Frank M. Webbe

Objective: We report normative data with non-athlete college students for three brief, public-domain performance validity tests (PVT) representing multiple performance domains: Rey’s Word Recognition Test (WRT), Rey’s Dot Counting Test (DCT), and A Random Letter Test of Auditory Vigilance (A-Test). Method: One hundred fifty-four non-athlete college students (45% female; representing four college years) were recruited and assigned randomly to Honest-Effort, Fake-Bad, or Instructed Fake-Bad groups. Fifty student-athletes were selected randomly for comparison. Differences for multiple measures of each test among the three effort groups were obtained, and receiver operating curve (ROC) cut scores representing suboptimal performance were reported. Results: Only the WRT measures met normality and homogeneity of variance assumptions. Multivariate analysis of variance with post-hoc Tukey tests showed significant differences between groups for WRT Total Correct and Combination scores. For DCT Combination Score and Total Errors and A-Test Omission Errors and Total Errors, non-parametric Kruskal–Wallis comparisons were conducted, each resulting in significant differences between Honest-Effort and sub-optimal performance (SOP) groups. Athletes also differed significantly from both SOP groups. ROC cut scores that suggested suboptimal effort were DCT Combination Score ≥ 15; WRT Combination Score ≤ 12; and A-Test Omission Errors ≥1. Measures were considered poor to excellent based on the area under the curve (AUC) percentages obtained through ROC analysis. Conclusion: The DCT Combination and A-Test Omission Errors were valid indicators of suboptimal performance. The WRT measures fell short of adequate prediction based on the AUC. Combining multiple PVT “failures” maximized identification of suspect performers and minimized inclusion of Honest-Effort participants.

Objective: Concussion is a growing public health concern given the large number of youth and collegiate athletes participating in collision sports. Sport-related concussions can have an adverse impact on student-athletes’ health and academic performance. Athletic programs within academic organizations are motivated to employ the most effective and efficient diagnostic and recovery procedures to minimize the duration and impact of these symptoms on student-athletes’ functioning. The present study sought to further our understanding regarding the value and frequency of conducting baseline assessments when evaluating sport-related concussions.Method: A total of 41 athletes (24 men, 17 women) between the ages of 18 and 22 were evaluated following suspected concussive injury between 2015 and 2018. Post-injury test results were compared to baselines that had been collected either 1 or 2 years prior, and to normative data, to determine consistency in diagnostic outcomes.Results: Baseline test/retest reliability using Pearson’s bivariate correlations revealed modest correlations on measures of verbal and visual memory (0.437–0.569) and very strong correlations on measures of reaction time and visual-motor speed (0.811–0.821). Meanwhile, minimal if any differences in clinical decision-making regarding the diagnostic outcome was observed when comparing post-injury test results to different baselines and to normative data.Conclusions: Findings indicate that yearly baseline testing may not improve diagnostic accuracy, and in many cases, normative data may be adequate for decision-making. Additional research should evaluate the potential benefit of baseline testing in return-to-play decision-making among broader athletic populations.

The General Ability Measure for Adults (GAMA) is a brief nonverbal assessment of general intellectual ability. Presently, there is a lack of research involving the use of the GAMA in a high-functioning population. Aviation pilots (n = 59) were referred for a neuropsychological evaluation and were concluded to be cognitively intact. They were administered a battery that included the GAMA and Wechsler Adult Intelligence Scale – 4th edition (WAIS-IV). A paired samples t-test revealed that IQ scores on the GAMA were significantly lower than IQ scores on the WAIS-IV, with WAIS-IV IQ being 7.54 points higher on average. Fisher’s exact test determined there was significant disagreement in score classification between the tests, with individuals classified as Above Average on the WAIS-IV often being classified as Average on the GAMA. The GAMA appears to significantly underrepresent true IQ in both score and classification when compared to a more robust measure of intellectual assessment. Clinically, this suggests that IQ screeners, such as the GAMA, may not be appropriate for assessing patients who are suspected to be of higher premorbid functioning. Future research should expand on these results to assess the validity of verbal-based IQ screening measures in high-functioning populations.

The limitations of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)’s embedded validity measures (EVMs) are well-documented, as estimates suggest up to 35% of invalid baseline performances go undetected. Few studies have examined standalone performance validity tests (PVT) as a supplement to ImPACT’s EVMs. College athletes (n = 1,213) were administered a preseason baseline assessment that included ImPACT and the Rey Dot Counting Test (DCT), a standalone PVT, among other measures. Sixty-nine athletes (5.69%) met criteria for suboptimal effort on either ImPACT or the DCT. The DCT detected more cases of suboptimal effort (n = 50) than ImPACT (n = 21). A χ² test of independence detected significant disagreement between the two measures, as only two individuals produced suboptimal effort on both (χ²(2) = 1.568, p = .210). Despite this disagreement, there were significant differences between the suboptimal effort DCT group and the adequate effort DCT group across all four ImPACT neurocognitive domains (U = 19,225.000, p < .001; U = 17,859.000, p < .001; U = 13,854.000, p < .001; U = 17,850.500, p < .001). The DCT appears to detect suboptimal effort otherwise undetected by ImPACT’s EVMs.

Objective: Following concussion, there is an array of sequelae including symptom burden, neurocognitive dysfunction, and balance impairment. However, the magnitude of change in balance performance has yet to be explored fully regarding its relationship with neurocognitive functioning or symptom endorsement. The present study hypothesized that the magnitude of change in balance performance from baseline to post-trauma would have unique predictive power in identifying acute clinical outcomes.Method: Sixty-eight college athletes completed annual preparticipation baseline testing and were later diagnosed with a concussion.Results: Linear regressions determined that the magnitude of change in balance performance was a better predictor of neurocognitive dysfunction and endorsement of “balance problems” than post-trauma balance performance alone.Conclusions: These findings highlight the importance of incorporating balance measurements during preparticipation baseline assessment.

We compared two modes of ascertaining symptom information in baseline concussion testing with 754 NCAA Division II collegiate athletes. All athletes reported symptoms in both a face-to-face structured clinical interview using the SCAT3 symptom scale items and the similar symptom self-report scale in the computerized ImPACT test. Males reported significantly more symptoms and with greater severity during the interview compared to the computerized self-report. If males report symptoms according to a different format in posttrauma assessments than baseline, differences may reflect mode of testing and not change due to concussion.

Improved detection of sport-related concussions can be enhanced by performance validity tests, such as the Rey Word Recognition Test (WRT). The WRT is brief and in the public domain but no norms exist for healthy college-athletes. The present study identified such normative values in a large college-athlete sample. Participants included 1,147 college-athletes, and four measures were collected: total words correct, words correct of the first 8, total number of intrusions, and combination score. The WRT was administered individually during baseline evaluations. Means and standard deviations were as follows: total correct words recognized, 10.47 (SD = 2.12); number of correct words out of the first eight words presented, 6.01 (SD = 1.41); number of intrusions, 0.89 (SD = 1.09); combination score, 15.59 (SD = 3.55). Females scored significantly higher than males in total words correct, number correct of the first eight, and combination score, and significantly lower in intrusions. The WRT proved to be a quick, easily administer test in the baseline testing setting. Only 22 athletes recognized all 15 words, and close to a normal distribution of scores was obtained, suggesting that an expectation of optimum performance by college-athletes as an inference of effortful performance would be misplaced.

Objectives: The Sport Concussion Assessment Tool-5 (SCAT5) was published in 2017; however, normative performance within the college athlete population on the optional 10-item word list has not been described. This study reports normative values for immediate memory trials, total immediate memory score and delayed recall of the 10-item word list. Methods: The SCAT5 was administered as part of the preparticipation medical testing to 514 collegiate student-athletes, aged 17–23 (M=19.65, SD=1.40; 64% male) prior to the 2017–2018 athletic season. Results: On the SCAT5’s optional 10-item word list, with a total possible immediate memory score of 30, participants recalled an average of 20.57 (SD=3.22) words over three learning trials, with an average for trial 3 of 8.13 (SD=1.32). The average delayed memory score was 6.59 (SD=1.85). Small but significant demographic comparisons were found. Women scored higher on both immediate and delayed recall, non-native speakers scored higher on delayed recall, and Black/African-American athletes scored lower than White athletes on immediate, and lower than White and Hispanic/Latino athletes on delayed recall. Conclusion: The 10-item word list on the SCAT5 eliminates the ceiling effect observed on the five-item word list of the SCAT3, therefore, increasing its clinical utility in the diagnosis of sports-related concussions. Significant demographic differences suggest use of category-specific norms for sex, native language and race/ethnicity.