title: Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT.
abstract: BACKGROUND
  Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs.
  
  
  OBJECTIVE
  To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT).
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers' standard criteria.
  
  
  RESULTS
  The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes.
  
  
  CONCLUSIONS
  The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders).
  
  
  CONCLUSIONS
  The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA linelson@mcw.edu.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Nelson
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Adam Y
authors.initials: AY
authors.lastname: Pfaller
authors.affiliation: Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Rein
authors.affiliation: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McCrea
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000523:psychology*; D001265:Athletic Injuries / Q000175:diagnosis / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications; D001924:Brain Concussion / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D013334:Students / Q000523:psychology; D055815:Young Adult
keywords: ANAM; Axon Sports; ImPACT; baseline testing; computerized testing; concussion; mild traumatic brain injury; neurocognitive testing; validity