Article summary of A rationale for performance validity testing in child and adolescent assessment by Kirkwood - Chapter

Performance validity tests (PVT) are objective measures that evaluate the validity of someone's execution of a performance-based test. These measures are not very sensitive to problems that occur because someone does not have the ability to perform, but instead are sensitive to noncredible effort.

Do noncredible presentations happen in children?

It appears that children are capable of deception under the right circumstances. They get increasingly deceptive as they develop the abilities that are necessary for it throughout childhood and adolescence. These noncredible presentations occur both consciously and unconsciously, and both with and without the influence of parents. Children and adolescents appear to be able to fake both psychiatric and physical difficulties, but also cognitive problems.

Noncredible responding occurs more in relation to a number of pediatric conditions and settings. The most noncredible effort can be seen in children with persistent problems after they have gotten a light head injury. We do not specifically know about other conditions and settings because they have not been studied in detail.

Why is subjective judgment inadequate for detecting noncredible data?

Noncredible effort can occur for many reasons. One of these reasons is deception, but others include separation anxiety, hunger or fatigue. In order for us to determine which steps to take we need to figure out the underlying motivation of children making the noncredible effort. However, to do this, invalid responses need to be recognized as invalid at first. Historically many clinicians rely on subjective judgment to do this when it comes to children. However, errors occur for many reasons and so an objective instrument is needed to improve clinical decision making. Adult practitioners have already adopted the use of PVTs, seeing them as a supplement to the subjective judgement. However, many child practitioners have not. This is mainly because they did not have access to any tools that objectively determine whether children are making a noncredible effort. Today, more PVTs for children have been developed.

Do validity test results matter?

Are there clinical implications of ability-based test interpretation?

PVT failure is associated with worse performance on different types of neuropsychological tests for both adults and children. This means that a noncredible effort can have a big effect on other test results as well. This means that if we do not suspect or recognize noncredible effort, we could interpret test results wrong, make inaccurate diagnoses or provide people with ineffective treatment. This could seriously harm both adults and children.

Are there clinical implications of the interpretation of self-reported data?

Many studies suggest that if children perform bad on PVTs, they are also more likely to misrepresent themselves when filling in self-report measures. Thus, the results of the PVT of a child can relate a lot to how they self-report their emotional, cognitive and health-related complains.

What are the broader implications of using or not using PVTs?

Using PVTs could give us a completely different understanding of individual cases, but there are also broader implications.

• Firstly, when we do not use PVTs in studies about children, we need to remain skeptical about all the things they conclude.
• Secondly, on a fundamental level we need to test the idea that all children put in adequate effort if they go through cognitive testing. This because the traditional belief that performance tests measure ability seems to not be true. Instead, performance tests also reflect different amounts of effort children put in.
• Thirdly, there are public health implications. If children that show noncredible performance are not found through testing, they use up many healthcare and educational resources.
• Finally, not finding noncredibly performing children creates unnecessary costs to society. Namely, the costs of malingered disability is extremely high.