Courtney McCaul1, Kyle B Boone1, Annette Ermshar1, Maria Cottingham2, Tara L Victor3, Elizabeth Ziegler4, Michelle A Zeller5, Matthew Wright6. 1. a California School of Forensic Studies, Alliant International University , Los Angeles , CA , USA. 2. b Mental Health Care Line, Veterans Administration Tennessee Valley Healthcare System , Nashville , TN , USA. 3. c Department of Psychology , California State University, Dominguez Hills , Carson , CA , USA. 4. d Spokane Veterans Administration , Spokane , WA , USA. 5. e West Los Angeles Veterans Administration Medical Center , Los Angeles , CA , USA. 6. f Department of Psychiatry , Harbor-UCLA Medical Center , Torrance , CA , USA.
Abstract
OBJECTIVE: To cross-validate the Dot Counting Test in a large neuropsychological sample. METHOD: Dot Counting Test scores were compared in credible (n = 142) and non-credible (n = 335) neuropsychology referrals. RESULTS: Non-credible patients scored significantly higher than credible patients on all Dot Counting Test scores. While the original E-score cut-off of ≥17 achieved excellent specificity (96.5%), it was associated with mediocre sensitivity (52.8%). However, the cut-off could be substantially lowered to ≥13.80, while still maintaining adequate specificity (≥90%), and raising sensitivity to 70.0%. Examination of non-credible subgroups revealed that Dot Counting Test sensitivity in feigned mild traumatic brain injury (mTBI) was 55.8%, whereas sensitivity was 90.6% in patients with non-credible cognitive dysfunction in the context of claimed psychosis, and 81.0% in patients with non-credible cognitive performance in depression or severe TBI. Thus, the Dot Counting Test may have a particular role in detection of non-credible cognitive symptoms in claimed psychiatric disorders. Alternative to use of the E-score, failure on ≥1 cut-offs applied to individual Dot Counting Test scores (≥6.0″ for mean grouped dot counting time, ≥10.0″ for mean ungrouped dot counting time, and ≥4 errors), occurred in 11.3% of the credible sample, while nearly two-thirds (63.6%) of the non-credible sample failed one of more of these cut-offs. CONCLUSIONS: An E-score cut-off of 13.80, or failure on ≥1 individual score cut-offs, resulted in few false positive identifications in credible patients, and achieved high sensitivity (64.0-70.0%), and therefore appear appropriate for use in identifying neurocognitive performance invalidity.
OBJECTIVE: To cross-validate the Dot Counting Test in a large neuropsychological sample. METHOD: Dot Counting Test scores were compared in credible (n = 142) and non-credible (n = 335) neuropsychology referrals. RESULTS: Non-credible patients scored significantly higher than credible patients on all Dot Counting Test scores. While the original E-score cut-off of ≥17 achieved excellent specificity (96.5%), it was associated with mediocre sensitivity (52.8%). However, the cut-off could be substantially lowered to ≥13.80, while still maintaining adequate specificity (≥90%), and raising sensitivity to 70.0%. Examination of non-credible subgroups revealed that Dot Counting Test sensitivity in feigned mild traumatic brain injury (mTBI) was 55.8%, whereas sensitivity was 90.6% in patients with non-credible cognitive dysfunction in the context of claimed psychosis, and 81.0% in patients with non-credible cognitive performance in depression or severe TBI. Thus, the Dot Counting Test may have a particular role in detection of non-credible cognitive symptoms in claimed psychiatric disorders. Alternative to use of the E-score, failure on ≥1 cut-offs applied to individual Dot Counting Test scores (≥6.0″ for mean grouped dot counting time, ≥10.0″ for mean ungrouped dot counting time, and ≥4 errors), occurred in 11.3% of the credible sample, while nearly two-thirds (63.6%) of the non-credible sample failed one of more of these cut-offs. CONCLUSIONS: An E-score cut-off of 13.80, or failure on ≥1 individual score cut-offs, resulted in few false positive identifications in credible patients, and achieved high sensitivity (64.0-70.0%), and therefore appear appropriate for use in identifying neurocognitive performance invalidity.
Authors: Kaley Boress; Owen J Gaasedelen; Anna Croghan; Marcie King Johnson; Kristen Caraher; Michael R Basso; Douglas M Whiteside Journal: Clin Neuropsychol Date: 2021-03-17 Impact factor: 4.373
Authors: Kaley Boress; Owen J Gaasedelen; Anna Croghan; Marcie King Johnson; Kristen Caraher; Michael R Basso; Douglas M Whiteside Journal: Clin Neuropsychol Date: 2021-02-22 Impact factor: 4.373