Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Prediction of driving ability after stroke and the effect of behind-the-wheel training

The aim of this study was to examine the predictive value of a neuropsychological test battery relating to an on-the-road driving evaluation and to determine whether patients who failed the driving test could improve their driving through behind-the-wheel training. Thirty-four stroke patients were compared with 20 healthy, matched controls. Patients who failed the driving test were offered driving practice at a driving school and were then reassessed (neuropsychologically and practically). On most of the cognitive tests, patients performed significantly less well than control subjects. Almost 50% of the controls and the patients failed the driving evaluation. None of the neuropsychological tests was able to predict the driving outcome. Of the patients who failed the first driving evaluation, 85% passed the second evaluation after driving practice. There are few controlled studies focusing on the stroke population and the effect of behind-the-wheel training. It is suggested that more controlled studies are needed with more homogenous patient-groups and reliable and quantitative outcome measures.     

Analysis of the elements of attention: A neuropsychological approach

A model for conceptualizing the components or elements of attention is presented. The model substitutes for the diffuse and global concept of attention a group of four processes and links them to a putative system of cerebral structures. Data in support of the model are presented; they are derived from neuropsychological test scores obtained from two samples, the first consisting of 203 adult neuropsychiatric patients and normal control subjects, and the second, an epidemiologically-based sample of 435 elementary school children. Principal components analyses of test scores from these two populations yielded similar results: a set of independent elements of attention that are assayed by different tests. This work presents a heuristic for clinical research in which the measurement of attention is essential.     

Cognitive and psychomotor tests as predictors of on-road driving ability in older primary care patients

This study examined the accuracy with which different cognitive and psychomotor assessment tools were able to predict driving ability among older primary care patients. A cross-sectional study of 50 older drivers (with an average age of 73.1 ± 7.0 years) was conducted. Participants who had been referred by their physicians for psychological assessment following a fitness-to-drive examination underwent both an on-road driving test and a cognitive assessment protocol that included the Senior Drivers Battery (SDB) that is currently administered at the Mobility and Land Transports Institute (MLTI) in Portugal, the Useful Field of View (UFOV) test, the Stroke Drivers Screening Assessment (SDSA), Addenbrooke’s Cognitive Examination Revised (ACE-R), the Trail Making Test, the Key Search test, and the Wechsler Adult Intelligence Scale (WAIS-III) Vocabulary and Block Design tests. Logistic regression analysis revealed that the performances of the participants on the SDSA, ACE-R, UFOV and SDB were the best predictors of on-road driving. Specific measures of processing speed and divided attention, visuospatial abilities, executive functions, psychomotor speed and global cognitive functioning may be useful for predicting unsafe driving. The practical implications of these findings are discussed with a view to developing new assessment models for determining driving fitness in older adults.     

An evaluation of the convergent validity of a face-to-face and virtual neuropsychological assessment counter balanced

The COVID-19 pandemic has highlighted the need for further research evaluating the validity of conducting a battery of neuropsychological assessments virtually compared with face-to-face administration. Previous research has suggested that some neuropsychological assessments yield valid results when administered virtually, however, much of the previous research focused on older adults. To determine the validity of virtually administered neuropsychological tests, 28 healthy participants were assessed using a within-subjects, counter-balanced design. Participants completed a neuropsychological assessment battery covering tests of general intellectual functioning, memory and attention, executive functioning, language and information processing speed, as well as effort. There was no significant difference between face-to-face administration of the neuropsychological battery compared with virtual administration for the majority of the tests used. However, there were significant differences in the Colour Naming Task, with participants making fewer errors on the colour naming task and inhibition/switching task when administered virtually compared with face-to-face administration. There was also a significant age cohort effect in the inhibition/switching task. There was also a trending significant difference in mode of administration for the Verbal Fluency Task. Virtually administered neuropsychological assessments largely provide a valid alternative to face-to-face assessments; however, consideration must be given to test selection as well as the population of participants that are being assessed. Other important considerations must focus on preserving the security and integrity of test materials, as well as administration in a medico-legal setting. Future research should focus on validating assessments with specific patient populations and developing a neuropsychological assessment battery using information technology.     

To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception , (II) spatial attention , (III) visuospatial processing , and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.     

Bears in our midst: Familiarity with Level 2 driving automation and attending to surprise on-road events

This study presents an on-road paradigm to measure the effect of Level 2 (L2) system familiarity on attention strategies to salient, but non-hazardous, driving-related events when using the driving automation. A vehicle with an oversized pink teddy bear on the back overtook participants three times while they drove a 2019 Mercedes-Benz C300 equipped with a L2 system for 1 h. This L2 system requires drivers to keep their hands on the wheel while activated. The L2 system was turned on or off, depending on the assigned condition, and participants varied in their familiarity with L2 systems. Cameras recorded participant eye glance behavior. After the drive, participants were asked to recall the bear and the number of times their mind had wandered from the driving task during the drive. Results show that the driving automation support gave only participants familiar with L2 systems an advantage for greater bear recall. Unfamiliar participants were at a relative disadvantage when assisted by the L2 system, with generally poorer bear recall than unfamiliar participants who drove with the system off. Better bear recall corresponded with wider on-road gaze dispersion and more instances of mind wandering. Our findings support the effectiveness of this paradigm to measure driver attention when using a L2 system under real-world conditions and highlight the need to consider the role of driving automation familiarity in future research.     

Driving fear and driving skills: comparison between fearful and control samples using standardised on-road assessment

The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate.     

Deterrence of drug driving: The impact of the ACT drug driving legislation and detection techniques

Drug driving is a significant road safety concern rendering the implementation of roadside drug testing in all Australian jurisdictions. The current research sought to examine the impact of recently introduced roadside oral fluid screening in the Australian Capital Territory (ACT). Specifically, the study sought to examine drivers’ awareness, perceptions and perceived deterrent impact of these operations and the degree to which they influence likelihood of future drug driving. A total of 801 male and female motorists aged 17–88 years of age completed a phone interview assessing demographics (e.g., driving and drug taking history), awareness and perceived effectiveness of roadside drug testing, and constructs central to both Classical Deterrence Theory (i.e., certainty, severity, swiftness) and reconceptualised deterrence theory (direct and vicarious experiences of both punishment and punishment avoidance) frameworks. Overall, despite an apparent decline in drug driving behaviour since the introduction of roadside testing, a large proportion of driver’s possessed a poor awareness of these operations and did not perceive a high certainty of apprehension. Age, punishment avoidance and vicarious punishment avoidance were found to predict future likelihood of drug driving, whilst Classical Deterrence Theory variables did not. Contrary to expectations and previous studies, few significant differences were found with regards to gender. Findings are interpreted in light of the recency of roadside drug testing in the ACT and the need for future studies to examine the impact of such operations. Further recommendations for augmenting the deterrence of drug driving are discussed.     

Crash risk evaluation of aggressive driving on motorways: Microscopic traffic simulation approach

This paper provides quantitative evaluation of safety implications of aggressive driving (speeding, following closely and weaving through traffic) by using microscopic traffic simulation approach. Combination of VISSIM and Surrogate Safety Assessment Model (SSAM) were used to model motorway and assess safety of the simulated vehicle. The use of vehicle conflicts was validated by correlating it to historic crashes. Crash risk, severity levels and the magnitude of the perceived benefits of aggressive driving were quantified relative to normal drivers under two scenarios: (1) congested, and (2) non-congested traffic conditions. Involvement in vehicle conflicts is used to determine crash-risk while reductions in Post Encroachment Time (PET) and travel time were used to determine the severity levels of the expected crashes and the magnitude of the perceived benefits. The results indicated that the crash risk of aggressive drivers was found to be in the range 3.10–5.8 depending on traffic conditions and type of road aggression. PET of the conflicts involving aggressive drivers reduced by 7–61% indicating high severity levels of the expected crashes. Moreover, the magnitude of the perceived benefit in terms of reduction in travel time was found to be as little as 1–2%. The study concluded that aggressive driving is entailed with a massive risk while its benefits are actually very little.     

Neuropsychological assessment with the Visual Gestalt Test: psychometric properties and differential diagnostic probabilities

The Visual Gestalt Test is a neuropsychological instrument developed for evaluation of learning and memory of visuo-spatial material. A revised strategy of scoring has motivated the present study, where data from 153 normal persons, 99 epilepsy patients, and 24 depressed patients are presented and compared. The Visual Gestalt Test is observed to discriminate between normal and diagnosed groups in several ways. Additionally it is found to discriminate between depressed and brain damage subgroups of patients. Data are presented in order to supplement previously published ways of scoring and norms. Practical guidelines for the clinical applications of the test are suggested as perspectives.     

Nomophobia and self-reported smartphone use while driving: An investigation into whether nomophobia can increase the likelihood of illegal smartphone use while driving

In Australia, illegal smartphone use while driving is on the rise, increasing the likelihood drivers could be distracted and crash. Smartphones avail users a sense of belonging, connectedness, and access to information. As such, the sensation of being without one’s smartphone has developed into the prevalence of nomophobia, defined as the fear and anxiety associated with being without smartphone. The aim of the current study was to specifically examine the relationship between smartphone use while driving and nomophobia by 1) determining the types and frequency of illegal phone use while driving and, 2) exploring the relationship between nomophobia and illegal phone use while driving. The sample consisted of 2,774 Victorian smartphone users (47.0% male) with a valid driver’s licence. Driver’s nomophobia levels were measured using the Nomophobia Questionnaire (NMP-Q), while driver’s smartphone use was measured using an original scale developed by the authors. A binary logistic regression was conducted which showed that the longer average time spent per day on a smartphone and a lack of knowledge of the mobile phone road law were the strongest positive predictors of illegal use (OR = 1.32, 95% CI = 1.09–1.60; OR = 1.84, 95% CI = 1.48–2.28, respectively). However, only one nomophobia factor (i.e., access to information) significantly predicted illegal smartphone use (OR = 1.06, 95% CI = 1.04–1.09). Smartphone use is a complex and contextual behaviour, therefore, focusing on the fear of being without in dependency overlooks the nuances of the need to be with. This study offered several practical interventions that may mitigate illegal smartphone use and reduce the likelihood of crashes among Victorian road users.     

Planning for driving retirement: The effect of driving perceptions,driving events,and assessment of driving alternatives

Most older adults will eventually stop driving, but few engage in planning for driving retirement. This study assessed whether driving stress, enjoyment, confidence, concerning driving events, and assessment of driving alternatives influence planning. Demographic factors were also included. Data were collected via a mailed transportation survey, with a final sample of 551 older adults who currently drive. Linear regression analyses revealed that more driving retirement planning was associated with greater driving stress, less driving confidence, and a more positive view of driving alternatives. Driving enjoyment and recent concerning driving events were not significantly related. Among the control variables, race and income were significantly related to planning, suggesting that lower income and identifying as Black race were associated with more planning. Gender only approached significance, suggesting that females may plan more than males. Overall, these findings suggest that more driving retirement planning is warranted. Some of the groups known to be at increased risk for driving reduction and cessation plan more for that eventuality than their counterparts. Implications of the study and suggestions for future research are discussed.     

The potential of gamification for user education in partial and conditional driving automation: A driving simulator study

Drivers must establish adequate mental models to ensure safe driver-vehicle interaction in combined partial and conditional driving automation. To achieve this, user education is considered crucial. Since gamification has previously shown positive effects on learning motivation and performance, it could serve as a measure to enhance user education on automated vehicles. We developed a tablet-based instruction involving gamified elements and compared it to instruction without gamification and a control group receiving a user manual. After instruction, participants (N = 57) experienced a 30-minute automated drive on a motorway in a fixed-base driving simulator. Participants who received the gamified instruction reported a higher level of intrinsic motivation to learn the provided content. The results also indicate that gamification promotes mental model formation and trust during the automated drive. Taken together, including gamification in user education for automated driving is a promising approach to enhance safe driver-vehicle interaction.     

Improving the driving practices of pizza deliverers: Response generalization and moderating effects of driving history

A practical intervention program, targeting the safety belt use of pizza deliverers at two stores, increased significantly the use of both safety belts (143% above baseline) and turn signals (25% above baseline). Control subjects (i.e., pizza deliverers at a third no-intervention store and patrons driving to the pizza stores) showed no changes in belt or turn signal use over the course of 7-month study. The intervention program was staggered across two pizza stores and consisted of a group meeting wherein employees discussed the value of safety belts, received feedback regarding their low safety belt use, offered suggestions for increasing their belt use, and made a personal commitment to buckle up by signing buckle-up promise cards. Subsequently, employee-designed buckle-up reminder signs were placed in the pizza stores. By linking license plate numbers to individual driving records, we examined certain aspects of driving history as moderators of pre- and postintervention belt use. Although baseline belt use was significantly lower for drivers with one or more driving demerits or accidents in the previous 5 years, after the intervention these risk groups increased their belt use significantly and at the same rate as drivers with no demerits or accidents. Whereas baseline belt use was similar for younger (under 25) and older (25 or older) drivers, younger drivers were markedly more influenced by the intervention than were older drivers. Individual variation in belt use during baseline, intervention, and follow-up phases indicated that some drivers require more effective and costly intervention programs to motivate their safe driving practices.     

The impact of culture and education on non-verbal neuropsychological measurements: a critical review

Clinical neuropsychology has frequently considered visuospatial and non-verbal tests to be culturally and educationally fair or at least fairer than verbal tests. This paper reviews the cross-cultural differences in performance on visuoperceptual and visuoconstructional ability tasks and analyzes the impact of education and culture on non-verbal neuropsychological measurements. This paper compares: (1) non-verbal test performance among groups with different educational levels, and the same cultural background (inter-education intra-culture comparison); (2) the test performance among groups with the same educational level and different cultural backgrounds (intra-education inter-culture comparisons). Several studies have demonstrated a strong association between educational level and performance on common non-verbal neuropsychological tests. When neuropsychological test performance in different cultural groups is compared, significant differences are evident. Performance on non-verbal tests such as copying figures, drawing maps or listening to tones can be significantly influenced by the individual's culture. Arguments against the use of some current neuropsychological non-verbal instruments, procedures, and norms in the assessment of diverse educational and cultural groups are discussed and possible solutions to this problem are presented.     

A cross-cultural analysis of aggressive driving: Evidence from Serbia and Romania

Using data from more than 700 drivers from Serbia and Romania, this study verified the dimensionality of aggressive driving in two countries from Eastern Europe. Specifically, the psychometric properties and invariance of the Romanian Driving Anger Expression Inventory (DAX; Deffenbacher et al., 2002, Sârbescu, 2012) were verified. Secondary aspects, such as differences in aggressive driving between countries or gender differences within countries, were also investigated. Our findings support the appropriateness of the three-factor structure in both countries, through the configural invariance of the DAX. Also, males report slightly higher levels of aggressive driving than women (small effect sizes), while Serbian drivers report higher levels of aggressive driving than Romanian drivers (strong effect sizes). Being the first research that verified the invariance of the DAX across two cultures, this study opens new paths and questions for research concerning aggressive driving.     

Computerized assessment in neuropsychology: A review of tests and test batteries

This article contains detailed reviews of 13 computerized neuropsychological and performance test batteries and six stand-alone computer tests. Tasks found on these instruments are described and tables illustrate which batteries employ which measures. In addition to issues of reliability and validity, special considerations apply to computerized assessment. These issues are discussed and readers are provided information to help them assess computerized tests in relation to their particular clinical and research needs. Since many computerized tests were developed as performance assessment tools, the relationship between performance and neuropsychological assessment is examined.     

Human factors of transitions in automated driving: A general framework and literature survey

The topic of transitions in automated driving is becoming important now that cars are automated to ever greater extents. This paper proposes a theoretical framework to support and align human factors research on transitions in automated driving. Driving states are defined based on the allocation of primary driving tasks (i.e., lateral control, longitudinal control, and monitoring) between the driver and the automation. A transition in automated driving is defined as the process during which the human-automation system changes from one driving state to another, with transitions of monitoring activity and transitions of control being among the possibilities. Based on ‘Is the transition required?’, ‘Who initiates the transition?’, and ‘Who is in control after the transition?’, we define six types of control transitions between the driver and automation: (1) Optional Driver-Initiated Driver-in-Control, (2) Mandatory Driver-Initiated Driver-in-Control, (3) Optional Driver-Initiated Automation-in-Control, (4) Mandatory Driver-Initiated Automation-in-Control, (5) Automation-Initiated Driver-in-Control, and (6) Automation-Initiated Automation-in-Control. Use cases per transition type are introduced. Finally, we interpret previous experimental studies on transitions using our framework and identify areas for future research. We conclude that our framework of driving states and transitions is an important complement to the levels of automation proposed by transportation agencies, because it describes what the driver and automation are doing, rather than should be doing, at a moment of time.