Ensuring test-taking validity is a crucial part of any neuropsychological evaluation. While all batteries ought to include well established test-taking validity measures regardless, it can still be helpful to be aware of an increased chance of poor performance validity prior to initiating testing. Studies repeatedly demonstrate that it is very difficult to predict which patient, particularly those without any clear incentive for poor test performance, will have invalid test performances based purely on subjective clinical judgment. Therefore, there is a need for an objective predictor of poor test taking validity. This study examines if a high endorsement of cognitive symptoms can indicate likely failure on test-taking validity measures.

All patients at an outpatient neurological clinic completed an intake background form prior to testing. On this form, patients were asked to endorse in which, if any, of nine cognitive areas they may be experiencing difficulty (memory, attention/concentration, word finding, etc.). Patients who endorsed at least eight out of the nine clinical symptoms on the intake form were included in the current study (N=7; age range 36-43 years). All patients were clinically referred for a comprehensive neuropsychological evaluation with a variety of conditions (e.g., stroke, memory concerns, and post-COVID-19 syndrome). Importantly, none of these patients were referred within a forensic context, and therefore, they did not have any clear external motivation or secondary gain. In addition to a battery of individual neuropsychological measures, each patient was administered performance validity tests (Test of Memory Malingering, Reliable Digits, and CVLT-3 Forced Choice).

In this sample, 57% of patients who endorsed all - or nearly all - cognitive symptoms on an intake form failed test-taking validity measures. Patients who failed validity measures did not meet passing criteria on two or more embedded or independent performance validity tests. This signifies a much higher rate than the typically observed base rates (∼15%) of test-taking invalidity across non-forensic clinical settings.

Preliminary findings suggest that those who indicate having cognitive problems in all (or nearly all) listed domains fail validity measures at a higher than expected rate, supporting the use of responses on a background from to indicate likely poor performance validity. Identification of high rates of symptomatic complaints, particularly symptoms that may extend beyond the initial referral question, should prompt practitioners to keenly evaluate performance validity and consider the results within the context of the patient’s presentation.