RBANS Validity Indices: a Systematic Review and Meta-Analysis
Neuropsychology practice organizations have highlighted the need for thorough evaluation of performance validity as part of the neuropsychological assessment process. Embedded validity indices are derived from existing measures and expand the scope of validity assessment. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief instrument that quickly allows a clinician to assess a variety of cognitive domains. The RBANS also contains multiple embedded validity indicators. The purpose of this study was to synthesize the utility of those indicators to assess performance validity. A systematic search was completed, resulting in 11 studies for synthesis and 10 for meta-analysis. Data were synthesized on four indices and three subtests across samples of civilians, service members, and veterans. Sufficient data for meta-analysis were only available for the Effort Index, and related analyses indicated optimal cutoff scores of ≥1 (AUC = .86) and ≥ 3 (AUC = .85). However, outliers and heterogeneity were present indicating the importance of age and evaluation context. Overall, embedded validity indicators have shown adequate diagnostic accuracy across a variety of populations. Recommendations for interpreting these measures and future studies are provided.
KeywordsRBANS Embedded validity indicators Effort Systematic review Meta-analysis
Compliance with Ethical Standards
Conflict of Interest
There are no conflicts of interest to disclose.
This work was supported by resources of Salisbury Veterans Affairs Health Care System; the Mid-Atlantic Mental Illness Research Education and Clinical Center; and the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the Department of Defense, or the U.S. Government.
- Armistead-Jehle, P., & Hansen, C. L. (2011). Comparison of the repeatable battery for the assessment of neuropsychological status effort index and stand-alone symptom validity tests in a military sample. Archives of Clinical Neuropsychology, 26(7), 592–601. https://doi.org/10.1093/arclin/acr049.PubMedGoogle Scholar
- Barker, M. D., Horner, M. D., & Bachman, D. L. (2010). Embedded indices of effort in the repeatable battery for the assessment of neuropsychological status (Rbans) in a geriatric sample. The Clinical Neuropsychologist, 24(6), 1064–1077. https://doi.org/10.1080/13854046.2010.486009.PubMedGoogle Scholar
- Bayan, S. M., Nitch, S., Kinney, D., & Kaminetskaya, M. (2018). Exploratory analysis of CVLT-II forced-choice recognition and RBANS EI base rates for forensically-committed, psychotic-disordered inpatients: Implications on clinical decision-making. Applied Neuropsychology: Adult, 25(1), 71-81. https://doi.org/10.1080/23279095.2016.1247092.
- Boone, K. B. (2013). Clinical practice of forensic neuropsychology: An evidence-based approach. New York: Guilford.Google Scholar
- Bush, S. S., Ruff, R. M., Troster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., et al. (2005). Symptom validity assessment: practice issues and medical necessity NAN policy & planning committee. Archives of Clinical Neuropsychology, 20(4), 419–426. https://doi.org/10.1016/j.acn.2005.02.002.PubMedGoogle Scholar
- Deeks, J. J., Macaskill, P., & Irwig, L. (2005). The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. Journal of Clinical Epidemiology, 58(9), 882–893. https://doi.org/10.1016/j.jclinepi.2005.01.016.PubMedGoogle Scholar
- Dickerson, F., Boronow, J. J., Stallings, C., Origoni, A. E., Cole, S. K., & Yolken, R. H. (2004). Cognitive functioning in schizophrenia and bipolar disorder: Comparison of performance on the repeatable battery for the assessment of neuropsychological status. Psychiatry Research, 129(1), 45–53. https://doi.org/10.1016/j.psychres.2004.07.002.PubMedGoogle Scholar
- Duff, K., Patton, D., Schoenberg, M. R., Mold, J., Scott, J. G., & Adams, R. L. (2003). Age- and education-corrected independent normative data for the RBANS in a community dwelling elderly sample. The Clinical Neuropsychologist, 17(3), 351–366. https://doi.org/10.1076/clin.17.3.351.18082.PubMedGoogle Scholar
- Duff, K., Beglinger, L. J., Theriault, D., Allison, J., & Paulsen, J. S. (2010). Cognitive deficits in Huntington's disease on the repeatable battery for the assessment of neuropsychological status. Journal of Clinical and Experimental Neuropsychology, 32(3), 231–238. https://doi.org/10.1080/13803390902926184.PubMedGoogle Scholar
- Dunham, K. J., Shadi, S., Sofko, C. A., Denney, R. L., & Calloway, J. (2014). Comparison of the repeatable battery for the assessment of neuropsychological status effort scale and effort index in a dementia sample. Archives of Clinical Neuropsychology, 29(7), 633–641. https://doi.org/10.1093/arclin/acu042.PubMedPubMedCentralGoogle Scholar
- Gogos, A., Joshua, N., & Rossell, S. L. (2010). Use of the repeatable battery for the assessment of neuropsychological status (RBANS) to investigate group and gender differences in schizophrenia and bipolar disorder. The Australian and New Zealand Journal of Psychiatry, 44(3), 220–229. https://doi.org/10.3109/00048670903446882.PubMedGoogle Scholar
- Gold, J. M., Queern, C., Iannone, V. N., & Buchanan, R. W. (1999). Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: Sensitivity, reliability, and validity. The American Journal of Psychiatry, 156(12), 1944–1950. https://doi.org/10.1176/ajp.156.12.1944.PubMedGoogle Scholar
- Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., & Millis, S. R. (2009). American Academy of clinical neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23(7), 1093–1129. https://doi.org/10.1080/13854040903155063.PubMedGoogle Scholar
- Lippa, S. M., Lange, R. T., Bhagwat, A., & French, L. M. (2017). Clinical utility of embedded performance validity tests on the repeatable battery for the assessment of neuropsychological status (RBANS) following mild traumatic brain injury. Appl Neuropsychol Adult, 24(1), 73–80. https://doi.org/10.1080/23279095.2015.1100617.PubMedGoogle Scholar
- Macaskill, P., Gatsonis, C., Deeks, J., Harbord, R., & Takwoingi, Y. (2010). Analysing and Presenting Results. In J. Deeks, P. Bossuyt & C. Gatsonis (Eds.), Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version 1.0 (pp. 1–61). The Cochrane Collaboration. Retrieved from http://methods.cochrane.org/
- McKay, C., Wertheimer, J. C., Fichtenberg, N. L., & Casey, J. E. (2008). The repeatable battery for the assessment of neuropsychological status (RBANS): Clinical utility in a traumatic brain injury sample. The Clinical Neuropsychologist, 22(2), 228–241. https://doi.org/10.1080/13854040701260370.PubMedGoogle Scholar
- Moore, R. C., Davine, T., Harmell, A. L., Cardenas, V., Palmer, B. W., & Mausbach, B. T. (2013). Using the repeatable battery for the assessment of neuropsychological status (RBANS) effort index to predict treatment group attendance in patients with schizophrenia. Journal of the International Neuropsychological Society, 19(2), 198–205.PubMedGoogle Scholar
- Morra, L. F., Gold, J. M., Ossenfort, K., & Strauss, G. (2014). C-78 predicting insufficient effort in schizophrenia using the repeated battery for the assessment of neuropsychological status effort index. Archives of Clinical Neuropsychology, 29(6), 602–603.Google Scholar
- O'mahar, K. M., Duff, K., Scott, J. G., Linck, J. F., Adams, R. L., & Mold, J. W. (2011). Brief report: The temporal stability of the repeatable battery for the assessment of neuropsychological status effort index in geriatric samples. Archives of Clinical Neuropsychology, 27(1), 114–118.PubMedPubMedCentralGoogle Scholar
- Patton, D. E., Duff, K., Schoenberg, M. R., Mold, J., Scott, J. G., & Adams, R. L. (2003). Performance of cognitively normal African Americans on the RBANS in community dwelling older adults. The Clinical Neuropsychologist, 17(4), 515–530. https://doi.org/10.1076/clin.17.4.515.27948.PubMedGoogle Scholar
- Peck, C., Masse, A., & Schroeder, R. (2014). C-86 the utility of the RBANS effort index in an inpatient psychiatric setting. Archives of Clinical Neuropsychology, 29(6), 605.Google Scholar
- Rabin, L. A., Barr, W. B., & Burton, L. A. (2005). Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA division 40 members. Archives of Clinical Neuropsychology, 20(1), 33–65. https://doi.org/10.1016/j.acn.2004.02.005.PubMedGoogle Scholar
- Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20(3), 310–319. https://doi.org/10.1076/jcen.20.3.310.823.PubMedGoogle Scholar
- Review Manager (RevMan) [Computer program]. (2014). Version 5.3. Copenhagen: The Nordic Centre, The Cochrane Collaboration. Google Scholar
- Schoenberg, M. R., Rinehardt, E., Duff, K., Mattingly, M., Bharucha, K. J., & Scott, J. G. (2012). Assessing reliable change using the repeatable battery for the assessment of neuropsychological status (RBANS) for patients with Parkinson's disease undergoing deep brain stimulation (DBS) surgery. The Clinical Neuropsychologist, 26(2), 255–270. https://doi.org/10.1080/13854046.2011.653587.PubMedGoogle Scholar
- Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545–561. https://doi.org/10.1076/1385-4046(199911)13:04;1-y;ft545.PubMedGoogle Scholar
- Wilk, C. M., Gold, J. M., Humber, K., Dickerson, F., Fenton, W. S., & Buchanan, R. W. (2004). Brief cognitive assessment in schizophrenia: Normative data for the repeatable battery for the assessment of neuropsychological status. Schizophrenia Research, 70(2–3), 175–186. https://doi.org/10.1016/j.schres.2003.10.009.PubMedGoogle Scholar
- Zimmer, A., Heyanka, D., & Proctor-Weber, Z. (2017). Concordance validity of PVTs in a sample of veterans referred for mild TBI. Applied Neuropsychology: Adult, 1–10.Google Scholar