Objective: Performance validity tests (PVT's) are increasingly more relevant to pediatric neuropsychological assessment in identifying adequate effort. Most of the currently utilized PVT's rely on adult norms or cutoff criteria, and yet, a large majority of children are able to “pass” them. Little is known, however, about the reasons behind “failing performance” on PVT's in kids. This study reviews the existing literature to identify psychiatric, legal, and medical correlates and/or clinical descriptors of children who perform below the suggested cutoffs on one of the most common PVT's, the Test of Memory Malingering (TOMM). Method: MEDLINE, Embase, PsycINFO, and EBM Reviews (including Cochrane) was used to identify relevant records published before October 2014. Extraction and quality analysis of the final sample was also performed. Results: Of the initial 272 records (193 after removing duplicates), 18 eligible articles were identified as meeting the inclusion criteria for further extraction. Relevant findings suggest that children performing below the suggested cutoffs are typically younger, have a diagnosis of a developmental disorder (e.g. autism), have low IQ, suffer from severe dysexecutive presentation, lack apparent investment in the assessment, or have active psychiatric diagnoses. Conclusion: The reasons behind limited performance on the TOMM in children are often different than those typically described in the adult literature, suggesting that the TOMM construct may be different in children than adults.