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While placebo effects are well recognized within clinical medicine, "nocebo effects" have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion. [ABSTRACT FROM AUTHOR]

If an examinee exerts inadequate effort to perform well during a psychological or neuropsychological exam, the resulting data will represent an inaccurate representation of the individual's true abilities and difficulties. In adult populations, methodologies to identify noncredible effort have grown exponentially in the last 2 decades. Though a comparatively modest amount of work has focused on tools to identify noncredible effort in pediatric populations, recent research has demonstrated that children can consistently pass several stand-alone symptom validity tests (SVTs) using cutoffs established with adults. However, no identified studies have examined the implications of pediatric SVT failure for ability-based test performance. The current sample consisted of 276 children aged 8-16 years referred consecutively for outpatient clinical neuropsychological consultation following mild traumatic brain injury (TBI). An earlier subgroup of this same case series that also included 17-year-olds was presented in Kirkwood and Kirk (2010). Nineteen percent of the current sample performed below the actuarial cutoff on the Medical Symptom Validity Test (MSVT). No background or injury-related variable differentiated those who passed from those who failed the MSVT. Performance on the MSVT was correlated significantly with performance on all ability-based tests and explained 38% of the total ability-based test variance. Participants failing the MSVT performed significantly worse on nearly all neuropsychological tests, with large effect sizes apparent across most tests. The results provide compelling evidence that practitioners should add objective SVTs to the evaluation of school-aged youth, even when secondary gain issues might not be readily apparent and particularly following mild TBI. (Contains 6 tables.)

Athletic concussion is a growing focus of attention for pediatricians. Although numerous literature reviews and clinical guidelines are now available pertaining to athletic concussion, few have focused on the pediatric athlete in particular. Sport-related concussions occur relatively frequently in children and adolescents, and primary health care providers are often responsible for coordinating clinical management. Here we summarize the scientific literature pertinent to the care of young athletes. We examine how concussion affects younger and older athletes differently at biomechanical, pathophysiological, neurobehavioral, and contextual levels. We also discuss important issues in clinical management, including preparticipation assessment, concussion evaluation and recovery tracking, and when and how to return pediatric athletes to play sports. We also briefly cover non-sportrelated interventions (eg, school support). With proper management, most children and adolescents sustaining a sport-related concussion can be expected to recover fully. Key Words concussion, mild traumatic brain injury, athletic injuries Abbreviations TBI--traumatic brain injury mTBI--mild traumatic brain injury PCS--postconcussive symptoms CISG--Concussion in Sport Group CSI--Concussion Symptom Inventory, OVER THE LAST 2 decades, sport-related concussion has received an increasing amount of popular and scientific attention. Because the athletic and financial stakes at the college and professional levels are […]

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures. [ABSTRACT FROM AUTHOR]