Thus, poor performance on these measures can also occur as a result of genuine cognitive impairment ( Dean, Victor, Boone, & Arnold, 2008 Slick, Sherman, & Iverson, 1999). Conversely, a drawback of embedded PVTs is that their cutoff scores are derived from instruments that also measure cognitive functioning. Particular strengths of embedded PVTs are that they provide clinicians with multiple opportunities to monitor engagement without having to lengthen testing ( Curtis, Greve, Bianchini, & Brennan, 2006 Gunner et al., 2012 Mathias, Greve, Bianchini, Houston, & Crouch, 2002). While stand-alone PVTs are designed to specifically assess effort, embedded PVTs are derived secondary to the instrument’s own clinical utility ( Heilbronner et al., 2009). PVTs are classified as either stand-alone or embedded measures ( Gunner, Miele, Lynch, & McCaffrey, 2012 Hilsabeck, Gordon, Hietpas-Wilson, & Zartman, 2011). Accordingly, the National Academy of Neuropsychology ( Bush et al., 2005) and the American Academy of Clinical Neuropsychology ( Heilbronner et al., 2009) have issued strong statements urging neuropsychologists to incorporate performance validity tests (PVTs) in every evaluation, regardless of the referral question ( Schroeder, Twumasi-Ankrah, Baade, & Marshall, 2012 Sharland & Gfeller, 2007), as these instruments provide insight into whether an examinee’s scores are likely reflective of their actual level of cognitive functioning or the result of them not putting forth maximum effort ( Constantinou, Bauer, Ashendorf, Fisher, & McCaffrey, 2005). Still, suboptimal effort can occur for a multitude of other reasons as well, including psychiatric conditions, inattentiveness, poor motivation, and fatigue ( Hunt, Ferrara, Miller, & Macciocchi, 2007 Lange, Pancholi, Bhagwat, Anderson-Barnes, & French, 2012). Performance validity testing is an integral part of any neuropsychological evaluation, particularly in a forensic setting or when there is a question of secondary gain ( Axelrod, Fichtenberg, Millis, & Wertheimer, 2006 Lee, Loring, & Martin, 1992). Performance validity test, Suboptimal effort, Epilepsy, Reliable digit span, Test of Memory Malingering Introduction
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