The Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury on Visual Choice Reaction Time

Abstract

Choice reaction time (CRT), the time required to discriminate and respond appropriately to different stimuli, is a basic measure of attention and processing speed. Here, we describe the reliability and clinical sensitivity of a new CRT test that presents lateralized visual stimuli and adaptively adjusts stimulus onset asynchronies using a staircase procedure. Experiment 1 investigated the test–retest reliability in three test sessions performed at weekly intervals. Performance in the first test session was accurately predicted from age and computer-use regression functions obtained in a previously studied normative cohort. Central processing time (CentPT), the difference between the CRTs and simple reaction time latencies measured in a separate experiment, accounted for 55% of CRT latency and more than 85% of CRT latency variance. Performance improved significantly across the three test sessions. High intraclass correlation coefficients were seen for CRTs (0.90), CentPTs (0.87), and an omnibus performance measure (0.81) that combined CRT and minimal SOA z-scores. Experiment 2 investigated performance in the same participants when instructed to feign symptoms of traumatic brain injury (TBI): 87% produced abnormal omnibus z-scores. Simulated malingerers showed greater elevations in simple reaction times than CRTs, and hence reduced CentPTs. Latency-consistency z-scores, based on the difference between the CRTs obtained and those predicted based on CentPT latencies, discriminated malingering participants from controls with high sensitivity and specificity. Experiment 3 investigated CRT test performance in military veterans who had suffered combat-related TBI and symptoms of post-traumatic stress disorder, and revealed small but significant deficits in performance in the TBI population. The results indicate that the new CRT test shows high test–retest reliability, can assist in detecting participants performing with suboptimal effort, and is sensitive to the effects of TBI on the speed and accuracy of visual processing.

The Bay Area Verbal Learning Test (BAVLT): Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

“…Each CCAB test session included the following additional computerized tests and questionnaires: Finger tapping (Hubel et al, 2013a,b), simple reaction time (Woods et al, 2015a,d), Stroop, digit span forward and backward (Woods et al, 2011a,b), verbal fluency (Woods et al, 2016a), visuospatial span (Woods et al, 2015c,e), trail making (Woods et al, 2015b), vocabulary, design fluency (Woods et al, 2016b), the Wechsler Test of Adult Reading (WTAR), choice reaction time (Woods et al, 2015a,f), risk and loss avoidance, delay discounting, the Paced Auditory Serial Addition Task (PASAT) (Woods et al, under review), the Cognitive Failures Questionnaire (CFQ) and the Posttraumatic Stress Disorder Checklist (PCL)(Woods et al, 2015g), and a local traumatic brain injury (TBI) questionnaire. Testing was performed in a quiet room using a pair of headphones and a Windows computer controlled by Presentation® software (Versions 13 and 14, NeuroBehavioral Systems, Berkeley CA).…”

Computerized Analysis of Verbal Fluency: Normative Data and the Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury

“…This insensitivity reflects the high coefficient of variation of correct-word scores in normative studies (see Table 1). In many neuropsychological tests, z-score cutoffs below -3.0 are needed to avoid falsely categorizing patients with abnormal performance as malingerers [75, 76]. However, to have a correct-word z-score of -3.0 in the current experiment, malingerers would need to retrieve fewer than 7.7 words in semantic conditions and only one word in phonemic conditions.…”

“…Each CCAB test session included the following computerized tests and questionnaires: finger tapping [73, 74], simple reaction time [75, 76], Stroop, digit span forward and backward [77, 78], verbal list learning, visuospatial span [79, 80], trail making [81], vocabulary, design fluency [82], the Wechsler Test of Adult Reading (WTAR), choice reaction time [75, 83], risk and loss avoidance, delay discounting, the Paced Auditory Serial Addition Task (PASAT) [84], the Cognitive Failures Questionnaire (CFQ) and the Posttraumatic Stress Disorder Checklist (PCL) [85], and a local traumatic brain injury questionnaire. Testing was performed in a quiet room using a standard Personal Computer (PC) controlled by Presentation® software (Versions 13 and 14, NeuroBehavioral Systems, Berkeley CA).…”

“…Subjects reported an average computer-use score of 5.09 (an average of 2–3 hours per day). In previous studies, we found that daily hours of computer-use correlated with performance both on tests that required responding with the mouse [75, 76, 79, 81, 85] and tests that required only verbal output, such as digit span [78] and the paced auditory serial addition test [84]. …”

“…Thus, while malingerers produced abnormal correct-word scores, they did so in a manner that failed to match the characteristics of non-malingering subjects with abnormal scores. In other neuropsychological tests, ancillary performance measures have shown utility in distinguishing simulated malingerers and controls with abnormal scores [75, 78, 81, 99, 100]. Thus, while malingerers may produce criterion scores in the abnormal range they do so in different manner from subjects with intrinsically limited processing abilities.…”