Clinical significance of test refusal among young children

The present study describes the incidence of test refusal at neuropsychological assessment, investigates its correlates, and its stability. The participants were 124 children aged 3.5 years whose development has been followed from birth in the Jyväskylä Longitudinal Study of Dyslexia (JLD). The frequency of test refusal on the Finnish version of the NEPSY was analyzed with respect to the children's concurrent and earlier cognitive and language skills, assessed using tests and parental ratings. Refusal during test-taking was found to be relatively common at this age, and high frequency of refusal at an earlier age was associated with similar tendency at a later age. High test refusal was associated with compromised neuropsychological and linguistic test scores. Missing data due to refusal were more common in neuropsychological tasks requiring verbal production. It is concluded that test refusals reflect a child's poor underlying skills and an attempt to avoid failure, rather than noncompliant or oppositional behavior.