Objective: Effort testing is a standard element in adult neuropsychological assessment. Research examining direct and embedded measures of effort has focused on adults. The adult model is now extended to children and adolescents. The purpose of this descriptive study was to examine direct and embedded performance validity tests (PVTs) in children and adolescents. The TOMM, a stand-alone PVT, was compared to two embedded measures of effort: CVLT-C/CVLT-II recognition discriminability and RDS. Method: The sample consisted of 44 children and adolescents (32 males) with a mean age of 12.3 years (6.11–18.07 years) referred for outpatient assessment. Concerns included ADHD, LD, and ASD. Cut-off scores on each test were based on previous studies: TOMM (<45 on Trial 1 or 2), CVLT-C/CVLT-II Discriminability Index (≤−0.5), and RDS (<8). Results: Results revealed 1/44 failures on the TOMM (2%), 12/44 failures on the CVLT-C/CVLT-II (27%), and 16/44 failures on the RDS (36%). Combined failures on CVLT-C/CVLT-II or RDS equaled 24/44 (55%). Furthermore, 3 out of 5 individuals with FSIQs ≤ 85 failed the RDS, CVLT-C/CVLT-II, or both (60%), with no failures on the TOMM. Conclusion: Stand-alone PVTs, such as the TOMM, may have exceedingly high specificity and insensitivity to low effort. Embedded measures, including the CVLT-C/CVLT-II and RDS may have overly high sensitivity, producing false positives. There were no behavioral observations or data to suggest 55% of the participants demonstrated low effort. Moreover, embedded measures may have limited utility in clients with lower IQ. PVTs used with adults may be limited in their applicability with children and adolescents.

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