Classification accuracy of multiple visual spatial measures in the detection of suspect effort

Douglas Whiteside, Danielle Wald, Michelle Busse

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


A wide variety of cognitive measures, particularly memory measures, have been studied for their ability to detect suspect effort, or biased responding on neuropsychological assessment instruments. However, visual spatial measures have received less attention. The purpose of this study was to evaluate the classification accuracy of several commonly used visual spatial measures, including the Judgment of Line Orientation Test, the Benton Facial Recognition Test, the Hooper Visual Organization Test, and the Rey Complex Figure Test-Copy and Recognition trials. Participants included 491 consecutive referrals who participated in a comprehensive neuropsychological assessment and met study criteria. Participants were divided into two groups identified as either unbiased responding (UR, N = 415) or biased responding (BR, N = 30) based on their performance on two measures of effort. The remaining participants (N = 46) had discrepant performance on the symptom validity measures and were excluded from further analysis. The groups differed significantly on all measures. Additionally, receiver operating characteristic (ROC) analysis indicated all of the measures had acceptable classification accuracy, but a measure combining scores from all of the measures had excellent classification accuracy. Results indicated that various cut-off scores on the measures could be used depending on the context of the evaluation. Suggested cut-off scores for the measures had sensitivity levels of approximately 32-46%, when specificity was at least 87%. When combined, the measures suggested cut-off scores had sensitivity increase to 57% while maintaining the same level of specificity (87%). The results were discussed in the context of research advocating the use of multiple measures of effort.

Original languageEnglish (US)
Pages (from-to)287-301
Number of pages15
JournalClinical Neuropsychologist
Issue number2
StatePublished - Feb 2011
Externally publishedYes


  • Effort
  • Neuropsychological evaluation
  • Symptom validity testing
  • Visual spatial


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