Cross-Validation of a Forced-Choice Validity Indicator to Enhance the Clinical Utility of the Rey Auditory Verbal Learning Test

A forced-choice (FC) recognition trial was recently developed as an embedded validity indicator for the Rey Auditory Verbal Learning Test (RAVLT), although it has not been replicated outside of the initial validation study. This study cross-validated the RAVLT FC trial for detecting invalid neuropsychological test performance and assessed the degree to which material-specific verbal memory impairment severity impacts its classification accuracy as a performance validity test (PVT). This cross-sectional study included 172 neuropsychiatric patients who completed the RAVLT and 4 independent criterion PVTs, which were used to classify validity groups (134 valid/38 invalid). Overall results showed the RAVLT FC had excellent classification accuracy for detecting invalid performance at a ≤13 cut-score (66% sensitivity/87% specificity). When patients were subdivided by memory impairment status, FC retained excellent classification accuracy among the normal memory and mild memory impairment groups with 66%-82% sensitivity and ≥89% specificity. Accuracy decreased among those with severe memory impairment, but remained significant with a lower, alternative cut-score of ≤11 (37% sensitivity/88% specificity). Findings were consistent with FC trials developed for other memory measures and support the utility of this novel RAVLT FC index for reliably identifying invalid performance, even in the context of significant verbal memory impairment. Public Significance Statement The Rey Auditory Verbal Learning Test (RAVLT) is a well-validated and commonly used verbal learning/memory test in neuropsychological evaluation. This study demonstrated that a forced-choice recognition trial previously developed as an embedded performance validity test greatly enhances the clinical and research utility of the RAVLT as it accurately detects invalid test performance, even in the context of genuine memory impairment of increasing severity, without contributing to significantly greater evaluation time/burden.