Postconcussive symptom exaggeration after pediatric mild traumatic brain injury

Area of Science:

• Neuropsychology
• Pediatric Traumatic Brain Injury

Background:

• Persistent postconcussive symptoms affect a minority of pediatric mild traumatic brain injury (mTBI) patients.
• In adults, poor performance on validity tests correlates with symptom complaints, but this link is unstudied in children.
• This study investigated the relationship between validity test performance and symptom reporting in pediatric mTBI cases.

Purpose of the Study:

• To determine if children with mild traumatic brain injury (mTBI) who fail a validity test report more persistent postconcussive symptoms than those who pass.
• To examine the predictive value of validity test performance on symptom report in pediatric mTBI.

Main Methods:

• A consecutive clinical case series of 191 pediatric patients (ages 8-17) evaluated after mTBI.
• Administration of the Medical Symptom Validity Test (MSVT) and a graded symptom scale.
• Analysis of validity test performance and symptom endorsement.

Main Results:

• 12% of participants (23 children) failed the MSVT.
• The group failing the MSVT reported significantly more postconcussive symptoms than the passing group (large effect size, P < .001).
• MSVT performance was a strong independent predictor of symptom report, even when controlling for factors like gender and prior psychiatric issues.

Conclusions:

• A portion of children with persistent complaints after mTBI may exhibit exaggerated or feigned symptoms.
• Undetected invalid responding can lead to diagnostic and treatment errors.
• Routine inclusion of clinical neuropsychologists and validity testing in pediatric mTBI evaluations and research is recommended.