Relationship of psychological/mild traumatic brain injury (mTBI) history and invalid reporting to self-reported executive function

Abstract

Individuals with mild traumatic brain injury (mTBI) often complain of executive functioning (EF) difficulties. There is a discrepancy between self-reported EF impairment and EF deficits on neuropsychological tests, with some arguing that self-report EF is more related to real-world functioning than EF tests. However, research suggests that self-reported EF may be related more to emotional distress and is vulnerable to invalid reporting. We examined the vulnerability of the short form Barkley Deficits in Executive Functioning Scale (BDEFS) to invalid reporting, using a simulated mTBI paradigm. We included four groups: individuals simulating mTBI with (N = 24) and without (N = 21) histories of mTBI/other psychological conditions and controls with (N = 21) and without (N = 25) histories of mTBI/other psychological conditions. As hypothesized, simulators performed worse on the BDEFS Total Score and EF Symptom Count relative to controls; however, this effect was larger within those who had no self-reported history of mTBI/other psychological conditions. We identified a preliminary cutoff on the EF Symptom Count that detected 42.8% of simulators, with 95% specificity relative to the controls with histories of mTBI/other psychological conditions. The present study emphasizes the need for validity scales on self-report EF measures such as the BDEFS.

Keywords:

• Executive functioning
• malingering
• mild traumatic brain injury

Data availability statement

Data can be made available upon request.

Notes

1 When we removed those with mTBI history from analyses, the pattern of results was generally unchanged; there remained a significant effect of simulator status, p < .001 for both Total Score and EF Symptom Count, a significant interaction, p = .029 for Total Score, p = .021 for EF Symptom Count; the main effect of psychological history also became significant, Total Score p = .012, EF Symptom Count p = .028.