Clinical Assessment, Computerized Methods, and Instrumentation (Computers in Psychology, 7)

CLINICAL ASSESSMENT COMPUTERIZED METHODS AND INSTRUMENTATION

CLINICAL ASSESSMENT, COMPUTERIZED METHODS, AND INSTRUMENTATION Ed rs

F.J.Maarse Nijmegen Institute for Cognition and Information (NICI) Nijmegen University, The Netherlands A.E.Akkerman LTP BV Amsterdam, The Netherlands A.N.Brand Department of Clinical Psychology University of Utrecht, The Netherlands L.J.M.Mulder Department of Environmental and Work Psychology University of Groningen, The Netherlands

LISSE ABINGDON EXTON (PA) TOKYO

Library of Congress Cataloging-in-Publication Data Applied for Copyright © 200 Swets & Zeitlinger B.V., Lisse, The Netherlands All rights reserved. No part of this publication or the information contained herein may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, by photocopying, recording or otherwise, without written prior permission from the publishers. Although all care is taken to ensure the integrity and quality of this publication and the information herein, no responsibility is assumed by the publishers nor the author for any damage to property or persons as a result of operation or use of this publication and/or the information contained herein. Published by: Swets & Zeitlinger Publishers http://www.szp.swets.nl/ This edition published in the Taylor & Francis e-Library, 2006. “ To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to http://www.ebookstore.tandf.co.uk/.” ISBN 0-203-97098-5 Master e-book ISBN

ISBN 90 265 (Print Edition)

Contents Preface

vii

Section I. Clinical Assessment 1 Computerized Measurement of Implicit Short Term Memory Retention in a Digit Copying Task C.Lafosse, M.Moeremans, G.De Corte, I.Leenen, H.Maes, and E. Vandenbussche 2 Neuropsychological Assessment of Spatial Memory: Using Object Relocation in Clinical Subjects R.P.C.Kessels, A.Postma, and E.H.F.de Haan 3 Developing a Computer-Supported, Collaborative Learning Environment for Argumentative Writing H.J.M.(Tabachneck-)Schijf, G.Erkens, J.Jaspers, and G.Kanselaar 4 A Multi-Media Computer Program for Training in Basic Professional Counseling Skills J.Adema and K.I.van der Zee 5 The Conquered Giant: The Use of the Computer in Play Therapy M.F.Delfos 6 A Conceptualization of Alexithymia and Defense Mechanisms in relation to Lateral Brain Dominance P.P.Moormann, N.Brand, E.Behrendt, and J.Massink 7 Quantification of Eye Blinks and Eye Tics in Gilles de la Tourette Syndrome by Means of Computer-Assisted Observational Analysis—Clinical Application J.H.M.Tulen, M.Azzolini, J.A.de Vries, W.H.Groeneveld, J.Passchier, and B.J.M.van de Wetering

2

15

26

41

53 66

85

Section II. Computerized Methods 8 Sequential Testing in Psychodiagnostics Using Minimax Decision Theory H.J.Vos 9 Visual Ordination Techniques in Grid Methodology: The Example of the Self-Confrontation Method

100 113

R.van Geel, H.de Mey, and N.Bendermacher 10 From Theory to Research: Computer Applications in a Novel Educational Program for Introductory Psychology N.Brand, G.Panhuijsen, H.Kunst, J.Boom, and H.Lodewijkx 11 Psychotherapy Treatment Decisions Supported by Select Care C.Witteman 12 A Method for the Assessment of Interpersonal Functioning in a Residential Group Therapy Program K.Linker

128

136 146

Section III. Instrumentation 13 Using Windows for Psychological Tests and Experiments with Real-time Requirements C.F.Bouwhuisen and F.J.Maarse 14 WinTask: Using Microsoft Windows ™ for Real-time Psychological Experiments J.Bos, E.Hoekstra, L.J.M.Mulder, J.A.Ruiter, J.R.Smit, D.Wybenga, and J.B.P Veldman 15 Mouse or Touch Screen J.van de Ven and A.de Haan 16 Automan: A Psychologically Based Model of a Human Driver L.Quispel, S.Warris, M.Heemskerk, L.J.M.Mulder, and P.C.van Wolffelaar 17 Workplace for Analysis of Task Performance J.Bos, L.J.M.Mulder, and R.J.van Ouwerkerk 18 Cognitive Analysis and Modeling of an Ambulance Dispatch Task R.J.van Ouwerkerk, R.Kramer, J.Bos, and L.J.M.Mulder Author Index

157

166

181 194 208 222

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Preface This seventh edition of ‘Computers in Psychology’ contains proceedings of the workshop with the same name held at the University of Utrecht in September 1999. The workshop is intended for psychologists and researchers working in the field of experimental psychology, who are engaged in dedicated professional use of computers for assessment or research. The organizing committee conducts these workshops in order to improve communication between technicians and researchers working at psychological laboratories, and psychologists working in the field of psycho-diagnostics, clinical assessment and neuropsychology. This book is divided into three sections: Clinical Assessment, Computerized Methods, and Instrumentation.

Clinical Assessment

This section contains contributions from seven different research areas. In Chapters 1 and 2, Lafossse and Kessels describe two clinical assessment tasks for short-term memory and spatial memory, respectively. Chapter 3 ((Tabachneck-) Schijf et al.) investigates progress in a collaborative learning environment, using argumentative texts. In Chapter 4 (Adema) and Chapter 5 (Delfos), computer programs are used for training in counseling skills and play therapy. In Chapter 6 (Moormann et al), the issue of alexithymia in relation to defense mechanisms is addressed. In Chapter 7 (Tulen), the last in the section Clinical Assessment, a computer-assisted observational analysis of eye blinks and eye tics in Gilles de la Tourette syndrome is presented.

Computerized Methods

This section focuses on methods realized with the use of computers, in clinical as well as in experimental settings. In the first contribution (Chapter 8), by Vos, optimal rules of sequential testing problems in psycho-diagnostics are derived. Chapter 9 (Van Geel et al.) presents visual ordination techniques in grid methodology. The computer program KUNGRID is applied to the self-confrontation method of Hermans (1976). Chapter 10 (Brand et al.) describes the application of a Testmanager program to a practical introductory course for psychology students. SelectCare is another computer program (Chapter 11, by Witteman), containing a decision making model for supporting

psychotherapists who need to decide how to treat patients suffering from depression. A method for the assessment of interpersonal functioning in a residential group therapy program (Chapter 12, by Linker) is the last topic of this section.

Instrumentation

The central issue of this section is the hardware and software needed for controlling and implementing psychological and ergonomic experiments. Chapters 13 and 14 (Bouwhuisen; Bos) describe the problems that have to be solved for real-time experimentation using Microsoft Windows 95/98. Van de Ven and de Haan, in Chapter 15, presents the differences between using a mouse and a touch screen as a computer input device. The last three contributions describe three experimental settings at the University of Groningen. The first contribution (Chapter 16), by Quispel et al., concerns a psychologically based model of a human driver. The second paper, by Bos et al. (Chapter 17), introduces a laboratory based environment for a broad range of day-to-day tasks. In the last contribution to this section and to the entire book, by Van Ouwerkerk et al. (Chapter 18), the results of a field study of the workload of ambulance dispatchers are used to build a virtual spatial navigation and planning environment in the laboratory.

Organization and background to ‘Computers in Psychology’

The Contact group for Instrumentation in Psychology in the Netherlands (KIP), and the users Group Computer Aided Diagnostics in the Netherlands (GCOP) recognized the significance of the computer for psychological research and assessment purposes as early as 1984, when they took the initiative to organize the first workshop ‘Computers in Psychology’. Since that first occasion, the workshop has been organized every two or three years. The purpose of the workshop is to provide a platform for the exchange of knowledge, insights and ideas concerning the use of the computer in psychological research and applied psychological work. The workshops are held to stimulate technicians, test developers and scientists to present newly developed instrumentation and methods of tackling the problems associated with real-time data-acquisition, data processing and information management.

Acknowledgements

Here we would like to acknowledge the numerous people who have contributed to the success of the last workshop in Utrecht and to the production of these proceedings. We

want to thank the members of the local organizing committee, which includes Nico Brand, Sibe Doosje, Wim Sjouw, Barbara Wesselingh and Erna Beeker. Due to their enthusiasm, the workshop became a great success. We also thank the audio-visual department of the Faculty of Social Sciences for their support. We could not forget to mention the members of the KIP and the GCOP for their help, advice and reviews. We thank the authors for their creative contributions and their cooperation in producing this book. Finally, we thank Karen Mansfield for her accurate corrections and improvements to the written English of all the chapters in this book. Frans J.Maarse

Section I CLINICAL ASSESSMENT

Chapter 1 Computerized Measurement of Implicit Short Term Memory Retention in a Digit Copying Task C.Lafosse1,2, M.Moeremans1, G.De Corte3, I.Leenen2, H.Maes2, and E.Vandenbussche2 1

Rehabilitation Center Hof ter Schelde, August Vermeylenlaan 6, B-2050 Antwerp, LO, Belgium 2 Laboratory of Neuropsychology, K.U.Leuven, Belgium 3 UIA, University of Antwerp, Belgium

Abstract Timing characteristics of memory recall appear to be as informative as accuracy measures. We argue that a specific kind of response time, namely the Inter-Response time (IRI), can be of special significance in measuring implicit short term memory retention in a digit copying task. In this study we investigated the congruent and empirical validity of the IRI as a behavioral correlate of short-term memory retention during digit copying. Normal subjects (n=107; age varying between 12 and 70 years) were asked to copy strings of 5 digits by echoing them on the numerical keyboard. The computer recorded the time that elapsed between the correct entry of two successive digits of a digit string: the Inter-Response Interval (IRI). First, congruent validity was established by investigating the (cor)relation between subjects’ IRI of the non-repeated digit strings and their Digit Span retention score measured by the WAIS. Second, based on Hebb’s paradigm, empirical validity was established by manipulating the recurrence of a particular digit string. The results showed a significant correlation between subjects IRI and their Digit Span score indicating that individual differences in the IRI of the non-repeated digits can be explained by differences in short term memory retention capacity. The results also showed that, according to Hebb’s paradigm, with the progress of the test trials, the IRI of the repeated digit strings decreases gradually (as it was stored in LTM), while the IRI of the nonrepeated strings (measuring STM retention capacity) remain stable indicating that STM retention can be dissociated from digit learning. These results suggest that classical and computerized assessment should be considered complementary. Each one can reveal different aspects of cognitive functioning. In this study, we demonstrated that response times

Computerized measurement of implicit short term memory

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are informative for measuring implicit memory functioning in a digit copying task.

Introduction Memory assessment is one of the principal objectives of neuropsychological evaluation. Therefore one would expect a considerable degree of sophistication on the part of the professional performing these assessments, both in the approach to the phenomena of memory and in the assessment of the procedures they select (Loring & Papanicolaou, 1987). However, since the clinical and research functions of clinical neuropsychology have moved away from establishing the cerebral localization of lesions and brain functions, it is more important to find practical methods of assessing implicit and explicit everyday memory performance in the laboratory (Loring & Papanicolaou, 1987) both for subjects with major and minor brain dysfunctions. Memory plays a part in the performance of a wide variety of everyday tasks in a rather implicit or indirect manner. For instance, Conrad and Hull (1967) found evidence that short-term memory is important in a person’s accuracy in copying alpha-numeric material by hand. In these kind of tasks memory intervenes in a rather automated and less conscious way in comparison with the classical laboratory memory tasks. However, what is done effortlessly by a normal person may require cognitive effort on the part of the brain damaged subject. Even minor neurological impairments may cause subtle and transient cognitive changes resulting in major “hidden” consequences for everyday functioning. For example, a transient but unnoticed “slowing” may be more traumatic because of its “hidden nature” than a continuous and perceivable side effect for which the subject can compensate (Thompson & Huppert, 1980). Consequently, whereas subjects with minor memory impairments will perform at ceiling level on everyday memory tests like, for instance, the Rivermead Behavioral Memory Test, they need more cognitive effort in comparison with normal persons on simple tasks such as copying digits due to slower information processing. The question now is, how can we measure memory retention adequately for tasks that at first sight do not explicitly refer to memory processing? An important condition by the implicit measurement of this kind of memory is that the subject is not aware that his memory is being tested. Most parameters registered by paper and pencil tests do not fulfil this requirement because they assess memory explicitly, so that subjects are aware of memory testing. Consequently, many subjects are confronted with their failing competence because their lost functions are being addressed. As a behavioral correlate of this kind of implicit memory function, the timing characteristics of recall appear to be more informative than reporting the subjects’ number of items correctly recalled. Indeed, response times can be registered implicitly, this means without explicitly informing the subjects. By means of computerized assessment response times can also be measured with millisecond precision. Consequently, subtle brain abnormalities and minor memory impairments affecting processing speed, which are difficult to detect by conventional pencil and paper tests, can be readily measured by a computer (Alpherts & Aldenkamp, 1990). Some studies illustrate the value of time registration in addition to traditional accuracy measures as a

Clinical assessment computerized methods

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sensitive and significant factor in performance. Harness et al. (1977) found that response latency was of special differential significance in the comparison of cognition and performance in subjects with organic brain damage and psychiatric patients. Glenn and Parsons (1990) specifically addressed the role of processing time in neuropsychological performance and combined it with accuracy measures to provide a more sensitive measure in detecting subtle alcohol impairment. We argue that a specific kind of response time, namely the Inter-Response time, can be of special significance in measuring implicit memory functioning in certain everyday tasks. There is some indication from experimental psychology that this may be the case. Based on the Inter-Response times, Chase and Simon (1973) defined the memory chunks during playing chess and how they are related to one another. In other words, they measured the implicit or indirect memory retrieval in playing chess by means of Interresponse times. We developed a computerized digit copying task based on the registration of subject’s Inter-Response Interval times (IRI). Digit strings, presented successively on the computer monitor, had to be echoed on an adapted numerical keyboard. Each digit string remains on the screen until the subject has completely entered it. The subjects work at their own pace (they were not instructed to perform at a particular pace). The computer recorded the time that elapsed between the entry of two successive digits in the digit string: the Inter-Response Interval (IRI). We argue that the IRI can be an implicit measurement of short-term memory retrieval during digit copying for two reasons. First, there is evidence that short-term memory plays a role in copying digit strings presented on a computer monitor (Conrad, 1966). Second, an analysis of this task reveals that subjects have to shift their fixation point from the monitor to the keyboard. This process of ‘shifting’ takes time and can be accurately measured by the IRI. During this time subjects have to store some digits in short-term memory. Therefore, individual differences in IRI may be explained by differences in short-term memory retention capacity. In this study we investigated the congruent and empirical validity of the IRI as a behavioral correlate of short-term memory retention during digit copying. Based on Hebb’s Recurring Digits paradigm (Hebb, 1961; Milner, 1970, 1971), which distinguishes short term from long term memory behaviorally, the trials consist of alternating non-repeated and, unknown to the subjects, a repeated digit string of five digits. First, congruent validity was established by investigating the (cor)relation between subjects’ IRI of the non-repeated digit strings and their Digit Span retention score measured by the WAIS. If individual differences in the IRI of the non-repeated digits can be explained by differences in STM capacity, then we expect a significant correlation between subjects IRI and their Digit Span score. Second, empirical validity was established by manipulating the recurrence of a particular digit string. If the IRI short term memory retention can be dissociated from digit learning, then we expect that, according to Hebb’s paradigm, with the progress of the test trials, the IRI of the repeated digit strings will decrease gradually (as it will have been stored in long term memory), while the IRI of the non-repeated strings (measuring STM capacity) will remain stable.

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Figure 1. Example of one of the test trials. In total, thirty-two strings of 5 digits are presented successively on the computer screen placed in front of the subjects. Method Subjects The subjects in this study were 107 normal persons (N=107; age varying between 12 and 70). None of these subjects had motor or visual problems that would interfere with correct performance of the task. All subjects were recruited either from one of two regular schools, from one university (psychology students and staff from the K.U.Leuven) or from one of three nursing homes, based on their voluntarily cooperation and availability. Task Thirty-two strings of 5 digits were presented successively on the computer screen placed in front of the subjects (see Figure 1). Fifteen unrepeated strings of 5 digits each, were presented successively. Based on Hebb’s Recurring Digit paradigm (Hebb, 1961; Milner, 1970) we manipulated also the recurrence of a particular digit string. Therefore, from trial four, a specific digit string (namely “2–5–1–9–6”) was alternated with a non repeated digit string. They were asked to copy each string by echoing them on the numerical keyboard. While performing this task, subjects worked at their own pace. Each digit string remained on the screen until the subject had completely entered it. Subjects could also monitor which digits they were entering and they were allowed to make corrections.

Clinical assessment computerized methods

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Figure 2. The Inter-Response Intervals (IRI) within one digit string, i.e. the time elapsed between the entry of two successive digits of a digit string. There are 5 digits, therefore each digit string consists of 4 IRI’s. The computer recorded the time that elapsed between the correct entry of two successive digits of a digit string: the Inter-Response Interval (IRI). There are 5 digits, therefore each digit string consists of 4 IRI’s (Figure 2). The adapted numerical keyboard differs from the default computer keyboard in the sense that the position of the digits was reversed (1 2 3 being at the top instead of the bottom). This arrangement has three advantages: (1) from the ergonomic point of view it gets priority (Conrad & Hull, 1966); (2) it fits in with daily life keyboard designs such as a telephone, a calculator, a teller machine etc. and hence increases the ecological validity; (3) the difficulty level of this keyboard layout will be roughly the same for subjects with and without computer experience. Experienced computer users can not profit from their skills because they are unfamiliar with this keyboard layout. For the other group it conforms more to subjects’ expectations of where numerals are to be found. To avoid any response bias that might be introduced by this particular keyboard, subjects were able to familiarize themselves extensively with this layout before the actual experiment. For this purpose a similar task was presented this time with non-repeated strings ranging from 1 to 4 digits. Furthermore, it should be emphasized that we investigated and optimized the user-interface of this task before the initial experiment. Procedure All subjects had to perform individually the digit copying task followed by the classical pen-and-paper WAIS Digit Span sub-test. The total duration of a test session lasted 15 minutes. Subjects were asked to copy, at their own pace, each string by echoing it on the adapted numerical keyboard. The experimenter told them that he wanted to investigate the human user-interface of a simple digit copying task. No suggestion was made with reference to a memory experiment.

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Data Analysis In this study we focused on the analysis of subjects’ response times for correctly entered digit strings. Congruent Validity. Congruent validity was investigated by calculating the relation between subject’s median IRI and short-term memory as measured afterwards by the Digit Span score (WAIS). This Digit Span test is a classical test that reflects the amount of digits that can be immediately attended to and stored in short-term memory. It encompasses a greater memory component in combining a forward and backward digit span, and thus makes it a more sensitive index than measuring the forward digit span alone (Kapur, 1994). We used a one-tailed non-parametric partial Spearman rank-order correlation coefficient to determine the degree of association between the subject’s median IRI (across digit strings) and their Digit Span score, corrected for age. Empirical Validity. Based on Hebb’s Recurring Digit paradigm (Hebb, 1961; Milner, 1970) we manipulated the recurrence of a particular digit string. We expected that, with the progress of the test trials, the median IRI within the repeated digit strings decreases gradually, in comparison with the median IRI within the non-repeated strings that would remain stable. In addition, we wondered whether the decrease could be attributed to an equal decrease of the four IRI’s within a digit string or to a more pronounced decrease in one particular IRI? It is worth looking more closely at this due to the light it may shed on the strategies involved in performing this task. Therefore, we carried out an ANOVA by means of multiple regression with a three Factorial Block design, examining main effects and factor interactions. The factors involved were respectively (1) the variable trial number (this factor occurred at 30 levels equal with the number of trials); (2) the variable repeat, (i.e. the variable indicating whether or not the string was repeated; it occurred at 2 levels, namely the recurring or non-recurring appearance of digit string; (3) the variable interval (occurring at 4 levels, namely the 4 individual IRI’s within a digit string). Since the test consists of all these conditions and all subjects passed the test (and consequently, all levels of the independent variables), subject scores will be considered as ‘blocks’ of observations. By this block design, variability in the dependent variable (i.e. IRI) due to inter-individual differences can be eliminated from the error variance. In this way, possible effects from the independent variables on the dependent variable might be revealed more efficiently. Results Congruent Validity. We used a one-tailed non-parametric partial Spearman rank-order correlation coefficient to determine the degree of association between the subject’s median IRI (across digit strings) and their Digit Span score, corrected for age. We found a significant negative correlation between subjects’ median IRI of the non-repeated digit strings and their Digit Span score: rs=−.56 (p