Coaching and the ability to simulate mild traumatic brain injury symptoms

This study assessed the ability of normal controls to simulate mild traumatic brain injury with or without the aid of general simulation strategies. An additional purpose was to evaluate the relative ability of four tests of performance motivation or malingering to discriminate among the five groups in this study. Twenty-one patients with documented mild traumatic brain injury (TBI) and 112 undergraduate students were administered the measures of symptom validity in randomized order with instructions either to perform to the best of their ability or to fake believable deficits. Students asked to malinger were either given instructions to do so with no guidance (No Strategies group or NS), a minimal level of guidance (Only Strategies group or OS) or a moderate level of guidance (Strategies and Example or SE). Students given simulation strategies (OS and SE groups) were able to match performance of the TBI group in only those instances when TBI performance was similar to the normal comparison group. When TBI performance fell considerably below the normal comparison group, naïve simulators (NS group) best approximated TBI performance. The degree of variability in the classification success of the four tests underscored the necessity of combining detection methods, as well as the need to develop new tests more resistant to attempts to feign brain injury.