Limited Predictive Accuracy of the Booklet Category Test in a Criminal Forensic Sample

Abstract

A known-groups design was used to evaluate the clinical decision rules of the validity indicators of the Booklet Category Test for the detection of malingered neurocognitive dysfunction (MND) in an incarcerated male sample. Participants were 128 inmates who were classified into MND and presumed valid groups using the Slick, Sherman, and Iverson (1999) criteria. While errors on Subtests I and II had the best classification accuracy at 71.1% with 95.1% specificity and 49.3% sensitivity, the associated area under the curve (AUC) indicated only “acceptable” discrimination due to poor sensitivity. Logistic regression confirmed that errors on Subtests I and II were the only statistically significant validity indicator. The remaining validity indicators performed poorly with AUCs at < .70, indicating no discriminative power. The effectiveness of the clinical decision rules of the validity indicators in predicting the presence of MND evidenced limited support. A positive finding on Subtest I and II errors was clinically significant in this sample, but negative results revealed no utility. Validity indices composed from different items may yield more effective results among male prisoners referred for neuropsychological evaluation.

Key words:

• logistic regression
• malingering
• neuropsychological assessment
• prisoners

Notes

Note. All figures are percentages. Data are organized by % within each group. PV = presumed valid; MND = malingered neurocognitive dysfunction.

AUC = Area Under the Curve.

Note. Comparisons performed using Hanley & McNeil (1983).

PPV = positive predictive value; NPV = negative predictive value; Sens = sensitivity; Spec = specificity.

Opinions expressed in this manuscript are those of the authors and not necessarily those of the Federal Bureau of Prisons or Department of Justice. This manuscript is based on a dissertation submitted by Leah Hanson Misialek in partial fulfillment of the requirements for a doctoral degree in clinical psychology at The School of Professional Psychology at Forest Institute in Springfield, MO.

A portion of these data was presented at the 31st National Academy of Neuropsychology Conference, 2011, Marco Island, FL.