Encyclopedia of Psychology and Law

mTBIs (more likely in an athlete) can prolong and

complicate recovery. It should be noted that recovery

is slower after more severe TBIs, including compli-

cated mTBIs, and some individuals may suffer persist-

ing symptoms that impair social and occupational

functioning. What is expected, however, is that the vast

majority of individuals who suffer mTBI will com-

pletely recover and have no persistent difficulties

attributable to the injury.

Psychological Evaluation of mTBI

For an individual who has sustained an mTBI, the pur-

pose of a psychological evaluation varies. Some evalua-

tions may be within days or a few weeks after an

accident, in the context of seeking assistance with man-

agement of cognitive and behavioral symptoms, whereas

others may be years later in the context of a personal

injury lawsuit seeking recompense for the injury. In these

latter cases, it is unlikely that any observed deficits

would be due to the direct effects of the mTBI, and other

causes for these should be explored. In athletics, a series

of brief evaluations, with cognitive testing typically done

via computerized assessment, may be performed to assist

in return-to-play decisions.

The clinical evaluation of the individual who has

suffered an mTBI typically includes the following:

review of available psychological and/or medical

records, clinical interview with the patient, neuropsy-

chological or cognitive testing, and psychological test-

ing. Each of these is briefly described below. When

reviewing medical records, psychologists seek to obtain

as much information as possible about the nature and

extent of the injury, such as how the individual behaved

immediately after injury, whether there is any docu-

mented loss of consciousness, and whether there is any

posttraumatic amnesia. In addition, it is useful to know

if the individual suffered other injuries in the accident,

such as orthopedic injuries, which might affect out-

come. If possible, medical records predating the injury

can be obtained to determine if the individual had pre-

existing medical or psychological problems, such as

learning disabilities or perhaps a seizure disorder that

might affect recovery. The clinical interview with the

patient should focus on the nature and extent of the

injury, as well as the symptoms, including cognitive,

behavioral, and psychological, that the patient is cur-

rently experiencing. How such symptoms are interfer-

ing with the patient’s daily life is important. In addition

to such injury information, the clinical interview should

address the following: medical and psychiatric history,

prescribed medications, neurological history such as

previous TBIs or learning disabilities, substance abuse,

current stressors in addition to the injury, occupation

and social functioning, and litigation status. In such

an interview, it is important to attempt to rule out

alternative causes for the symptoms the person is expe-

riencing. For instance, complaints for difficulty concen-

trating post-mTBI may not be due to the injury per se

but to a preexisting anxiety disorder.

Because of the symptoms described above, evalua-

tion of the mTBI patient typically includes both

neuropsychological and psychological testing. Neu-

ropsychological testing should include use of

well-normed and psychometrically sound tests with

established reliability and validity. A battery of tests

should evaluate, at minimum, intelligence (e.g., Wechsler

Adult Intelligence Test–III), learning and memory (e.g.,

California Verbal Learning Test–II), attention (e.g.,

Conners’ Continuous Performance Test), visuospatial

processing (e.g., Judgment of Line Orientation), and

executive functioning (e.g., Wisconsin Card Sorting

Test). Other cognitive domains may need to be

assessed, including academic (e.g., Wide Range

Achievement Test) and sensory-motor functioning

(e.g., Finger Tapping Test), depending on the nature of

the referral and patient complaints.

In addition to evaluating specific areas of cognitive

functioning, it is important to evaluate the patient’s

effort or motivation, which may be suspect, particu-

larly in a forensic setting where there may be motive

for performing poorly (e.g., getting a larger monetary

settlement in a personal injury case or evading respon-

sibility in a criminal trial). If this is not done, impaired

cognitive performances may erroneously be attributed

to the mTBI and not to a patient’s poor effort. When

patients exert poor effort consciously for external

reward, this is termed malingering.Psychologists have

recently developed multiple cognitive tests to detect

malingering or poor effort that are efficient and accu-

rate. For instance, one commonly used test requires

patients to learn multiple word pairs (which appears

difficult) and then to recognize each of the words on

separate trials when a distractor word is presented.

Because the word pairs are so obvious (e.g., grass-

green), this test is actually quiet easy, and individuals

with serious neurological disorder or mental retardation

perform well on it. A poor performance in an individ-

ual with mTBI is suspicious for poor effort, and

performance on other cognitive testing is thus of

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