A-225 The Rey Dot Counting Test as a Tool for Detecting Suboptimal Performance in Athlete Baseline Testing

Objective The limitations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)‘s embedded validity measures (EVMs) are well-documented, as estimates suggest up to 35% of invalid baseline performances go undetected (Gaudet & Weyandt, 2017). Few studies have examined standalone performance validity tests (PVT) as a supplement to ImPACT’s EVMs (Gaudet & Weyandt, 2017). Method College athletes (n = 1,213) were administered a preseason baseline assessment that included ImPACT and the Rey Dot Counting Test (DCT), a standalone PVT, among other measures. Results Sixty-nine athletes (5.69%) met criteria for suboptimal effort on either ImPACT or the DCT. The DCT detected more cases of suboptimal effort (n = 50) than ImPACT (n = 21). A χ2 test of independence detected significant disagreement between the two measures, as only 2 individuals produced suboptimal effort on both (χ2(2) = 1.568, p = .210). Despite this disagreement, there were significant differences between the suboptimal effort DCT group and the adequate effort DCT group across all four ImPACT neurocognitive domains (U = 19225.000, p < .001; U = 17859.000, p < .001; U = 13854.000, p < .001; U = 17850.500, p < .001). Conclusions The DCT appears to detect suboptimal effort otherwise undetected by ImPACT’s EVMs.

A-228 Are Those Who Fail Performance Validity Measures High Utilizers of Healthcare?

Objective One study reported that suboptimal effort on performance validity tests (PVTs) is associated with higher healthcare utilization within a VA setting, defined as the number of Emergency Department visits and inpatient hospitalizations. The current study sought to expand on this by examining whether PVT failure is associated with higher number of outpatient visits in a military sample with a history of mild traumatic brain injury (mTBI). Method The medical records of 43 participants, 13 of whom failed the PVT Green’s Word Memory Test (WMT), were reviewed for the number of encounters since the mTBI and the reason for the encounter. The two groups (passed vs. failed) did not differ significantly on demographic variables (39 males, mean age 39, 65% Caucasian). Results The overall number of medical encounters was not significant between the two groups after controlling for years since the mTBI (F(1, 40) = 2.67, p = .11); however, once three participants with (>2 years) missing records were excluded (final n = 40), the PVT failure group was seen significantly more often, (F(1, 37) = 8.23, p = .01). The PVT failures had a higher number of encounters with physical therapy (t(38) = −2.79, p = .01) and orthopedics (t(38) = −2.10, p = .04). Conclusions Preliminary results suggest that suboptimal effort is not associated with higher healthcare utilization; however, when participants with more than two years of missing records were excluded, those who failed PVTs were seen more frequently by physical therapy and orthopedic specialties. Limitations for future investigations are highlighted.

The Rey Dot Counting Test as a Tool for Detecting Suboptimal Performance in Athlete Baseline Testing

Objective The limitations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)’s embedded validity measures (EVMs) are well-documented, as estimates suggest up to 35% of invalid baseline performances go undetected. Few studies have examined standalone performance validity tests (PVT) as a supplement to ImPACT’s EVMs. Method College athletes (n = 1,213) were administered a preseason baseline assessment that included ImPACT and the Rey Dot Counting Test (DCT), a standalone PVT, among other measures. Results Sixty-nine athletes (5.69%) met criteria for suboptimal effort on either ImPACT or the DCT. The DCT detected more cases of suboptimal effort (n = 50) than ImPACT (n = 21). A χ2 test of independence detected significant disagreement between the two measures, as only two individuals produced suboptimal effort on both (χ2(2) = 1.568, p = .210). Despite this disagreement, there were significant differences between the suboptimal effort DCT group and the adequate effort DCT group across all four ImPACT neurocognitive domains (U = 19,225.000, p < .001; U = 17,859.000, p < .001; U = 13,854.000, p < .001; U = 17,850.500, p < .001). Conclusions The DCT appears to detect suboptimal effort otherwise undetected by ImPACT’s EVMs.

A-77 Validity Testing with Youth Populations: D-KEFS Trail Making Test Conditions 4:2 Ratio as an Embedded Validity Indicator

Objective The Trail Making Test B:A ratio is an embedded validity indicator (EVI) for neuropsychological assessment (NA; Ruffolo, Guilmette, & Willis, 2000). Recent literature supports D-KEFS Trail Making Test Conditions 4:2 (analogous to B:A) ratio (D-KEFS 4:2) as an EVI (Erdodi et al., 2018). The present study sought to assess the utility of D-KEFS 4:2 as an EVI for youth populations, using the Test of Memory Malingering (TOMM) to operationalize effort. Method 102 children (81.2% male, Mage = 11.88) completed a NA, including D-KEFS 4:2 and TOMM. Receiver operator characteristics (ROC) curve analysis calculating Area Under the Curve (AUC) determined whether D-KEFS 4:2 accurately categorized participants’ effort (represented by TOMM performance). Results D-KEFS 4:2 (cut-off = 1.60: Erdodi et al., 2018) produced sensitivity of 9.09% and specificity of 91.25% in predicting TOMM performance on Trial 1 (TOMM1; AUC = 0.488) and 0.00% and 91.09% in predicting Trial 2 (TOMM2; AUC = 0.772). As a TOMM2 cut-off of 49 is suggested as more sensitive to inadequate effort, another analysis showed D-KEFS 4:2 yielded sensitivity of 33.33% and specificity of 91.92% (AUC = 0.710) in predicting TOMM2 performance with the more conservative cutoff. Conclusions This study suggests that D-KEFS 4:2 is an adequate EVI in predicting suboptimal effort when operationalized by TOMM performance, particularly when more conservative TOMM cutoffs are used. D-KEFS 4:2 detected true effortful performance with excellent specificity but exhibited poor detection of suboptimal performance. As a result, D-KEFS 4:2 has utility as an EVI in youth populations, but should not be used independently.