The Role of Athletic Scholarship on Suboptimal Performance in Baseline Concussion Testing
Objective: To date, there is a very limited amount of research regarding the topic of sandbagging (i.e., intentional poor performance) during concussion baseline testing in a collegiate athlete population. It is known that student-athletes may underreport their concussive symptoms so they can return to play more quickly,and may purposefully lower their baseline results to appear less impaired following a head injury so as to avoid exclusion from play(Echemendia & Cantu, 2003; Reilly 2011). At this point in time, it is difficult to make statements regarding sandbagging because the incidence of this behavior is unknown. Accordingly,this study had a two-fold purpose; (a) to describe the incidence of self-reported sandbagging behaviors on baseline neurocognitive testing at this institution and (b) to identify factors predicting suboptimal effort on baseline neurocognitive assessments. Furthermore, scholarship status in relation to effort given on baseline testing was explored, representing a novel finding. Method: Seventy-four graduated student-athletes from the Florida Institute of Technology (FIT) completed an online survey that asked them to look back on their baseline testing attitude and performance during their time at FIT. Participants answered demographic questions, reported their athletic scholarship aid status during their years at FIT, and rated the level of effort they gave at baseline testing. In addition, participants were asked to report if they sandbagged at baseline testing. If they admitted to sandbagging, they were asked what their reasons were for committing this behavior via provided answer choices or a text entry box. Lastly, participants reported if they ever heard a teammate say he or she sandbagged. The current study allowed for the identification of athletes who admitted to performing with less than maximal effort at baseline testing, including those who intentionally wanted a low score. This study could then determine how poor effort, and sandbagging appeared across several measures, correcting for a major limitation of previous research. Both performance-based measures (Sport Concussion Assessment Tool, 2nd, 3rd, 5thEdition (SCAT-2, SCAT-3, SCAT-5); Immediate Post Concussion Assessment Tool (ImPACT); Patient Health Questionnaire, 9 item (PHQ-9)) and effort-based measures (Rey Word Recognition Test (WRT); Rey Dot Counting Test (DCT); ImPACT Invalidity Index) were included. Qualitative observation was utilized rather than a statistical comparison with a significant outcome due to a small number of sandbaggers in the sample.Results:20% of this sample admitted via self-report to not giving their best effort at baseline testing, and reasons for committing this behavior varied. Seven percent of the sample admitted to sandbagging, with the most frequent reason being fear of losing playing time. Additionally, 31%of the sample admitted that they heard a teammate say that he or she sandbagged at baseline testing. The most common reasons participants heard their teammates give for sandbagging were fear of losing playing time, followed by fear of someone taking his or her position and fear of losing athletics scholarship aid. Supporting the importance of such financial assistance, 70% of the sample reported they could not have attended FIT without their athletics scholarship aid. Conclusions: This survey allowed the FIT Concussion Management Program (CMP) to learn more information about their athletes and check in on how seriously athletes viewed concussion testing. A very small number of athletes admitted to sandbagging behavior, and even then, they did not engage in this behavior during every year of participation, which is welcome news for the CMP. This study posed questions, and collected information that is not well known or discussed, and therefore significantly added to the incomplete literature that currently exists on sandbagging, how it might be measured most accurately, and the conditions that motivate participants to the behavior. The primary limitation was the small number of participants who admitted to giving sub-optimal effort on their baseline tests. Future research using this methodology should grow the sample size until a sufficient number of sandbaggers have identified themselves to allow inferential statistical comparisons. Additionally, the existent record keeping of contact information was not optimal, and in future studies that attempt to solicit responses from former athletes, it will be necessary to take extraordinary measures to find up-to-date contact information.