Can You Really Fail A Neuropsychological Evaluation?

Three different questions hide inside “can you fail a neuropsychological evaluation,” and almost every article on the subject answers one while implying it answered all three.

The cognitive tests have no passing score. Your memory, attention and processing speed get compared against people your age with your education, so a low score is a measurement, not a grade.

The validity measures are a different animal. Those can be failed, and the report then says your profile is invalid. About 16 percent of patients in ordinary clinical practice fail a performance validity test. Failing one isn’t the same event as faking.

Then there’s a third category, small but real, where the evaluation ends in a hiring decision instead of a diagnosis. Those end in a yes or a no.

Which of the three you’re sitting for decides what a bad day in the testing room costs you.

Can You Fail A Neuropsychological Evaluation?

No, and also yes, depending on which part of it you mean.

You can’t fail a neuropsychological evaluation the way you fail an exam. There’s no passing score. But you can produce an invalid profile, which happens when validity measures suggest your scores don’t reflect your real ability. Invalid isn’t the same as faking, and about 16 percent of patients in ordinary clinical practice fail a performance validity test.

That distinction is the whole article. Hold onto it, because the rest of this page is about what sits on either side of it.

The cognitive portion works by comparison. If you recall 8 of 15 words on a list-learning task, that number means nothing until it’s placed against a normative sample of people who share your age and years of education. Eight words might land you at the 40th percentile at 68 years old and the 9th percentile at 28. Same performance, different meaning. A neuropsychological evaluation exists to produce that comparison, not a verdict.

The Three Things People Mean By “Fail”

Most of the anxiety around this question comes from collapsing three separate events into one word.

Failing the cognitive tests. Doesn’t exist. Low scores are findings. A profile showing impaired verbal memory and intact processing speed isn’t a failure, it’s the answer to the referral question. The stages of a neuropsychological assessment are built to produce that pattern, not a score to clear.

Failing the validity measures. Real, and it has consequences. Every defensible battery includes measures built to detect whether the data holds up. Fail enough of them and the report says so.

Failing a determination. Some evaluations end in a recommendation rather than a diagnosis. Public safety pre-employment screening is the clearest example. There, someone decides yes or no, and that is a pass or fail in the plain sense of the words.

Most pages answering this question online stop at the first one.

What “Invalid” Means On A Neuropsychological Report

Invalid means the examiner can’t vouch for the numbers. It doesn’t mean you lied.

Validity measures come in two families, and they measure different things. Performance validity tests, usually shortened to PVTs, look at whether your performance on cognitive tasks is credible. Symptom validity tests, or SVTs, look at whether your self-reported symptoms are credible. A person can pass one family and fail the other, which is why both get administered.

Some validity measures are standalone. The Test of Memory Malingering, the Word Memory Test and the Victoria Symptom Validity Test are the ones you’re most likely to encounter, and they look deceptively easy on purpose. Others are embedded, meaning they’re indicators pulled out of tests you’re already taking for other reasons. On the symptom side, the MMPI-3 carries a set of validity scales built into the questionnaire itself.

How many of these you get matters more than most patients realize, and it’s the question to ask if you’re choosing an evaluator. Sherman, Slick and Iverson wrote in 2020 that “neuropsychological evaluations that contain no PVTs at all would not meet acceptable testing standards,” and that examiners should “administer at least two or three but ideally multiple PVTs.” A report resting on one validity measure is a weaker document than one resting on six, whichever way the result comes back. Our post on detecting malingering in forensic evaluations goes deeper into how the instruments are combined, and what tests are involved in a neuropsychological evaluation covers the cognitive side of the battery.

One thing you won’t find on this page: cutoff scores, or any description of how failure is scored. Publishing that would compromise the measures for every patient who takes them afterward, including the ones who need the results to hold up.

How Often Do People Fail Validity Testing?

About 16 percent of the time in ordinary clinical practice, and the number moves a lot depending on who’s being tested and why.

The best figure available comes from a 2024 systematic review and meta-analysis by Roor and colleagues in Neuropsychology Review, which pooled 47 studies covering 6,484 patients. Pooled PVT failure rate: 16 percent, 95 percent confidence interval 14 to 19 percent. Drop the two studies where applying standard cutoffs was most likely to misclassify patients and it becomes 15 percent, interval 13 to 18. Heterogeneity across the source studies was high, so 16 percent is a pooled estimate, not a rate to expect in any particular clinic.

One structural limit is worth knowing, because it cuts in a useful direction. Of those 47 studies, 43 gave each patient a single performance validity test. Four gave two. None gave more than two. So that 16 percent is close to a single-test failure rate, and the next section is about why a single failed test isn’t a finding.

By setting:

Setting	Pooled PVT failure rate	95% CI	Studies
Private practice	27%	15 to 40	2
Epilepsy clinic	19%	10 to 29	7
Psychiatric institute	15%	10 to 21	6
Rehabilitation clinic	13%	4 to 25	4
Medical hospital	12%	10 to 15	25

Read the intervals, not just the percentages. That private practice figure rests on two studies and its interval runs from 15 to 40 percent, which makes it a signal rather than a number worth quoting. The medical hospital row, built on 25 studies with an interval of 10 to 15, is the sturdiest cell in the table.

By diagnosis:

Population	Pooled PVT failure rate	95% CI
Psychogenic non-epileptic seizures	33%	24 to 43
ADHD assessment	17%	11 to 23
Mild to moderate TBI	17%	10 to 25
Multiple sclerosis	13%	9 to 18
Epilepsy	11%	6 to 16
Mild cognitive impairment	9%	4 to 16
Parkinson’s disease	6%	1 to 15

Read the multiple sclerosis and epilepsy rows carefully. Those are patients with confirmed neurological disease failing performance validity tests at pooled rates of 13 and 11 percent. The paper doesn’t report what those particular patients had at stake financially, and only four of the 47 studies screened external incentive out at all. In those four the pooled rate fell to 10 percent, interval 5 to 15. Taking the incentive away lowers the number. It doesn’t take it to zero.

Litigation is a different population. The most-cited estimate comes from Mittenberg and colleagues in 2002, who surveyed American Board of Clinical Neuropsychology members about 33,531 annual cases and reported probable malingering or symptom exaggeration in 29 percent of personal injury cases, 30 percent of disability cases, 19 percent of criminal cases and 8 percent of medical cases. One caveat, and it isn’t the one you usually see. Those figures are practitioners’ case determinations rather than one protocol applied uniformly, but they aren’t impressions either: respondents said scores below empirical cutoffs on forced-choice tests informed 57 percent of the determinations, and validity scales on personality tests another 38 percent. What the number isn’t is a single measured failure rate you can line up against Roor’s 16 percent. Different method, different question.

Does One Failed Validity Test Mean You Were Faking?

No, and treating it that way is a methodological error with a specific false-positive cost attached.

Sherman, Slick and Iverson published a 20-year update to the malingering criteria in Archives of Clinical Neuropsychology in 2020. On single-test failure their conclusion is blunt: “A single low PVT score as the criterion for PVT failure will thus result in an unacceptably high false-positive rate, especially in people with limited education or below-average intellectual abilities.”

Notice who that last clause names. Less formal schooling and a lower baseline raise your odds of a false positive, independent of anything you did in the room.

Their replacement rule is a ratio, not a count. They argue it’s “more appropriate to consider the ratio of PVT failures to total PVT scores rather than the absolute number of PVTs administered,” and they work the arithmetic: failing two of seven scores “would appear to meet criteria for invalid responding, as would failing four of 14 PVT scores; failing two of 14 PVT scores likely would not.” Two failures mean one thing out of seven and something else out of fourteen. If a report calls your profile invalid, the denominator is a fair question to ask.

Their criteria also require four things together, not one. An external incentive has to exist. The presentation has to be invalid. There have to be marked discrepancies between test data, reported symptoms and outside evidence. And the behavior can’t be fully explained by a developmental, medical or psychiatric condition. One failed measure satisfies none of that on its own.

One published case shows how hard the judgment can get, and it comes with a published rebuttal, which is the part that makes it worth your time.

Loring and Goldstein reported a single case in Archives of Clinical Neuropsychology in 2019: a woman in her early fifties with multiple sclerosis confirmed by oligoclonal bands in her spinal fluid, an elevated IgG index and plaques on MRI. Her prescriptions ran to zonisamide, lamotrigine, gabapentin, venlafaxine, baclofen, trazodone and alprazolam as needed, plus glatiramer acetate for the MS. Seven psychoactive drugs at once.

She was tested twice, by two different neuropsychology services at the same academic medical center, roughly 18 months apart. In the first evaluation she cleared the easy Victoria Symptom Validity Test items at 20 of 24 and scored 12 of 24 on the hard items, which is chance. In the second she failed the Word Memory Test: 67.5 percent immediate recall, 72.5 percent delayed recall, 50 percent consistency.

In that same second session she recalled 12 of 15 words on the Rey Auditory Verbal Learning Test delay, the 74th percentile, with 15 of 15 recognition hits and zero false positives. Her delayed recognition on Logical Memory was 28 of 30, above the 75th percentile. On the NIH Toolbox picture sequence memory task she scored 127, the 96th percentile.

Loring and Goldstein concluded that “false positive PVT failure rates are likely higher in patients with independently established neurologic disease” and that a one-size-fits-all reading of subthreshold scores “is insufficient to replace good clinical practice.”

Then Graver and Green answered them in print in Applied Neuropsychology: Adult in 2020. Their argument: on the Word Memory Test, a patient with real memory impairment usually shows a wide gap between the very easy recognition subtests and the harder recall ones, on the order of 30 points. This patient’s gap was about 12. She scored below the dementia group mean on the easiest items and above it on the harder ones, which is backwards. They read the profile as non-credible performance, not MS.

The disagreement is the useful part, so don’t let anyone tell you this is settled. Two sets of experienced neuropsychologists read the same scores in peer-reviewed journals and reached opposite conclusions. That is what validity assessment actually looks like from the inside. It is a judgment supported by data, not a machine that prints a verdict.

Which is why who runs your evaluation matters more than any single score in it. Dr. Colet’s practice takes referrals from both plaintiff and defense counsel in Florida injury litigation, and her published work includes assessment of malingering and deception. A practice hired by both sides has no structural reason to prefer either answer. A practice hired by one side does.

Why Real Patients Fail Effort Tests

Fatigue, pain and sedating medication are the usual culprits, and none of them involves an intent to deceive.

Pain pulls attention away from the task in front of you. Anticonvulsants, benzodiazepines and some antidepressants slow processing speed and blunt working memory, and the MS case above involved seven psychoactive prescriptions at once. Depression flattens motivation in a way that looks like poor effort on a graph and feels like nothing at all from the inside. Untreated sleep apnea, a bad night before the appointment, testing in your second language, limited formal education, low literacy, a normative sample that doesn’t match your background: all of it can push a score below a cutoff that was validated on somebody else. Sherman and colleagues name education and baseline ability specifically, which is worth remembering if either applies to you.

Genuine severe impairment can do it too. That’s the uncomfortable part. Some validity measures were normed on the assumption that anyone with real cognitive capacity will clear them, and people with substantial neurological injury sometimes don’t.

A low score with valid effort is a finding worth having. It’s the reason neuropsychologists evaluate the conditions they do rather than just screening for them.

What An Invalid Result Actually Means In Your Case

It depends on who asked for the evaluation, and the range runs from a scheduling inconvenience to a dead expert opinion.

Setting	Who’s reading it	What an invalid profile does	The mechanism
Florida personal injury	Plaintiff or defense counsel	The expert opinion becomes attackable on admissibility, before a jury hears any of it	Fla. Stat. 90.702
Workers compensation	Carrier, employer	The cognitive portion of the claim loses its evidentiary support	Report can’t quantify the deficit
Long-term disability (ERISA)	The insurer’s reviewer	Insurers cite it as evidence of exaggeration, sometimes off a single failed score	Plan terms plus internal review
Social Security disability	DDS examiner, then an ALJ	Test data carries less weight, so other medical evidence has to carry the claim	Objective medical evidence standard
Criminal competency, Florida	The court	The expert may be unable to reach an opinion on the six statutory capacities	Fla. Stat. 916.12(3)
Public safety pre-employment	The hiring agency	A determination gets made either way	Agency hiring standard, not state law

The Florida civil row is the one attorneys underestimate. Florida moved from Frye to Daubert when the Supreme Court adopted the amendments to the evidence code in May 2019, and Florida Statute 90.702 now requires that expert testimony be “based upon sufficient facts or data” and be “the product of reliable principles and methods.” An invalid profile is not a credibility problem you argue about in front of a jury. It’s a sufficiency-of-the-data problem you argue about at a hearing, and it can end the opinion before trial. That’s a different and much worse outcome for whichever side commissioned the report, which is why Florida attorneys who use psychological evaluations to prove personal injury damages should be asking about validity protocol before the appointment, not after.

On the criminal side, Florida Statute 916.12(3) requires an examining expert to consider and specifically report on six capacities: appreciating the charges, appreciating the range and nature of possible penalties, understanding the adversarial nature of the process, disclosing pertinent facts to counsel, showing appropriate courtroom behavior, and testifying relevantly. An invalid profile can leave an expert unable to answer any of them.

For disability claimants specifically, what a neuropsychological evaluation involves in a disability claim covers the process side, and how to prove a traumatic brain injury covers the adjacent problem of a normal MRI in a real injury.

The One Evaluation You Can Actually Fail

Pre-employment psychological screening for police officers, firefighters, corrections officers and probation officers ends in a recommendation. That’s a pass or fail in the ordinary sense.

Dr. Colet performs these evaluations. The output isn’t a diagnosis or a percentile table, it’s a judgment about suitability for a specific job with specific stressors, and the hiring agency acts on it. Someone can be in good health and still not be recommended for a particular role.

One thing to be clear about, because it gets misstated: Florida’s minimum qualifications don’t impose this. Florida Statute 943.13 covers law enforcement, correctional and correctional probation officers, and it requires a physical examination by a licensed physician, physician assistant or licensed advanced practice registered nurse, to specifications set by the Criminal Justice Standards and Training Commission. The words psychological and psychologist appear nowhere in the section. Firefighter qualifications sit elsewhere in Florida law, under Chapter 633, so none of that speaks to them. Where these evaluations happen, they happen because an individual agency requires them as a condition of hire.

Can You Retake A Neuropsychological Evaluation If The Results Were Invalid?

Usually yes, though retesting brings its own complications and the timing matters.

Practice effects are the main one. Once you’ve seen a memory list or a puzzle, your second performance is partly a measure of having seen it before. Most examiners want meaningful time between administrations, and some tests have alternate forms for exactly this reason. If the first evaluation was invalid because of a treatable cause, fixing the cause first is the point. A medication review, treating the sleep apnea, getting the depression addressed, then retest.

Whether a retest is available at all depends on who’s paying and why. In a clinical referral it’s usually a scheduling question. In litigation, a second examination often needs agreement between counsel or a court order.

Who sees the invalid finding depends on the same thing. A clinical report goes to you and to the referring provider. A report commissioned by an attorney, a carrier or a court goes to whoever commissioned it, on their terms. If you paid for it yourself, Florida gives you a specific right here. Florida Statute 490.009(1)(n) makes it grounds for discipline when a licensed psychologist fails “to make available to a patient or client, upon written request, copies of test results, reports, or documents in the possession or under the control of the licensee which have been prepared for and paid for by the patient or client.” Ask in writing.

If you want the practical picture of scope and turnaround before you commit, how long a psychological evaluation takes in 2026 breaks it down by evaluation type.

How To Protect The Validity Of Your Evaluation

Sleep, medication honesty and telling the examiner when something’s wrong. That’s most of it.

Don’t study. There’s nothing to study, and practicing a task you’ll be given later corrupts the measurement you came for. Sleep normally the night before and eat before you arrive, because a five-hour battery on an empty stomach produces a processing speed score that describes your blood sugar.

Take your medications as prescribed and tell the examiner exactly what you took and when. This matters more than almost anything else on this list, and people hide it because they’re embarrassed. A benzodiazepine or an opioid in your system is interpretable data. An undisclosed one is a confound the examiner will find anyway, in the shape of a validity failure nobody can explain.

Bring your glasses and hearing aids. Say so if you’re in pain, if you didn’t sleep, if English isn’t your first language, if you’re having a bad symptom day. Every one of those goes in the report as context, and context is what stops a low score from being read as a bad-faith score.

And try. Not because trying earns you a better outcome, but because a battery you didn’t engage with produces nothing anyone can use, including you.

Where To Start

If you’re a patient, the useful question isn’t whether you can fail a neuropsychological evaluation. It’s whether the person doing yours administers enough validity measures to draw a defensible conclusion, and whether they’ll read a single flagged score in the context of your actual medical history.

If you’re an attorney, ask that question before the examination, about your own expert and about the other side’s.

You can’t fail a neuropsychological evaluation on the strength of a low score. Plenty of people do walk out with a report nobody can use. Those are different problems, and only one of them is in your hands.

FC PsychExperts runs neuropsychological evaluations and forensic psychological evaluations out of offices in Jupiter and Fort Lauderdale, with court-qualified testimony across Florida’s 1st, 15th, 17th, 19th and 20th Judicial Circuits. Dr. Lauren Miller handles the neuropsychological work. Call 561-870-0411, Monday through Friday, 7:30 AM to 4:30 PM.

FAQs

Can you fail a neuropsychological evaluation?

Not the cognitive tests. Those have no passing score, because your results are compared against a normative sample of people your age and education level rather than against a cutoff. You can fail the validity measures built into the battery, which produces an invalid profile rather than a failing grade. Those are two different events with different consequences.

What does it mean if my neuropsychological test results are invalid?

It means the examiner can’t vouch for the numbers, not that you were caught lying. Invalid results can’t support a diagnosis, a treatment plan or an expert opinion, so the practical effect is that the evaluation didn’t answer the question it was ordered to answer. Pain, sedating medication, depression, poor sleep and severe genuine impairment can all produce it.

How often do people fail validity testing in a neuropsychological evaluation?

A 2024 meta-analysis in Neuropsychology Review pooled 47 studies covering 6,484 patients and found a 16 percent pooled failure rate on performance validity tests, with a 95 percent confidence interval of 14 to 19 percent. Subgroup rates were as low as 6 percent in Parkinson’s disease and as high as 33 percent in psychogenic non-epileptic seizures. In the four studies that screened out patients with an external incentive, the pooled rate fell to 10 percent.

Does failing one validity test mean I was malingering?

No. Sherman, Slick and Iverson concluded in 2020 that using a single low performance validity score as the criterion for failure produces an unacceptably high false-positive rate, especially in people with limited education or below-average intellectual ability. They recommend judging the ratio of failed scores to total scores administered rather than the raw count, so failing two of seven measures means something different from failing two of 14. Their criteria also require an external incentive, marked discrepancies with outside evidence, and the ruling out of medical and psychiatric explanations.

Can an invalid neuropsychological evaluation hurt my injury or disability claim?

It can, and in Florida civil litigation the damage is structural rather than just persuasive. Florida Statute 90.702 requires expert testimony to be based on sufficient facts or data, so an invalid profile becomes an admissibility problem that can end the opinion before a jury hears it. In disability claims, insurers commonly cite a failed validity score as evidence of exaggeration.

Can I retake a neuropsychological evaluation if the results were invalid?

Usually, though practice effects mean examiners want meaningful time between administrations and sometimes use alternate test forms. If the invalidity had a treatable cause, such as sedating medication or untreated depression, addressing that first is the point of waiting. In litigation, a second examination often requires agreement between counsel or a court order.

Can I get a copy of my own neuropsychological test results?

If you paid for the evaluation yourself, yes, and you should ask in writing. Florida Statute 490.009(1)(n) makes it grounds for discipline when a licensed psychologist fails to make available to a patient, on written request, copies of test results and reports prepared for and paid for by that patient. Reports commissioned by an attorney, insurer or court are released on the requesting party’s terms instead.