There is overwhelming evidence that the presence of secondary gain is an independent predictor of both performance validity and neuropsychological test outcomes. In addition, studies have demonstrated that genuine cognitive and/or psychological conditions can influence performance validity testing, both in the presence and absence of secondary gain. However, few studies have examined these factors in a large sample of academic accommodation seeking college students. The current study examined base rates of symptom validity test failure, the possibility of a “Near-Pass” intermediate group on symptom validity tests, the influence of diagnoses on performance indicators, and whether performance validity differed for “Near-Pass” patients relative to those who pass and those who fail performance validity indicators.

The Personality Assessment Inventory (PAI) is a commonly used instrument in neuropsychological assessment; however, it lacks a symptom validity test (SVT) that is sensitive to cognitive response bias (also referred to as non-credible responding), as defined by performance on cognitive performance validity tests (PVT). Therefore the purpose of the present study was to derive from the PAI item pool a new SVT, named the Cognitive Response Bias Scale (CRBS), that is sensitive to non-credible responding, and to provide initial validation evidence supporting the use of the CRBS in a clinical setting. The current study utilized an existing neuropsychological outpatient clinical database consisting of 306 consecutive participants who completed the PAI and PVTs and met inclusion criteria. The CRBS was empirically derived from this database utilizing primarily an Item Response Theory (IRT) framework. Out of 40 items initially examined, 10 items were ultimately retained based on their empirical properties to form the CRBS. An examination of the internal structure of the CRBS indicated that 8 items on the CRBS demonstrated good fit to the graded response IRT model. Overall scale reliability was good (Cronbach’s alpha = 0.77) and commensurate with other SVTs. Examination of item content revealed the CRBS consisted of items related to somatic complaints, psychological distress, and denial of fault. Items endorsed by participants exhibiting lower levels of non-credible responding consisted of vague and non-specific complaints, while participants with high levels of non-credible responding endorsed items indicating ongoing active pain and distress. The CRBS displayed expected relationships with other measures, including high positive correlations with negative impression management (r = 0.73), depression (r = 0.78), anxiety (r = 0.78), and schizophrenia (r = 0.71). Moderate negative correlations were observed with positive impression management (r = -0.31), and treatment rejection (r = -0.42). Two hierarchical logistic regression models showed the CRBS has significant predictive power above and beyond existing PAI SVTs and clinical scales in accurately predicting PVT failure. The overall classification accuracy of the CRBS in detecting failure on multiple PVTs was comparable to other SVTs (area under the curve = 0.72), and it displayed moderate sensitivity (i.e., 0.31) when specificity was high (i.e., 0.96). These operating characteristics suggest that the CRBS is effective at ruling in the possibility of non-credible responding, but not for ruling it out. The conservative recommended cut score was robust to effects of differential prediction due to gender and education. Given the extremely small sample subsets of forensic-only and non-Caucasian participants, future validation is required to establish reliable cut-offs when inferences based on comparisons to similar populations are desired. Results of the current study indicate the CRBS has comparable psychometric properties and clinical utility to analogous SVTs in similar personality inventories to the PAI. Furthermore, item content of the CRBS is consistent with and corroborates existing theory on non-credible responding and cognitive response bias. This study also demonstrated that a graded response IRT model can be useful in deriving and validating SVTs in the PAI, and that the graded response model provides unique and novel information into the nature of non-credible responding.

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Lors d'une évaluation neuropsychologique, il est attendu du patient une mobilisation optimale de ses capacités cognitives, afin d’objectiver de la façon la plus précise possible son tableau clinique. Sa collaboration et son implication au cours de l'examen sont en effet fondamentales puisqu’elles participent fortement à la validité de ses résultats, et de ce fait à la solidité des conclusions diagnostiques. Le biais de réponse se définit aujourd’hui comme l’ensemble des comportements visant à intentionnellement modifier ses performances cognitives. Malgré une abondante littérature sur ce concept au cours des deux dernières décennies, plusieurs questions perdurent, particulièrement en regard de ses aspects qualitatifs et des mécanismes associés. A travers quatre études, ce projet de thèse a tenté de répondre à ces problématiques, en apportant des connaissances complémentaires sur le biais de réponse. Une première expérimentation s’est ainsi intéressée à préciser la nature des comportements liés au biais de réponse, en l’explorant de façon originale dans plusieurs domaines cognitifs et au sein d’un échantillon mixte, incluant notamment des patients présentant une altération cognitive. Elle a permis de mettre en lumière un large répertoire de ses manifestations, et a apporté des arguments en faveur d’une participation de facteurs cognitifs dans la production du biais de réponse. Les deux études suivantes se sont vouées à adapter et valider trois outils psychométriques spécifiques à l’évaluation du biais de réponse (Performance Validity Tests), en testant leur pertinence et leur efficacité dans une large population francophone clinique et générale. Enfin, le dernier volet a cherché à comprendre le rôle joué par les facteurs associés au biais de réponse, en analysant son lien avec les processus exécutifs et métacognitifs. L’analyse des observations a alors confirmé l’existence d’une influence du fonctionnement exécutif dans le biais de réponse. L’ensemble des résultats recueillis à l’issue de ce travail souligne la complexité et la richesse du biais de réponse et permet de suggérer une nouvelle modélisation de ce concept, tenant compte de son caractère multidimensionnel et possiblement multifactoriel. / During a neuropsychological evaluation, optimal mobilization of the patient’s cognitive capacities is required in order to accurately objectify their clinical picture. The collaboration and involvement of the patient during the examination are fundamental to the validity of the results and hence the strength of the diagnostic. The current definition of response bias is the set of behaviours intended to intentionally modify one's cognitive performances. Despite an extensive literature on this concept over the last two decades, several questions remain, particularly regarding the qualitative aspects and the associated mechanisms. Through four studies, this dissertation has tried to answer these issues by providing complementary knowledge on response bias. The first experiment aimed to clarify the nature of behaviours related to response bias, in several cognitive domains and in a mixed sample including patients with cognitive impairment. This has shed light on a broad repertoire of its manifestations and has provided arguments for the participation of cognitive factors in the production of response bias. The following two studies have adapted and validated three specific psychometric tools known as Performance Validity Tests, by testing their relevance and effectiveness in large French-speaking samples including neurological patients and the general population. Finally, the last part sought to understand the role played by the factors associated with response bias, by analysing its link with the executive and metacognitive processes. The observations analysis has confirmed the existence of an impact of the executive functioning in response bias. All the results gathered underline the complexity and richness of response bias and suggest a new modelling of this concept, considering its multidimensional and possibly multifactorial nature.