How do we measure attention? Using factor analysis to establish construct validity of neuropsychological tests

We investigated whether standardized neuropsychological tests and experimental cognitive paradigms measure the same cognitive faculties. Specifically, do neuropsychological tests commonly used to assess attention measure the same construct as attention paradigms used in cognitive psychology and neuroscience? We built on the “general attention factor”, comprising several widely used experimental paradigms (Huang et al., 2012). Participants (n = 636) completed an on-line battery (TestMyBrain.org) of six experimental tests [Multiple Object Tracking, Flanker Interference, Visual Working Memory, Approximate Number Sense, Spatial Configuration Visual Search, and Gradual Onset Continuous Performance Task (Grad CPT)] and eight neuropsychological tests [Trail Making Test versions A & B (TMT-A, TMT-B), Digit Symbol Coding, Forward and Backward Digit Span, Letter Cancellation, Spatial Span, and Arithmetic]. Exploratory factor analysis in a subset of 357 participants identified a five-factor structure: (1) attentional capacity (Multiple Object Tracking, Visual Working Memory, Digit Symbol Coding, Spatial Span), (2) search (Visual Search, TMT-A, TMT-B, Letter Cancellation); (3) Digit Span; (4) Arithmetic; and (5) Sustained Attention (GradCPT). Confirmatory analysis in 279 held-out participants showed that this model fit better than competing models. A hierarchical model where a general cognitive factor was imposed above the five specific factors fit as well as the model without the general factor. We conclude that Digit Span and Arithmetic tests should not be classified as attention tests. Digit Symbol Coding and Spatial Span tap attentional capacity, while TMT-A, TMT-B, and Letter Cancellation tap search (or attention-shifting) ability. These five tests can be classified as attention tests.

Understanding the Profile of Cancer-Related Cognitive Impairments: A Critique of Meta-Analyses

A large body of evidence indicates that cancer survivors who have undergone chemotherapy have cognitive impairments. Substantial disagreement exists regarding which cognitive domains are impaired in this population. We suggest that is in part due to inconsistency in how neuropsychological tests are assigned to cognitive domains. The purpose of this paper is to critically analyze the meta-analytic literature on cancer-related cognitive impairments (CRCI) to quantify this inconsistency. We identified all neuropsychological tests reported in seven meta-analyses of the CRCI literature. Although effect sizes were generally negative (indicating impairment), every domain was declared to be impaired in at least one meta-analysis and unimpaired in at least one other meta-analysis. We plotted summary effect sizes from all the meta-analyses and quantified disagreement by computing the observed and ideal distributions of the one-way χ2 statistic. The actual χ2 distributions were noticeably more peaked and shifted to the left than the ideal distributions, indicating substantial disagreement among the meta-analyses in how neuropsychological tests were categorized to domains. A better understanding of the profile of impairments in CRCI is essential for developing effective remediation methods. To accomplish this goal, the research field needs to promote better agreement on how to measure specific cognitive functions.

The relationship between the Wechsler Memory Scale-Revised (WMS-R) Attention index and putative measures of Attention

Although the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) is one of the more frequently used measures of memory and attention, its Attention/Concentration Index (ACI) has been minimally researched. If the ACI is to be used as a measure of "attention," the need exists to determine if it is related to other measures theoretically argued to be sensitive to attention deficits. The present study evaluated the relationship between the WMS-R ACI and other putative measures of attention by comparing individuals labeled as Attention Impaired [ACI at least 15 points < General Memory Index (GMI)] versus those labeled as Memory Impaired (GMI at least 15 points < ACI). Contrary to expectations, the Attention Impaired group scored equal to the Memory Impaired group on all measures theorized to be sensitive to attention deficits (Trails A and B time, Trails B errors, Rey AVLT interference list), except for statistically weaker performance on Trails A errors. In contrast but as expected, the Memory Impaired group scored statistically worse on all memory tests (Rey AVLT, all TPT variables). The groups also did not differ on tests argued not to be differentially affected by either attention or memory (WAIS-R FIQ, Category Test). It is concluded that the WMS-R Attention Index is not related to deficits on other measures sensitive to attention, further emphasizing the need to identify more clearly specific attention constructs.

Factor structure of the Halstead-Reitan neuropsychological battery: a review and integration

The Halstead-Reitan Neuropsychological Battery (HRNB) was the first factor-analyzed neuropsychological battery. It was based on a series of tests studied in Ward Halstead's laboratory at the University of Chicago, was accomplished in collaboration with a group of eminent statisticians, and was published in 1947 . Four factors were extracted based on Halstead's tests called central integrative field, abstraction, power, and directional and constituted what was described as biological intelligence. Since this original analysis, Reitan's additions to the battery, and the proposal of Reitan and Wolfson's model of neuropsychological functioning, this factor-analytic research continued. This article reviews factor-analytic research concluding that Halstead's analysis has held up reasonably well and there is support for the Reitan and Wolfson model. However, Reitan's revisions of the battery added tests that form a distinct language factor and the sensory-perceptual tests that generally form a separate factor. Other tests and scoring methods used in individual studies modified the core battery and produced somewhat differing solutions. The complexity of the tests prevents the HRNB from being a factorially pure battery, and simple structure is rarely, if ever, reached. Current versions of the HRNB appear to evaluate both "biological" and "psychometric" intelligence, which appear to load on separate factors.

The effect of cognitive, personality, and background factors on the WAIS-III Arithmetic subtest

In the Wechsler system the Arithmetic subtest has been viewed as a measure of concentration, working memory, or freedom from distractibility. However, a wide range of other influences on Arithmetic performance has been proposed. The current study was intended to examine these to further characterize what is measured by the Arithmetic subtest. Participants were 118 adults referred for neuropsychological assessment. The results indicate a strong association between WAIS-III Arithmetic and the other WMI (Working Memory Index) subtests. Arithmetic also showed a high association with Arithmetic skill and verbal memory. Moderate contributions to Arithmetic performance were found for most other cognitive measures. Measures of anxiety and of background factors, such as perceived difficulty learning Arithmetic, were weakly related to Arithmetic scores. These results suggest that although Arithmetic may be considered a measure of concentration or working memory, many other factors influence it and its specificity as a concentration measure is limited.

Neuropsychological assessment of African children: evidence for a universal brain/behavior omnibus within a coconstructivist paradigm

Cross-cultural neuropsychology with African and American children provides evidence of consistent deficit patterns in attention, working memory, and learning in children at risk from disease affecting brain function by means of similar pathophysiologic mechanisms (e.g., cerebral malaria (CM) and sickle-cell disease (SCD); HIV in African and American children). These brain-behavior disease processes are also modified in a consistent manner cross-culturally by quality of developmental milieu and caregiving. We then present findings from the pioneering use of computerized cognitive rehabilitation therapy (CCRT) with Ugandan children surviving CM and with HIV. This neuropsychological evidence that CCRT enhances positive brain plasticity in a consistent manner across cultures supports the "coconstructive" paradigm (Li, 2003), since plasticity across the life span is the hallmark of this approach. Coconstructivism is a holistic multi-dimensional approach that emphasizes reciprocal biocultural influences across the life span. It also emphasizes the reciprocal interaction of culture and the genome in shaping brain/mind at multiple levels: neurobiological, cognitively, behavioral, and sociocultural (Li, 2003). Cross-cultural neuropsychology in healthy and diseased brains, brain imaging technologies, and genomic research can triangulate the manner in which a universal brain/behavior omnibus drives plasticity across the life span. As such, the further scientific characterization of the brain/behavior omnibus can provide the vital lynchpin between biology and culture in Li's coconstructive paradigm, revolutionizing our understanding of intelligence and culture.

Speeded Paper-Pencil Sustained Attention and Mental Speed Tests

Mental speed (MS) and sustained attention (SA) are theoretically distinct constructs. However, tests of MS are very similar to SA tests that use time pressure as an impeding condition. The performance in such tasks largely relies on the participants’ speed of task processing (i.e., how quickly and correctly one can perform the simple cognitive tasks). The present study examined whether SA and MS are empirically the same or different constructs. To this end, 24 paper-pencil and computerized tests were administered to 199 students. SA turned out to be highly related to MS task classes: substitution and perceptual speed. Furthermore, SA showed a very close relationship with the paper-pencil MS factor. The correlation between SA and computerized speed was considerably lower but still high. In a higher-order general speed factor model, SA had the highest loading on the higher-order factor; the higher-order factor explained 88% of SA variance. It is argued that SA (as operationalized with tests using time pressure as an impeding condition) and MS cannot be differentiated, at the level of broad constructs. Implications for neuropsychological assessment and future research are discussed.

Aufmerksamkeitsdiagnostik

Ziel dieses Beitrags ist es, die im deutschen Sprachraum verfügbaren Aufmerksamkeitstests einzelnen Aufmerksamkeitskomponenten zuzuordnen und zu charakterisieren. Zur Klärung des Konstrukts Aufmerksamkeit werden konzeptuelle Überlegungen angestellt, eine Arbeitsdefinition vorgelegt und eine Abgrenzung von verwandten Konstrukten wie Konzentration, Arbeitsgedächtnis und Wahrnehmungsgeschwindigkeit herausgearbeitet. Rationale und faktorenanalytische Ansätze zur Struktur der Aufmerksamkeit werden dargestellt und daraus ein Modell zur Aufmerksamkeitsstruktur mit den Komponenten Alertness, Selektion, Daueraufmerksamkeit und Focus-Execute / Konzentrierte Aufmerksamkeit abgeleitet. Anhand des Modells wird die angestrebte Klassifikation der Tests vorgenommen. Insgesamt wird deutlich, dass eine reine Messung der einzelnen Aufmerksamkeitskomponenten noch nicht möglich ist, weil die Testleistungen mit anderen Fähigkeiten konfundiert sind und die Struktur der Aufmerksamkeit noch nicht befriedigend geklärt ist. Empfehlungen zur Entwicklung und Auswahl von Aufmerksamkeitstests werden gegeben.

Latent Factors Underlying Individual Differences in Attention Measures

Following theoretical considerations that relate attention to perception and also to the executive control of performance in complex tasks ( Bundesen, 1990 ; Logan & Gordon, 2001 ), two latent factors underlying individual differences in attention measures are assumed: Perceptual attention and Executive attention. The included attention measures are derived from the neuropsychology-based attention model by Sturm and Zimmermann (2000) , the action-oriented five-component model by Neumann (1992) , and the working memory model according to Baddeley (1986) . Furthermore, one psychometric attention measure ( Moosbrugger & Goldhammer, 2005 ) was selected. A sample of 232 students aged between 19 and 40 completed a test battery of 11 attention and concentration tests. For investigating the appropriateness of the hypothesized two-factor structure, confirmatory factor models, including Perceptual attention and Executive attention as latent factors, were tested. The results support the two-factor structure and, thereby, the hypothesis, that perceptual and executive attention are major factors underlying individual differences in attention measures.

Messen Konzentrationstests Konzentration?

Zusammenfassung. In zwei Untersuchungen mit N = 117 und N = 90 Studierenden wurde die Struktur von Konzentrationstestleistungen mit Hilfe von konfirmatorischen Faktorenanalysen untersucht. Die Probanden bearbeiteten insgesamt 11 bzw. 10 Tests zur Erfassung von Konzentration und verwandten Konstrukten (z.B. Informationsverarbeitungsgeschwindigkeit) sowie weitere Tests zur Validierung der Konzentrationsfaktoren. In Untersuchung 1 wurde ein Modell mit einem allgemeinen Konzentrationsfaktor präferiert. Der Faktor wurde durch den Zahlen-Symbol-Test (BIS-ZS) markiert und erwies sich als weitgehend unabhängig von der Intelligenz. Die übrige Konzentrationstestvarianz wurde durch verbale, figurale und numerische Fähigkeiten sowie zum Teil durch Merkfähigkeit erklärt. Der Konzentrationsfaktor wurde in Untersuchung 2, in der zum Teil andere Tests eingesetzt worden waren, repliziert. Der Zahlen-Symbol-Test (BIS-ZS) zeigte wieder eine hohe Ladung. Der Faktor konnte von numerischen und figuralen Fähigkeiten, von der Intelligenz sowie von Reaktionsgeschwindigkeit abgegrenzt werden. Es wird gefolgert, dass die meisten hier verwendeten Konzentrationstests die gleiche Fähigkeit erfassen, nämlich Konzentration. Am besten gelingt dies mit dem Zahlen-Symbol-Test (BIS-ZS). Die einzelnen Testleistungen hängen unterschiedlich stark von konstruktfernen Fähigkeiten ab. Für die einzelnen Tests wurden diese Fähigkeiten identifiziert.

Minor head trauma

This article reviews the persisting difficulty and the importance of the diagnosis of minor head trauma. The diagnosis has been complicated by pervasive disagreement regarding diagnostic criteria. This is primarily a result of the fact that evidence for actual injury is hard to obtain in minor cases because most symptoms tend to be subjective and have high base rates in the normal, uninjured population. At the same time, the diagnostic decision has important implications for patients in terms of treatment, expectancy for future function and lifestyle, and compensation for injuries. Decision theory leads us to the awareness of diagnostic errors. In addition to correct determination, the clinician can make an error of not diagnosing an injury when it has in fact occurred or making a positive diagnosis where there is no injury. The optimal strategy is to set the cutoff at the midpoint of these two error probabilities. The clinician may be willing to make one error rather than the other depending on the cost and bias involved. The second error is more likely to be made when the clinician stands as a strong advocate for the patient and willing to provide any help necessary to encourage treatment, give patients a rationale for understanding their symptoms, and help them obtain compensation for injuries. This can also lead to significant overdiagnosis of injury. The first error is more likely to be made when the clinician recognizes the potential for increasing costs to the health-care industry, the court system, and increasing personal injury claims. He or she may also recognize the vulnerability to the risk for symptom invalidity, the perpetuation of patient symptoms through suggestion, and the need for a biologic explanation for life stressors and preexisting emotional and personality constraints. It can be argued that the most objective diagnostic opinion, uninfluenced by the above biases, should ultimately be in the best interest of the patient, the clinician, legal consultants, and society. Based on the findings in this chapter, at least four symptom constellations can be identified. These have differing probabilities for residual symptoms of minor head trauma and include the following: 1. These patients' symptoms clearly meet the criteria from Table 2. This includes several findings from 1 to 10 of Table 1, together with abnormal neuropsychologic testing on the AIR, General Neuropsychological Deficit Scale, or other indicators of diminished cortical integrity. This group of patients shows a very strong probability of having experienced a brain injury and for showing residual symptoms of minor head trauma. 2. These patients have experienced concussional symptoms (e.g., headache, mild confusion, and balance and visual symptoms) that were documented at the time of injury but sustained no or brief (< 15 seconds) LOC or PTA and, therefore, do not qualify for the diagnosis in Table 2. They may still have several symptoms from Table 1, including objective findings from neuroscanning and variable neuropsychologic testing, especially in measures of attention and delayed recall. This group also shows a high probability for residual, unresolved concussional, and related symptoms. 3. These patients may have shown evidence of concussional symptoms at the time of injury, with no or brief LOC, PTA, or other symptoms from Table 1 (1-10). They continue to show persistent symptoms after 6 months to 1 year. With this group, there is a strong probability that emotional, motivational and premorbid personality factors are either causing or supporting these residual symptoms. 4. In these patients, clearly identifiable postconcussive symptoms at the time of injury are not easy to identify, and perhaps headache is the only reported symptom. There was no LOC or PTA, and virtually none of symptoms 1 to 10 in Table 1 are observed. These patients show strong evidence of symptom invalidity on MMPI-2 or other measures, and marked somatoform, depression, anx

Working memory in young children: evidence for modality-specificity and implications for cerebral reorganization in early childhood

Digit span (DS) and visual-spatial memory span (VMS) tasks have been considered indices of auditory and visual spatial processing, respectively, often classified as "primary memory" or "attention". There has been limited evidence for their modality specificity, however. We present two children who showed visual spatial processing deficiencies (including VMS) and non-dominant manual inefficiency with normal visual-spatial perception, auditory-verbal processing and dominant fine manual skills. These children support a distinction between auditory and visual-spatial memory span. These findings are discussed with regard to a hypothesis that the unique expression of VMS is time-limited, that visual-spatial processing becomes more verbalized as children learn to read and that these behavioral changes produce a lateral shift in cortical processing of visual spatial information.

Short-term trends in Dutch children's attention problems

Changes in the prevalence of attention problems in Dutch children were examined by a comparison of prevalence rates in 1988 and 1993. On both occasions a representative sample of fourth-grade children from 82 regular elementary schools participated in the study. Both teacher reports and scores on an attention test indicated a small decrease in attention problems. We also found that the prevalence of other behavioral/emotional and reading problems had decreased or had remained unchanged. Subject to the limitations of the study, we concluded that the attention problems of fourth-grade Dutch children are not worsening.

Assessment of Attention: Further Validation of the Star Counting Test

Two studies are presented in which the validity of the Star Counting Test (SCT), an attention test for children, was examined. In the first study the test was administered to a sample of 339 elementary school children of 9 years old. In addition, a commonly used achievement test for reading comprehension was administered and teacher-ratings of attention behavior and other classroom behaviors were gathered. Results showed that the SCT is related to teacher-ratings of attention and much weaker to other classroom behaviors. In addition, the relationship of the SCT with attention behavior could be separated from the relationship of reading comprehension with attention behavior. In the second study the SCT and a number of standard attention tests were administered to a group of children with attention problems and a group of normal controls. The performance of the latter group appeared to be better on the SCT and on standard attention tests reflecting working memory. No differences were found between the groups on attention tests that measure predominantly perceptual motor speed. In general, the results of the study tend to support the validity of the SCT.