Influence of poor effort on self-reported symptoms and neurocognitive test performance following mild traumatic brain injury

J Clin Exp Neuropsychol. 2010 Apr;


Lange, R. T., G. L. Iverson, B. L. Brooks and V. L. Rennison.



When considering a diagnosis of postconcussion syndrome, clinicians must systematically evaluate and eliminate the possible contribution of many differential diagnoses, comorbidities, and factors that may cause or maintain self-reported symptoms long after mild traumatic brain injury (MTBI). One potentially significant contributing factor is symptom exaggeration. The purpose of the study is to examine the influence of poor effort on self-reported symptoms (postconcussion symptoms and cognitive complaints) and neurocognitive test performance following MTBI. The MTBI sample consisted of 63 referrals to a concussion clinic, evaluated within 5 months post injury (M = 2.0, SD = 1.0, range = 0.6-4.6), who were receiving financial compensation from the Workers’ Compensation Board. Participants completed the Post-Concussion Scale (PCS), British Columbia Cognitive Complaints Inventory (BC-CCI), selected tests from the Neuropsychological Assessment Battery Screening Module (S-NAB), and the Test of Memory Malingering (TOMM). Participants were divided into two groups based on TOMM performance (15 fail, 48 pass). There were significant main effects and large effect sizes for the PCS (p = .002, d = 0.79) and BC-CCI (p = .011, d = 0.98) total scores. Patients in the TOMM fail group scored higher than those in the TOMM pass group on both measures. Similarly, there were significant main effects and/or large effect sizes on the S-NAB. Patients in the TOMM fail group performed more poorly on the Attention (p = .004, d = 1.26), Memory (p = .006, d = 1.16), and Executive Functioning (p > .05, d = 0.70) indexes. These results highlight the importance of considering the influence of poor effort, in conjunction with a growing list of factors that can influence, maintain, and/or mimic the persistent postconcussion syndrome.

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