B-55The Ecological Validity of Executive-Type Neuropsychological Test Measures in Traumatic Brain Injury

Objective: Neuropsychological tests play a figural role in characterizing the breadth and severity of cognitive impairment that may disable a patient in terms of their ability to engage in various activities of daily living in the real world. As such, it is of paramount importance that these tests accurately predict disability in the real world. The present study examined the sensitivity of various neuropsychological tests, including those with high-purported ecological validity, in distinguishing between those who were symptomatic and suffered from a traumatic brain injury (TBI) with complaints of activities of daily living (ADL) or without complaints of ADL. Method: Patients (n = 71) with TBI who were symptomatic or asymptomatic were assessed on the Behavioral Assessment of Dysexecutive Syndrome (BADS), Wisconsin Card Sorting test, Trail Making Test, Wechsler Abbreviated Scale of Intelligence (third edition), and the Tower of London an average of 2.61 years (±1.91 years) post-injury. Results: Those who reported ADL disability did not differ significantly from those who did not report ADL disability across all measures except for the Modified Six-Elements (MSE) and Rule Shift Cards (RSC) subtests of the BADS. Conclusions: The results suggest that, except for the MSE and RSC, traditional neuropsychological tests may not be sensitive to real-world disability in this patient population. These findings demonstrate limitations of neuropsychological testing, yet suggest that measures with better ecological validity may be more predictive of real-world functioning.