Postconcussive symptom exaggeration after pediatric mild traumatic brain injury.

Abstract:

BACKGROUND:A minority of pediatric patients who have mild traumatic brain injury (mTBI) report persistent postconcussive symptoms. In adults, failure on validity tests, which help to detect exaggerated or feigned problems, is associated with symptom complaints. No pediatric studies have examined the relationship between validity test performance and symptom report. We hypothesized that children failing a validity test would report significantly more postconcussive symptoms than those passing. METHODS:Using a consecutive clinical case series design, we examined 191 patients aged 8 to 17 years seen for neuropsychological evaluation after mTBI. Participants were administered a validity test (Medical Symptom Validity Test; MSVT) and completed a graded symptom scale as part of a neuropsychological battery. RESULTS:A total of 23 participants (12%) failed the MSVT. The Fail group endorsed significantly more postconcussive symptoms than the Pass group, with a large effect size (P < .001; d = 1.1). MSVT performance remained a robust unique predictor of symptom report even after controlling for other influential factors (eg, female gender, premorbid psychiatric problems). CONCLUSIONS:A subset of children who had persistent complaints after mTBI may be exaggerating or feigning symptoms. If such negative response bias remains undetected, errors in etiologic statements and less than optimal treatment may occur. Because the detection of invalid responding is well established in neuropsychology, clinical neuropsychologists should be incorporated routinely into clinical care for patients who have persistent complaints. To better control for noninjury effects in future pediatric mTBI studies, researchers should add validity tests to neurobehavioral outcome batteries.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Kirkwood MW,Peterson RL,Connery AK,Baker DA,Grubenhoff JA

doi

10.1542/peds.2013-3195

subject

Has Abstract

pub_date

2014-04-01 00:00:00

pages

643-50

issue

4

eissn

0031-4005

issn

1098-4275

pii

peds.2013-3195

journal_volume

133

pub_type

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