Detecting Negative Response Bias Within the Trauma Symptom Inventory–2 (TSI-2): a Review of the Literature

This systematic review was performed to summarize existing research on the symptom validity scales within the Trauma Symptom Inventory–Second Edition (TSI-2), a relatively new self-report measure designed to assess the psychological sequelae of trauma. The TSI-2 has built-in symptom validity scales to monitor response bias and alert the assessor of non-credible symptom profiles. The Atypical Response scale (ATR) was designed to identify symptom exaggeration or fabrication. Proposed cutoffs on the ATR vary from ≥ 7 to ≥ 15, depending on the assessment context. The limited evidence available suggests that ATR has the potential to serve as measure of symptom validity, although its classification accuracy is generally inferior compared to well-established scales. While the ATR seems sufficiently sensitive to symptom over-reporting, significant concerns about its specificity persist. Therefore, it is proposed that the TSI-2 should not be used in isolation to determine the validity of the symptom presentation. More research is needed for development of evidence-based guidelines about the interpretation of ATR scores.

A-183 Base Rates of Performance and Symptom Validity Test Failures in Active Duty and Veteran Samples Referred for Attention-Deficit/Hyperactivity Disorder Evaluation

Objective To evaluate base rates of abnormal MMPI-2-RF symptom validity test (SVT) and stand-alone performance validity test (PVT) scores in active duty (ad) service member and Veterans Affairs clinical samples referred for neuropsychological assessment of ADHD. Method MMPI-2-RF SVT scores and various PVTs were evaluated in two samples referred specifically for assessment of ADHD: service members (N = 82) and Veterans (N = 355). SVT and PVT outcomes were then compared to published data establishing invalid base rates in larger, more general samples. Results Elevated MMPI-2-RF overreport scales (F-r ≥ 79; FS, RBS, and FBS-r ≥ 80; & Fp-r ≥ 70) ranged from 14.6% (FBS-r) to 40.0% (RBS) in the ad sample and 12.0% (FBS-r) and 28.9% (RBS) in the veteran sample. MMPI-2-RF profiles that were invalidated due to overreport (e.g., F-r = 120, all others ≥100) were under 5% on the veteran sample and no greater than 6.1% in the ad sample. Elevations on underreport scales were higher in the veteran sample (L-r = 12.9%, K-r = 2.0%) than the ad sample (L-r = 3.7%, K-r = 1.2%). In the ad sample, 21.5% failed one PVT and 6.3% failed two. In the Veteran sample, 23.4% failed one PVT. Conclusions Elevated MMPI-2-RF overreport scales were relatively common on ad and Veterans referred for ADHD evaluations. However, frequencies of elevated and invalidated scales were diminished relative to overall base rates reported in national data. Regarding PVT failure, both samples were lower than national average invalid rates. Despite the incentive inherent in ADHD exams, invalidity in both samples were consistently lower for both SVTs and PVTs.

A-177 Classification Statistics of the Clinical Assessment of Attention Deficit – Adult (CAT-A) Negative Impression Scale for ADHD Evaluations in an Active Duty Sample

Objective To evaluate the classification statistics of the Clinical Assessment of Attention Deficit – Adult (CAT-A) Negative Impression (NI) scale, relative to the MMPI-2-RF in an active duty military sample. We hypothesized that MMPI-2-RF RBS would have the largest AUC. Method Retrospective review of 108 active duty service members consecutively referred to neuropsychology for clinical ADHD evaluations in a Midwest Army Health Center. Cases with missing data (10) and failures of MMPI-2-RF response consistency scales (3) were removed from analysis, resulting in final sample of 95. Average age was 32.62 (SD = 8.87) and average education was 14.66 (SD = 2.66). MMPI-2-RF symptom validity scales (F-r, Fp-r, Fs, FBS-r, and RBS) were employed as criterion measures at all standard cut-offs to evaluate the CAT-A NI scale. Results ROC analyses for the MMPI-2-RF over-reporting symptom validity scales ranged from 0.599 to 0.808, with the MMPI-2-RF RBS scale >79 demonstrating the lowest AUC (0.599; p 52. With specificity held at or above 0.90, sensitivities ranged from 22.86 to 60.00, with positive and negative predictive values ranging from 11.1 to 58.8 and 66.7 to 98.8, respectively. Conclusions The CAT-A NI scale demonstrated reasonable AUC values for nearly all MMPI-2-RF over-reporting scales. Psychologically-based over-reporting scales were superior to cognitively-based over-reporting scales in terms of classification statistics. The optimal cut in the current data (>52) is slightly higher (though roughly commensurate) to the cut score for atypical responses in the CAT-A manual (>45).

A-130 Validity-10, Remaining-12 and Total NSI Scores as Measures of Symptom Validity in Service Members with a History of mTBI

Objective The Neurobehavioral Symptom Inventory (NSI), a commonly used self-report measure of concussive symptoms, is frequently employed throughout the Defense Health Agency. Embedded measures of symptom validity have been developed that include the Validity-10 and total NSI score. A recent investigation in a small sample of veterans (n = 45) suggested that the 12 items on the NSI that do not contribute to the Validity-10 (Remaining-12) perform in a manner similar to the Validity-10. The current study sought to evaluate the classification accuracy of the Validity-10, Remaining-12 and total NSI score in a larger sample to assess the relative utility of each. Method The NSI and MMPI-2-RF scores of 255 active duty Service Members and Veterans seen ≥4 months after mild Traumatic Brain Injury (mTBI) were evaluated. MMPI-2-RF criterion were defined as over-reporting (>79 on Fs, RBS, and/or FBS-r; >78 on F-r; >69 on Fp-r) and invalid (>119 on F; >99 on all other scales). Results Correlations between all MMPI-2-RF over-report scales and the Validity-10, Remaining-12, and NSI total were roughly commensurate and significant at the p < 0.001 level. AUC values for the RF over-report protocols were as followings: Validity-10 = 0.87, Remaining-12 = 0.89, NSI total = 0.89. AUC values for invalid RF protocols were as follows: Validity-10 = 0.91, Remaining-12 = 0.92, NSI total = 0.93. Conclusions The current findings indicate reasonable and equivalent classification accuracies for the Validity-10, Remaining-12, and NSI total score. These data can be taken to suggest that there is limited uniqueness of the Validity-10 relative to the remaining NSI items.