78 Utility of the D-KEFS Color Word Interference Test as a Measure of Performance Validity in Adults Referred for a Psychoeducational Evaluation

Abstract

Objective:Previous investigations have demonstrated the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Color Word Interference Test (CWIT) as an embedded validity indicator in mixed clinical samples and traumatic brain injury. The present study sought to cross-validate previously identified indicators and cutoffs in a sample of adults referred for psychoeducational testing.Participants and Methods:Archival data from 267 students and community members self-referred for a psychoeducational evaluation at a university clinic in the South were analyzed. Referrals included assessment for attention-deficit hyperactivity disorder, specific learning disorder, autism spectrum disorder, or other disorders (e.g., anxiety, depression). Individuals were administered subtests of the D-KEFS including the CWIT and several standalone and embedded performance validity indicators as part of the evaluation. Criterion measures included The b Test, Victoria Symptom Validity Test, Medical Symptom Validity Test, Dot Counting Test, and Reliable Digit Span. Individuals who failed 0 criterion measures were included in the credible group (n = 164) and individuals failing 2 or more criterion measures were included in the non-credible group (n = 31). Because a subset of the sample were seeking external incentives (e.g., accommodations), individuals who failed only 1 of the criterion measures were excluded (n = 72). Indicators of interest included all test conditions examined separately, the inverted Stroop index (i.e., better performance on the interference trial than the word reading or color naming trials), inhibition and inhibition/switching composite, and sum of all conditions.Results:Receiver Operating Characteristics (ROC) curves were significant for all four conditions (p < .001) and the inverted stroop index (p = .032). However, only conditions 2, 3 and 4 met minimal acceptable classification accuracy (AUC = .72 - 81). ROC curves with composite indicators were also significant (p < .001), with all three composite indicators meeting minimal acceptable classification accuracy (AUC = .71- .80). At the previously identified cutoff of age corrected scale score of 6 for all four conditions, specificity was high (.88 -.91), with varying sensitivity (.23 - .45). At the previously identified cutoff of .75 for the inverted stroop index, specificity was high (.87) while sensitivity was low (.19). Composite indicators yielded high specificity (.88 - .99) at previously established cutoffs with sensitivity varying from low to moderate (.19 - .48). Increasing the cutoffs (i.e., requiring higher age corrected scale score to pass) for composite indicators increased sensitivity while still maintaining high specificity. For example, increasing the total score cutoff from 18 to 28 resulted in moderate sensitivity (.26 vs .52) with specificity of .91.Conclusions:While a cutoff of 6 resulted in high specificity for most conditions, the sum of all four conditions exhibited the strongest classification accuracy and appears to be the most robust indicator which is consistent with previous research (Eglit et al., 2019). However, a cutoff of 28 as opposed to 18 may be most appropriate for psychoeducational samples. Overall, the results suggest that the D-KEFS CWIT can function as a measure of performance validity in addition to a measure of processing speed/executive functioning.