Multivariate base rates of potentially problematic scores on the NIH Toolbox Emotion Battery.

OBJECTIVE: To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB). METHOD: Participants (N = 753; ages 18-85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e., Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores. RESULTS: The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e., 18-49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity. CONCLUSIONS: Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized.

The Sport Concussion Assessment Tool: A multidimensional symptom model for detecting elevated post-concussion symptoms.

Objective: Investigate whether a four-factor model of post-concussion symptoms (i.e. cognitive, physical, affective, and sleep-arousal) aids in identifying student-athletes with persistent concerns not reflected by a total symptom score. Method: Collegiate student-athletes (N = 32,066) from the Concussion Assessment Research and Education consortium completed the Sport Concussion Assessment Tool, 3rd edition Symptom Evaluation at baseline and two post-injury follow-ups (i.e. beginning RTP and 6-month). Confirmatory factor analysis was used to compare a one- and four-factor model of post-concussion symptoms. Normative reference data were compared across stratifications (e.g. sex, prior concussions, and number of pre-existing conditions) using Mann-Whitney U tests, and elevation rates (i.e. ≥84th percentile) for subscales and the total score were recorded. Results: The four-factor model fit well before and after injury (CFIs > .95). Greater symptom severity on the subscale and total scores was associated with female sex (ps<.001, r range: .07 to .14) and more pre-existing conditions (ps<.001, η2 range: .01 to .04), while having more prior concussions was only related to total symptom scores (ps<.001, η2<.01). After a concussion, a sizeable portion of student-athletes (i.e., RTP = 11.8%; 6-month = 8.3%) had subscale elevations despite no total score elevation. Physical subscale elevations at RTP were the most common (i.e., 11.9%), driven by head and neck pain. Conclusion: After a sport-related concussion, a four-factor symptom model can be used to assess persistent symptoms in collegiate student-athletes. Identifying athletes with domain-specific elevations may help clinicians identify areas for further assessment and, in some cases, personalized rehabilitation plans.

Cognitive, Sleep-Arousal, Physical, and Affective Domain Scores on the Post-Concussion Symptom Scale: Added Utility in Detecting Symptom Elevations among Student-Athletes with a Remote History of Concussion.

OBJECTIVE: The evaluation of self-reported symptoms is a standard component of concussion assessment and management. Clinicians typically evaluate a total symptom severity score rather than scores corresponding to specific symptom domains (i.e., cognitive, sleep-arousal, physical, and affective symptoms). This study examined (i) whether elevations in specific symptom domains would be missed when interpreting only the total symptom severity score and (ii) if a single symptom domain elevation was more common than having elevated symptoms across multiple domains. METHOD: Adolescent student-athletes (N = 1,008) with concussion history (i.e., ≥6 months since last concussion) completed the Post-Concussion Symptom Scale (PCSS). The PCSS total score and cognitive, sleep-arousal, physical, and affective domain scores were calculated. To determine if symptoms were elevated, scores were compared to normative data matched on gender and pre-existing conditions, with scores considered elevated if they were ≥84th percentile. The frequency of total and domain score elevations were calculated and stratified by gender and number of prior concussions (i.e., 1 or ≥2 prior concussions). RESULTS: Overall, 26% of student-athletes had an elevated symptom domain score without being elevated on the total score. The most common symptom presentation was to have a single elevated symptom domain (21%), followed by two (11%), three (8%), or four elevated domains (6%). CONCLUSIONS: Interpreting PCSS symptom domains may be beneficial in detecting student-athletes with elevated symptoms following a remote concussion. Roughly a quarter of student-athletes have domain-specific symptom elevations that would be missed by interpreting the total score alone.

Test-Retest Reliability and Reliable Change on the NIH Toolbox Cognition Battery.

OBJECTIVE: Researchers and practitioners can detect cognitive improvement or decline within a single examinee by applying a reliable change methodology. This study examined reliable change through test-retest data from the English-language National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) normative sample. METHOD: Participants included adults (n = 138; age: M ± SD = 54.8 ± 20.0, range: 18-85; 51.4% men; 68.1% White) who completed test-retest assessments about a week apart on five fluid cognition tests, providing raw scores, age-adjusted standard scores (SS), and demographic-adjusted T-scores (T). RESULTS: The Fluid Cognition Composite (SS: ICC = 0.87; T-score: ICC = 0.84) and the five fluid cognition tests had good test-retest reliability (SS: ICC range = 0.66-0.85; T-score: ICC range = 0.64-0.86). The lower and upper bounds of 70%, 80%, and 90% confidence intervals (CIs) were calculated around change scores, which serve as cutoffs for determining reliable change. Using T-scores, 90% CI, and adjustment for practice effects, 32.3% declined on one or more tests, 9.7% declined on two or more tests, 36.6% improved on one or more tests, and 5.4% improved on two or more tests. CONCLUSIONS: It was common for participants to show reliable change on at least one test score, but not two or more test scores. Per an 80% CI, test-retest difference scores beyond these cutoffs would indicate reliable change: Dimensional Change Card Sort (SS ≥ 14/T ≥ 10), Flanker (SS ≥ 12/T ≥ 8), List Sorting (SS ≥ 14/T ≥ 10), Picture Sequence Memory (SS ≥ 19/T ≥ 13), Pattern Comparison (SS ≥ 11/T ≥ 8), and Fluid Cognition Composite (SS ≥ 10/T ≥ 7). The reliable change cutoffs could be applied in research or practice to detect within-person change in fluid cognition at the individual level.