The TestMyBrain Digital Neuropsychology Toolkit: Development and Psychometric Characteristics.

INTRODUCTION: To allow continued administration of neuropsychological evaluations remotely during the pandemic, tests from the not-for-profit platform, TestMyBrain.org (TMB), were used to develop the TMB Digital Neuropsychology Toolkit (DNT). This study details the psychometric characteristics of the DNT, as well as the infrastructure and development of the DNT. METHOD: The DNT was primarily distributed for clinical use, with (72.8%) of individuals requesting access for clinical purposes. To assess reliability and validity of the DNT, anonymous data from DNT test administrations were analyzed and compared to a large, non-clinical normative sample from TMB. RESULTS: DNT test scores showed acceptable to very good split-half reliability (.68-.99). Factor analysis revealed three latent factors, corresponding to processing speed, working memory, and a broader general cognitive ability factor that included perceptual reasoning and episodic memory. Average test scores were slightly poorer for the DNT sample than for the TMB comparison sample, as expected given the clinical use of the DNT. CONCLUSIONS: Initial estimates of reliability and validity of DNT tests support their use as digital measures of neuropsychological functioning. Tests within cognitive domains correlated highly with each other and demonstrated good reliability and validity. Future work will seek to validate DNT tests in specific clinical populations and determine best practices for using DNT outcome measures to assess engagement and psychological symptomatology.

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.

Higher integration scores are associated with facial emotion perception differences in dissociative identity disorder.

BACKGROUND: Recovery from dissociative identity disorder (DID) is associated with the process of integration, which includes an increasing sense of self-cohesion and ownership over one's own emotions. Emotion perception is a construction based on interplay between stored knowledge (past experience), and incoming sensory inputs, suggesting changes in emotion perception might occur at different levels of integration - but this remains unexplored. Therefore, we examined the association between integration, psychiatric symptoms, and facial emotion perception. We hypothesized higher integration would be associated with fewer psychiatric symptoms, and differences in the perception of emotions. METHODS: Participants were 82 respondents to a cross-sectional web-based study. All participants met self-report cutoff scores for posttraumatic stress disorder (PTSD) and DID using the PTSD Checklist for DSM-5 and Multiscale Dissociation Inventory, respectively. Participants completed a psychometrically-matched test of facial emotion perception for anger, fear, and happiness called the Belmont Emotion Sensitivity Test. Participants also completed the Beck Depression Inventory II, Childhood Trauma Questionnaire, and Integration Measure, a validated measure of self-cohesion. RESULTS: Higher integration scores were associated with lower depression, PTSD, and autobiographical memory disturbance scores. Repeated-measures ANCOVA confirmed integration significantly interacted with emotion category on the facial emotion perception task. Specifically, higher integration scores were associated with greater accuracy to fearful and angry faces. CONCLUSIONS: While acknowledging the limitations of a cross-sectional design, our results suggest that the process of integration is associated with fewer psychiatric symptoms, and more accurate facial emotion perception. This supports treatment guidelines regarding integration as a therapeutic goal for DID.