Language-based embedded performance validity measures in traumatic brain injury

No studies to date have investigated the Boston Naming Test (BNT) as an embedded performance validity test (PVT). This study investigated the classification accuracy of the Boston Naming Test (BNT) and the Verbal Fluency Test (FAS and Animal Fluency), as embedded PVTs in a compensation-seeking mild traumatic brain injury (MTBI) sample (N = 57) compared to a non-compensation-seeking moderate-to-severe TBI (STBI) sample (N = 61). Participants in the MTBI sample who failed two or more PVTs were included, as were STBI participants who passed all PVTs. The classification accuracy of the individual tests and a logistically derived combined (LANGPVT) measure were studied. Results showed significant group differences (p < .05) on BNT, Animal Fluency, and LANGPVT between the MTBI and STBI groups. However, receiver operating characteristic (ROC) analyses indicated that only LANGPVT had acceptable classification accuracy (area under the curve > .70). Setting specificity at approximately .90, the recommended LANGPVT cutoff scores had sensitivity of .26. Results indicated that, similar to other embedded PVTs, these measures had low sensitivity when adequate specificity levels were maintained. However, extremely low scores on these measures are unlikely to occur in non-compensation-seeking, non-language-impaired, STBI cases.