Neuropsychological test validity in Veterans presenting with subjective complaints of ‘very severe’ cognitive symptoms following mild traumatic brain injury

Abstract

Objective: This study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI).Background: Persistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings.Methods: Self-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from ‘none’ to ‘very severe’. Veterans also completed brief neuropsychological testing which included measures of performance validity.Results: Study 1 examined data from 122 participants and demonstrated that veterans reporting a ‘very severe’ cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test.Conclusion: Veterans with suspected mTBI who report ‘very severe’ cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing.