Assessing the relevance of test of memory malingering (TOMM) trial 2 performance after failure of trial 1 among veterans with self-reported histories of mild traumatic brain injury

Objective: Despite empirically established cut scores for Trial 1 of the Test of Memory Malingering (TOMM), the interpretive significance of failing Trial 1 while passing Trial 2 remains equivocal, possibly due to the original manual’s emphasis on Trial 2. This study examined whether individuals with a Trial 1 fail/Trial 2 pass pattern demonstrate cognitive profiles more similar to individuals who fail both trials or pass both trials. Method: Participants were 203 Veterans with a history of self-reported mild traumatic brain injury (mTBI) who completed a comprehensive neuropsychological evaluation in a multicenter study. Based on TOMM performance, participants were classified into Pass-Pass, Fail-Pass, and Fail-Fail groups. Standardized measures of learning and memory, attention/processing speed, executive functioning, and additional performance validity tests were examined. One-way analyses of variance were conducted to compare cognitive performance across groups. Results: The Fail-Pass group did not differ from the Fail-Fail group and performed significantly worse than the Pass-Pass group across learning and memory, attention/processing speed, executive functioning, and overall performance. Similarly, the Fail-Pass and Fail-Fail groups demonstrated comparable rates of failure on at least one additional independent performance validity test, with both groups exhibiting significantly higher failure rates than the Pass-Pass group. Conclusions: Veterans who fail TOMM Trial 1 but pass Trial 2 demonstrate cognitive and performance validity profiles more consistent with those who fail both trials than those who pass both trials. Consequently, Trial 2 pass status does not negate the clinical significance of Trial 1 failure in those with a history of self-reported mTBI.