College Students' Normative and Sub-optimal Performance on Three Brief, Public Domain Performance-Validity Measures for Concussion Baseline Testing: A Randomized Parallel Groups Trial.

Abstract

Objective: We report normative data with non-athlete college students for three brief, public-domain performance validity tests (PVT) representing multiple performance domains: Rey's Word Recognition Test (WRT), Rey's Dot Counting Test (DCT), and A Random Letter Test of Auditory Vigilance (A-Test).

Method: One hundred fifty-four non-athlete college students (45% female; representing four college years) were recruited and assigned randomly to Honest-Effort, Fake-Bad, or Instructed Fake-Bad groups. Fifty student-athletes were selected randomly for comparison. Differences for multiple measures of each test among the three effort groups were obtained, and receiver operating curve (ROC) cut scores representing suboptimal performance were reported.

Results: Only the WRT measures met normality and homogeneity of variance assumptions. Multivariate analysis of variance with post-hoc Tukey tests showed significant differences between groups for WRT Total Correct and Combination scores. For DCT Combination Score and Total Errors and A-Test Omission Errors and Total Errors, non-parametric Kruskal-Wallis comparisons were conducted, each resulting in significant differences between Honest-Effort and sub-optimal performance (SOP) groups. Athletes also differed significantly from both SOP groups. ROC cut scores that suggested suboptimal effort were DCT Combination Score ≥ 15; WRT Combination Score ≤ 12; and A-Test Omission Errors ≥1. Measures were considered poor to excellent based on the area under the curve (AUC) percentages obtained through ROC analysis.

Conclusion: The DCT Combination and A-Test Omission Errors were valid indicators of suboptimal performance. The WRT measures fell short of adequate prediction based on the AUC. Combining multiple PVT "failures" maximized identification of suspect performers and minimized inclusion of Honest-Effort participants.