Search

Objective: Performance validity assessment is an important component of concussion baseline testing and Immediate Post-Concussion and Cognitive Testing (ImPACT) is the most commonly used test in this setting. A review of invalid performance on ImPACT was published in 2017, focusing largely on the default embedded validity indicator (Default EVI) provided within the test. There has since been a proliferation in research evaluating the classification accuracy of the Default EVI against independently developed, alternative ImPACT-based EVIs, necessitating an updated review. The purpose of this study was to provide an up-to-date review of the prevalence of invalid performance on ImPACT and to examine the relative effectiveness of ImPACT-based EVIs. Method: Literature related to the prevalence of invalid performance on ImPACT and the effectiveness of ImPACT-based EVIs, published between January 2000 and May 2020, was critically reviewed. Results: A total of 23 studies reported prevalence of invalid performance at baseline testing using ImPACT. Six percent of baseline assessments were found to be invalid by the ImPACT's Default EVI, and between 22.31% and 34.99% were flagged by alternative EVIs. Six studies assessed the effectiveness of ImPACT-based EVIs, with the Default EVI correctly identifying experimental malingerers only 60% of the time. Alternative ImPACT-based EVIs identified between 73% and 100% of experimental malingerers. Conclusions: The ImPACT's Default EVI is not sufficiently sensitive, and clinicians should consider alternative indicators when assessing invalid performance. Accordingly, the base rate of invalid performance in athletes at baseline testing is likely well above the 6% previously reported.

Objective: To create novel Immediate Post-Concussion and Cognitive Testing (ImPACT)-based embedded validity indicators (EVIs) and to compare the classification accuracy to 4 existing EVIImPACT., Method: The ImPACT was administered to 82 male varsity football players during preseason baseline cognitive testing. The classification accuracy of existing EVIImPACT was compared with a newly developed index (ImPACT-5A and B). The ImPACT-5A represents the number of cutoffs failed on the 5 ImPACT composite scores at a liberal cutoff (0.85 specificity); ImPACT-5B is the sum of failures on conservative cutoffs (≥0.90 specificity)., Results: ImPACT-5A ≥1 was sensitive (0.81), but not specific (0.49) to invalid performance, consistent with EVIImPACT developed by independent researchers (0.68 sensitivity at 0.73-0.75 specificity). Conversely, ImPACT-5B ≥3 was highly specific (0.98), but insensitive (0.22), similar to Default EVIImPACT (0.04 sensitivity at 1.00 specificity). ImPACT-5A ≥3 or ImPACT-5B ≥2 met forensic standards of specificity (0.91-0.93) at 0.33 to 0.37 sensitivity. Also, the ImPACT-5s had the strongest linear relationship with clinically meaningful levels of invalid performance of existing EVIImPACT., Conclusions: The ImPACT-5s were superior to the standard EVIImPACT and comparable to existing aftermarket EVIImPACT, with the flexibility to optimize the detection model for either sensitivity or specificity. The wide range of ImPACT-5 cutoffs allows for a more nuanced clinical interpretation., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

To assess noncredible performance on the NIH Toolbox Cognitive Battery (NIHTB-CB), we developed embedded validity indicators (EVIs). Data were collected from 98 adults (54.1% female) as part of a prospective multicenter cross-sectional study at 4 mild traumatic brain injury (mTBI) specialty clinics. Traditional EVIs and novel item-based EVIs were developed for the NIHTB-CB using the Medical Symptom Validity Test (MSVT) as criterion. The signal detection profile of individual EVIs varied greatly. Multivariate models had superior classification accuracy. Failing ≥4 traditional EVIs at the liberal cutoff or ≥3 at the conservative cutoff produced a good combination of sensitivity (.57 to .61) and specificity (.92 to .94) to MSVT. Combining the traditional and item-based EVIs improved sensitivity (.65 to .70) at comparable specificity (.91 to .95). In conclusion, newly developed EVIs within the NIHTB-CB effectively discriminated between patients who passed versus failed the MSVT. Aggregating EVIs within the same category into validity composites improved signal detection over univariate cutoffs. Item-based EVIs improved classification accuracy over that of traditional EVIs. However, the marginal gains hardly justify the burden of extra calculations. The newly introduced EVIs require cross-validation before wide-spread research or clinical application. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores., Setting: Sport-related concussion management program at a regionally accredited university., Participants: A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students., Design: Cross-sectional design based on differential incentive status: motivated to do poorly to return to play more quickly after sustaining a concussion (athletes) versus motivated to do well due to incentivizing performance (students)., Main Measures: Immediate Post-Concussion and Cognitive Testing (ImPACT), performance validity tests, and measures of cognitive ability., Results: Half of the athletes failed at least 1 embedded validity indicator within ImPACT (51.8%), and the traditional neuropsychological tests (49.4%), with large effects for performance validity on cognitive test scores (d: 0.62-1.35), incentive status (athletes vs students; d: 0.36-1.15), and the combination of both factors (d: 1.07-2.20) on measures of attention and processing speed., Conclusion: Invalid performance on baseline assessment is common (50%), consistent across instruments (ImPACT or neuropsychological tests) and settings (one-on-one or group administration), increases as a function of incentive status (risk ratios: 1.3-4.0) and results in gross underestimates of the athletes' true ability level, complicating the clinical interpretation of the postinjury evaluation and potentially leading to premature return to play.

Objective: To compare spontaneous reporting of health complaints in a sample of refugee survivors of torture with a history of moderate/severe traumatic brain injury (TBI) with survivors of torture without TBI and analyze the contribution of posttraumatic stress disorder symptoms to health outcomes., Participants: Treatment-seeking refugee survivors of torture with a moderate/severe TBI (n = 85) and a control group (n = 72) of survivors who suffered a physical injury during their persecution but had no history of a head injury., Measures: Health outcomes included a self-report of general physical health (scale 1-5), number of medical visits, and a scaled score of the number of health complaints. The Harvard Trauma Questionnaire (HTQ) was used to measure posttraumatic stress disorder., Results: Moderate/severe TBI was associated with more health complaints but not higher HTQ scores. TBI and HTQ scores are independently associated with a greater number of health complaints, and an interaction between TBI and HTQ scores suggests that the relationship between moderate/severe TBI and the number of health complaints strengthened with increased posttraumatic stress disorder symptom severity., Conclusions: Health complaints may be a common expression of psychological trauma, and service providers should be certain to explore both medical and psychological contributors when assessing refugee survivors of torture.

This study examined differences in the spread of semantic activation within and between the cerebral hemispheres. A lateralised lexical decision task using indirect priming was presented to 58 undergraduates with primes and targets separated by 215 or 750 milliseconds (ms). Prime and target words were presented to the same or opposite visual fields and were either directly related (book-read), indirectly related (lion-[tiger]-stripes), or unrelated (cup-street). At 215 ms participants exhibited significant priming effects to directly related words in all conditions except when primes and targets were both presented to the right hemisphere (RH). In contrast, priming to indirectly related words was effective only when primes and targets were presented to opposite hemispheres. At 750 ms, significant priming occurred for directly related words in all conditions, and for indirectly related words when primes were presented to the RH. Results suggest that priming for directly and indirectly related concepts occurs unilaterally in each hemisphere before 215 ms. Both prime types activate semantic networks in the RH within 750 ms, whereas the LH processes information in a more focused manner. This suggests that activation spreads contralaterally from each hemisphere first to directly and then to indirectly related concepts, indicating the importance of incorporating contralateral priming contrasts in lexical decision tasks.

Seventy-six participants performed a visual half-field lexical decision task at two different stimulus onset asynchronies (50 or 750 ms). Word targets were primed either by a highly associated word (e.g., CLEAN-DIRTY), a weakly associated word (e.g., CLEAN-TIDY), or an unrelated word (e.g., CLEAN-FAMILY) projected to either the same or opposite visual field (VF) as the target. In the short SOA, RVF-left hemisphere primes resulted in high associate priming regardless of target location (ipsilateral or contralateral to the prime) whereas LVF-right hemisphere primes produced both high and low associate priming across both target location conditions. In the long SOA condition, contralateral priming patterns converged, demonstrating only high associate priming in both VF locations. The results of this study demonstrate the critical role of interhemispheric transfer in semantic processing and indicate a need to elaborate current models of semantic processing.