The Relationship Between Suboptimal Effort and Post-Concussion Symptoms in Children and Adolescents With Mild Traumatic Brain Injury

Abstract

This retrospective chart review study explored the relationship between suboptimal effort and post-concussion symptoms in pediatric mild traumatic brain injury (mTBI). Participants were 382 clinically referred children and adolescents between 8 and 16 years of age who sustained an mTBI. Suboptimal effort was identified using reliable digit span and age-corrected scaled scores from the Numbers subtest of the Children's Memory Scale (CMS); 20% of the sample were classified as non-credible performers. Chi-square analyses and t-tests were used to examine differences in post-concussion symptoms and neuropsychological test performance between credible and non-credible performers. Linear regression was used to examine whether CMS Numbers performance predicted post-concussion symptoms after controlling for baseline symptoms and other relevant demographic- and injury-related factors. We found that non-credible performers presented with a greater number of post-concussion symptoms as compared with credible performers. Additionally, non-credible performers demonstrated comparatively poorer performance on neuropsychological tests of focused attention and processing speed. These results suggest that children and adolescents with mTBI who fail effort testing might have a greater tendency to exaggerate post-concussion symptoms and cognitive impairment. The clinical implications of these findings are discussed.

Predictors of Post-concussive Symptoms in Young Children: InjuryversusNon-injury Related Factors

“…Additionally, there were several pre-morbid variables which have been shown to be associated with persistent PCS that were not measured in this study. These include pre-morbid somatization (Grubenhoff et al, 2016;Nelson et al, 2016), post-injury child coping (Woodrome et al, 2011), post-injury symptom exaggeration (Araujo et al, 2014;Kirkwood, Peterson, Connery, Baker, & Grubenhoff, 2014), and postinjury family litigation (Connery, Peterson, Baker, & Kirkwood, 2016). Finally, given our groups differed on age it proved difficult to tease out the effects of age.…”

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

“…20,44 In addition to postural instability assessment, the Romberg test may also serve as a method to determine if patients are exaggerating their postinjury deficits in a manner that reflects balance dysfunction. 42 The idea that some youths may exaggerate or feign symptoms after concussion has been studied in the context of neuropsychological testing and symptom reporting, 1,7,26 but it has not received substantial attention with regard to postural stability tests. Previous work suggests that approximately 23% of children failed a well-validated performance validity test after a concussion.…”

Effort, symptom validity testing, performance validity testing and traumatic brain injury

“…While below cut-score SVT performance relates to increased symptom endorsement in individuals with mTBI [ 119 , 120 ], since most neuropsychological tests measure cognitive ability, Larrabee [ 41 ] suggests that the term ‘performance validity’ should be used instead of SVT or ‘effort’ or other terms discussed in this section or previously mentioned in this review. Performance validity testing or PVT is probably a much more accurate description, because the cognitive measure is not necessarily evaluating a symptom.…”