Detecting malingered neurocognitive dysfunction: Comparative analysis of freestanding and embedded performance validity tests

Detecting malingered neurocognitive dysfunction is a major issue in forensic context, particularly in legal proceeding/insurance assessment after a traumatic brain injury (TBI), condition frequently associated with persistent cognitive impairments that may potentially be related to malingering. Consequently, research has devoted considerable efforts on developing tools to verify symptoms authenticity. This study compared two freestanding performance validity tests (PVTs) (Amsterdam Short-Term Memory Test-ASTM; Word Completion Memory Test-WCMT) and five embedded PVTs (Rey Complex Figure Test-RCFT-Copy and Recall trials; Reliable Digit Span-RDS; Rey Auditory Verbal Learning Test-RAVLT-Recognition and Total Learning trials) in a sample of 120 participants, including 15 patients with TBI (<i>M_age</i> = 44.40), 52 experimental simulators (<i>M_age</i> = 29.52) and 53 control (<i>M_age</i> = 29.77). Group performance was analyzed to assess tests' discriminatory power, and Receiver Operating Characteristic (ROC) curves were used to examine tools' sensitivity and specificity. Results indicated that experimental simulators performance on the ASTM, WCMT, and RAVLT differed significantly from TBI patients and controls. The RDS and RCFT did not discriminate experimental simulators from TBI group. ROC curves analysis reveals that the most accurate tests in this battery for detecting malingering were the ASTM and the RAVLT-Total Learning score. This study offers implications for identifying malingering in medico-legal settings, underscoring the importance of incorporating PVTs into clinical practice.