• Robert J Spencer, Brigid Waldron-Perrine, Lauren L Drag, Percival H Pangilinan, Bradley N Axelrod, and Linas A Bieliauskas.
• a Department of Mental Health Services , VA Ann Arbor Healthcare System , Ann Arbor , MI , USA.
• Brain Inj. 2017 Jan 1; 31 (1): 32-38.

ObjectiveThis study explored the utility of combining data from measures of performance validity and symptom validity among Veterans undergoing neuropsychological evaluation for mild traumatic brain injury (mTBI).BackgroundPersistent cognitive impairments following mTBI are often reported by returning combat veterans. However, objectively-measured cognitive deficits are not common among individuals with mTBI, raising the question of whether negative impression management influences self-ratings.MethodsSelf-report ratings were obtained for memory, concentration, decision-making, and processing speed/organization using a 5-point scale ranging from 'none' to 'very severe'. Veterans also completed brief neuropsychological testing which included measures of performance validity.ResultsStudy 1 examined data from 122 participants and demonstrated that veterans reporting a 'very severe' cognitive deficit were over three times as likely to demonstrate poor effort on a validity test than those without a very severe rating. Study 2 replicated these findings in an independent sample of 127 veterans and also demonstrated that both severity of self-report ratings and performance on an embedded measure of effort were predictive of poor effort on a stand-alone performance validity test.ConclusionVeterans with suspected mTBI who report 'very severe' cognitive impairment have a greater likelihood of putting forth sub-optimal effort on objective testing.

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