The Effects of Repeated Testing, Simulated Malingering, and Traumatic Brain Injury on High-Precision Measures of Simple Visual Reaction Time

David L Woods, John M Wyma, E William Yund, Timothy J Herron, David L Woods, John M Wyma, E William Yund, Timothy J Herron

Abstract

Simple reaction time (SRT), the latency to respond to a stimulus, has been widely used as a basic measure of processing speed. In the current experiments, we examined clinically-relevant properties of a new SRT test that presents visual stimuli to the left or right hemifield at varying stimulus onset asynchronies (SOAs). Experiment 1 examined test-retest reliability in 48 participants who underwent three test sessions at weekly intervals. In the first test, log-transformed (log-SRT) z-scores, corrected for the influence of age and computer-use, were well predicted by regression functions derived from a normative population of 189 control participants. Test-retest reliability of log-SRT z-scores was measured with an intraclass correlation coefficient (ICC = 0.83) and equaled or exceeded those of other SRT tests and other widely used tests of processing speed that are administered manually. No significant learning effects were observed across test sessions. Experiment 2 investigated the same participants when instructed to malinger during a fourth testing session: 94% showed abnormal log-SRT z-scores, with 83% producing log-SRT z-scores exceeding a cutoff of 3.0, a degree of abnormality never seen in full-effort conditions. Thus, a log-SRT z-score cutoff of 3.0 had a sensitivity (83%) and specificity (100%) that equaled or exceeded that of existing symptom validity tests. We argue that even expert malingerers, fully informed of the malingering-detection metric, would be unable to successfully feign impairments on the SRT test because of the precise control of SRT latencies that would be required. Experiment 3 investigated 26 patients with traumatic brain injury (TBI) tested more than 1 year post-injury. The 22 patients with mild TBI showed insignificantly faster SRTs than controls, but a small group of four patients with severe TBI showed slowed SRTs. Simple visual reaction time is a reliable measure of processing speed that is sensitive to the effects of malingering and TBI.

Keywords: aging; computer; effort; feigning; head injury; motor; reliability; timing errors.

Figures

Figure 1
Figure 1
The SRT paradigm. Stimuli were high-contrast bulls-eyes presented to the left or right hemifield for a duration of 200 ms at randomized stimulus onset asynchronies (SOAs) ranging from 1000–2000 ms in five 250 ms steps. Stimuli could occur in the visual hemifield ipsilateral (shown) or contralateral to the responding hand.
Figure 2
Figure 2
Mean SRT latencies as a function of age. SRT latencies from individual participants in normative data (norm, blue diamonds), Experiment 1a (open red squares), Experiment 2 (simulated malingering, green triangles) and Experiment 3 (patients with mTBI, red circles, sTBI, striped red circles). The normative age-regression slope is shown. Simulated malingerers with SRT latencies >600 ms are not included.
Figure 3
Figure 3
Mean stimulus detection times (SDTs) as a function of age. SDTs were derived by subtracting movement initiation time (measured in a finger-tapping experiment performed in the same test session) from SRTs. SDTs are shown for normative data (norm, blue diamonds), Experiment 1a (open red squares), Experiment 2 (simulated malingering, green triangles) and Experiment 3 (patients with mTBI, red circles, sTBI, striped red circles). The normative age-regression slope is shown.
Figure 4
Figure 4
Log-SRT z-scores and SDT z-scores for the normative group and the three experiments. Data from two simulated malingerers with SDT z-scores greater than 12.0 and two simulated malingerers with SDT z-scores less than −4.0 are not shown. The red lines show p < 0.05 thresholds for normative log-SRT and SDT z-scores.
Figure 5
Figure 5
SRT latencies of individual participants in the three replications of Experiment 1. The ordinate shows the SRT latencies from the earlier session and the abscissa shows the SRT latencies from the later session. Pearson correlations were r = 0.59 (Session 1 vs. Session 2), r = 0.80 (Session 2 vs. Session 3), and r = 0.53 (Session 1 vs. Session 3).

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