Rates of Invalid Baseline Concussion Testing May Be Alarmingly High

MedicalResearch.com Interview with:

Christopher Abeare, Ph.D. Associate Professor Clinical Neuropsychology Department of Psychology University of Windsor Windsor, Ontario

Dr. Christopher Abeare

Christopher Abeare, Ph.D.
Associate Professor
Clinical Neuropsychology
Department of Psychology
University of Windsor
Windsor, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In this study, we examined the prevalence of invalid performance on baseline neurocognitive testing in sport concussion. Baseline testing is a commonly employed practice in which the cognitive abilities of athletes are assessed pre-season. These baseline test results are then used as a point of comparison against which post-injury neurocognitive test results can be compared, thereby creating a more individualized approach to the assessment of neurocognitive functioning.

However, there has been growing concern about the validity of baseline test results, meaning that there is concern over the degree to which the scores on these baseline tests actually reflect an athlete’s true cognitive ability. There are many reasons why their test scores might not reflect their actual ability, ranging from inattentiveness during testing and lack of appreciation of the importance of doing their best on testing to intentional underperformance (aka “sandbagging” or malingering).

As a result of these concerns, 4 different validity measures have been developed. We compared these 4 validity measures, head to head, in a sample of 7897 athletes aged 10 to 21 years.

We found that 56% of athletes failed at least 1 of these validity measures, suggesting that as many as 56% of  athletes have scores that may not reflect their true ability level. We then tested the hypothesis that age would be related to the proportion of athletes with invalid performance. Our findings supported this hypothesis in that nearly 84% of 10-year-olds failed at least one validity measure and 29% of 21-year-olds failed at least one. 

MedicalResearch.com: What should readers take away from your report?

Response: The findings suggest that the rates of invalid performance on baseline testing may be alarmingly high. Thus, clinicians should pay close attention to the validity of baseline performance, when evaluating athletes after sustaining a concussion. We recommend a conservative approach of examining all 4 validity measures and carefully calibrating the interpretation of the post-injury data based upon the validity of the baseline test results. If the baseline results are thought to be invalid, then normative data can be used as a reference to make return to play learning or return to play decisions.   

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research should examine performance validity on baseline testing using a comprehensive set of well-validated performance validity tests that are commonly used in neuropsychological assessments. These data would provide greater confidence in the prevalence of invalid performance on testing.

MedicalResearch.com: Is there anything else you would like to add?

 Response: I would like to add that baseline testing has the potential to be a valuable component of concussion management, as it provides individualized approach to assessment, theoretically improving assessment and diagnosis. However, the issue of performance validity needs to be addressed in order to maximize the usefulness of baseline testing. 


Abeare CA, Messa I, Zuccato BG, Merker B, Erdodi L. Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator. JAMA Neurol. Published online March 12, 2018. doi:10.1001/jamaneurol.2018.0031

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