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The Importance of Demographically Adjusted Cutoffs: Age and Education Bias in Raw Score Cutoffs Within the Trail Making Test

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Abstract

This study was designed to develop validity cutoffs by utilizing demographically adjusted T-scores on the trail making test (TMT), with the goal of eliminating potential age and education-related biases associated with the use of raw score cutoffs. Failure to correct for the effect of age and education on TMT performance may lead to increased false positive errors for older adults and examinees with lower levels of education. Data were collected from an archival sample of 100 adult outpatients (MAge = 38.8, 56% male; MEd = 13.7) who were clinically referred for neuropsychological assessment at an academic medical center in the Midwestern USA after sustaining a traumatic brain injury (TBI). Performance validity was psychometrically determined using the Word Memory Test and two multivariate validity composites based on five embedded performance validity indicators. Cutoffs on the demographically corrected TMT T-scores had generally superior classification accuracy compared to the raw score cutoffs reported in the literature. As expected, the T-scores also eliminated age and education bias that was observed in the raw score cutoffs. Both T-score and raw score cutoffs were orthogonal to injury severity. Multivariate models of T-score based cutoff failed to improve classification accuracy over univariate T-score cutoffs. The present findings provide support for the use of demographically adjusted validity cutoffs within the TMT. They produced superior classification to raw score-based cutoffs, in addition to eliminating the bias against older adults and examinees with lower levels of education.

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References

  • Abeare, C., Messa, I., Whitfield, C., Zuccato, B., Casey, J., Rykulski, N., & Erdodi, L. (2018). Performance validity in collegiate football athletes at baseline neurocognitive testing. The Journal of Head Trauma Rehabilitation, 1.

  • Abeare, C. A., Messa, I., Zuccato, B. G., Merker, B., & Erdodi, L. A. (2018). Prevalence of invalid performance on baseline testing for sport-related concussion by age and validity indicator. Advanced online publication. JAMA Neurology, 75, 697. https://doi.org/10.1001/jamaneurol.2018.0031.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Academy of Clinical Neuropsychology. (2007). American Academy of clinical neuropsychology (AACN) practice guidelines for neuropsychological assessment and consultation. The Clinical Neuropsychologist, 21(2), 209–231. https://doi.org/10.1080/13825580601025932.

    Article  Google Scholar 

  • American Congress on Rehabilitation Medicine. (1993). Definition of mild traumatic brain injury. The Journal of Head Trauma Rehabilitation, 8(3), 86–87.

    Article  Google Scholar 

  • An, K. Y., Charles, J., Ali, S., Enache, A., Dhuga, J., & Erdodi, L. A. (2019). Re-examining performance validity cutoffs within the complex ideational material and the Boston naming test-short form using an experimental malingering paradigm. Journal or Clinical and Experimental Neuropsychology, 41(1), 15–25. https://doi.org/10.1080/13803395.2018.1483488.

    Article  PubMed  Google Scholar 

  • Arnold, G., Boone, K. B., Lu, P., Dean, A., Wen, J., Nitch, S., & McPhearson, S. (2005). Sensitivity and specificity of finger tapping test scores for the detection of suspect effort. The Clinical Neuropsychologist, 19(1), 105–120. https://doi.org/10.1080/13854040490888567.

    Article  PubMed  Google Scholar 

  • Ashendorf, L., Clark, E. K., & Sugarman, M. A. (2017). Performance validity and processing speed in a VA Polytrauma sample. The Clinical Neuropsychologist, 31(5), 857–866.

    Article  Google Scholar 

  • Ashendorf, L., Jefferson, A. L., O’Connor, M. K., Chaisson, C., Green, R. C., & Stern, R. A. (2008). Trail making test errors in normal aging, mild cognitive impairment, and dementia. Archives of Clinical Neuropsychology, 23, 129–137.

    PubMed  PubMed Central  Google Scholar 

  • Axelrod, B. N., Fichtenberg, N. L., Liethen, P. C., Czarnota, M. A., & Stucky, K. (2001). Performance characteristics of postacute traumatic brain injury patients on the WAIS-III and WMS-III. The Clinical Neuropsychologist, 15(4), 516–520.

    Article  Google Scholar 

  • Axelrod, B. N., Fichtenberg, N. L., Millis, S. R., & Wertheimer, J. C. (2006). Detecting incomplete effort with digit span from the Wechsler adult intelligence scale – Third edition. The Clinical Neuropsychologist, 20(3), 513–523.

    Article  Google Scholar 

  • Axelrod, B. N., Meyers, J. E., & Davis, J. J. (2014). Finger tapping test performance as a measure of performance validity. The Clinical Neuropsychologist, 28(5), 876–888. https://doi.org/10.1080/13854046.2014.907583.

    Article  PubMed  Google Scholar 

  • Bigler, E. D. (2012). Symptom validity testing, effort, and neuropsychological assessment. Journal of the International Neuropsychological Society, 18, 632–642.

    Article  Google Scholar 

  • Bigler, E. D. (2015). Neuroimaging as a biomarker in symptom validity and performance validity testing. Brain Imaging and Behavior, 9, 421–444. https://doi.org/10.1007/s11682-015-9409-1.

    Article  PubMed  Google Scholar 

  • Boone, K. B. (2009). The need for continuous and comprehensive sampling of effort/response bias during neuropsychological examination. The Clinical Neuropsychologist, 23(4), 729–741. https://doi.org/10.1080/13854040802427803.

    Article  PubMed  Google Scholar 

  • Boone, K. B. (2013). Clinical practice of forensic neuropsychology. New York, NY: Guilford.

    Google Scholar 

  • Bortnik, K. E., Boone, K. B., Marion, S. D., Amano, S., Ziegler, E., Victor, T. L., & Zeller, M. A. (2010). Examination of various WMS-III logical memory scores in the assessment of response bias. The Clinical Neuropsychologist, 24(2), 344–357. https://doi.org/10.1080/13854040903307268.

    Article  PubMed  Google Scholar 

  • Bush, S. S., Heilbronner, R. L., & Ruff, R. M. (2014). Psychological assessment of symptom and performance validity, response bias, and malingering: Official position of the Association for Scientific Advancement in psychological injury and law. Psychological Injury and Law, 7(3), 197–205.

    Article  Google Scholar 

  • Busse, M., & Whiteside, D. (2012). Detecting suboptimal cognitive effort: Classification accuracy of the Conner’s continuous performance test-II, brief test of attention, and trail making test. The Clinical Neuropsychologist, 26(4), 675–687.

    Article  Google Scholar 

  • Cavaco, S., Gonçalves, A., Pinto, C., Almeida, E., Gomes, F., Moreira, I., Fernandes, J., & Teixeira-Pinto, A. (2013). Trail making test: Regression-based norms for the Portuguese population. Archives of Clinical Neuropsychology, 28(2), 189–198.

    Article  Google Scholar 

  • Chafetz, M. D., Williams, M. A., Ben-Porath, Y. S., Bianchini, K. J., Boone, K. B., Kirkwood, M. W., Larrabee, G. J., & Ord, J. S. (2015). Official position of the American Academy of clinical neuropsychology Social Security Administration policy on validity testing: Guidance and recommendations for change. The Clinical Neuropsychologist, 29(6), 723–740.

    Article  Google Scholar 

  • Carone, D.A. (2008). Children with moderate/severe brain damage/dysfunction outperform adults with mild-to-no brain damage on the Medical Symptom Validity Test. Brain Injury, 22(12), 960-971.

  • Conners, K. C. (2004). Conner’s continuous performance test (CPT II). Version 5 for windows. Technical guide and software manual. North Tonawada, NY: Multi-Health Systems.

    Google Scholar 

  • Corrigan, J. D., & Hinkeldey, N. S. (1987). Relationships between parts a and B of the trail making test. Journal of Clinical Psychology, 43, 402–409.

    Article  Google Scholar 

  • Cottingham, M. E., Victor, T. L., Boone, K. B., Ziegler, E. A., & Zeller, M. (2014). Apparent effect of type of compensation seeking (disability vs. litigation) on performance validity test scores may be due to other factors. The Clinical Neuropsychologist, 28(6), 1030–1047. https://doi.org/10.1080/13854046.2014.951397.

    Article  PubMed  Google Scholar 

  • Curtis, K. L., Greve, K. W., & Bianchini, K. J. (2009). The Wechsler adult intelligence scale-III and malingering in traumatic brain injury. Assessment, 16(4), 401–414.

    Article  Google Scholar 

  • Davis, J. J., & Millis, S. R. (2014). Examination of performance validity test failure in relation to number of tests administered. The Clinical Neuropsychologist, 28(2), 199–214. https://doi.org/10.1080/13854046.2014.884633.

    Article  PubMed  Google Scholar 

  • Dean, A. C., Victor, T. L., Boone, K. B., Philpott, L. M., & Hess, R. A. (2009). Dementia and effort test performance. The Clinical Neuropsychologist, 23, 133–152.

    Article  Google Scholar 

  • Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. (2000). The California verbal learning test-second edition. San Antonio TX: The Psychological Corporation.

    Google Scholar 

  • Donders, J., & Strong, C. A. H. (2015). Clinical utility of the Wechsler adult intelligence scale – Fourth edition after traumatic brain injury. Assessment, 22(1), 17–22.

    Article  Google Scholar 

  • Donders, J., & Strong, C. H. (2011). Embedded effort indicators on the California verbal learning test – Second edition (CVLT-II): An attempted cross-validation. The Clinical Neuropsychologist, 25, 173–184.

    Article  Google Scholar 

  • Dunn, L. M., & Dunn, D. M. (2007). Peabody Picture Vocabulary Test, Fourth Edition. San Antonio, TX: Pearson.

  • Erdodi, L. A. (2019). Aggregating validity indicators: The salience of domain specificity and the indeterminate range in multivariate models of performance validity assessment. Applied Neuropsychology. Adult, 26(2), 155–172. https://doi.org/10.1080/23279095.2017.1384925.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Abeare, C. A., Lichtenstein, J. D., Tyson, B. T., Kucharski, B., Zuccato, B. G., & Roth, R. M. (2017). WAIS-IV processing speed scores as measures of non-credible responding – The third generation of embedded performance validity indicators. Psychological Assessment, 29(2), 148–157.

    Article  Google Scholar 

  • Erdodi, L. A., Abeare, C. A., Medoff, B., Seke, K. R., Sagar, S., & Kirsch, N. L. (2018). Asingle error is one too many: The Forced Choice Recognition trial on the CVLT-II as ameasure of performance validity in adults with TBI. Archives of Clinical Neuropsychology, 33(7),845-860.https://doi.org/10.1093/arclin/acx110.

  • Erdodi, L. A., Dunn, A. G., Seke, K. R., Charron, C., McDermott, A., Enache, A., Maytham, C., & Hurtubise, J. (2018). The Boston naming test as a measure of performance validity. Psychological Injury and Law, 11, 1–8. https://doi.org/10.1007/s12207-017-9309-3.

    Article  Google Scholar 

  • Erdodi, L. A., Hurtubise, J. L., Charron, C., Dunn, A., Enache, A., McDermott, A., & Hirst, R. (2018). The D-KEFS trails as performance validity tests. Psychological Assessment, 30(8), 1081–1095.

    Article  Google Scholar 

  • Erdodi, L. A., Jongsma, K. A., & Issa, M. (2017). The 15-item version of the Boston naming test as an index of English proficiency. The Clinical Neuropsychologist, 31(1), 168–178. https://doi.org/10.1080/13854046.2016.1224392.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Kirsch, N. L., Sabelli, A. G., & Abeare, C. A. (2018). The grooved pegboard test as a validity indicator – A study on psychogenic interference as a confound in performance validity research. Psychological Injury and Law, 11(4), 307–324. https://doi.org/10.1007/s12207-018-9337-7.

    Article  Google Scholar 

  • Erdodi, L. A., & Lichtenstein, J. D. (2019). Information processing speed tests as PVTs. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment. A neuropsychological perspective. New York, NY: Guilford.

    Google Scholar 

  • Erdodi, L. A., Nussbaum, S., Sagar, S., Abeare, C. A., & Schwartz, E. S. (2017). Limited English proficiency increases failure rates on performance validity tests with high verbal mediation. Psychological Injury and Law, 10(1), 96–103.

    Article  Google Scholar 

  • Erdodi, L. A., Pelletier, C. L., & Roth, R. M. (2018). Elevations on select Conners’ CPT-II scales indicate noncredible responding in adults with traumatic brain injury. Applied Neuropsychology. Adult, 25(1), 19–28. https://doi.org/10.1080/23279095.2016.1232262.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., & Rai, J. K. (2017). A single error is one too many: Examining alternative cutoffs on trial 2 on the TOMM. Brain Injury, 31(10), 1362–1368. https://doi.org/10.1080/02699052.2017.1332386.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Roth, R. M., Kirsch, N. L., Lajiness-O’Neill, R., & Medoff, B. (2014). Aggregating validity indicators embedded in Conners’ CPT-II outperforms individual cutoffs at separating valid from invalid performance in adults with traumatic brain injury. Archives of Clinical Neuropsychology, 29(5), 456–466. https://doi.org/10.1093/arclin/acu026.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Sagar, S., Seke, K., Zuccato, B. G., Schwartz, E. S., & Roth, R. M. (2018). The Stroop test as a measure of performance validity in adults clinically referred for neuropsychological assessment. Psychological Assessment, 30(6), 755–766. https://doi.org/10.1037/pas0000525.

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Seke, K. R., Shahein, A., Tyson, B. T., Sagar, S., & Roth, R. M. (2017). Low scores on the grooved pegboard test are associated with invalid responding and psychiatric symptoms. Psychology & Neuroscience, 10(3), 325–344. https://doi.org/10.1037/pne0000103.

    Article  Google Scholar 

  • Erdodi, L. A., Tyson, B. T., Abeare, C. A., Lichtenstein, J. D., Pelletier, C. L., Rai, J. K., & Roth, R. M. (2016). The BDAE complex ideational material – A measure of receptive language or performance validity? Psychological Injury and Law, 9, 112–120. https://doi.org/10.1007/s12207-016-9254-6.

    Article  Google Scholar 

  • Erdodi, L. A., Tyson, B. T., Abeare, C. A., Zuccato, B. G., Rai, J. K., Seke, K. R., et al. (2018). Utility of critical items within the recognition memory test and word choice test. Applied Neuropsychology. Adult, 25(4), 327–339. https://doi.org/10.1080/23279095.2017.1298600.

    Article  PubMed  Google Scholar 

  • Etherton, J. L., Bianchini, K. J., Heinly, M. T., & Greve, K. W. (2006). Pain, malingering, and performance on the WAIS-III processing speed index. Journal of Clinical and Experimental Neuropsychology, 28(7), 1218–1237.

    Article  Google Scholar 

  • Gladsjo, J. A., Schuman, C. C., Evans, J. D., Peavy, G. M., Miller, S. W., & Heaton, R. K. (1999). Norms for letter and category fluency: Demographic corrections for age, education, and ethnicity. Assessment, 6(2), 147–178.

    Article  Google Scholar 

  • Glassmire, D. M., Wood, M. E., Ta, M. T., Kinney, D. I., & Nitch, S. R. (2019). Examining false-positive rates of Wechsler adult intelligence scale (WAIS-IV) processing speed based embedded validity indicators among individuals with schizophrenia spectrum disorders. Psychological Assessment, 31(1), 120–125. https://doi.org/10.1037/pas0000650.

    Article  PubMed  Google Scholar 

  • Golden, C. J., & van den Broek, A. (1998). Potential impact of age-and education-corrected scores on HRNB score patterns in participants with focal brain injury. Archives of Clinical Neuropsychology, 13(8), 683–694.

    Article  Google Scholar 

  • Green, P. (2003). Green’s Word Memory Test. Edmonton, Canada: Green’s Publishing

  • Green, P., Flaro, L., & Courtney, J. (2009). Examining false positives on the word memory test in adults with mild traumatic brain injury. Brain Injury, 23, 741–750.

    Article  Google Scholar 

  • Green, P., Iverson, G., & Allen, L. (1999). Detecting malingering in head injury litigation with the word memory test. Brain Injury, 13, 813–819.

    Article  Google Scholar 

  • Greiffenstein, M. F., Baker, W. J., & Gola, T. (1994). Validation of malingered amnesia measures with a large clinical sample. Psychological Assessment, 6(3), 218–224.

    Article  Google Scholar 

  • Greve, K. W., Curtis, K. L., Bianchini, K. J., & Ord, J. S. (2009). Are the original and second edition of the California verbal learning test equally accurate in detecting malingering? Assessment, 16(3), 237–248.

    Article  Google Scholar 

  • Grimes, D. A., & Schulz, K. F. (2005). Refining clinical diagnosis with likelihood ratios. The Lancet, 365(9469), 1500–1505.

    Article  Google Scholar 

  • Halstead, W. (1947). Brain and intelligence. A quantitative study of the frontal lobes. Chicago: University of Chicago Press.

    Google Scholar 

  • Hamdan, A. C., & Hamdan, E. M. (2009). Effects of age and education on the trail making test in a healthy Brazilian sample. Psychology & Neuroscience, 2(2), 199–203.

    Article  Google Scholar 

  • Hashimoto, R., Meguro, K., Lee, E., Kasai, M., Ishii, H., & Yamaguchi, S. (2006). Effect of age and education on the trail making test and determination of normative data for Japanese elderly people: The Tajiri project. Psychiatry and Clinical Neurosciences, 60, 422–428.

    Article  Google Scholar 

  • Hayward, L., Hall, W., Hunt, M., & Zubrick, S. R. (1987). Can localized brain impairment be simulated on neuropsychological test profiles? Australian and New Zealand Journal of Psychiatry, 21, 87–93.

    Article  Google Scholar 

  • Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtis, G. (1993). Wisconsin card sorting test (WCST) manual revised and expanded. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Heaton, R. K., Miller, S. W., Taylor, M. J., & Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Participants, C. (2009). American Academy of clinical neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23, 1093–1129. https://doi.org/10.1080/13854040903155063.

    Article  PubMed  Google Scholar 

  • Heinly, M. T., Greve, K. W., Bianchini, K., Love, J. M., & Brennan, A. (2005). WAIS digit-span-based indicators of malingered neurocognitive dysfunction: Classification accuracy in traumatic brain injury. Assessment, 12(4), 429–444.

    Article  Google Scholar 

  • Hester, R. L., Kinsella, G. J., Ong, B., & McGregor, J. (2005). Demographic influences on baseline and derived scores from the trail making test in healthy and older Australian adults. The Clinical Neuropsychologist, 19, 45–54.

    Article  Google Scholar 

  • Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.

    Article  Google Scholar 

  • Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.

    Book  Google Scholar 

  • Iverson, G., Green, P., & Gervais, R. (1999). Using the word memory test to detect biased responding in head injury litigation. Journal of Cognitive Rehabilitation, 17(2), 4–8.

    Google Scholar 

  • Iverson, G. L., Lange, R. T., Green, P., & Frazen, M. D. (2002). Detecting exaggeration and malingering with the trail making test. The Clinical Neuropsychologist, 16(3), 398–406.

    Article  Google Scholar 

  • Jasinski, L. J., Berry, D. T., Shandera, A. L., & Clark, J. A. (2011). Use of the Wechsler adult intelligence scale digit span subtest for malingering detection: A meta-analytic review. Journal of Clinical and Experimental Neuropsychology, 33(3), 300–314.

    Article  Google Scholar 

  • Kim, N., Boone, K. B., Victor, T., Lu, P., Keatinge, C., & Mitchell, C. (2010). Sensitivity and specificity of a digit symbol recognition trial in the identification of response bias. Archives of Clinical Neuropsychology, 25(5), 420–428. https://doi.org/10.1903/arclin/acq040.

    Article  PubMed  Google Scholar 

  • Lange, R. T., Iverson, G. L., Brickell, T. A., Staver, T., Pancholi, S., Bhagwat, A., & French, L. M. (2013). Clinical utility of the Conners’ continuous performance test-II to detect poor effort in U.S. military personnel following traumatic brain injury. Psychological Assessment, 25(2), 339–352.

    Article  Google Scholar 

  • Lange, R. T., Iverson, Zakrewski, M. L., Ethel-King, P. E., & Franzen, M. D. (2005). Interpreting the trail making test following brain injury: Comparison of traditional time scores and derived indices. Journal of Clinical and Experimental Neuropsychology, 27, 897–906.

  • Larrabee, G. J. (2003). Detection of malingering using atypical performance patterns on standard neuropsychological tests. The Clinical Neuropsychologist, 17(3), 410–425. https://doi.org/10.1076/clin.17.3.410.18089.

    Article  PubMed  Google Scholar 

  • Larrabee, G. J. (2008). Aggregation across multiple indicators improves the detection of malingering: Relationship to likelihood ratios. The Clinical Neuropsychologist, 22, 410–425. https://doi.org/10.1080/13854040701494987.

    Article  Google Scholar 

  • Larrabee, G. J. (2012). Assessment of malingering. In G. J. Larrabee (Ed.), Forensic neuropsychology: A scientific approach (Second ed., pp. 116–159). New York: Oxford University Press.

  • Larrabee, G. J. (2014). Minimizing false positive errors with multiple performance validity tests: Response to Bilder, sugar, and Hellemann. The Clinical Neuropsychologist, 28(8), 1230–1242.

    Article  Google Scholar 

  • Lichtenstein, J. D., Erdodi, L. A., & Linnea, K. S. (2017). Introducing a forced-choice recognition task to the California verbal learning test – Children’s version. Child Neuropsychology, 23(3), 284–299. https://doi.org/10.1080/09297049.2015.1135422.

    Article  PubMed  Google Scholar 

  • Lichtenstein, J. D., Holcomb, M., & Erdodi, L. A. (2018). One-minute PVT: Further evidence for the utility of the California verbal learning test—Children’s version forced choice recognition trial. Journal of Pediatric Neuropsychology, 4, 94–104.

    Article  Google Scholar 

  • Lu, P. H., Boone, K. B., Cozolino, L., & Mitchell, C. (2003). Effectiveness of the Rey–Osterrieth complex figure test and the Meyers and Meyers recognition trial in the detection of suspect effort. The Clinical Neuropsychologist, 17, 426–440.

    Article  Google Scholar 

  • MacNeill Horton, A., & Roberts, C. (2001). Derived trail making test indices in a sample of substance abusers: Demographic effects. International Journal of Neuroscience, 1(1–2), 123–132.

    Article  Google Scholar 

  • Marshall, P., Schroeder, R., O’Brien, J., Fischer, R., Ries, A., Blesi, B., & Barker, J. (2010). Effectiveness of symptom validity measures in identifying cognitive and behavioral symptom exaggeration in adult attention deficit hyperactivity disorder. The Clinical Neuropsychologist, 24, 1204–1237.

    Article  Google Scholar 

  • Martin, P. K., Schroeder, R. W., & Odland, A. P. (2015). Neuropsychologists’ validity testing beliefs and practices: A survey of north American professionals. The Clinical Neuropsychologist, 29(6), 741–746.

    Article  Google Scholar 

  • McCrea, M. A. (2008). Mild traumatic brain injury and postconcussion syndrome: The new evidence base for diagnosis and treatment. New York: Oxford University Press.

    Google Scholar 

  • Merten, T., Bossink, L., & Schmand, B. (2007). On the limits of effort testing: Symptom validity tests and severity of neurocognitive symptoms in nonlitigant patients. Journal of Clinical and Experimental Neuropsychology, 29(3), 208–318.

    Article  Google Scholar 

  • Mitrushina, M., Boone, K. B., Razani, J., & D’Elia, L. F. (2005). Handbook of normative data for neuropsychological assessment. New York, NY: Oxford University Press.

    Google Scholar 

  • Newcombe, F. (1969). Missile wounds of the brain. London: Oxford University Press.

    Google Scholar 

  • O’Bryant, S. E., Hilsabeck, R. C., Fisher, J. M., & McCaffrey, R. J. (2003). Utility of the trail making test in the assessment of malingering in a sample of mild traumatic brain injury litigants. The Clinical Neuropsychologist, 17(1), 69–74.

    Article  Google Scholar 

  • Odland, A. P., Lammy, A. B., Martin, P. K., Grote, C. L., & Mittenberg, W. (2015). Advanced administration and interpretation of multiple validity tests. Psychological Injury and Law, 8, 46–63.

    Article  Google Scholar 

  • Ord, J. S., Boettcher, A. C., Greve, K. J., & Bianchini, K. J. (2010). Detection of malingering in mild traumatic brain injury with the Conners’ continuous performance test-II. Journal of Clinical and Experimental Neuropsychology, 32(4), 380–387.

    Article  Google Scholar 

  • Pearson (2009). Advanced Clinical Solutions for the WAIS-IV and WMS-IV – Technical Manual. San Antonio, TX: Author.

  • Perianez, J. A., Rios-Lago, M., Rodriguez-Sanchez, J. M., Adrover-Roig, D., Sanchez-Cubillo, I., Crespo-Facorro, B., et al. (2007). Trail making test in traumatic brain injury, schizophrenia, and normal ageing: Sample comparisons and normative data. Archives of Clinical Neuropsychology, 22, 433–447.

    Article  Google Scholar 

  • Powell, M. R., Locke, D. E. C., Smigielski, J. S., & McCrea, M. (2011). Estimating the diagnostic value of the trail making test for suboptimal effort in acquired brain injury rehabilitation patients. The Clinical Neuropsychologist, 25(1), 108–118.

    Article  Google Scholar 

  • Proto, D. A., Pastorek, N. J., Miller, B. I., Romesser, J. M., Sim, A. H., & Linck, J. M. (2014). The dangers of failing one or more performance validity tests in individuals claiming mild traumatic brain injury-related postconcussive symptoms. Archives of Clinical Neuropsychology, 29, 614–624.

    Article  Google Scholar 

  • Rai, J., An, K. Y., Charles, J., Ali, S., & Erdodi, L. A. (2019). Introducing a forced choice recognition trial to the Rey Complex Figure Test. Psychology & Neuroscience.

  • Rasmusson, X. D., Zonderman, A. B., Kawas, C., & Resnick, S. M. (1998). Effects of age and dementia on the trail making test. The Clinical Neuropsychologist, 12(2), 169–178.

    Article  Google Scholar 

  • Reitan, R. M. (1958). The validity of the trail making test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.

    Article  Google Scholar 

  • Reitan, R. M., & Wolfson, D. (1993). The Halstead–Reitan neuropsychological test battery: Theory and clinical interpretation (2nd ed.). Tucson, AZ: Neuropsychology Press.

    Google Scholar 

  • Retain, R. M. (1955). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology, 19, 393–394.

    Article  Google Scholar 

  • Ruffolo, L. F., Guilmette, T. J., & Willis, W. J. (2000). Comparison of time and error rates on the trail making test among patients with head injuries, experimental malingerers, patients with suspected effort on testing, and normal controls. The Clinical Neuropsychologist, 14, 223–230.

    Article  Google Scholar 

  • Salazar, X. F., Lu, P. H., Wen, J., & Boone, K. B. (2007). The use of effort tests in ethnic minorities and in non-English speaking and English as a second language populations. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment: A neuropsychological perspective (pp. 405–427). New York: Guilford.

    Google Scholar 

  • Sanchez-Cubillo, I., Perianez, J. A., Adrover-Roig, D., Rodriguez-Sanchez, J. M., Rios-Lago, M., Tirapu, J. E. E. A., & Barcelo, F. (2009). Construct validity of the trail making test: Role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. Journal of the International Neuropsychological Society, 15(3), 438–450.

    Article  Google Scholar 

  • Schutte, C., Axelrod, B. N., & Montoya, E. (2015). Making sure neuropsychological data are meaningful: Use of performance validity testing in medicolegal and clinical contexts. Psychological Injury and Law, 8(2), 100–105.

    Article  Google Scholar 

  • Schwartz, E. S., Erdodi, L., Rodriguez, N., Jyotsna, J. G., Curtain, J. R., Flashman, L. A., & Roth, R. M. (2016). CVLT-II forced choice recognition trial as an embedded validity indicator: A systematic review of the evidence. Journal of the International Neuropsychological Society, 22(8), 851–858. https://doi.org/10.1017/S1355617716000746.

    Article  PubMed  Google Scholar 

  • Shura, R. D., Miskey, H. M., Rowland, J. A., Yoash-Gatz, R. E., & Denning, J. H. (2016). Embedded performance validity measures with postdeployment veterans: Cross-validation and efficiency with multiple measures. Applied Neuropsychology. Adult, 23, 94–104. https://doi.org/10.1080/23279095.2015.1014556.

    Article  PubMed  Google Scholar 

  • Solomon, R. E., Boone, K. B., Miora, D., Skidmore, S., Cottingham, M., Victor, T., et al. (2010). Use of the WAIS-III picture completion subtest as an embedded measure of response bias. The Clinical Neuropsychologist, 24, 1243–1256.

    Article  Google Scholar 

  • Spencer, R. J., Axelrod, B. N., Drag, L. L., Waldron-Perrine, B., Pangilinan, P. H., & Bieliauskas, L. A. (2013). WAIS-IV reliable digit span is no more accurate than age corrected scaled score as an indicator of invalid performance in a veteran sample undergoing evaluation for mTBI. The Clinical Neuropsychologist, 27(8), 1362–1372.

    Article  Google Scholar 

  • Spreen, O., & Benton, A. L. (1965). Comparative studies of some psychological tests for cerebral damage. Journal of Nervous and Mental Disease, 140, 323–333.

    Article  Google Scholar 

  • Sugarman, M. A., & Axelrod, B. N. (2015). Embedded measures of performance validity using verbal fluency tests in a clinical sample. Applied Neuropsychology. Adult, 22(2), 141–146.

    Article  Google Scholar 

  • Tan, J. E., Slick, D. J., Strauss, E., & Hultsch, D. F. (2002). How'd they do it? Malingering strategies on symptom validity tests. The Clinical Neuropsychologist, 16(4), 495–505. https://doi.org/10.1076/clin.16.4.495.13909.

    Article  PubMed  Google Scholar 

  • Tombaugh, T. (2004). Trail making test a and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology, 19(2), 203–214.

    Article  Google Scholar 

  • Trueblood, W. (1994). Qualitative and quantitative characteristics of malingered and other invalid WAIS-R and clinical memory data. Journal of Clinical and Experimental Neuropsychology, 14(4), 697–607.

    Google Scholar 

  • Tyson, B. T., Baker, S., Greenacre, M., Kent, K., J., Lichtenstein, J. D., Sabelli, A., & Erdodi, L.A. (2018). Differentiating epilepsy from psychogenic nonepileptic seizures using neuropsychological test data. Epilepsy & Behavior, 87, 39-45.

  • Webber, T. A., Critchfield, E. A., & Soble, J. R. (2018). Convergent, discriminant and concurrent validity of nonmemory-based performance validity tests. Epublished ahead of print. Assessment., 107319111880487. https://doi.org/10.1177/1073191118804874.

  • Wechsler, D. (2008). Technical and interpretive manual for the Wechsler adult intelligence scale (Fourth ed.). San Antonio, TX: Pearson.

  • Wechsler, D. (2009). Wechsler memory scale — Fourth edition (WMS–IV). San Antonio, TX: Pearson.

    Google Scholar 

  • Whiteside, D., Wald, D., & Busse, M. (2011). Classification accuracy of multiple visual spatial measures in the detection of suspect effort. The Clinical Neuropsychologist, 25, 287–301.

    Article  Google Scholar 

  • Wilkinson, G. S., & Robertson, G. J. (2006). Wide range achievement test 4. Lutz, FL: Psychological Assessment Resources, Inc..

    Google Scholar 

  • Wolfe, P. L., Millis, S. R., Hanks, R., Fichtenberg, N., Larrabee, G. J., & Sweet, J. J. (2010). Effort indicators within the California verbal learning test-II (CVLT-II). The Clinical Neuropsychologist, 24(1), 153–168.

    Article  Google Scholar 

  • Woods, D. L., Wyma, J. M., Herron, T. J., & Yund, E. W. (2015). The effects of aging, malingering, and traumatic brain injury on computerized trail-making test performance. PLoS One, 10(6), e0124345.

    Article  Google Scholar 

  • Yuspeh, R. L., Drane, D. L., Huthwaite, J. S., & Klingler, L. K. (2000). Derived Trail making test indices: Normative observations. Archives of Clinical Neuropsychology, 15, 653–850.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, Neuropsychology Track, University of Windsor, 168 Chrysler Hall South, 401 Sunset Ave, Windsor, ON, N9B 3P4, Canada

    Christopher Abeare & Laszlo Erdodi

  2. Brain-Cognition-Neuroscience Program, University of Windsor, Windsor, ON, N9B 3P4, Canada

    Alana Sabelli & Brian Taylor

  3. Jefferson Neurobehavioral Group, New Orleans, LA, USA

    Matthew Holcomb

  4. Canandgua Veteran’s Administration Hospital, Rochester, NY, USA

    Claudiu Dumitrescu

  5. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA

    Ned Kirsch

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  5. Claudiu Dumitrescu
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  7. Laszlo Erdodi
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Correspondence to Laszlo Erdodi.

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Relevant ethical guidelines were followed throughout the project. All data collection, storage and processingwas done with the approval of relevant institutional authorities regulating research involving humanparticipants, in compliance with the 1964 Helsinki Declaration and its subsequent amendments or comparableethical standards.

Funding Information

This project received financial support from the University of Windsor, Faculty of Arts, Humanities, and Social Sciences Collaborative Research Grant.

Conflict of Interest

This project received financial support from the University of Windsor, Faculty of Arts, Humanities, and SocialSciences Collaborative Research Grant. Relevant ethical guidelines were followed throughout the project. Drs.Abeare, Holcomb and Erdodi perform forensic consultations and medicolegal evaluations, for which theyreceive financial compensation.

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Abeare, C., Sabelli, A., Taylor, B. et al. The Importance of Demographically Adjusted Cutoffs: Age and Education Bias in Raw Score Cutoffs Within the Trail Making Test. Psychol. Inj. and Law 12, 170–182 (2019). https://doi.org/10.1007/s12207-019-09353-x

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