Neurocognitive Concussion Test Performance for Student Athletes on the Autism Spectrum.

OBJECTIVE: To examine baseline neurocognitive functioning among adolescent athletes on the autism spectrum based on self-reported level of academic performance. METHOD: Participants in this cross-sectional, observational study were 6,441 adolescent athletes with a self-reported diagnosis of autism who completed pre-season neurocognitive testing using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT); 4,742 reported a co-occurring learning disorder (LD), and 6,612 individuals without autism or LD were included as a control group. The majority (57%) self-reported Average Academic Performance, 39% Above Average, and 4% Below Average performance. RESULTS: Athletes with self-reported autism (with or without LD; 12.2%) were 2.74x (95% CI: 2.17-2.82) more likely to fall below cutoffs for ImPACT Embedded Invalidity Indicators (EVIs), with a significant interaction between self-reported Diagnosis and Academic Performance; individuals with co-occurring autism and LD who reported Below Average Academic Performance had the greatest likelihood of scoring below cutoffs (22%), followed by ASD without LD (14.8%) and Controls (14.6%) with Below Average Academic Performance. Analyses of variance (ANOVAs) revealed main effects of Diagnosis and Academic Performance on neurocognitive performance, with interactions on all ImPACT Composite Scores except Processing Speed. CONCLUSION: Athletes with self-reported ASD are more likely to fall below ImPACT EVIs and score worse on ImPACT, with greater likelihood/worse performance related to level of academic functioning. Academic performance should be considered when interpreting neurocognitive testing data, to best index neuropsychological functioning associated with concussion in this population. The current findings highlight the importance of individual participant baseline neuropsychological testing for individuals on the autism spectrum.

Progesterone Levels in Adolescent Female Athletes May Contribute to Decreased Cognitive Performance During Acute Phase of Sports-Related Concussion.

Although many outcome studies pertaining to sports-related concussion exist, female athletes with concussion remain an understudied group. We examined whether neurocognitive performance in adolescent females with sports-related concussion (SRC) is related to menstrual cycle-related hormone levels measured at one-week post-concussion, one-month post-concussion, or both. Thirty-eight female athletes, ages 14-18, were matched into two groups: SRC or healthy control. Self-reported symptom scores were higher among concussed females in the luteal phase, when progesterone levels are highest. Results suggest that progesterone levels may contribute to a heightened experience of symptoms during the acute phase of SRC, providing further evidence of a possible link between progesterone and symptom scores following concussion.

The prevalence and correlates of scores falling below ImPACT embedded validity indicators among adolescent student athletes.

Objective: Valid performance on preseason baseline neurocognitive testing is essential for accurate comparison between preseason and post-concussion test results. Immediate Post-Concussion and Cognitive Testing (ImPACT) is commonly used to measure baseline neurocognitive function in athletes. We examined the prevalence of invalid performance on ImPACT baseline testing and identified correlates of invalid performance. Method: The sample included 66,998 adolescents (ages 14-18, M = 15.51 years, SD = 1.22) who completed ImPACT baseline tests between 2009 and 2019. Invalid performance was determined by the embedded validity indicators (EVI). Associations between invalid performance, demographic characteristics, and health conditions were assessed using chi-square tests and odds ratios (ORs). Results: Overall, 7.2% of adolescents had baseline tests identified as invalid by one or more of the EVIs. Individual validity indicators classified between 0.5% and 3.7% tests as invalid. Higher frequencies of invalid scores were observed among youth with neurodevelopmental, academic, and medical conditions. Youth who reported having learning disabilities (n = 3126), receiving special education (n = 3563), or problems with attention-deficit/hyperactivity disorder (ADHD; n = 5104) obtained invalid baselines at frequencies of 16.4%, 16.0%, and 11.1%, respectively. Moreover, youth who reported receiving treatment for a substance use disorder (n = 311) or epilepsy (n = 718) obtained invalid baselines at frequencies of 17.0% and 11.1%, respectively. Conclusions: The base rate of invalid performance on ImPACT's EVIs was approximately 7%, consistent with prior research. Adolescents self-reporting neurodevelopmental conditions, academic difficulties, or a history of treatment for medical conditions obtained invalid baseline tests at higher frequencies. More research is needed to better understand invalid scores in youth with pre-existing conditions.

Reliable Change Indices for the Serial Administration of the Concussion Clinical Profiles Screening Tool.

CONTEXT: The Concussion Clinical Profiles Screening Tool (CP Screen) self-report concussion symptom inventory is often administered at weekly intervals. However, 1-week reliable change indices (RCIs) for clinical cutoffs and the test-retest reliability of the CP Screen are unknown. OBJECTIVE: To document RCI cutoff scores and 1-week test-retest reliability for each profile and modifier of the CP Screen for men and women. DESIGN: Case series. SETTING: A large US university. PATIENTS OR OTHER PARTICIPANTS: One hundred seventy-three healthy college students. MAIN OUTCOME MEASURE(S): Participants completed 2 administrations of the CP Screen 7 days apart. The CP Screen items yielded 5 clinical profiles and 2 modifiers. Spearman ρ coefficients (rs), intraclass correlation coefficients (ICCs), single measures, and unbiased estimates of reliability (UERs) were used to assess test-retest reliability. Wilcoxon signed-rank tests assessed differences across time. Reliable change index values and cutoff scores are provided at 90%/95% CIs. All analyses were performed for the total sample and separately for men and women. RESULTS: Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for men were as follows: ocular, vestibular >2/>4; anxiety/mood, cognitive/fatigue, and migraine >3/>3; sleep >4/>6; and neck >2/>2. Reliable change index cutoffs for clinically significant change (increase/decrease) at a 90% CI for women were as follows: anxiety/mood ≥2/≥4; cognitive/fatigue, migraine, ocular, vestibular, and sleep ≥3/≥3; and neck ≥1/≥1. Correlations for the CP Screen ranged from 0.51 (migraine) to 0.79 (anxiety/mood) for the total sample, from 0.48 (migraine) to 0.84 (vestibular) for men, and from 0.51 (migraine) to 0.77 (ocular) for women. Test-retest indices for each profile and modifier were moderate to good for the total sample (ICC, 0.64-0.82; UER, 0.79-0.90), men (ICC, 0.60-0.87; UER, 0.76-0.94), and women (ICC, 0.64-0.80; UER, 0.78-0.89). CONCLUSION: The CP Screen is reliable and stable across a 1-week interval, and established RCIs for men and women can help identify meaningful change throughout recovery.

Sports Neuropsychologists' Ratings of Clinical Criteria Used to Help Determine Concussion Recovery: A Brief Survey Report.

OBJECTIVE: To identify criteria used by sports neuropsychologists in determining recovery following sport-related concussion. METHODS: Forty-six sports neuropsychologists completed a custom survey, rating the importance of specific criteria for determining concussion recovery in youth versus adults. Percentages and modal ratings were documented. RESULTS: "Back to work/school without accommodations," "No headache after neurocognitive testing," "Feeling 100% back to normal," and "No symptoms after noncontact exertion" were rated highest for youth and adults. "Physician examination without concerns" and "Balance testing" were the two lowest rated items for both youth and adults. For youth, "sufficient" amount of time symptom-free needed for recovery was seen as longer than for adults. CONCLUSIONS: There was some similarity in how sports neuropsychologists determine concussion recovery for both adults and youth. Future studies should include a larger sample size and concussion experts from other specialties to identify the current multidisciplinary standard of care.

Understanding racial differences in computerized neurocognitive test performance and symptom-reporting to deliver culturally competent patient-centered care for sport-related concussion.

OBJECTIVE: This study examined neurocognitive performance and symptoms between concussed Black and White collegiate athletes at baseline, post-injury, and change from baseline to post-injury. METHOD: The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) was used to measure neurocognitive performance and four concussion symptom clusters for 235 concussed collegiate athletes. Between-groups differences were documented at baseline and post-injury, along with change in scores for sex/race, and sport/race groups, using ANOVAs. Baseline scores, and days-to-post-test were covariates in post-injury comparisons. Symptom endorsement by race was evaluated using chi-square analyses. RESULTS: At baseline, group comparisons by race and sex showed that Black male/female athletes scored lower on reaction time (RT; p = .008), White females scored higher on verbal memory (VerbMem; p = .001), Black females scored lower on visual motor processing speed (VMS; p = .001), and Black football athletes scored slower/poorer on RT (p = .001) and VMS (p = .006). Post-injury, Black males scored lower on visual memory (VisMem; p = .005) and VMS (p = .002), and Black football athletes scored slower on VMS (p = .005), whereas White non-football athletes scored higher on VerbMem (p = .002) and reported fewer symptoms. Significant time-by-sport/race interactions were found for VerbMem (p < .001), VisMem (p < .001) and reported symptoms. With respect to post-injury symptom scores/endorsement, Black athletes scored significantly higher for physical (p = .01) and sleep (p = .01) symptoms. CONCLUSION: These findings drive the conversation of how subjective measures of symptoms, and objective clinical concussion measures, may relate to the concussion recovery process and providing a culturally competent clinical management approach for diverse patients.

Information seeking behaviors and attitudes of wives of former football players regarding chronic traumatic encephalopathy.

This study examines CTE-related knowledge and information-seeking behaviors of caregivers of persons who are at high risk of CTE. Online survey responses were collected from 64 females, ages 18-74, who were married to former college, semiprofessional, or professional football players and were fluent in English. Ranging from 0 to 18, a score was calculated to represent level of CTE knowledge. Participants were classified into groups based on their spouse's reported symptoms and diagnosis. Approximately 87% of participants reported that their spouses have been diagnosed with a football-related concussion and were significantly more likely to seek out information from a healthcare provider, a scientific journal or article, and post/comment on social media compared to spouses of symptomatic/undiagnosed and non-symptomatic groups. Participants reported 77% of available information as probably true, with social media thought to be highly credible. Highest levels of dissatisfaction were reported for league-sponsored websites and physicians/healthcare providers. Although the majority of participants sought CTE related information on regular or social media, and the internet, information sources differed amongst the groups. These findings may help healthcare providers and organizations develop more effective health-related educational programs that will help the wives make informed decisions regarding care for their spouses with respect to CTE.

The Frequency of Low Scores on ImPACT in Adolescent Student-Athletes: Stratification by Race and Socioeconomic Status Using Multivariate Base Rates.

This study examined the associations between the frequency of low scores on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) by race and socioeconomic status (SES), using the proxy of Title I school status, among adolescent student-athletes and calculated multivariate base rates. There were 753 participants assigned to groups based on race (White: n = 430, 59.8%; Black: n = 289, 40.2%) and SES. Black student-athletes obtained more low neurocognitive test scores, which was associated with lower SES. The current study offers a resource to clinicians involved in concussion management who may wish to consider race and SES when interpreting ImPACT test performances.

Using change scores on the vestibular ocular motor screening (VOMS) tool to identify concussion in adolescents.

OBJECTIVE: To develop clinical cutoffs using change scores for the VOMS individual items and an overall VOMS change score that identified concussion in adolescent athletes. METHODS: Change score clinical cutoffs were calculated from a sample of adolescents (13-18 years) with SRC (n = 147) and a sample of uninjured adolescents CONTROL (n = 147). Receiver operating characteristic (ROC) curves, with area under the curve (AUC), based on Youden's J statistic were used to identify optimal cutoffs for identifying SRC from CONTROLS using VOMS individual item change scores, an overall VOMS change scores, and NPC distance (cm). RESULTS: AUC values for VOMS item change scores ranged from .55 to .71. Optimal change score cutoffs were ≥1 for VOMS items and ≥3 for overall VOMS change score. The optimal cutoff for NPC distance was ≥3 cm. A ROC analysis revealed a three-factor model (AUC = .76) for identifying SRC that included vertical vesibular ocular reflex (VVOR), visual motion sensitivity (VMS), and NPC distance items. The AUC (.73) for the overall VOMS change score was higher than any individual VOMS AUC values. CONCLUSIONS: This study supports an alternate scoring approach and clinical interpretation of VOMS items involving change scores that account for pretest symptoms.

Norm-Based Cutoffs as Predictors of Prolonged Recovery After Adolescent Sport-Related Concussion.

OBJECTIVES: To identify predictors of prolonged recovery (ie, >28 days) using patient demographic factors and healthy, norm-based cutoffs on a multimodal test battery in adolescents after sport-related concussions (SRCs). DESIGN: Retrospective cohort. Patients were deemed recovered after successful completion of return-to-play/school protocols and received medical clearance. SETTING: Community concussion clinic. PATIENTS: Male and female adolescent student athletes diagnosed with a SRC and evaluated within 1 week of injury. INDEPENDENT VARIABLES: Patient demographics, medical history, injury description, computerized neurocognitive testing, vestibular/ocular testing, and symptoms at initial clinical visit. MAIN OUTCOME MEASURES: Performance on clinical testing to predict recovery duration, classified as normal (<28 days) or prolonged (>28 days). RESULTS: A total of 201 adolescent student athletes (age = 15.3 ± 1.4 years) were included (female 35%). Average recovery duration for the entire cohort was 22.3 ± 13.3 days, with 22% (n = 45) of adolescent student athletes taking >28 days to recover. The final model was 88.3% accurate in classifying normal and prolonged recovery. Predictor variables included sex, loss of consciousness, history of ocular disorder, history of concussion, performance on visual motor speed composite, visual motion sensitivity symptom provocation and near point of convergence distance, number-naming total time, and symptom count. CONCLUSIONS: These findings suggest that using norm-based cutoffs from cognitive, oculomotor, and vestibulo-ocular testing and symptom reporting, clinicians can accurately predict a prolonged recovery (sensitivity = 81%) and normal recovery (specificity = 83%) in an adolescent, SRC cohort.

A Cross-Cultural Examination of Parental Knowledge of Concussion in Three Countries.

The aim of the present study was to examine and compare knowledge regarding concussion among parents of youth soccer players, ages 5-17, from the United States, Israel, and Sicily. Results revealed parents from the United States were more knowledgeable than Israeli and Sicilian parents and were more likely to have a previous history of concussion in their children, themselves, and their social contacts. The success of concussion education, programming, and legislation in the US may account for the greater knowledge of US parents and is reason to advocate for similar resources for youth athletes internationally.

Comparing Patient- and Clinician-Administered Near Point of Convergence After Concussion.

OBJECTIVE: (1) To compare patient- and clinician-administered measurements of near point of convergence (NPC) distance including the percentage of patients exceeding clinical cutoffs among concussed adolescents and (2) to assess the reliability of patient- and clinician-measured NPC distances. METHODS: A total of 762 patients (mean = 15.51, SD = 3.09 y) within 30 days of concussion participated. The NPC distance was measured consecutively with the patient and clinician controlling the fixation target. The differences between patient (PT) and clinician (CLIN) measurements and cases exceeding cutoffs (ie, ≥5 cm) were examined with a series of t tests and chi-square tests, respectively. Intraclass correlation coefficients and unbiased estimate of reliability were performed. RESULTS: The NPC measurements were similar, t(761) = -.26, P = .79, between the PT (mean = 3.52, SD = 3.77 cm) and CLIN (mean = 3.54, SD = 3.97 cm) conditions. The number of measurements that exceeded cutoffs was similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10), and the number of measurements classified as abnormal/invalid was also similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10). There was excellent reliability between the methods (intraclass correlation coefficients = .85, unbiased estimate of reliability = .92). CONCLUSION: The findings support the application of this assessment in clinical settings where the clinician may not have direct contact with their patient and rely on the patient (eg, telehealth).

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury.

Health factors impacting both the occurrence of, and recovery from traumatic brain injury (TBI) vary in complexity, and present genuine challenges to researchers and healthcare professionals seeking to characterize injury consequences and determine prognosis. However, attempts to clarify causal links between injury characteristics and clinical outcomes (including mortality) often compel researchers to exclude pre-existing health conditions (PECs) in their samples, including psychiatric history, medication usage, and other comorbid conditions. In this pre-registered population-based study (total starting n = 939,123 patients), we examined trends in PEC incidence over 22 years in the state of Pennsylvania (1997-2019) in individuals sustaining TBI (n = 169,452) and individuals with orthopedic injury (n = 87,637). The goal was to determine how PECs interact with age and injury severity to influence short-term outcomes. A further goal was to determine whether number of PECs, or specific PEC clusters contributed to worse outcomes within the TBI cohort, compared with orthopedic injury alone. Primary findings indicate that PECs significantly influenced mortality within the TBI cohort; patients having four or more PECs were associated with approximately a two times greater likelihood of dying in acute care (odds ratio [OR] 1.9). Additionally, cluster analyses revealed four distinct PEC clusters that are age and TBI severity dependent. Overall, the likelihood of zero PECs hovers at ∼25%, which is critical to consider in TBI outcomes work and could potentially contribute to the challenges facing intervention science with regard to reproducibility of findings.

Compliance with State Concussion Legislation in Non-School-Affiliated Youth Sport Leagues.

Youth league administrators (N = 172) documented knowledge of/compliance with state concussion legislation, and were assigned to groups based on whether their state concussion legislation extended to non-school-affiliated (NSA) youth sport leagues: EXTEND (50.6%) or NOT EXTEND (49.4%). Administrators within the EXTEND group were 2.7x more likely to report having a formal concussion policy. Only 90.7% confirmed a policy for removing concussed athletes from play, and 75% required independent medical clearance, and 82% mandated education for coaches, 49.1% for parents, and 35.9% for athletes. These results raise questions regarding compliance with state concussion legislation, especially for NSA youth sports leagues.

Cross-cultural exploration of baseline ImPACT Quick Test performance among football athletes in Zambia.

OBJECTIVE: Concussion is a global sport injury; however, this public health issue has yet to be studied across Africa. It is unknown if tests such as the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) Quick Test (QT) are culturally appropriate for implementation as part of a concussion screening protocol in Zambia or other African nations. Study objectives included: 1) establish that Zambian athletes are able to complete the iPad-based ImPACT QT with respect to language or cultural barriers that may exist, and 2) document baseline neurocognitive percentile ranks among Zambian football athletes on the ImPACT QT. METHODS: This study was completed with adult premiere league football athletes in Zambia (n = 125) aged 24.48 ± 5.41. Participants completed the ImPACT QT neurocognitive assessment prior to a preseason practice. Outcome measures were average performance on 3 factor scores: Motor Speed, Memory, and Attention Tracker, presented as percentile ranks using normative data built-into the ImPACT QT. RESULTS: Zambian athletes scored nearly two standard deviations below the mean on Motor Speed (7th percentile), using North American normative data. However, performance on Attention Tracker (44th percentile) and Memory (56th percentile) was within the average range. CONCLUSION: Results of the current study show that Zambian athletes are able to complete the ImPACT QT, despite any language or cultural differences that may exist. In addition, preliminary percentile ranks suggest Zambian football athletes have average scores on Attention and Memory and below average scores on Motor Speed. These data are the first to explore Zambian athletes' performance on a cognitive concussion measure.

Test Order Does Not Affect Vestibular/Ocular Motor Screening Item Scores in High School Athletes.

OBJECTIVE: To compare VOMS item scores between a fixed and randomized administration order in a sample of nonconcussed high school athletes. DESIGN: Post-test only, quasi-experimental design. SETTING: Local high schools in a mid-west region of the United States. PATIENTS: Fifty nonconcussed high school athletes (M = 15.64; SD = 1.12 years) completed the VOMS in a randomized testing order (RANDOM), and 49 (M = 15.64; SD = 1.12 years) completed the VOMS in the fixed testing order (FIXED). The groups were matched on age, sex, learning disorder, attention-deficit/hyperactivity disorder, concussion history, and baseline concussion symptoms. INTERVENTIONS: The Vestibular/Ocular Motor Screening (VOMS) tool comprises pretest symptoms, smooth pursuit (SP), horizontal/vertical saccade (HSAC/VSAC), average near-point of convergence (NPC) distance, convergence symptoms, horizontal/vertical vestibular ocular reflex (HVOR/VVOR), and visual motion sensitivity (VMS). MAIN OUTCOME MEASURES: Mann-Whitney U tests were performed to examine differences between FIXED and RANDOM groups on VOMS items. RANDOM scores were rearranged in order of administration and combined with the FIXED group scores, and a Freidman test was performed for repeated measures. RESULTS: There were no significant differences between FIXED and RANDOM groups on VOMS pretest symptoms (U = 1171, P = 0.57), SP (U = 1122.5, P = 0.35), HSAC (U = 1128.5, P = 0.44), VSAC (U = 1055.5, P = 0.16), convergence symptoms (U = 1129.0, P = 0.41), average NPC distance (U = 979.0, P = 0.06), HVOR (U = 1085.0, P = 0.25), VVOR (U = 1126.0, P = 0.41), and VMS scores (U = 1101.0, P = 0.32). When VOMS items were rearranged and the sample was combined, there were no differences for repeated measures [χ2 (6) = 9.92, P = 0.13]. CONCLUSIONS: There were no significant differences on VOMS items between FIXED and RANDOM groups for repeated measures. The testing order of VOMS items does not affect VOMS scores in nonconcussed high school athletes.

Establishing Test-Retest Reliability and Reliable Change for the King-Devick Test in High School Athletes.

OBJECTIVE: To establish test-retest reliability in nonconcussed high school athletes and compare absolute change, reliable change indices (RCIs), and minimal detectable change (MDC) methods for classifying impairment after sport-related concussion. DESIGN: Prospective, repeated measures. SETTING: High schools from the Midwest and Central regions of the United States. PARTICIPANTS: A convenience sample of 772 nonconcussed high school athletes (n = 546 men) completed preseason K-D testing. In addition, 69 athletes completed a second postseason K-D test, and 54 athletes sustained a concussion and completed postconcussion K-D tests. INTERVENTION: K-D test. MAIN OUTCOME MEASURES: Data for age, sex, and concussion history were determined using preseason K-D test outcomes. Test-retest reliability, RCIs, and MDCs were calculated using postseason K-D tests (M = 98.9, SD = 9.1 days). Postinjury K-D assessments within 5 days of injury (M = 1.5, SD = 1.5 days) were used to classify impairment on K-D using absolute change, RCI, and MDC methods. RESULTS: Significant effects for age (P < 0.001) and history of concussion (P = 0.001) were supported on baseline K-D time, with no sex differences (P = 0.21). Preseason to postseason reliability for K-D times was 0.60 (intraclass correlation coefficient, 95% CI, 0.43-0.73), although 38% of athletes exhibited slower postseason K-D times compared with baseline. Impairment on K-D exhibited for 72% of the concussed sample using absolute change, 48% using MDC, and 44% using RCI methods. CONCLUSIONS: K-D exhibited moderate test-retest reliability across 1 season. Absolute change yielded the highest sensitivity for preinjury to postinjury impairment on the K-D compared with RCI and MDC methods.

Comparing Before- and After-School Neurocognitive Performance in High School Athletes: Implications for Concussion Management.

OBJECTIVE: To compare before- and after-school neurocognitive performance and total symptoms in a sample of nonconcussed high school athletes. DESIGN: Repeated-measures, counterbalanced design. SETTING: Midwest high schools. PARTICIPANTS: Thirty-nine nonconcussed high school athletes. INTERVENTIONS: The Immediate Post-Concussion Assessment and Cognitive Testing battery was administered before and after school in a counterbalanced testing order. MAIN OUTCOME MEASURES: Neurocognitive and total symptom scores. RESULTS: Paired-sample t tests revealed no significant differences in verbal memory (P = 0.43), visual memory (P = 0.44), processing speed (P = 0.94), reaction time (P = 0.16), or total symptoms (P = 0.52) between before- and after-school testing sessions. CONCLUSIONS: The results of this study expand on best practice guidelines for baseline and postinjury concussion computerized neurocognitive testing and symptom report administration. This study suggests that sports medicine professionals can administer computerized neurocognitive testing before or after school without concern of confounding factors affecting performance or total symptoms.

Relationship between Standalone Performance Validity Test Failure and Emotionality among Youth/student Athletes Experiencing Prolonged Recovery following Sports-related Concussion.

This study documented the rate of Performance Validity Testing (PVT) failure in 81 youth athletes, aged 10-21 years, experiencing prolonged recovery following sports-related concussion, and the relationship between PVT and emotional symptoms. Neuropsychological assessments were conducted across three test sessions with a stand-alone PVT at each session. Results showed that 48% (39/81) of individuals failed at least one PVT, with an overall PVT failure rate of 26% (64/243). Those failing at least one PVT scored significantly higher on anxiety but not depression or somatization. Results illustrate the importance of including measures of emotional and behavioral functioning in testing following SRC.

Brief iPad-Based Assessment of Cognitive Functioning with ImPACT® Quick Test: Prevalence of Low Scores Using Multivariate Base Rates.

OBJECTIVE: The ImPACT® Quick Test is a brief iPad-based battery of neurocognitive tests that has been standardized on a sample of children, adolescents, and adults (ages 12-70). This study provides information on the prevalence of ImPACT® Quick Test scores falling below specific percentiles in the normative sample to aid in clinical interpretation and reduce the risk of over-interpreting, or misinterpreting, a single low score. METHOD: Participants were 683 individuals ranging in age from 12 to 70, who were assessed individually. The ImPACT® Quick Test includes five subtests, contributing to three factor scores: motor speed, memory, and attention tracker. The prevalence of low factor scores, stratified by age and sex, were calculated using multivariate base rates. RESULTS: In the total sample, obtaining 1 or more scores below the 25th percentile was common (base rate, BR = 47.2%), but obtaining 2 or more scores in this range was uncommon (BR = 15.3%). Similarly, obtaining 1 or more scores below the 16th percentile was common (BR = 31.4%), but obtaining two or more scores in this range was uncommon (BR = 6.9%). There were small differences in BRs between sexes and the number of low scores was fairly similar across the age groups. CONCLUSION: Results from this study parallel previous work illustrating that a substantial percentage of healthy individuals will obtain one or more low test scores when administered a brief battery of cognitive tests. Given that some healthy individuals will obtain a single score below expected cut-offs, clinicians should caution against overinterpreting a single low test score.