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Some Youths May Be Exaggerating Postconcussive Symptoms, Study Suggests

After suffering a concussion, some youths may feign or exaggerate their persistent symptoms, suggests a study published online today in the journal Pediatrics.

To assess the persistence of youths' concussion symptoms, researchers examined 191 patients between the ages of 8 and 17. All were run through a battery of neuropsychological tests, including a performance-validity test (called the "Medical Symptom Validity Test"), which is a computerized verbal-memory test that can be passed by children with a second- to third-grade reading level. The youths underwent these tests a median of six weeks after their injury, no earlier than one week-post injury, and no later than 52 weeks post-injury.

The researchers compared the results of these tests to the self-reported symptoms from each child to determine whether some children were exaggerating their lingering symptoms.

Of the 191 youths who completed the performance-validity test, 168 passed and 23 failed. The "fail" group reported significantly more lingering symptoms than the "pass" group, including headaches, trouble remembering, sensitivity to bright lights, dizziness, trouble paying attention, "feeling in a fog," and sensitivity to loud noises.

Based on these findings, the authors concluded that "some meaningful percentage of school-aged children and adolescents demonstrate noncredible neuropsychological test performance." 

"Although it is possible that certain children failed the MSVT but still provided valid symptom reports," the authors write, "we believe this is fairly unlikely in most cases given that a strong relationship exists between invalid performance-based test data and invalid self-report data in comparable adult studies." Previous research has suggested that certain children feign concussion symptoms to get out of schoolwork or sports, or due to a host of psychological factors (such as depression).

"The results provided compelling evidence that objective [performance validity tests] should be added to the neuropsychological evaluation of school-aged youth" who have suffered concussions, the authors conclude.

They warn, however, that when determining whether a child is feigning or exaggerating concussion symptoms, medical professionals should utilize more than simply performance-validity-test results. The child's developmental, medical, educational, and environmental background must also be considered, they write.

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