Victoria Symptom Validity Test performance in a heterogenous clinical sample

We retrospectively reviewed Victoria Symptom Validity Test (VSVT) in 374 patients who underwent neuropsychological assessment in an academic hospital-based practice. Patients were classified as either non-TBI clinically referred (generally patients referred from neurology, neurosurgery, or medicine), clinically referred TBI (no known external financial incentive), and non-clinical referrals (e.g., attorney-referred, Worker's Compensation). Three patients were not classified into any group and considered separately. Intentional response distortion, defined as statistically less than chance performance on hard VST items, was present in only 1/306 (0.3%) clinically referred non-TBI patients, and no clinically referred TBI patient obtained scores significantly less than chance on this measure. One additional clinically referred patient with a non-neurologic diagnosis who was subsequently found to be pursuing a disability claim also performed worse than chance. In contrast, 5/25 patients (20%) referred by attorneys or otherwise deemed a priori to be at-risk for deficit exaggeration performed less than chance. These data suggest that intentional response distortion in patients referred for non-forensic neuropsychological evaluation is rare. Performances by specific diagnosis using different classification criteria are also presented.