29. Face Validity of Neuropsychological Assessments in Traumatic Brain Injury Populations

Abstract

Abstract Purpose Neuropsychological testing underpins return-to-play and return-to-duty decisions following traumatic brain injury (TBI). Yet, the face validity of performance and symptom validity tests (PVTs and SVTs) remains unexamined in TBI populations. In performance-driven contexts such as sport, where identity and pressure to return are powerful, perceived test credibility may shape effort, engagement, and symptom reporting. This review critically examined the empirical literature on face validity in neuropsychological assessment of adults with TBI. Data Selection An English-language systematic search was conducted in February 2026 across PubMed, PsycINFO, and SPORTDiscus. Studies were included if they were quantitative, peer-reviewed, involved adults (≥18 years) with TBI, incorporated PVTs/SVTs, and explicitly examined or operationalized face validity. Two independent reviewers screened studies, and eligible articles were coded using a standardized extraction form. Data Synthesis Six studies were identified; after screening, three met the inclusion criteria. None directly measured face validity; instead, it was inferred from task features such as perceived cognitive demand (Test of Effort), contextual realism (Charge of Quarters Duty Test), or item transparency (Personality Assessment Inventory). Although measures (Reliable Digit Span, Test of Memory Malingering, Dot Counting Test) demonstrated convergent or discriminant validity, none were assessed for perceived face validity. Overall, face validity was treated as a conceptual assumption rather than a measurable determinant of engagement or assessment integrity. Conclusions Despite the high-stakes nature of sport-related concussion management, face validity remains unexamined, mainly in neuropsychological assessment. Its potential influence on engagement and performance has not been directly evaluated. Systematic investigation is needed to strengthen return-to-play decision-making and promote athlete safety.