Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Glena Andrews, PhD., MSCP

Second Advisor

Wayne Adams, PhD.

Third Advisor

William Buhrow, PsyD.


It has become increasingly clear many patients do not manifest sufficient effort over the course of a neuropsychological evaluation (Horner, VanKirk, Dismuke, Turner, & Muzzy, 2014). While tests of memory and learning are considered to be the gold-standard in effort measurement, they are vulnerable to coaching (Bianchini, Greve, & Love, 2003). Fortunately, interest in assessing effort through other cognitive domains has grown over the last few years. In the current study, participants were divided into two groups, simulators and controls. All participants completed the Medical Symptom Validity Test (MSVT, Green, 2004), the Trail Making Test (TMT), the Verbal Fluency Test (VFT), and Sorting Test (ST) of the Delis-Kaplan Executive Function System (Delis, Kaplan & Kramer, 2001). It was hypothesized simulators would demonstrate significantly lower performance on all subtests of the D-KEFS and the MSVT. MANOVA revealed statistically significant differences on MSVT and TMT. Scaled scores from the 5 TMT conditions demonstrated the largest between group differences. VFT and ST variables did not demonstrate sensitivity to low effort. A new aggregate index based on participant performance on TMT conditions, demonstrated excellent ROC results with sensitivity of 71% and specificity of 100% based on the cutoff selected. Further research remains necessary EMBEDDED PERFORMANCE iii to use the Trail Making Test Validity Index (TMTVI) to delineate low effort groups from clinical populations and controls. Keywords: performance validity, effort, malingering, Delis-Kaplan Executive Function System, Trail Making Test, Verbal Fluency, Sorting Test, Medical Symptom Validity Test