“Sometimes There’s a Grey Zone”: Exploring psychologists’ performance validity beliefs and practices
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Date
2025-08
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University of New Brunswick
Abstract
Background: Performance validity measures were developed to detect noncredible performance during cognitive assessment. Although these measures were first developed for use in the context of litigation or disability claims, more recent research has shown performance validity also impacts the results of cognitive assessments in situations without obvious financial motivation (Green, 2003; McWhirter et al., 2020; Rohling et al., 2002; Roor et al., 2023). As a result, current practice guidelines recommend the inclusion of multiple embedded validity indicators (EVIs) and standalone performance validity tests (PVTs) in every cognitive assessment (Bush et al., 2005; Heilbronner et al., 2009). Since the publication of these recommendations, surveys have shown a marked increase in PVT/EVI adoption by neuropsychologists (Martin et al., 2015). Nevertheless, little is known about the adoption of PVTs and EVIs outside of neuropsychology and the use of quantitative surveys prevents exploration of how psychologists make decisions about assessing performance validity in ambiguous or challenging situations.
Objectives: To address these limitations, this qualitative study explored psychologists’ use of, and beliefs about, performance validity assessment. Also examined was how this real-world use compares to the guidelines provided by professional organizations.
Method: Semi-structured interviews were conducted with 25 Canadian psychologists whose clinical practice focused on cognitive assessment. Information gathered during the interviews was examined using content and thematic analyses.
Results: Performance validity measures were used less frequently among our participants than in previous survey studies. Participants’ choices to use performance validity measures were influenced by training, contextual factors, emotional reactions to performance validity assessment, faith in clinical judgment, perceived benefits of performance validity assessment, and practical considerations. Markedly variable practices were reported in terms of performance validity measure selection, the number of measures used, and how results are interpreted. The reported practices were only partially consistent with professional practice recommendations.
Conclusions: The results suggest training in performance validity is essential to address barriers to performance validity assessment within and outside neuropsychology, as well as to increase consistency in practices across psychologists. Training should prepare psychologists to navigate the ambiguities inherent in assessing performance validity.