CVLT-II Forced Choice Recognition Trial as an Embedded Validity Indicator: A Systematic Review of the Evidence.
The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test, 2nd edition, was designed as an embedded performance validity test (PVT). To our knowledge, this is the first systematic review of classification accuracy against reference PVTs.



Results from peer-reviewed studies with FCR data published since 2002 encompassing a variety of clinical, research, and forensic samples were summarized, including 37 studies with FCR failure rates (N=7575) and 17 with concordance rates with established PVTs (N=4432).



All healthy controls scored >14 on FCR. On average, 16.9% of the entire sample scored ≤14, while 25.9% failed reference PVTs. Presence or absence of external incentives to appear impaired (as identified by researchers) resulted in different failure rates (13.6% vs. 3.5%), as did failing or passing reference PVTs (49.0% vs. 6.4%). FCR ≤14 produced an overall classification accuracy of 72%, demonstrating higher specificity (.93) than sensitivity (.50) to invalid performance. Failure rates increased with the severity of cognitive impairment.



In the absence of serious neurocognitive disorder, FCR ≤14 is highly specific, but only moderately sensitive to invalid responding. Passing FCR does not rule out a non-credible presentation, but failing FCR rules it in with high accuracy. The heterogeneity in sample characteristics and reference PVTs, as well as the quality of the criterion measure across studies, is a major limitation of this review and the basic methodology of PVT research in general. (JINS, 2016, 22, 851-858).
1Neuroscience Center,Waukesha Memorial Hospital,Waukesha,Wisconsin.
Eben S
ES
Schwartz
2Department of Psychology,University of Windsor,Windsor ON,Canada.
Laszlo
L
Erdodi
2Department of Psychology,University of Windsor,Windsor ON,Canada.
Nicholas
N
Rodriguez
3Neuropsychology Program,Geisel School of Medicine at Dartmouth,Lebanon,New Hampshire.
Jyotsna J
JJ
Ghosh
4Department of Neurology and Neurological Sciences,Stanford Health Care,Stanford,California.
Joshua R
JR
Curtain
3Neuropsychology Program,Geisel School of Medicine at Dartmouth,Lebanon,New Hampshire.
Laura A
LA
Flashman
3Neuropsychology Program,Geisel School of Medicine at Dartmouth,Lebanon,New Hampshire.
Robert M
RM
Roth
D060825:Cognitive Dysfunction / Q000175:diagnosis*; D006801:Humans; D008306:Malingering / Q000175:diagnosis*; D009483:Neuropsychological Tests / Q000592:standards*; D011594:Psychometrics / Q000295:instrumentation*; D011597:Psychomotor Performance / Q000502:physiology*
Malingering; Memory deficits; Neuropsychology; Review; Symptom evaluation; Systematic; Validity of results