EXAMINER Assessments

Domain: Working Memory

Dot Counting

The dot counting task measures verbal working memory. The examinee is asked to look at a screen with a mixed array of green circles, blue circles and blue squares. The examinee is asked to count all of the blue circles on the screen one at a time, out loud and remember the final total. Once the examinee finishes counting the blue circles on one screen, the examiner switches the display to a different mixed array of green circles, blue circles and blue squares. The examinee is instructed to count the blue circles in the new display. The number of different displays presented to the examinee in each trial increases from two to seven over six experimental trials. After counting the blue circles on all of the displays presented within a trial, the examinee is asked to recall the total number of blue circles that were counted in each of the different displays in the order in which they were presented. Partial credit is given based on how many totals the examinee can recall correctly from each trial.

N-back

The n-back paradigm is a widely used measure of working memory that requires flexible updating capabilities. EXAMINER includes a spatial 1-back and 2-back task to assess spatial working memory. The 1-back requires maintaining and updating one location at a time, whereas the more difficult 2-back requires maintaining and updating two locations.

 

Domain: Inhibition

Flanker

A row of five arrows is presented in the center of the screen. The examinee is required to indicate whether the centrally presented arrow is pointing either to the left or right by pressing the left or right arrow key. The examinee is presented with two different conditions during the task, incongruent and congruent. In the congruent trials, the non-target arrows point in the same direction as the target arrow, and in the incongruent trials, they point in the opposite direction. Examinees should respond as quickly and accurately as possible.

Continuous Performance Test (CPT)

The continuous performance task is a classic response inhibition task, which requires subjects to respond to a certain type of stimulus and withhold a response to another.

Antisaccades

This is an eye movement task. The subjects look at a fixation point in the center of a computer screen and move their eyes upon presentation of a laterally presented stimulus. In the first block (pro-saccade), subjects are instructed to move their eyes in the direction of the presented stimulus. In the second and third blocks (antisaccade), subjects are instructed to move their eyes in the opposite direction of the presented stimulus.

Dysexecutive Errors

An underlying assumption in developing the EXAMINER battery is that executive related deficits can manifest as impulsive errors, failure to shift set, perseverative behavior, and stimulus-boundedness, even when achievement scores on tests are unremarkable. Accordingly, we generated a composite error score#using false responses and rule violations on a variety of EXAMINER tasks, including CPT, verbal fluency tasks, Flanker and Set Shifting.

 

Domain: Set Shifting

Set Shifting

Participants are required to match a stimulus on the top of the screen to one of two stimuli in the lower corners of the screen. If task-homogeneous blocks, participants perform either Task A (e.g., classifying shapes) or Task B (e.g., classifying colors). In task-heterogeneous blocks, participants alternate between the two tasks pseudo-randomly. The combination of task-homogeneous and task-heterogeneous blocks allows measurement of general switch costs and latency differences between heterogeneous and homogeneous blocks) and specific switch costs (differences between the switch and non-switch triads within the heterogeneous block).

 

Domain: Fluency

Phonemic Fluency

For the phonemic fluency task, examinees are instructed to name as many words as they can that begin with a particular letter of the alphabet as quickly as they can. Sixty seconds are allowed for each letter.

Category Fluency

For the category fluency task, examinees are asked to generate as many items that they can think of that belong to a particular category as quickly as possible. Sixty seconds are allowed for each category.

 

Domain: Planning

Unstructured Task

This task was modeled after the 6-elements test (Shallice & Burgess, 1991). Subjects are presented with three booklets, each containing five pages of simple puzzles (four per page).The puzzles were designed to be cognitively simple (e.g., connect the dots; trace the design) but average completion times range from 4 to 60 seconds. Each puzzle has a designated point value, and subjects are given 6 minutes to earn as many points as possible. Irrespective of actual point value, puzzles can have a high cost-benefit ratio (i.e., the time required to complete the puzzle makes it less desirable) or a low cost-benefit ratio (i.e., the time required to complete the puzzle makes it more desirable). In addition, the proportion of low cost-benefit items decreases as subjects proceed through a booklet. Subjects need to plan ahead, avoid items that are strategically poor choices, and be cognizant of when a particular booklet offers diminishing returns.

 

Domain: Insight

Insight

Examinees are asked to rate themselves on their performance immediately after completing the well-normed verbal fluency tasks. They are instructed to assess their own performance relative to a hypothetical sample of 100 people of a similar age and level of education.

 

Domain: Social Cognition and Behavior

The Social Norms Questionnaire

This task measures subjects’ crystallized knowledge of social norms in a linguistically and cognitively simple manner. This yes-no questionnaire is designed to determine the degree to which subjects actually understand and can accurately identify implicit but widely accepted social boundaries in the dominant US culture. The Social Norms Questionnaire includes both socially inappropriate behaviors (e.g., cut in line if you are in a hurry, pick your nose in public) and generally acceptable behaviors (e.g., tell a coworker your age, blow your nose in public). The subject must decide whether the behavior is socially appropriate or not if it were hypothetically enacted with an acquaintance or coworker.

Behavior Rating Scale

This rating scale is completed by the examiner after completion of the testing. Examiners restrict their ratings to behaviors that they have observed directly, but include all observed behaviors, regardless of the context. Thus, although behaviors during the actual assessment will likely provide the bulk of data, examiners should also note behaviors exhibited in all other situations, such as the waiting room and walking to and from the exam room. There are nine behavioral domains to rate, including agitation, stimulus-boundedness, perseverations, decreased initiation, motor stereotypies, distractibility, the degree of social/emotional engagement, impulsivity, and social appropriateness.