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<p>The present study developed and evaluated embedded symptom validity indicators (SVIs) derived from the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for identifying noncredible symptom reporting in Veterans undergoing neuropsychological evaluation in an epilepsy monitoring unit (EMU). Archival data from 388 Veterans evaluated between 2015 and 2018 were analyzed. Four WHODAS-derived SVIs were examined: the Total Scale (WTS), 12-Item Scale (W12), Severity Scale (WSS), and Discriminant Item Scale (WDS). Participants failing two or more stand-alone symptom validity tests were classified as invalid responders. Receiver operating characteristic analyses evaluated classification accuracy by employment status and diagnostic subgroup. WHODAS total scores were significantly correlated with established symptom validity measures (<i>r</i> = .34–0.60, all <i>p</i> &lt; .001). Among participants who were working or attending school, the WDS demonstrated the highest sensitivity while maintaining specificity ≥ 0.90 (AUC = 0.76, sensitivity = 0.78, specificity = 0.91). Classification accuracy was lower among participants who were not working or attending school (AUCs = 0.71–0.75). Subgroup analyses showed particularly strong performance among employed Veterans with epilepsy (W12 AUC = 0.87) and psychogenic nonepileptic seizures (PNES; WTS AUC = 0.83). These findings suggest that atypical patterns of disability endorsement on the WHODAS may provide useful supplemental information regarding response validity. Although classification performance varied across indices and subgroups, several WHODAS-derived indicators demonstrated clinically meaningful classification accuracy and warrant further investigation as embedded measures of response credibility within functional disability assessments.</p>

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The Development of Symptom Validity Indices for the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Epilepsy Monitoring Unit Veteran Sample

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • A. Andrew Dimmick,
  • Troy A. Webber,
  • Brian I. Miller

摘要

The present study developed and evaluated embedded symptom validity indicators (SVIs) derived from the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for identifying noncredible symptom reporting in Veterans undergoing neuropsychological evaluation in an epilepsy monitoring unit (EMU). Archival data from 388 Veterans evaluated between 2015 and 2018 were analyzed. Four WHODAS-derived SVIs were examined: the Total Scale (WTS), 12-Item Scale (W12), Severity Scale (WSS), and Discriminant Item Scale (WDS). Participants failing two or more stand-alone symptom validity tests were classified as invalid responders. Receiver operating characteristic analyses evaluated classification accuracy by employment status and diagnostic subgroup. WHODAS total scores were significantly correlated with established symptom validity measures (r = .34–0.60, all p < .001). Among participants who were working or attending school, the WDS demonstrated the highest sensitivity while maintaining specificity ≥ 0.90 (AUC = 0.76, sensitivity = 0.78, specificity = 0.91). Classification accuracy was lower among participants who were not working or attending school (AUCs = 0.71–0.75). Subgroup analyses showed particularly strong performance among employed Veterans with epilepsy (W12 AUC = 0.87) and psychogenic nonepileptic seizures (PNES; WTS AUC = 0.83). These findings suggest that atypical patterns of disability endorsement on the WHODAS may provide useful supplemental information regarding response validity. Although classification performance varied across indices and subgroups, several WHODAS-derived indicators demonstrated clinically meaningful classification accuracy and warrant further investigation as embedded measures of response credibility within functional disability assessments.