The Relation Between Testing Environment and Baseline Performance in Child and Adolescent Concussion Assessment

Area of Science:

• Pediatric neurology
• Sports medicine
• Cognitive neuroscience

Background:

• Previous studies indicated disparities in cognitive performance for concussion baseline assessments between group and individual settings.
• Accurate baseline data is crucial for clinical decisions regarding post-concussion cognitive and symptom recovery.

Purpose of the Study:

• To investigate if standardized testing procedures eliminate performance differences in cognitive assessments for concussion between group and individual settings.
• To compare cognitive performance, symptom reporting, and invalid performance rates between group and individual baseline concussion assessments.

Main Methods:

• A cohort study (Level of evidence, 3) involving 939 participants (aged 5-18 years).
• Participants were matched for age, sex, and ADHD status, with 313 tested individually and 626 in a group setting.
• Concussion baseline assessments utilized the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the Multimodal Assessment of Cognition & Symptoms for Children (MACS).

Main Results:

• No significant differences in cognitive performance (Learning and Memory, Response Speed, Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time) or symptom reporting were observed between group and individual settings.
• Rates of invalid performance did not differ between settings for the overall cohort.
• An interaction effect for invalid performance was noted in younger children (5-12 years) with ADHD, showing higher rates in group settings.

Conclusions:

• Standardized administration procedures and trained personnel result in comparable outcomes for group and individual baseline concussion assessments.
• Observed prior differences between settings may stem from variations in test administration and supervision, not the setting itself.
• Emphasizes the critical role of standardized procedures and adequate supervision in baseline concussion evaluations.