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Beyond the Test Room: Performance Validity Tests and Real-World Functioning

Poster Session A - Saturday, March 7, 2026, 3:00 – 5:00 pm PST, Fairview/Kitsilano Ballrooms

Sage Radlmeier¹ (sage.radlmeier@gmail.com), Amir Sepehry², Izabela Schultz³; ¹UBC

Background: Ecological validity in neuropsychological testing refers to the extent to which a test’s performance predicts real-world functioning, a commonly accepted focus on the inferences drawn from test results rather than the test itself. Despite the widespread clinical and forensic use of Performance Validity Tests (PVTs) to assess performance credibility, their relationship to real-world functioning remains poorly understood. Much of the existing research relies on simulated feigning paradigms, which do not adequately reflect real patient contexts. As a result, PVTs are frequently validated using other neuropsychological measures rather than real-world outcomes. Aim: This review examines the ecological validity of commonly used PVTs and identifies gaps in functional outcome data within the literature. We hypothesized that PVTs would show limited association with real-world functioning. Method: A systematic review was conducted across clinical samples and forensic populations. Studies were examined for evidence linking PVT performance to everyday cognitive, behavioural, or functional outcomes, including daily functioning and work capacity. Results: Across studies, PVTs generally demonstrated good diagnostic accuracy in controlled simulation contexts. However, there was minimal modern evidence linking PVT scores to real-world functional outcomes, and few studies incorporated ecologically meaningful criteria. Conclusion: While PVTs inform diagnostic and treatment decisions, limited ecological validation increases the risk of misclassifying response validity and function. These findings underscore the need for future research that integrates ecologically grounded outcome measures into the validation of PVTs. Funding: This research received no external funding.

Topic Area: METHODS: Other