A-228 Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare?

Objective One study reported that suboptimal effort on performance validity tests (PVTs) is associated with higher healthcare utilization within a VA setting, defined as the number of Emergency Department visits and inpatient hospitalizations. The current study sought to expand on this by examining whether PVT failure is associated with higher number of outpatient visits in a military sample with a history of mild traumatic brain injury (mTBI). Method The medical records of 43 participants, 13 of whom failed the PVT Green’s Word Memory Test (WMT), were reviewed for the number of encounters since the mTBI and the reason for the encounter. The two groups (passed vs. failed) did not differ significantly on demographic variables (39 males, mean age 39, 65% Caucasian). Results The overall number of medical encounters was not significant between the two groups after controlling for years since the mTBI (F(1, 40) = 2.67, p = .11); however, once three participants with (>2 years) missing records were excluded (final n = 40), the PVT failure group was seen significantly more often, (F(1, 37) = 8.23, p = .01). The PVT failures had a higher number of encounters with physical therapy (t(38) = −2.79, p = .01) and orthopedics (t(38) = −2.10, p = .04). Conclusions Preliminary results suggest that suboptimal effort is not associated with higher healthcare utilization; however, when participants with more than two years of missing records were excluded, those who failed PVTs were seen more frequently by physical therapy and orthopedic specialties. Limitations for future investigations are highlighted.

A-155 Association of Feigned Attentional Symptoms with Intra-Individual Variability in Intellectual Functioning

Objective The association between feigned Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms and intellectual functioning was examined in a sample of undergraduate students instructed to simulate ADHD. Method 90 undergraduate students completed the Wechsler Adult Intelligence Scale (WAIS-IV), b Test, and Green’s Word Memory Test (WMT) as part of a larger study [mean age 19.23 years (SD 1.67), range 17–26 years old; mean 12.47 years of education (SD .86); 58.9% female; 58.9% Caucasian, 32.2% African American, 8.9% Other]. Intra-individual variability (IIV) was calculated as standard deviation of the overall test battery mean for the 10 core WAIS-IV subtests. Results A moderate association was found between WAIS-IV IIV and b Test E-score (r = .397, p < .05). WAIS-IV IIV was also moderately associated with b Test errors (d errors r = .299, p < .05; commissions r = .284, p < .05; omissions r = .463, p < .01) and completion time (r = .332, p < .05). No significant relationships were found between WAIS-IV IIV and WMT performance. Conclusions Given that IIV within intellectual functioning was correlated with performance on b Test but not WMT, this suggests the variability in objectively measured intelligence for simulators is associated with feigned attentional symptoms but not feigned memory symptoms. These findings implicate detection of malingered symptom presentation for ADHD to be more sensitive in the attentional domain compared to memory. Therefore, performance validity tests assessing attentional abilities may be more applicable in diagnostic settings aimed at detection of ADHD.

A-40 Predictors of Failed Effort Testing at Initial Clinic Visit for Concussion Rehabilitation and Outcomes

Objective Neuropsychological evaluation of concussion typically includes performance validity testing to assess effort. The aim of this study was to explore the usefulness of effort testing as part of initial screening for concussion rehabilitation, including determining the factors that predict effort testing and evaluate outcomes between “good effort” and “failed effort” groups. Method Records of 76 patients aged 16–66 years old (M = 40.58 years, SD = 14.18) seen for rehabilitation of non-sport concussion from 2018–2019 were reviewed. Patients completed clinical interview, neurocognitive screening (ImPACT), effort testing (Word Memory Test), vestibular/oculomotor screening (VOMS), and the post-concussion symptom scale (PCSS). A logistic regression (LR) was conducted to predict effort, with predictors including mental health history, secondary gain, work injury, days post-injury, and PCSS. A series of one-way ANOVAs evaluated outcomes from concussion rehabilitation between the good and failed effort groups. Results Failed effort occurred in 42% of cases. The LR accurately classified 81.8% of individuals, with mental health history (p = .01) and PCSS (p = .02) as the only significant predictors of effort. There were no differences in recovery time (p = .56) between effort groups, but the failed effort group took longer to return to work (p = .03). Half of individuals who failed effort were seen until discharge, and 69% of them reported no symptoms/mild symptoms at discharge. Conclusions Failure of effort testing was predicted by a history of mental health and high symptom burden. Individuals who fail effort testing at initial visit for concussion rehabilitation take longer to return to functional activity but are capable of achieving recovery with compliance and appropriate rehabilitation.

Patterns of Cognitive Test Scores and Symptom Complaints in Persons with TBI Who Failed Performance Validity Testing

Objective:To determine clinically meaningful subgroups of persons with traumatic brain injury (TBI) who have failed performance validity testing.Method:Study participants were selected from a cohort of 674 participants with definitive medical evidence of TBI. Participants were those who failed performance validity testing (the Word Memory Test, using the standard cutoffs). Participants were administered cognitive tests and self-report questionnaires. Test and questionnaire results were summarized as 12 dimension scores. Cluster analysis using the k-means method was performed.Results:Cluster analysis for the 143 retained participants indicated three subgroups. These subgroups differed on patterns of scores. Subgroup 1 was impaired for memory and had no excessive complaints. Subgroup 2 had impaired memory and processing speed as well as concern regarding cognition function. Subgroup 3 showed impairment on all cognitive tests and excess complaints in multiple areas.Conclusions:These results provide a preliminary basis for improved understanding of poor performance validity.

Mozart Sharpens and Mahler Degrades the Word Memory Trace

We investigated the impact of the Mozart effect on word memory when music was heard in the delay rather than using music to induce mood or as background music. A sample of N = 84 participants was randomly assigned to one of three groups listening to a one-minute sound clip of Mozart (Kleine Nachtmusik) or Mahler (Adagietto) during the delay, with a third control group waiting in silence for the word memory test. Words were positive, negative or neutral and matched for word length and frequency. The word memory task was repeated three times (enforced rehearsal). Word memory was best after Mozart and worst after Mahler, with memory performance in the control condition in between. The Mozart effect occurred for word memory across positive, negative and neutral words. The Mozart effect also occurred independently of ethnicity, or the level of happiness in the participants. We conclude that word memory traces sharpened after Mozart’s music because the sonogram and spectrograms showed that this music had self-contained and bounded phrases like in psycholinguistic structures of words and sentences. In contrast, word memory traces may have washed out and degraded during the delay because Mahler’s music was flowing like a foreign language speech stream where a native speaker would not be able to parse words.

Performance Validity Testing in Justice-Involved Adults with Fetal Alcohol Spectrum Disorder

Objectives:A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits.Method:The sample comprised 80 justice-involved adults (ages 19–40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale – Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding – Symbol Search, Vocabulary – Digit Span), and the Wechsler Memory Scale – Fourth Edition (Logical Memory II Recognition).Results:Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35–76%). Across both groups, substantially more participants with IQ <70 failed two or more PVTs (90%), compared to those with an IQ ≥70 (44%).Conclusions:Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD.

Atypical Visual Scan Path Affects Remembering in ADHD

Objective:Several studies agree on the link between attention and eye movements during reading. It has been well established that attention and working memory (WM) interact. A question that could be addressed to better understand these relationships is: to what extent can an attention deficit affect eye movements and, consequently, remembering a word? The main aims of the present study were (1) to compare visual patterns of word stimuli between children with Attention Deficit Hyperactivity Disorder (ADHD) and typically developing (TD) children, during a visual task on word stimuli; (2) to examine the WM accuracy of the word stimuli; and (3) to compare the dynamic of visual scan path in both groups.Method:A total of 49 children with ADHD, age and sex matched with 32 TD children, were recruited. We used eye-tracking technology in which the Word Memory Test was implemented. To highlight the scan path of participants, two measures were used: the ordered direction of reading and the entropy index.Results:ADHD groups showed a poorer WM than TD group. They did not follow a typical scan path across the words compared with TD children, but their visual scanning was discontinuous, uncoordinated, and chaotic. ADHD groups showed an index of entropy among the four categories of saccades higher than TD group.Conclusions:The findings were discussed in light of two directions: the relationship between atypical visual scan path and WM and the training implications related to the necessity of redirecting the dynamic of visual scan path in ADHD to improve WM.