Assessing Preseason Baseline Cognitive Functioning in High School Student Athletes: A "Hybrid" Approach

Objective: International consensus statements highlight the value of neuropsychological testing for sport-related concussion. Computerized measures are the most frequently administered assessments of pre-injury baseline and post-injury cognitive functioning, despite known measurement limitations. To our knowledge, no studies have explored the convergent validity of computerized Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and traditional, well-validated paper and pencil (P&P) neuropsychological tests in high school student athletes. This study aimed to assess a "hybrid"adolescent test battery composed of ImPACT and P&P measures to determine the extent of shared variance among ImPACT and P&P tests to inform comprehensive yet streamlined assessment. Method: Participants included male and female high school student athletes in the Southeastern United States participating in American football, hockey, and soccer who completed a battery of ImPACT and P&P tests (N = 69). Results: We performed principal component analysis with ProMax rotation to determine components of the hybrid battery that maximally accounted for observed variance of the data (Kaiser-Meyer-Olkin factor adequacy = 0.71). Our analysis revealed four independent factors (Verbal Learning and Memory, ImPACT Memory and Speed, Verbal Processing Speed/Executive Functions, and Nonverbal Processing Speed/Executive Functions) explaining 75% of the variance. Conclusions: Findings of this study in adolescent student athletes support those from the adult literature demonstrating the independence of ImPACT and P&P tests. Providers should be aware of limitations in using standalone ImPACT or P&P measures to evaluate cognitive functioning after concussion. If confirmed in a larger, clinical sample, our findings suggest that a hybrid battery of computerized and P&P measures provides a broad scope of adolescent cognitive functioning to better inform recovery decisions, including return to play after concussion.