The Association between Self-Reported Psychiatric Symptoms and Performance Validity Test Failure across Brain Injury Severity Levels

Performance validity testing is a routine procedure used in neuropsychological assessment to ensure an examinee is putting forth a performance that is an accurate representation of their ability. There is increasing evidence that individuals reporting high levels of psychiatric symptoms as well as those with mild traumatic brain injury (mTBI) fail performance validity tests (PVTs) more often. This research sought to determine if the high base rate of failure (BRFail) in the mTBI sample were related to an increase of self-reported psychiatric elevations. An archival dataset of 480 individuals either with an orthopedic injury, mTBI, or moderate-severe traumatic brain injury (msTBI) diagnosis (Dx) referred for neuropsychological testing was retrospectively analyzed. Of the sample, 70.4% were male and the average age was 39.3 years (SD = 11.9). Participants took part in a routine neuropsychological assessment which included the Word Memory Test (WMT). Those in the mTBI Dx group failed the WMT more often than those with msTBI. There was no interaction between Dx and failing PVTs on psychiatric symptom reporting. Results did show a relationship between Dx and PVT failure on some psychiatric symptom scales independently. Failing the WMT was related to poorer outcome on neurocognitive tests. Overall, no interaction between PVT outcome and Dx was found on self-reported psychiatric symptoms, each factor independently explained a significant amount of variance. Results suggest clinicians should continue to be aware of factors that may contribute to PVT failure in their practice, such as elevated psychiatric symptom reporting and diagnostic group membership