large discrepancy in base rate of failure was observed on the RFIT, with failures in 92% of participants with less than six years of education, as compared to 52% and 59% failure in those with 7-11 and 12+ years, respectively. Variability in base rates of DCT failure across levels of education, although less extreme than on the RFIT, again demonstrated higher rates of failure in participants with less than six years of education (0-6: 71%, 7-11: 54%, 12+: 52%).

These findings add to the existing literature surrounding measurement of suboptimal effort in Spanish-speaking populations. Base rates of PVT failure on both standalone and embedded measures were generally much higher than those reported in prior studies of forensic or compensation-seeking groups, including some with Spanish speaking participants. These high rates of failure are likely attributable, at least in part, to sample characteristics, due to the high proportion of individuals engaged in litigation associated with workplace injuries on construction sites at the study location. Such findings illustrate the importance of a thorough effort assessment for this population. Finally, results demonstrating reduced specificity of the RFIT in Spanish-speaking participants with less than six years of education, suggesting caution is warranted for its use in neuropsychological evaluations with such individuals.

Recent consensus guidelines have advocated for the use of multivariate performance validity assessment on ability-based measures such those used in neuropsychological assessment. Further, previous research has demonstrated that aggregating performance validity indicators may produce superior classification accuracy. The present study builds upon this research by aggregating data from three of the most commonly used performance validity measures (Test of Memory Malingering [TOMM], Rey Fifteen Item Test with recognition trial [FIT plus recognition], and Reliable Digit Span [RDS]) to create a performance validity composite measure in a veteran mild traumatic brain injury (mTBI) population.

Data of patients evaluated at a VA hospital who had completed the RDS, FIT plus recognition, and TOMM as part of their clinical neuropsychological evaluation were analyzed (n = 20). Two composite performance validity indexes were created: a Single Cutoff Performance Validity Index (SC-PVI), which measures the quantity of failures across performance validity measures (PVMs) by summing the total number of PVM failures, and a Multiple Cutoff Performance Validity Index (MC-PVI) which measures the number of failures as well as degree of failure(s) across measures of performance validity (e.g., a participant would attain a score of 3 if their PVM performance failed to reach a conservative cut point; they would obtain a score of 1 if they met conservative cut point, yet failed to reach a liberal cut point).

Only one participant (5%) attained a score of 0 on the SC-PVI (i.e., passing all PVTs using standard cutoffs) and MC-PVI (i.e., passing the most liberal cut points on all three PVMs). Conversely, eight participants (40%) attained a score of 3 on the SC-PVI (i.e., failed all three PVMs) and four participants (20%) attained a score of 9 (i.e., failed the most conservative cut points on all three PVMs). Results showed a significant (p < .001) ordinal association between the two indices (G = .984); however, there was no significant agreement between SC-PVI and MC-PVI models (k = -.087; p = .127).

Data revealed discordant findings between the three PVMs utilized. The majority of participants (75%) scored between 2-8 on the MC-PVI, meaning that they did not exceed all liberal cut points or fail all conservative cut points. These “grey area” scores suggest an indeterminate range of performance validity, which cannot be captured by a solitary cut point or neatly classified as pass or fail. The utility of multiple cutoff performance validity models (i.e., aggregating PVMs to consider the severity of failure and number of failures) is that they capture the nuance of these data when determining and discussing the credibility of a profile. Multiple cut point data also highlight how the choice of cutoff influences the outcome of performance validity research and clinical decision making. As such, future research on the classification accuracy of this MC-PVI is needed.

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).

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.

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.

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.

Neuropsychological evaluations are used to examine a person’s current cognitive functioning. Performance validity tests (PVT) are included in neuropsychological test batteries to ensure that examinees are performing to the best of their abilities and identify non-credible performance. There are two types of PVTs: freestanding and embedded. A freestanding PVT is a cognitive test created to evaluate performance validity and do not measure any type of cognition directly. Meanwhile, an embedded PVT is a task design to evaluate some sort of cognition (e.g., memory) by using traditional neuropsychological tests (e.g., Trail Making Test) and performance validity. Research suggests that undergraduate college students are not always performing to the best of their abilities when completing a comprehensive neuropsychological battery. In fact, in one study where an undergraduate college sample was given three PVTs, it was reported that 56% of the participants failed at least one PVT in their first session and 31% in their second session. Research has also shown that speaking multiple languages can influence cognition. The purpose of this study was to identify in three credible language groups of college students what PVTs does bilingualism influence higher failure rates. It was predicted that bilingual college students would significantly demonstrate higher PVTs failure rates compared to monolingual college students.

The sample consisted of 70 English first language monolinguals (EFLM), 33 English first language bilinguals (EFLB), and 68 English second language bilinguals (ESLB) that were psychologically and neurologically healthy. All participants completed a comprehensive neuropsychological battery in English. The Rey-Osterrith complex figure copy test, Comalli Stroop part A, B, and C, Trail Making Test part A and B, Symbol Digit Modalities Test written and oral parts, Controlled Oral Word Association Test (COWAT) letter fluency, and Finger Tapping Test were the tasks used as embedded PVTs to evaluate failure rates in our sample. Moreover, all participants were credible (i.e., they did not fail two or more PVTs). PVT cutoff scores were selected for each embedded PVT from previous literature. Chi-square analysis were used to evaluate failure rates between language groups on each PVT.

We found no significant failure rate differences between language groups on any of the PVTs. However, while no significant group differences were found, on the COWAT letter fluency results revealed higher failure rates between the three language groups (i.e., 13% EFLM, 24% EFLB, and 22% ESLB) compared to other PVTs.

Our data suggested no significant failure rate differences between language groups. It has been suggested in previous studies that linguistic factors impact PVT performance and test interpretation. On the COWAT letter fluency task, it is possible that language is driving higher failure rates between bilingual speakers, even though we found no significant failure rates or performance differences between the three language groups. Future studies should examine language groups and other cultural variables (e.g., time perspective) to determine what may be driving high failure rates on the COWAT letter fluency task in credible participants.

Some RCFT indices are effective Performance Validity Test (PVTs) during neuropsychological evaluations. A combination score that includes the copy score, true positive recognition, and atypical errors has proven to be especially useful (see Lu et al, 2003). However, this score was derived from administration that deviated from protocols outlined by Meyers & Meyers (1995) in that the Recognition trial was administered after the 3-minute delay instead of the 30-minute delay. The current study examined the utility of the RCFT combination score as a performance validity test (PVT) when completing the recognition trial after the 30-minute delay.

This study utilized archival data from 298 Veterans who presented for a clinical neuropsychological evaluation at a southern Veterans Affairs Medical Center. The evaluation included up to nine PVTs and all trials of the RCFT (per Meyers & Meyers, 1995). Patients were considered credible if all PVT performance fell within normal limits. This resulted in 232 patients in the credible group (Mage = 52.9 years, SDage = 15.2, Medu = SDedu = 2.5, 88% male, 71.2% White, 28.3% Black/African American). Patients were considered non-credible if they failed >2 PVTs. This resulted in 66 patients in the non-credible group (Mage = 51.6, SDage = 13.79, Medu = SDedu = 2.4, 92.4% male, 56.1% White, 43.9% Black/African American). Group assignment was also clinically confirmed. Receiver operating characteristic (ROC) curve analyses were conducted to discriminate between credible and non-credible groups utilizing the established RCFT combination score.

RCFT combination scores distinguished groups, with credible participants scoring higher than non-credible participants (F[1, 296]=63.76, p<.001, d=1.11; M = 56.9, SD = 9.3 vs. M = 46.5, SD = 9.5, respectively). A ROC analysis indicated AUC = .800 (95% CI = .73 to .86). When specificity was set at >90%, a cut-score of <46.5 yielded sensitivity at 46.0%. The analogous cut-score from the Lu et al. (2003) study (i.e., <47) was associated with a specificity of 88.7 and sensitivity of 46.0% in the current study.

As the Lu et al. (2003) established the combination score of the RCFT with procedures that deviated from the standardized protocol outlined by Meyers and Meyers (1995), clinicians who opted to adhere to Meyers and Meyers’ full protocol may have concerns about using the combination score as a PVT. The current study established a similar cut-off score to what Lu et al., (2003) reported (i.e., <46.5 vs. <47) while following a different administration procedure of the RCFT. Also, the index was moderately sensitive in the current study (i.e., 45.5%) but less so than what Lu et al. reported when using a cut-score that had >90% specificity (i.e., 75.9% sensitivity). This suggests that the index may be robust to deviations in administration procedures. Difference in sensitivity could be related to difference between samples. As the current sample was derived from a clinical, VA setting, current findings extend the generalizability of the index. Future research would benefit exploring if any subgroups would benefit from adjusted cut-scores to reduce the risk of false positive identification.

As neuropsychologists aim to collect valid data, maximize the utility of assessments, make effective use of time, and best serve patient populations, measurement of performance validity is considered a critical issue for the field. As effort may vary across an evaluation, including performance validity tests (PVTs) throughout the assessment is important. Incorporating embedded PVTs in addition to free standing PVTs can be particularly useful in this regard. COWAT and animal naming are commonly administered verbal fluency measures. While there have been past investigations into their potential for detecting invalid performance, they are limited, and more research is needed. Perhaps most promising, Sugarman and Axelrod (2015) described a logistic regression derived formula utilizing the combined raw scores of COWAT and animal naming. The current study aimed to investigate the use of embedded PVTs within COWAT and animal naming to provide further support for the use of embedded PVTs in these measures.

All subjects were from a mixed clinical sample comprising military veterans from two VA Medical Centers in the northeast U.S., who were referred for neuropsychological evaluation. Subjects deemed credible had zero PVT failures. Subjects were considered non-credible performers if they failed at least two out of a possible eight PVTs administered. Subjects who failed one PVT were excluded from the study (n = 53). The final sample consisted of 116 individuals with credible performance (Mean Age = 35.5, SD = 8.8; Mean Edu = 13.6, SD = 2; Mean Est. IQ = 106, SD = 7.9) and 94 individuals with psychometrically determined non-credible performance (Mean Age = 38.5, SD = 9.4; Mean Edu = 113, SD = 2.1; Mean Est. IQ = 101, SD = 8.7). Performance of COWAT and animals in detecting non-credible performances was evaluated through calculation of classification accuracy statistics and use of the logistic regression formulas reported in Sugarman and Axelrod (2015).

For COWAT, the optimal cutoff was a raw score of <27 (specificity = 89%; sensitivity = 31%), and a T-score of <35 (specificity = 92%; sensitivity = 31%). For animal naming, optimal cutoffs were <16 for raw score (specificity = 92%, sensitivity = 38%) and <37 for T-score (specificity = 91%; sensitivity = 33%). The logistic regression formula based on raw scores for both COWAT and animal naming was inadequately sensitive at the recommended cutoff in this sample, but a coefficient of > .28 was revealed to be optimal (91% specificity; 42% sensitivity). When the formula for T-scores was used, a coefficient of > .38 was optimal (91% specificity; 28% sensitivity).

Results of the current research suggest that PVTs embedded within the commonly administered COWAT and animal naming verbal fluency tests can effectively detect low effort, in concordance with generally accepted standards. A logistic regression formula using raw scores in particular appears to be most effective, consistent with findings reported by Sugarman and Axelrod (2015).

Performance validity tests (PVTs) are included in neuropsychological testing to ensure examinees are performing to the best of their abilities. There are two types of PVTs: embedded and free standing. Embedded PVTs are tests that are derived from standard neuropsychological tests of various cognitive domains. Freestanding PVTs are tests that are designed with the intention of being a PVT. Research studies show that undergraduate samples do not always performed to the best of their abilities. The purpose of this study was to cross-validate previous research on the topic of performance validity in a college sample. It was predicted that the non-credible group would demonstrate higher failure rates on embedded PVTs compared to the credible group.

The sample consisted of 198 neurologically and psychologically healthy undergraduate students with a mean age of 19.69 (SD = 2.11). Participants were broken into two groups: non-credible (i.e., participants that failed two or more PVTs) and credible (i.e., participants that did not failed two or more PVTs). The Rey-Osterrith copy test, Comalli Stroop part A (CSA), B (CSB), and C (CSC), Trail Making Test part A and B, Symbol Digit Modalities Test written (SDMT-W) and oral (SDMT-O) parts, Controlled Oral Word Association Test (COWAT) letter fluency, and Finger Tapping Test were used to evaluate failure rates in our sample. PVT cutoff scores were use from previously validated in the literature. Chi-square analysis was used to evaluate failure rates between the groups.

Chi-square analysis revealed significant failure rate differences between groups on several PVTs. Results revealed that 15% of the non-credible group failed the CSA compared to 1% of the credible group, X2=14.77, p=.000. Meanwhile, 26% of the non-credible group failed the CSB compared to 2% of the credible group, X2=24.72, p=.000. Furthermore, results showed that 11% of the non-credible group failed the CSC compared to 1% of the credible group, X2=13.05, p=.000.Next, 48% of the non-credible group failed the Trail Making Test part A compared to 8% of the credible group, X2=31.61, p=.000. We also found that 15% of the non-credible group failed the SDMT-W part compared to 1% of the credible group,X2=19.18, p=.000. Meanwhile, on the SDMT-O part 19% of the non-credible group failed compared to 1% of the credible group, X2=25.52, p =.000. On the COWAT letter fluency task 74% of the non-credible group failed compared to 19% of the credible group, X2=36.90, p=.000. Finally, results revealed on the Finger Tapping Test 19% of the non-credible group failed compared to 3% of the credible group, X2=10.01, p=.002.

As expected, the non-credible participants demonstrated significantly higher PVT failure rates compared to credible participants. A possible explanation driving higher failure rates in our sample can be due to cultural variables (e.g., bilingualism). It was suggested by researchers that linguistic factors may be impacting higher PVT failure rates and developing a false-positive error. Future research using undergraduate samples need to identify which PVT’s are being impacted by linguist factors.

The Brief Visuospatial Memory Test-Revised (BVMT-R) Recognition Discrimination (RD) index has emerged as an embedded performance validity test (PVT). However, there do not appear to be any studies that have examined its utility in Spanish-speaking samples. This pilot study examined the classification accuracy of the BVMT-R RD for detecting performance invalidity in a Spanish-speaking forensic sample.

This cross-sectional study utilized a sample of 89 Spanish speakers that were administered the BVMT-R during an outpatient neuropsychological evaluation. Out of the 89 Spanish speakers, 43 were subjects in litigation, 32 were neurological patients evaluated for clinical purposes, and 14 were healthy controls. The sample was 67% male/33% female, 53% South American, 33% Caribbean (Dominican, Puerto Rican, Cuban), 10% Central American, 3% North American (Mexican), and 1% Spanish, with a mean age of 44.2 years (SD = 14.2; range = 20-78) and mean education of 11 years (SD = 3.7; range = 0-20). Test administration for each patient was completed in Spanish by a fluent, Spanish-speaking examiner. In total, 64/89 (72%) were classified as valid and 25/89 (28%) as invalid based on performance across the Test of Memory Malingering (TOMM), at least one additional PVT (Rey-15 item memory test; Rey Dot Counting Test; Reliable Digit Span; WHO-AVLT recognition trial) and objective diagnostic criteria identifying invalid performance. Analyses included three univariate analyses of variance (ANOVA), with the groups (healthy vs neurological vs litigation) as independent variables and performance on BVMT-RD as the dependent variable.

Statistically significant differences among the groups were found F(2,86)=8.32, p < .001). Post-hoc analysis (Scheffe test) showed the mean of the litigation group to be significantly lower than the means of the other two groups (healthy and neurological), which showed no difference between them. An ANOVA with validity groups as the fixed factor and BVMT-R RD index as the dependent variable was significant F(1,85)= 21.02, p <.001). Results of a ROC curve analysis yielded statistically significant AUC (.794). The optimal cut-score was BVMT-R RD < 5 (48% sensitivity/88% specificity).

Results of the BVMT-R RD index in this Spanish-speaking population differed by subgroup, with worse performance seen in individuals involved in litigation, compared to those who were not (healthy and neurological). Notably, the BVMT-R RD index significantly differentiated validity groups, maintaining adequate sensitivity and good specificity. Overall, results demonstrate promise for BVMT-RD as a PVT for Spanish-speaking populations.