The Intermediate Visual and Auditory Continuous Performance Test as a neuropsychological measure

Archives of Clinical Neuropsychology 18 (2003) 199–214 The Intermediate Visual and Auditory Continuous Performance Test as a neuropsychological measure Timothy P. Tinius∗ Psychology Department, St. Cloud State University, 420 7th Avenue South, St. Cloud, MN 56301, USA Accepted 10 December 2001 Abstract The Intermediate Visual and Auditory (IVA) Continuous Performance Test (CPT) and Neuropsychological Impairment Scale (NIS) were completed with adults diagnosed with mild traumatic brain injury (mTBI), adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), and controls. On the IVACPT, the mTBI and ADHD groups performed significantly lower on the full and secondary scales for attention and response accuracy. For individual scales, the mTBI and ADHD groups showed lower performance on measures of reaction time, inattention, impulsivity, and variability of RT. The mTBI and ADHD groups showed similar patterns of performance on the IVA. On the NIS, the mTBI and ADHD groups reported more neuropsychological symptoms than the control group and the mTBI group reported more neuropsychological symptoms than the ADHD group. The results are discussed in regard to changes in cognitive processing and sustained attention in individuals diagnosed with mTBI and ADHD. © 2002 National Academy of Neuropsychology. Published by Elsevier Science Ltd. All rights reserved. Keywords: Neuropsychology; CPT; mTBI; ADHD 1. Introduction A change in attention is the most common neuropsychological symptom associated with brain damage (Lezak, 1995). The sequential processing and capacity characteristics of attention assessed with the Digit Span Test (Wechsler, 1981) can be resistant to aging and brain damage (Lezak, 1995). Other characteristics of attention such as focused or selective attention, ∗ Tel.: +1-320-255-4157. E-mail address: (T.P. Tinius). 0887-6177/02/$ – see front matter © 2002 National Academy of Neuropsychology. PII: S 0 8 8 7 - 6 1 7 7 ( 0 1 ) 0 0 1 9 6 - 2 200 T.P. Tinius / Archives of Clinical Neuropsychology 18 (2003) 199–214 sustained attention, divided attention, and alternating attention (Solhberg & Mateer, 1989; Van Zomeren & Brouwer, 1990) may be more important and often of greater clinical concern after brain damage (Lezak, 1995). Slow processing (i.e., reaction time) in combination with these characteristics may have broad ranging effects on all cognitive functions and reduce cognitive productivity (Lezak, 1995). A Continuous Performance Test (CPT) can measure processing speed in addition to focused, sustained, divided, and alternating attention characteristics in a neuropsychological evaluation. The term CPT was first coined by Rosvold, Mirsky, Sarason, Bransome, and Beck (1956), but researchers use a wide variety of presentation methods (auditory, visual, or verbal) and performance measures such as hit rate, commission (impulsivity), and omission (inattention). Some studies have examined simple reaction time (SRT) to one stimulus while other studies have used choice reaction time (CRT) to two or more stimuli that require different responses to the stimuli or require a response for one stimuli and inhibition of a response for another stimuli. Separate reviews found that auditory sustained attention on a CPT (Gentilini, Nichelli, & Schoenhuber, 1989; Parasuraman, Mutter, & Molloy, 1991) and verbal sustained attention with the Paced Auditory Serial Attention Task (Gronwall, 1989) were impaired after mild traumatic brain injury (mTBI). Using a computer to present visual stimuli and measure reaction time (RT) on a CPT task, individuals with mTBI (Collins & Long, 1996; Stuss et al., 1989) and severe TBI (Loken, Thornton, Otto, & Long, 1995) had slower choice visual RT. Recently, SRT and CRT on a visual CPT were highly correlated with the Halstad Impairment Index of the Halstad–Reitan Battery in individuals with TBI (Western & Long, 1996) and discriminated between individuals with TBI and controls (Collins & Long, 1996). A deficit in attention is a symptom of Post-Concussion Syndrome (e.g., mTBI) and Attention Deficit Hyperactivity Disorder (ADHD) diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV; American Psychiatric Association, 1994). The DSM-IV also lists three core symptoms of inattention, impulsivity, and hyperactivity for ADHD. ADHD was originally described as a childhood disorder, but clinical experience suggested that adults or parents of a child with symptoms of ADHD also might show problems with sustained attention. The diagnosis of attention problems in adults with mTBI and ADHD can be evaluated with a CPT or a structured self-report to quantify the number and severity of symptoms. There are self-report scales to measure symptoms of attention problems in adults with ADHD (Conners, Erhardt, & Sparrow, 1999) or other neuropsychological disorders such as mTBI (O’Donnell, DeSoto, DeSota, & Reynolds, 1994). On a visual CPT, mTBI and ADHD groups had slower RT and more variability in RT compared to the control group (Arcia & Gualtieri, 1994). On the Gordon Diagnostic to System CPT (Gordon, 1988), adults diagnosed with mTBI had fewer correct responses and greater block variability on the vigilance and distractibility tasks but no differences in RT (Burg, Burright, & Donovick, 1995). Despite the clinical use of self-report scales or a CPT to measure attention, there is little information comparing self-report of attention and CPT performance in mTBI and ADHD groups. Thus, the purpose of this study was to measure the performance of adults with mTBI and ADHD on a CPT task, to measure the self-report of neuropsychological symptoms in mTBI and ADHD groups, and to determine if there was a relationship between self-report of symptoms and performance on a CPT. The CPT used was the Intermediate Visual and Auditory T.P. Tinius / Archives of Clinical Neuropsychology 18 (2003) 199–214 201 (IVA) CPT, which can assess auditory and visual attention on the same task. Previous CPT studies measured on a computer in persons with mTBI and ADHD used visual stimuli to record RT as a measure of processing speed. The RT for auditory attention could not be measured in neuropsychological testing and the IVA may provide a method to measure the characteristics of auditory attention. The literature reviewed above suggests deficits in visual sustained attention in mTBI and ADHD groups, and it was hypothesized that a separate pattern of deficits on the IVA CPT auditory and visual subscales could be identified in mTBI and ADHD groups. The Neuropsychological Impairment Scale (NIS; O’Donnell et al., 1994) was used for a quantitative measure of self-report symptoms. This scale would help determine if there is a different pattern in the self-report of neuropsychological symptoms in the mTBI group compared to the ADHD group. Past research has shown a wide variety of cognitive, emotional, and physical symptoms after mTBI (Rimel, Giordani, (...truncated)