A Single Error Is One Too Many: The Forced Choice Recognition Trial of the CVLT-II as a Measure of Performance Validity in Adults with TBI

OBJECTIVE: The Forced Choice Recognition (FCR) trial of the California Verbal Learning Test-Second Edition (CVLT-II) was designed to serve as a performance validity test (PVT). The present study was designed to compare the classification accuracy of a more liberal alternative (≤15) to the de facto FCR cutoff (≤14). METHOD: The classification accuracy of the two cutoffs was computed in reference to psychometrically defined invalid performance, across various criterion measures, in a sample of 104 adults with TBI clinically referred for neuropsychological assessment. RESULTS: The FCR was highly predictive (AUC: .71-.83) of Pass/Fail status on reference PVTs, but unrelated to performance on measures known to be sensitive to TBI. On average, FCR ≤15 correctly identified an additional 6% of invalid response sets compared to FCR ≤14, while maintaining .92 specificity. Patients who failed the FCR reported higher levels of emotional distress. CONCLUSIONS: Results suggest that even a single error on the FCR is a reliable indicator of invalid responding. Further research is needed to investigate the clinical significance of the relationship between failing the FCR and level of self-reported psychiatric symptoms.