Invalid Baseline Testing with ImPACT: Does Sandbagging Occur with High School Athletes?

Area of Science:

• Neuropsychology
• Sports Medicine
• Adolescent Health

Background:

• ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is widely used for high school athletes.
• Baseline testing accuracy is crucial for post-concussion evaluation and return-to-play decisions.
• Concerns exist regarding the validity of baseline neurocognitive test scores in adolescent populations.

Purpose of the Study:

• To determine the frequency of valid, invalid, and sandbagging scores in ImPACT baseline tests among high school athletes.
• To compare baseline-to-postconcussion cognitive changes between athletes with valid baseline scores and those with invalid or sandbagging scores.

Main Methods:

• Retrospective analysis of ImPACT baseline test scores from 6,346 high school athletes.
• Identification of invalid scores using embedded Invalidity Indicators and sandbagging scores using specific red flags.
• Evaluation of postconcussion scores for 266 athletes to compare cognitive changes.

Main Results:

• Over half of athletes (51.99%) had valid baseline scores.
• A significant proportion exhibited invalid (4.24%) or sandbagging (47.42%) scores.
• Statistically significant differences were observed in baseline-to-postconcussion changes between valid and invalid/sandbagging scorers.

Conclusions:

• The high prevalence of invalid and sandbagging scores suggests widespread underperformance in baseline ImPACT testing.
• Improved test administration procedures are necessary to ensure maximal effort and attention from athletes.
• Clinicians should exercise increased caution when using the baseline-to-postconcussion paradigm for return-to-play decisions.