The present study assessed Matrix Reasoning (MR) as an embedded validity indicator (EVI) in youth athletes vulnerable to sport-related concussion, using performance on the Test of Memory Malingering (TOMM) to operationalize effort. 

Matrices tasks have been examined as EVI for pediatric neropsychological assessment (NA; McKinsey, Prieler, & Raven, 2003), and recent literature suggests a cutoff T-score of 43 for MR in the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) may demonstrate utility within youth athletes completing baseline NA.

103 youth athletes (76% male, M_age = 12.14) completed a NA, including MR (cutoff T = 43) and TOMM (cut-offs = 45 and 49). Sensitivity and specificity for MR were calclated. Reciever operator characteristics (ROC) curve analysis determined whether MR performance accurately categorized participants' effort (represented by TOMM performance). 

MR (cut-off T = 43; Sussman et al., 2019) produced sensitivity of 9.09% and specificity of 91.36% in predicting TOMM Trial 1 performance (TOMM1; AUC = 0.449) and 0.00% and 91.18% in predicting TOMM Trial 2 (TOMM2; AUC = 0.074). As a TOMM2 cut-off of 49 offers greater sensitivity to inadequate effort, a further analysis showed MR yielded sensitivity of 0.00% and specificity of 91.00% (AUC = 0.330) in predicting TOMM2 performance with the more conservative cutoff. 

MR is an adequate EVI in predicting sufficient effort on TOMM, detecting true effortful performance; however, it was inadequate in detecting true non-effortful performance. A more stringent TOMMM cutoff did not improve sensitivity; thus, MR exhibited poor detection of inadequate effort. Overall, MR has utility as an EVI to support adequate effort in youth athlete populations but should not be used independently. This finding is clinically important because adequate effort at baseline is imperative in determining recovery from concussion.