Back to the drawing board—The relationship between self-report and neuropsychological tests of cognitive flexibility in clinical cohorts: A systematic review and meta-analysis.

Abstract

Objective: Cognitive flexibility has been previously described as the ability to adjust cognitive and behavioral strategies in response to changing contextual demands. Cognitive flexibility is typically assessed via self-report questionnaires and performance on neuropsychological tests in research and clinical practice. A common assumption among researchers and clinicians is that self-report and neuropsychological tests of cognitive flexibility assess the same or similar constructs, but the extent of the relationship between these two assessment approaches in clinical cohorts remains unknown. We undertook a systematic review and meta-analysis to determine the relationship between self-report and neuropsychological tests of cognitive flexibility in clinical samples. Method: We searched 10 databases and relevant gray literature (e.g., other databases and pearling) from inception to October 2020 and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Eleven articles including 405 participants satisfied our eligibility criteria. Results: A multilevel random-effects meta-analysis revealed no relationship between self-report and neuropsychological tests of cognitive flexibility (0.01, 95% CI [−0.16 to 0.18]). Individual random-effects meta-analyses between 12 different tests pairs also found no relationship. Conclusion: Based on our results, it is clear that the two assessment approaches of cognitive flexibility provide independent information—they do not assess the same construct. These findings have important ramifications for future research and clinical practice—there is a need to reconsider what constructs self-report and neuropsychological tests of “cognitive flexibility” actually assess, and avoid the interchangeable use of these assessments in clinical samples.

Investigating self-report and neuropsychological assessments of cognitive flexibility in people with and without persistent pain: An online, cross-sectional, observational study

“…97 Our group was the first to undertake two comprehensive meta-analyses that investigated the relationship between a range of self-report and neuropsychological assessments of cognitive flexibility. In both clinical 33 and nonclinical 32 cohorts, we found little-to-no relationship between self-report and neuropsychological assessments of cognitive flexibility. However, a recent study with a large sample (n = 246) of non-clinical, younger adults reported a small, but significant relationship (r = À0.22) between the CFS and the WCST (perseverative errors).…”

“…There is a building body of evidence that, although these self-report and neuropsychological assessments both purport to be capturing ‘cognitive flexibility’, they are unlikely to be tapping into shared, or similar, constructs. 32 , 33 In people with and without fibromyalgia, there appears to be a lack of association between self-reported cognitive and behavioural flexibility (i.e. Shift subscale of the BRIEF) and neuropsychological tests of cognitive flexibility (i.e.…”

Can Cognitive Flexibility and Clinical Perfectionism Be Used to Identify People with Anorexia Nervosa?

“…In addition, this study used a self-report assessment of cognitive flexibility. It is well known that self-report and neurocognitive assessments of cognitive flexibility do not relate well [ 3 , 47 , 48 , 49 ]; hence, the findings of this study cannot be generalised beyond self-reported cognitive flexibility. Future research may wish to replicate the current study using a neurocognitive task of cognitive flexibility.…”

The role of cognitive flexibility in self-injurious thoughts and behaviors: A systematic review.

“…Therefore, it is possible that self-reported task-switching ability is not a key correlate of NSSI among people who are highly vulnerable to emotion dysregulation (e.g., persons with BPD). Nonetheless, a recent meta-analysis found that self-reported measures of cognitive flexibility were poor proxies for performance in task-switching behavioral paradigms among clinical cohorts (Howlett et al, 2022). Thus, it is unclear if perceived task-switching ability maps on to objective performance for persons with SITB, particularly under conditions that often precipitate these problems (e.g., emotional distress).…”

“…Relatedly, factors associated with older age may also enhance cognitive flexibility (e.g., greater knowledge and life experiences related to a given task demand; Ionescu, 2012). Second, we found that researchers used a wide variety of assessment tools to measure and score cognitive flexibility—many of which demonstrate low correlations with each other (e.g., Stroop, verbal fluency, and WCST; Delis et al, 2001; Howlett et al, 2022; Whiteside et al, 2016). Lastly, none of the studies we reviewed assessed participants’ motivation or effort to perform well in task-switching and generative flexibility paradigms.…”