The impact of pediatric neuropsychological consultation in mild traumatic brain injury: a model for providing feedback after invalid performance

Abstract

Objective: In recent years, pediatric practitioners have increasingly recognized the importance of objectively measuring performance validity during clinical assessments. Yet, no studies have examined the impact of neuropsychological consultation when invalid performance has been identified in pediatric populations and little published guidance exists for clinical management. Here we provide a conceptual model for providing feedback after noncredible performance has been detected. In a pilot study, we examine caregiver satisfaction and postconcussive symptoms following provision of this feedback for patients seen through our concussion program. Methods: Participants (N = 70) were 8–17-year-olds with a history of mild traumatic brain injury who underwent an abbreviated neuropsychological evaluation between 2 and 12 months post-injury. We examined postconcussive symptom reduction and caregiver satisfaction after neuropsychological evaluation between groups of patients who were determined to have provided noncredible effort (n = 9) and those for whom no validity concerns were present (n = 61). Results: We found similarly high levels of caregiver satisfaction between groups and greater reduction in self-reported symptoms after feedback was provided using the model with children with noncredible presentations compared to those with credible presentations. Conclusion: The current study lends preliminary support to the idea that the identification and communication of invalid performance can be a beneficial clinical intervention that promotes high levels of caregiver satisfaction and a reduction in self-reported and caregiver-reported symptoms.

Keywords:

• Validity testing
• pediatric neuropsychological assessment
• noncredible effort

Acknowledgment

The authors thank Derek Mason for assistance in preparing the manuscript and to Yana Suchy for reviewing an earlier draft of the conceptual model.