This will only take a minute: Time cutoffs are superior to accuracy cutoffs on the forced choice recognition trial of the Hopkins Verbal Learning Test - Revised

Objective This study was designed to evaluate the classification accuracy of the recently introduced forced-choice recognition trial to the Hopkins Verbal Learning Test - Revised (FCR (HVLT-R) ) as a performance validity test (PVT) in a clinical sample. Time-to-completion (T2C) for FCR (HVLT-R) was also examined. Method Forty-three students were assigned to either the control or the experimental malingering (expMAL) condition. Archival data were collected from 52 adults clinically referred for neuropsychological assessment. Invalid performance was defined using expMAL status, two free-standing PVTs and two validity composites. Results Among students, FCR (HVLT-R) <= 11 or T2C >= 45 seconds was specific (0.86-0.93) to invalid performance. Among patients, an FCR (HVLT-R) <= 11 was specific (0.94-1.00), but relatively insensitive (0.38-0.60) to non-credible responding0. T2C >= 35 s produced notably higher sensitivity (0.71-0.89), but variable specificity (0.83-0.96). The T2C achieved superior overall correct classification (81-86%) compared to the accuracy score (68-77%). The FCR (HVLT-R) provided incremental utility in performance validity assessment compared to previously introduced validity cutoffs on Recognition Discrimination. Conclusions Combined with T2C, the FCR (HVLT-R) has the potential to function as a quick, inexpensive and effective embedded PVT. The time-cutoff effectively attenuated the low ceiling of the accuracy scores, increasing sensitivity by 19%. Replication in larger and more geographically and demographically diverse samples is needed before the FCR (HVLT-R) can be endorsed for routine clinical application.