Date Presented 04/05/19
The Computerized Alternating Attention Test (CAAT) assesses alternating attention regularly in clinic and follow-up assessments in patients with schizophrenia. When performing the CAAT, subjects were required to alternately judge two types of rules: digit and shape. A shorter time for completing the CAAT indicates better alternating attention. Our validation of CAAT indicated that the CAAT had the acceptable test-retest agreement, negligible practice effect, and acceptable concurrent validity.
Primary Author and Speaker: Wen-Chyn Lue
Contributing Authors: Gong-Hong Lin, Shu-Chun Lee, Ching-Lin Hsieh
PURPOSE: Deficits of alternating attention is the core type of attention deficit in patients with schizophrenia. However, lack of precise and efficient measures of alternating attention may have caused clinicians cannot precisely detect the deficits of alternating attention in the patients, which hampers the efficacy of treatment. The aims of the study were to develop a Computerized Alternating Attention Test (CAAT) and examine its test-retest reliability, random measurement error, practice effect, concurrent and ecological validity in patients with schizophrenia.
DESIGN: We recruited patients by convenience sampling from two community-based psychiatric rehabilitation day centers affiliated with a medical center in northern Taiwan. Patients were included in this study if they met the following criteria: (1) diagnosis of schizophrenia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (2) age ≥ 20 years, and (3) score of the Mini-Mental Status Examination (MMSE) ≥21 points. The exclusion criteria of this study were patients with (1) diagnosis of other neurological or psychiatric diseases affecting cognition (e.g., stroke or depression), (2) another severe medical condition or psychiatric disorder that required treatment during study, or (3) unstable severity of illness [specifically, the scores of the Clinical Global Impressions Scale-Severity (CGI-S) were different between the first and last assessments of the study].
METHOD: We developed the CAAT on the basis of expert input and examinee feedback. To examine the psychometric properties of the CAAT, each participant was assessed four times, with 1-week intervals. In each assessment, the participants completed both CAAT and Tablet-based Symbol Digit Modalities Test (T-SDMT). The participants were also assessed using the Lawton Instrumental Activities of Daily Living Scale (LIADL). We used the intra-class correlation coefficient (ICC) to examine the test-retest agreement of the two alternating attention tests, the percentage of minimal detectable change (MDC%) to examine the random measurement error, the standardized response mean (SRM) to examine the practice effect, and Pearson’s correlation coefficient (Pearson’s r) to examine the concurrent validity and ecological validity.
RESULTS: The CAAT contains 30 trials in a practice session, 24 trials in a simulation test and 72 trials in a formal test. When performing the CAAT, subjects were required to alternately judge two types of rules: determine whether the digit greater than 5 and whether the shape is symmetrical. The CAAT automatically records the total time needed for completing the test and the number of errors. A shorter time for completing the CAAT indicates better alternating attention. Fifty-seven participants were recruited in this study. The results showed that the test-retest agreement of the CAAT was acceptable (ICC = 0.64–0.76). The random measurement errors of the C-DVT were acceptable (MDC% = 29.6%–33.8%). The practice effect of the CAAT was negligible (SRM = 0.07-0.27). The concurrent validity of the CAAT was moderate (r = -0.51 with T-SDMT). The ecological validity of the CAAT was poor (r = −0.30 with the LIADL). The CAAT had the acceptable test-retest agreement, negligible practice effect, and acceptable concurrent validity in patients with schizophrenia.
CONCLUSION: These features of the CAAT supported repeatedly assessments of alternating attention in the patients, such as regular assessments in the clinic and follow-up assessments in research. However, the substantial amount of random measurement error and the insufficient ecological validity were needed further studies to investigate or revise the CAAT.
References
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