| Concussions make up a large portion of sports-related injuries. Research has identified a distinct pathophysiology and quantified mild, transient cognitive deficits associated with concussion. One method of monitoring concussion symptoms and informing return-to-play decisions in sports is preseason baseline neurocognitive testing that can be compared with postconcussion testing results. However, individuals are at greater risk of producing uninterpretable results when there is potential for external gain. Performance validity tests were developed to identify invalid testing data and are strongly supported in the neuropsychological community. The current study evaluated the embedded performance validity indicators of the ImPACT, the most widely used computerized baseline and post-concussion assessment tool, using a three-group simulation design. The Victoria Symptom Validity Test (VSVT) was also administered for comparison with the ImPACT's indicators. The ImPACT's five standard validity indicators were only moderately sensitive to intentionally poor performance. A combination of 9 indicators provided better sensitivity and perfect specificity, while the classification characteristics of the Word Memory Correct Distractors score was comparable to the VSVT. Thus, the ImPACT's standard validity indicators are insufficient for detecting intentionally poor performance. Further research must be conducted before other embedded alternatives are employed, and a stand-alone performance validity test should be administered during baseline testing until that time. Suggestions for improving performance validity research with the ImPACT are provided. |
