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Access Type
WSU Access
Date of Award
January 2023
Degree Type
Dissertation
Degree Name
Ph.D.
Department
Psychology
First Advisor
Lisa J. Rapport
Abstract
Performance validity testing is used to determine the extent to which an examinee’s test performances reflect their true neurocognitive abilities and the extent to which those performances are affected by the examinee’s engagement in testing. The validity of assessment results is highly dependent on the examinee’s response style, which can account for as much as 50% of the outcome in test scores. Traditional methods of assessing performance validity have numerous weaknesses, among them, that the results can be consciously manipulated by examinees who wish to feign cognitive impairment. This study tested the ability of pupillary dilation patterns on tests of performance validity to enhance neuropsychologists’ diagnostic accuracy in discriminating true from feigned impairment due to traumatic brain injury (TBI). Pupillometry provides information about physiological and psychological processes related to deception, cognitive load, and familiarity and is outside of conscious control. Patrick, Rapport, Kanser, Hanks, and Bashem (2021) established proof of concept for the utility of pupillometry applied to the Test of Memory Malingering (TOMM), a commonly used performance validity test (PVT). The current study replicated and extended this work by evaluating the incremental utility of pupillary-derived indices on the Warrington Recognition Memory Test for Words (RMT). Participants included 214 adults in three groups: adults with bona fide TBI (TBI; n = 51) and healthy comparisons instructed to perform their best (HC; n = 72), and neurologically healthy adults instructed and incentivized to feign simulate cognitive impairment due to TBI (SIM; n = 91). Moreover, this study examined differences in pupillary patterns among simulators who were and were not successful at feigning TBI, including individuals who did and did not target the RMT for failure. A computerized version of the RMT was administered in the context of a comprehensive neuropsychological battery. Indices of interest included two pure pupillary indices: a simple measure of baseline effort (Effort-Baseline) and a nuanced measure of dynamic engagement (Effort-Range). A pupillo-behavioral index was also evaluated: Dilation-response inconsistency (DRI) captured the frequency with which examinees displayed a pupillary familiarity response to the correct answer but selected the unfamiliar stimulus (incorrect answer). The results generally replicated Patrick et al. (2021), as all three indices were useful in discriminating between groups and provided incremental utility to traditional accuracy scores. Effort-Baseline appeared sensitive to oculomotor dysfunction due to TBI (i.e., increasing accurate identification of that group); adults with TBI displayed lower chronic arousal as compared to the two groups of healthy adults (SIM, HC). In fact, the TBI group showed lower Effort-Baseline than both unsuccessful simulators who were detected as feigners and successful simulators who passed PVTs but effectively feigned TBI on other tests. Dynamic engagement yielded a hierarchical structure such that SIM were more dynamically engaged than TBI followed by HC. As predicted, simulators engaged in DRI significantly more frequently than other groups. Moreover, DRI added unique information to RMT accuracy in classifying unsuccessful simulators from all other groups. Lastly, the relationship between estimated IQ, pupillary indices, and success of simulation was evaluated. Notably, estimated IQ was positively associated with RMT accuracy for honest-responding groups (SIM, TBI) but not simulators. Taken together, the findings support continued research on the application of pupillometry to performance validity assessment: Pupillometry provided unique information beyond traditional accuracy scores. Overall, the findings highlight the promise of biometric indices in multimethod assessments of performance validity.
Recommended Citation
Patrick, Sarah, "Detecting Feigned Cognitive Impairment Using Pupillometry On The Warrington Recognition Memory Test For Words" (2023). Wayne State University Dissertations. 3766.
https://digitalcommons.wayne.edu/oa_dissertations/3766