Award Date

August 2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Daniel Allen

Second Committee Member

Gloria Wong-Padoongpatt

Third Committee Member

Michelle G. Paul

Fourth Committee Member

Jennifer Keene

Number of Pages



Given the reported negative consequences of sport related concussion (SRC), establishing the validity of concussion management tools is essential if they are used to determine the severity of concussion, track recovery or decline, implement effective interventions, and assist in return-to-play decision making. Previous research has found cognitive and symptoms differences on ImPACT, the most widely used SRC assessment measure, between monolingual and bilingual student athletes. Before further investigation of these differences can occur, measurement invariance of ImPACT must be established to ensure that differences are not attributable to measurement error. The current study has two aims: 1) to replicate a four-factor model recently identified using subtest scores of ImPACT on baseline and post-concussion assessments in monolingual English-Speaking athletes and bilingual English- and Spanish-speaking athletes and 2) to establish measurement invariance across groups at both baseline and at post-concussion. Participants included high school athletes who were administered the ImPACT for baseline assessment and following suspected concussion. Baseline assessments included 7,948 monolingual English-speaking athletes and 7,938 bilingual English and Spanish speaking athletes, and post-concussion assessments included 562 monolingual and 558 bilingual athletes. The monolingual and bilingual groups were matched on age, sex, and sport type at baseline assessment and at post-concussion assessment. Confirmatory factor analysis (CFA) was used to test a number of competing models to determine if the four-factor model provided the best fit of the data. Eighteen independent test scores selected from ImPACT cognitive tests were used in the CFAs. Multigroup CFA was used to examine invariance of the best fitting model. Results from CFAs indicated that the four-factor model provided the best fit in all samples. The four factors in the model included Visual Memory, Visual Reaction Time, Verbal Memory, and Working Memory. Additionally, residual invariance, the strictest level of invariance, was achieved at baseline and post-concussion across groups. The current results provide strong support for measurement invariance for a four-factor model of cognitive abilities estimated from ImPACT test scores. The results further suggest that any differences between monolingual English-speaking and bilingual Spanish- and English- speaking athletes reported in ImPACT studies are not caused by measurement error but may reflect real group differences. The reasons for these differences remain unclear. Given the increase in bilingual individuals in the United States, and among high school athletics, future research should investigate other forms of error such as item bias and predictive validity to further understand if group differences reflect real differences between these athletes.


concussion; cross-cultural; IMPACT; language; neuropsychology; psychometrics


Clinical Psychology

Degree Grantor

University of Nevada, Las Vegas




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