Invalid symptom reporting and performance: What are we missing?

In the evaluation of neurorehabilitation patients involved in compensation or litigation, it is often assumed that poor performance or exaggerated symptoms reflects an intentional attempt to game the system.The purpose of this article is to review multiple issues that can contribute to invalid symptom reporting and performance.Multiple factors relevant to normal behavior, including observations from social psychology and behavioral economics, are important in the context of invalid symptom reporting and performance. These factors, which include pre-injury traits and beliefs (e.g., beliefs about prognosis and symptoms after TBI), factors at the time of initial treatment (e.g., expectations of recovery, nocebo effects, stereotype threat), and thoughts and feelings during evaluations (e.g., anger, resentment, injustice), may be important explanations. To best serve our patients, further research is needed to illuminate these relative effects on performance compared to "not trying.".