The Relation Between Testing Environment and Baseline Performance in Child and Adolescent Concussion Assessment

Am J Sports Med. 2014 Jul;42(7):1716-23. doi: 10.1177/0363546514531732. Epub 2014 Apr 30.


Background: Previous research has demonstrated differences in cognitive performance when baseline concussion assessment is performed in a group versus an individual setting. Accurate baseline assessment is imperative when such data are used to make clinical decisions regarding cognitive and symptom recovery after concussion.

Hypothesis: The use of similar standardized test administration procedures and test conditions across group and individual settings results in no differences in cognitive performance or symptom reporting.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 939 participants (aged 5-18 years), including 313 tested individually and 626 tested in a group setting, matched on age, sex, and attention-deficit/hyperactivity disorder status, were administered concussion baseline assessment using the desktop version of the Immediate Post-Concussion Assessment and Cognitive Testing and a new pediatric measure, the Multimodal Assessment of Cognition & Symptoms for Children. Cognitive performance, symptom reports, and rates of invalid performance were compared between settings.

Results: No significant differences were found between individual and group testing settings for the age-based Learning and Memory Accuracy composite and Response Speed composite standard scores on the Multimodal Assessment of Cognition & Symptoms for Children. Accounting for age and sex, adolescents' performance on the Immediate Post-Concussion Assessment and Cognitive Testing revealed no differences between settings on the 4 composite raw scores (Verbal Memory, Visual Memory, Visual Motor Speed, and Reaction Time). Furthermore, symptom reporting was similar between settings on both measures. Rates of invalid performance did not differ between the 2 administration groups for either age group. There was an interaction effect for invalid performance between attention-deficit/hyperactivity disorder and setting in younger children (aged 5-12 years), with higher rates of invalid performance for children in the group setting with attention-deficit/hyperactivity disorder compared with those without, although there were no differences in the individual setting.

Conclusion: In this sample, children given a baseline assessment in a group setting performed no differently than children tested individually when standardized administration procedures were used by trained test administrators. Previous evidence suggesting differences between settings may be attributable to the variability in test administration and supervision rather than the environment itself. The importance of standardized procedures and proper supervision during baseline concussion assessment is supported by these findings.

Keywords: baseline testing; computerized testing; concussion testing; neurocognitive testing.

MeSH terms

  • Adolescent
  • Athletes / psychology
  • Athletic Injuries / complications*
  • Athletic Injuries / diagnosis
  • Brain Concussion / complications*
  • Brain Concussion / diagnosis
  • Child
  • Cohort Studies
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Neuropsychological Tests
  • Post-Concussion Syndrome / diagnosis*
  • Post-Concussion Syndrome / etiology*
  • Recovery of Function
  • Sports