Neuropsychological Outcome, Post Concussion Symptoms, and Forensic Considerations in Mild Closed Head Trauma

Controversy regarding the long-term outcome of mild head trauma (MHT) is discussed. Variable results are related to potential methodological problems such as failure to consider issues of sensitivity, specificity, base-rates of symptoms in non-injured populations, and failure to match control to MHT subjects on demographic and motivational factors. Meta-analytic data from well-conducted studies show good long-term neuropsychological recovery for most persons who have sustained MHT. Symptom base-rate data show poor specificity for several so-called "post-concussion" symptoms, which occur frequently in non-brain damaged populations. Persistence of "post-concussive" complaints is considered as a function of somatization, which is potentially amenable to effective cognitive behavioral treatment. Forensic aspects of MHT are discussed, with particular reference to appropriate methods of clinical and scientific inference, and evaluation for malingering.