We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The last two decades have been marked by excitement for measuring implicit attitudes and implicit biases, as well as optimism that new technologies have made this possible. Despite considerable attention, this movement is marked by weak measures. Current implicit measures do not have the psychometric properties needed to meet the standards required for psychological assessment or necessary for reliable criterion prediction. Some of the creativity that defines this approach has also introduced measures with unusual properties that constrain their applications and limit interpretations. We illustrate these problems by summarizing our research using the Implicit Association Test (IAT) as a case study to reveal the challenges these measures face. We consider such issues as reliability, validity, model misspecification, sources of both random and systematic method variance, as well as unusual and arbitrary properties of the IAT’s metric and scoring algorithm. We then review and critique four new interpretations of the IAT that have been advanced to defend the measure and its properties. We conclude that the IAT is not a viable measure of individual differences in biases or attitudes. Efforts to prove otherwise have diverted resources and attention, limiting progress in the scientific study of racism and bias.
Designers rely on many methods and strategies to create innovative designs. However, design research often overlooks the personality and attitudinal factors influencing method utility and effectiveness. This article defines and operationalizes the construct design mindset and introduces the Design Mindset Inventory (D-Mindset0.1), allowing us to measure and leverage statistical analyses to advance our understanding of its role in design. The inventory’s validity and reliability are evaluated by analyzing a large sample of engineering students (N = 473). Using factor analysis, we identified four underlying factors of D-Mindset0.1 related to the theoretical concepts: Conversation with the Situation, Iteration, Co-Evolution of Problem–Solution and Imagination. The latter part of the article finds statistical and theoretically meaningful relationships between design mindset and the three design-related constructs of sensation-seeking, self-efficacy and ambiguity tolerance. Ambiguity tolerance and self-efficacy emerge as positively correlated with design mindset. Sensation-seeking, which is only significantly correlated with subconstructs of D-Mindset0.1, is both negatively and positively correlated. These relationships lend validity D-Mindset0.1 and, by drawing on previously established relationships between the three personality traits and specific behaviors, facilitate further investigations of what its subconstructs capture.
With the increased use of computer-based tests in clinical and research settings, assessing retest reliability and reliable change of NIH Toolbox-Cognition Battery (NIHTB-CB) and Cogstate Brief Battery (Cogstate) is essential. Previous studies used mostly White samples, but Black/African Americans (B/AAs) must be included in this research to ensure reliability.
Method:
Participants were B/AA consensus-confirmed healthy controls (HCs) (n = 49) or mild cognitive impairment (MCI) (n = 34) adults 60–85 years that completed NIHTB-CB and Cogstate for laptop at two timepoints within 4 months. Intraclass correlations, the Bland-Altman method, t-tests, and the Pearson correlation coefficient were used. Cut scores indicating reliable change provided.
Results:
NIHTB-CB composite reliability ranged from .81 to .93 (95% CIs [.37–.96]). The Fluid Composite demonstrated a significant difference between timepoints and was less consistent than the Crystallized Composite. Subtests were less consistent for MCIs (ICCs = .01–.89, CIs [−1.00–.95]) than for HCs (ICCs = .69–.93, CIs [.46–.92]). A moderate correlation was found for MCIs between timepoints and performance on the Total Composite (r = -.40, p = .03), Fluid Composite (r = -.38, p = .03), and Pattern Comparison Processing Speed (r = -.47, p = .006).
On Cogstate, HCs had lower reliability (ICCs = .47–.76, CIs [.05–.86]) than MCIs (ICCs = .65–.89, CIs [.29–.95]). Identification reaction time significantly improved between testing timepoints across samples.
Conclusions:
The NIHTB-CB and Cogstate for laptop show promise for use in research with B/AAs and were reasonably stable up to 4 months. Still, differences were found between those with MCI and HCs. It is recommended that race and cognitive status be considered when using these measures.
Adequate measurement of psychological phenomena is a fundamental aspect of theory construction and validation. Forming composite scales from individual items has a long and honored tradition, although, for predictive purposes, the power of using individual items should be considered. We outline several fundamental steps in the scale construction process, including (1) choosing between prediction and explanation; (2) specifying the construct(s) to measure; (3) choosing items thought to measure these constructs; (4) administering the items; (5) examining the structure and properties of composites of items (scales); (6) forming, scoring, and examining the scales; and (7) validating the resulting scales.
In this chapter we review advanced psychometric methods for examining the validity of self-report measures of attitudes, beliefs, personality style, and other social psychological and personality constructs that rely on introspection. The methods include confirmatory-factor analysis to examine whether measurements can be interpreted as meaningful continua, and measurement invariance analysis to examine whether items are answered the same way in different groups of people. We illustrate the methods using a measure of individual differences in openness to political pluralism, which includes four conceptual facets. To understand how the facets relate to the overall dimension of openness to political pluralism, we compare a second-order factor model and a bifactor model. We also check to see whether the psychometric patterns of item responses are the same for males and females. These psychometric methods can both document the quality of obtained measurements and inform theorists about nuances of their constructs.
This study evaluated the validity and reliability of the Persian version of the Disaster Resilience Measuring Tool (DRMT-C19).
Methods
The research was a methodological, psychometric study. Standard translation processes were performed. Face validity and content validity were determined along with construct and convergent validity. To determine the final version of the questionnaire, 483 health care rescuers were selected using a consecutive sampling method. Other resilience-related questionnaires were used to assess concurrent validity. All quantitative data analyses were conducted using SPSS 22 and Jamovi 2.3.28 software.
Results
The content validity and reliability were indicated using Scale’s Content Validity Ratio (S-CVR) = 0.92 and Scale’s Content Validity Index (S-CVI) = 0.93. The comprehensiveness of the measurement tool = 0.875%. Cronbach’s α = 0.89 and the test re-test reliability using interclass correlation coefficients (ICC) = 0.68 to 0.92. Exploratory factor analysis determined 4 factors which accounted for more than 58.54% of the variance among the items. Confirmatory factor analysis determined 12 factors. The concurrent validity between the DRMT-C19 and the Connor-Davidson Resilience Scale (CD-RISC) was r = 0.604 (P ≤ 0.0001).
Conclusions
The DRMT-C19 has satisfactory psychometric properties and is a valid, reliable, and valuable tool for assessing resilience against disasters in Iran’s Persian-speaking health care rescuers.
In light of the growing threat of climate change and urgency of mitigation at the societal and individual level, an exponentially growing body of research has addressed how and what people think about climate change—ranging from basic judgments of truth and attitudes about risk to predictions of future outcomes. However, the field is also beset by a striking variety of items and scales used to measure climate change beliefs, with notable differences in content, untested structural assumptions, and unsatisfactory or unknown psychometric properties. In a series of four studies (total N = 2,678), scales for the assessment of climate change beliefs are developed that are comprehensive and balanced in content and psychometrically sound. The latent construct structure is tested, and evidence of high rank-order stability (1-year retest-reliability) and predictive validity (for policy preferences and actual behavior) provided.
This study examined the validity of a visual inspection time (IT) task as a measure of processing speed (PS) in a sample of children with and without cerebral palsy (CP). IT tasks measure visualization speed without focusing on the motor response time to indicate decision making about the properties of those stimuli.
Methods:
Participants were 113 children ages 8–16, including 45 with congenital CP, and 68 typically developing peers. Measures were a standard visual IT task that required dual key responding and a modified version using an assistive technology button with response option scanning. Performance on these measures was examined against traditional Wechsler PS measures (Coding, Symbol Search).
Results:
IT performance shared considerable variance with traditional paper-pencil PS measures for the group with CP, but not necessarily in the typically developing group. Concurrent validity was found for both IT task versions with traditional PS measures in the group with CP. IT classification accuracy for lowered PS showed modest sensitivity and good specificity particularly for the modified IT task.
Conclusions:
As measures of PS in children with CP who are unable to validly participate in traditional PS tasks, IT tasks demonstrate adequate concurrent validity and may serve as a beneficial alternative measure of PS in this population.
This chapter considers the role of neuropsychology in the diagnostic process. It covers who can undertake a neuropsychological assessment, when to undertake an assessment, and some of the assumptions underlying neuropsychological assesssment. Basic psychometrics are covered, using the premise that undertanding a few basic concepts is sufficient for most practioners as more complex ideas are developed from these basics. This includes the normal distribution, different types of average, the standard deviation, and the correlation. Next, the relationship between different tyes of metrics is discussed, focusing on IQ/Index scores, T-scores, scaled scores, and percentiles.
Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate.
Aims
To present the psychometrics of a short outcome measure of key clinical areas including symptoms.
Method
The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered.
Results
The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = −0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships.
Conclusions
The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.
Whether the recent rise in adolescent self-reported depressive symptoms is influenced by changing reporting behavior is much debated. Most studies use observed sum scores to document trends but fail to assess whether their measures are invariant across time, a prerequisite for meaningful inferences about change. We examined whether measurement noninvariance, indicative of changing perceptions and reporting of symptoms, may influence the assessment of time trends in adolescent depressive symptoms.
Methods
Data stem from the nationwide repeated cross-sectional Ungdata-surveys (2010–2019) of 560 712 responses from adolescents aged 13 to 19 years. Depressive symptoms were measured with the Kandel and Davies' six-item Depressive Mood Inventory. Using structural equation modeling, we examined measurement invariance across time, gender and age, and estimated the consequences of noninvariance on cross-cohort time trends.
Results
Across most conditions, the instrument was found measurement invariant across time. The few noninvariant parameters detected had negligible impact on trend estimates. From 2014, latent mean depressive symptom scores increased among girls. For boys, a U shaped pattern was detected, whereby an initial decrease in symptoms was followed by an increase from 2016. Larger issues of noninvariance were found across age in girls and between genders.
Conclusions
From a measurement perspective, the notion that changed reporting of symptoms has been an important driver of secular trends in depressive symptoms was not supported. Thus, other causes of these trends should be considered. However, noninvariance across age (in girls) and gender highlights that depressive symptoms are not necessarily perceived equivalently from early to late adolescence and across gender.
Neuropsychological assessment of preschool children is essential for early detection of delays and referral for intervention prior to school entry. This is especially pertinent in low- and middle-income countries (LMICs), which are disproportionately impacted by micronutrient deficiencies and teratogenic exposures. The Grenada Learning and Memory Scale (GLAMS) was created for use in limited resource settings and includes a shopping list and face-name association test. Here, we present psychometric and normative data for the GLAMS in a Grenadian preschool sample.
Methods:
Typically developing children between 36 and 72 months of age, primarily English speaking, were recruited from public preschools in Grenada. Trained Early Childhood Assessors administered the GLAMS and NEPSY-II in schools, homes, and clinics. GLAMS score distributions, reliability, and convergent/divergent validity against NEPSY-II were evaluated.
Results:
The sample consisted of 400 children (190 males, 210 females). GLAMS internal consistency, inter-rater agreement, and test-retest reliability were acceptable. Principal components analysis revealed two latent factors, aligned with expected verbal/visual memory constructs. A female advantage was observed in verbal memory. Moderate age effects were observed on list learning/recall and small age effects on face-name learning/recall. All GLAMS subtests were correlated with NEPSY-II Sentence Repetition, supporting convergent validity with a measure of verbal working memory.
Conclusions:
The GLAMS is a psychometrically sound measure of learning and memory in Grenadian preschool children. Further adaptation and scale-up to global LMICs are recommended.
Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.
Aims:
To draft and evaluate a new self-report scale – the Health Anxiety Behavior Inventory (HABI) – for the measurement of negatively reinforced health anxiety behaviours.
Method:
We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test–retest reliability, and sensitivity to change.
Results:
Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73–.87) and 2-week test–retest reliability (r=.75–.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.
Conclusions:
The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.
Access to psychedelic drugs is liberalizing, yet responses are highly unpredictable. It is therefore imperative that we improve our ability to predict the nature of the acute psychedelic experience to improve safety and optimize potential therapeutic outcomes. This study sought to validate the ‘Imperial Psychedelic Predictor Scale’ (IPPS), a short, widely applicable, prospective measure intended to be predictive of salient dimensions of the psychedelic experience.
Methods
Using four independent datasets in which the IPPS was completed prospectively – two online surveys of ‘naturalistic’ use (N = 741, N = 836) and two controlled administration datasets (N = 30, N = 28) – we conducted factor analysis, regression, and correlation analyses to assess the construct, predictive, and convergent validity of the IPPS.
Results
Our approach produced a 9-item scale with good internal consistency (Cronbach's α = 0.8) containing three factors: set, rapport, and intention. The IPPS was significantly predictive of ‘mystical’, ‘challenging’, and ‘emotional breakthrough’ experiences. In a controlled administration dataset (N = 28), multiple regression found set and rapport explaining 40% of variance in mystical experience, and simple regression found set explained 16% of variance in challenging experience. In another (N = 30), rapport was related to emotional breakthrough explaining 9% of variance.
Conclusions
Together, these data suggest that the IPPS is predictive of relevant acute features of the psychedelic experience in a broad range of contexts. We hope that this brief 9-item scale will be widely adopted for improved knowledge of psychedelic preparedness in controlled settings and beyond.
Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data.
Methods
We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors.
Results
The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms).
Conclusion
The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data.
Identify which NIH Toolbox Cognition Battery (NIHTB-CB) subtest(s) best differentiate healthy controls (HC) from those with amnestic mild cognitive impairment (aMCI) and compare the discriminant accuracy between a model using a priori “Norm Adjusted” scores versus “Unadjusted” standard scores with age, sex, race/ethnicity, and education controlled for within the model. Racial differences were also examined.
Methods:
Participants were Black/African American (B/AA) and White consensus-confirmed (HC = 96; aMCI = 62) adults 60–85 years old that completed the NIHTB-CB for tablet. Discriminant function analysis (DFA) was used in the Total Sample and separately for B/AA (n = 80) and White participants (n = 78).
Results:
Picture Sequence Memory (an episodic memory task) was the highest loading coefficient across all DFA models. When stratified by race, differences were noted in the pattern of the highest loading coefficients within the DFAs. However, the overall discriminant accuracy of the DFA models in identifying HCs and those with aMCI did not differ significantly by race (B/AA, White) or model/score type (Norm Adjusted versus Unadjusted).
Conclusions:
Racial differences were noted despite the use of normalized scores or demographic covariates—highlighting the importance of including underrepresented groups in research. While the models were fairly accurate at identifying consensus-confirmed HCs, the models proved less accurate at identifying White participants with an aMCI diagnosis. In clinical settings, further work is needed to optimize computerized batteries and the use of NIHTB-CB norm adjusted scores is recommended. In research settings, demographically corrected scores or within model correction is suggested.
Empathy is a key factor to examine in development, because of its predictive associations with both aggression and successful prosocial behaviour. However, established measures of empathy for Low-to-Middle Income Countries, including South Africa, are lacking. In children, parent-report measures are key. However, a local study examining empathy and aggression (Malcolm-Smith et al., 2015) found poor psychometric performance for a widely used parent-report measure of dispositional empathy, the Griffith Empathy Measure (GEM). We thus investigated which of two questionnaires measuring dispositional cognitive and affective empathy perform better in this context.
Method:
We contrasted internal consistency reliability of a simplified version of the GEM (SGEM; n = 160) and a parent-report version of the Questionnaire of Cognitive and Affective Empathy (QCAE; n = 440) in a low-mid socio-economic status sample. Convergence between the measures and factor structure were also assessed.
Results:
The parent-report version of the QCAE performed well as a measure of child dispositional cognitive and affective empathy, with good reliability (overall α = 0.90 vs. SGEM α = .63), and confirmatory factor analysis supporting the two-factor structure. The SGEM’s reliability and failure to correlate with QCAE indicated poor psychometric performance.
Conclusion:
This is the first psychometric evaluation of the QCAE as a parent-report measure, and our results indicate that it should prove useful for future assessments of dispositional empathy in children across a variety of contexts.
Item-response theory (IRT) represents a key advance in measurement theory. Yet, it is largely absent from curricula, textbooks and popular statistical software, and often introduced through a subset of models. This Element, intended for creativity and innovation researchers, researchers-in-training, and anyone interested in how individual creativity might be measured, aims to provide 1) an overview of classical test theory (CTT) and its shortcomings in creativity measurement situations (e.g., fluency scores, consensual assessment technique, etc.); 2) an introduction to IRT and its core concepts, using a broad view of IRT that notably sees CTT models as particular cases of IRT; 3) a practical strategic approach to IRT modeling; 4) example applications of this strategy from creativity research and the associated advantages; and 5) ideas for future work that could advance how IRT could better benefit creativity research, as well as connections with other popular frameworks.
Modified Mini-Mental State Examination (3MSE) is often used to screen for dementia, but little is known about psychometric validity in American Indians.
Methods:
We recruited 818 American Indians aged 65–95 for 3MSE examinations in 2010–2013; 403 returned for a repeat examination in 2017–2019. Analyses included standard psychometrics inferences for interpretation, generalizability, and extrapolation: factor analysis; internal consistency-reliability; test-retest score stability; multiple indicator multiple cause structural equation models.
Results:
This cohort was mean age 73, majority female, mean 12 years education, and majority bilingual. The 4-factor and 2nd-order models fit best, with subfactors for orientation and visuo-construction (OVC), language and executive functioning (LEF), psychomotor and working memory (PMWM), verbal and episodic memory (VEM). Factor structure was supported for both research and clinical interpretation, and factor loadings were moderate to high. Scores were generally consistent over mean 7 years. Younger participants performed better in overall scores, but not in individual factors. Males performed better on OVC and LEF, females better on PMWM. Those with more education performed better on LEF and worse on OVC; the converse was true for bilinguals. All differences were significant, but small.
Conclusion:
These findings support use of 3MSE for individual interpretation in clinic and research among American Indians, with moderate consistency, stability, reliability over time. Observed extrapolations across age, sex, education, and bilingual groups suggest some important contextual differences may exist.
Although the cognitive profiles of people experiencing homelessness have been described in the literature, the neuropsychological profile of people experiencing complex homelessness has not been delineated. Complex homelessness is homelessness that continues despite the provision of bricks and mortar solutions. People experiencing complex homelessness often have an array of physical health, mental health, substance use, neurodevelopmental and neurocognitive disorders. The present study aimed to delineate the neuropsychological profile of people experiencing complex homelessness and explore the utility of neuropsychological assessment in supporting this population.
Participants and Methods:
19 people experiencing complex homelessness in Sydney, Australia, were consecutively referred by specialist homelessness services for neuropsychological assessment. They underwent comprehensive assessment of intelligence, memory and executive functioning and completed questionnaires to screen for the presence of ADHD, PTSD, depression, anxiety and stress. A range of performance validity measures were included. Referrers were asked to complete questionnaires on history of childhood trauma, psychological functioning, drug and alcohol use, functional cognitive abilities, homelessness factors, personality, risk of cognitive impairment and adaptive functioning and to note existing or suspected mental health, neurodevelopmental and neurocognitive disorders. Referrers also completed a post-assessment pathways questionnaires to identify whether the neuropsychological assessment facilitated referral pathways (e.g., for government housing or financial assistance). Clinicians completed a post-assessment diagnosis survey, which was compared to the pre-assessment known or suspected diagnoses. Finally, referrers were asked to complete a satisfaction questionnaire regarding the neuropsychological assessment.
Results:
Mean (SD) WAIS-IV indexes were VCI = 81.1 (14.5), PRI = 86.1 (10.9), WMI = 80.5 (13.0), PSI = 81.6 (10.2). Mean WMS-IV Flexible (LMVR) indexes were AMI = 68.3 (19.6), VMI = 77.1 (19.3), IMI = 72.7 (17.2), and DMI = 70.5 (17.6). The majority of participants showed unusual differences between WAIS-IV and TOPF-predicted WAIS-IV scores and between WAIS-IV General Ability and WMS-IV Flexible (LMVR) scores. Demographically corrected scores on tests of executive functioning were mostly one or more standard deviations below the mean. The majority of participants screened positive on screening measures of executive dysfunction, PTSD and ADHD and had elevated self-reported psychological distress scores. At least one new diagnosis was made for nine (47%) participants, established diagnoses were confirmed for two (11%) participants, diagnoses were supported for 15 (79%) participants, tentative diagnoses were made for 16 (84%) participants, and five (26%) participants had at least one diagnosis disconfirmed/unsupported. Referrers indicated that the majority of post-assessment pathways were more accessible following the neuropsychological assessment and that they were very satisfied with the neuropsychological assessments overall.
Conclusions:
This is one of the first studies to delineate the neuropsychological profile of people experiencing complex homelessness using robust psychometric approaches, including performance validity tests. This population experiences a high burden of cognitive impairment and associated substance use, neurodevelopmental and mental health comorbidities. Neuropsychological assessment makes referral pathways more accessible and is valued by referrers of people experiencing complex homelessness.