Every Second Counts: A Comparison of Four Dot Counting Test Scoring Procedures for Detecting Invalid Neuropsychological Test Performance

Although performance validity tests (PVTs) are an integral element of neuropsychological assessment, most PVTs have historically been restricted to the memory domain. The Dot Counting Test (DCT) is a nonmemory PVT shown to reliably identify invalid performance. Although several traditional and abbreviated scoring methods have been derived, no study to date has directly compared the available scoring approaches within a single sample. This cross-sectional study cross-validated 4 different DCT scoring approaches, including the traditional rounded E-score proposed within the manual, an unrounded E-score, and 2 abbreviated scoring procedures based on 4- and 6-card versions (DCT-4 and DCT-6, respectively) in a diverse mixed clinical neuropsychiatric sample (N = 132). Validity groups were established by 5 independent criterion PVTs (102 valid and 30 invalid). Receiver operating characteristic curve analyses yielded significant areas under the curve (AUCs = .84−.86) for the overall sample, with sensitivities of 50%-67% at ≥89% specificity. The DCT scores had outstanding classification accuracy (AUCs ≥ .92; sensitivities = 80%−83%) in the unimpaired group and excellent classification accuracy in the impaired group (AUCs = .79−.81; sensitivities = 43%−60%). Whereas negligible differences emerged between the 4 scoring methods for the cognitively intact group, the DCT-4 showed notably stronger psychometric properties among the overall sample in general and the mild cognitive impairment group in particular. Results corroborate previous findings suggesting that the DCT is a robust PVT, regardless of the employed scoring procedure, and replicate support for the abbreviated DCT-4 as the recommended validity indicator. Public Significance Statement This study provided further cross-validation support for the clinical utility of the Dot Counting Test (DCT) as a brief, nonmemory performance validity test among a diverse neuropsychiatric population and replicated recent novel findings regarding abbreviated DCT scoring approaches that allow for more accurate assessment of validity status while minimizing evaluation time burden and associated costs.