Disentangling response initiation difficulties from response inhibition in autism spectrum disorder: A sentence-completion task.

It has been proposed that individuals with autism spectrum disorder (ASD) struggle both with response initiation and with response inhibition, both of which are functions of the executive system. Experimental tasks are unlikely pure measures of a single cognitive domain, and in this study we aim at understanding the contributions of response initiation difficulties to possible deficits in inhibitory control in autism. A sample of adults diagnosed with ASD and a control sample participated in this study. To participants it was asked to perform a sentence-completion task with two different condition: Part A-targeting response initiation and Part B-engaging inhibitory processes. Importantly, we have analyzed the B-A latencies that have been proposed for the removal of the response initiation confound effect. Results show that no differences between the groups were found in accuracy measures, either in Part A (ASD: M = 0.78; Controls: M = 0.90) nor Part B (ASD: M = 0.03; Controls: M = 0.02). However, in both conditions autistic participants were significantly slower to respond than the group of participants with typical development (Part A-ASD: M = 2432.5 ms; Controls M = 1078.5 ms; Part B-ASD M = 6758.3 ms; Controls M = 3283.9 ms). Critically, we show that when subtracting the response times of Part A from Part B (B-A latencies) no group differences attributable to inhibitory processes remained (ASD: M = 4325.76; Controls: M = 2205.46). With this study we corroborate the existence of difficulties with response initiation in autism and we question the existence of troubles in inhibition per se.

Response initiation and inhibition and the relationship with fluid intelligence across the adult lifespan.

BACKGROUND: Cognitive processes associated with frontal lobe functioning are often termed "executive functions." Two such processes are initiation and inhibition or the starting and stopping of responses. It has recently been claimed dysfunction of executive abilities can be explained by a single measure of fluid intelligence. Here, we test this claim, specifically for the executive abilities of response initiation and inhibition, across the healthy lifespan. METHOD: In a cohort of 336 healthy adults (18-89 years), initiation and inhibition were assessed with the Hayling test, Stroop test, and phonemic and semantic verbal fluency. All participants also completed a measure of fluid intelligence. The relationship between fluid intelligence and executive measures was explored across the lifespan using a continuous approach. Mediation models were computed to assess whether age-related decline across the four initiation/inhibition tasks could be fully explained by a single measure of fluid intelligence. RESULTS: Age was negatively correlated with response initiation/inhibition and fluid intelligence. The mediation analyses identified only partial mediation of fluid intelligence for age and Hayling performance. By contrast, fluid intelligence did not mediate performance on the Stroop test or phonemic and semantic verbal fluency. CONCLUSIONS: Response initiation/inhibition are not able to be explained by fluid intelligence. The results support a multifactorial theory of executive functions and provide evidence for the inclusion of multiple specific executive measures in a thorough neuropsychological assessment of age-related cognitive decline.

Cognitive and Behavioral Inhibition Deficits in Parkinson's Disease: The Hayling Test as a Reliable Marker.

OBJECTIVE: The present study seeks to provide an overview of executive (inhibition and flexibility) deficits in Parkinson's disease (PD) by combining a cognitive and behavioral approach. METHODS: Fifteen PD patients and 15 healthy controls underwent a neuropsychological and behavioral assessment including the Hayling and Trails Tests, the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease (QUIP-RS), the Behavior Rating Inventory of Executive Function (BRIEF-A), and the Short Form-36 Health Survey (SF-36). The level of awareness of executive functioning was also analyzed. We finally explored how these neuropsychological and clinical outcomes could relate to each other. RESULTS: PD patients performed significantly worse in both neuropsychological tasks designed to evaluate inhibition abilities. They also reported more inhibition difficulties in everyday life and poorer quality of life. Associations between neuropsychological measures and self-reports were found. Moreover, as indicated by the discrepancy score, PD patients were as accurate as their relatives in self-reporting their executive daily difficulties. CONCLUSION: Inhibition and cognitive flexibility impairments assessed by the neuropsychological tests (Hayling and Trails tests) seem to capture daily life executive problems in PD. Furthermore, our study provides a deeper understanding of PD patients' and their relatives' experience of these executive dysfunctions.

Inhibition impairment in frontotemporal dementia, amyotrophic lateral sclerosis, and Alzheimer's disease: clinical assessment and metabolic correlates.

The ability to reject an automatic tendency, i.e. inhibition, has been linked to the prefrontal cortex, but its neural underpinnings are still controversial. Neurodegenerative diseases represent an interesting model to explore this issue, given its frequent impairment in these disorders. We investigated the inhibitory impairment and its neural basis using four different tests, which evaluate the presence of inhibitory dysfunction (Stroop test, Hayling test, and two graphical perseveration tests), and assessed their correlation with brain metabolism using 18F-fluorodeoxyglucose positron emission tomography in a group of 76 participants with behavioral variant frontotemporal dementia (bvFTD), Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS) and healthy controls (HC). Inhibition impairment was more frequent in bvFTD and AD, than ALS and HC. AD and bvFTD only differed in the strategy used in Hayling test, and the frequency of impairment in graphical perseveration tests. Correlation between inhibition tests was moderate. The Stroop test correlated with several regions of the frontal and parietal lobes, mainly on the left side. Hayling test correlated with almost all regions of the frontal lobe and, especially, with the orbitofrontal cortex. Some differences in the impaired regions in each disease were found. Inhibition ability was mainly impaired in bvFTD and AD, and it correlated with the bilateral frontal lobe metabolism. There were certain particularities according to the specific task and patients evaluated. These dissimilarities may support the concept of inhibition as a multidimensional construct, with the involvement of common and divergent neural mechanisms.

Brazilian norms and effects of age and education on the Hayling and Trail Making Tests / Normas brasileiras e efeitos de idade e escolaridade no Teste Hayling e no Teste de Trilhas

Abstract Objectives To describe normative data for the Hayling Test and the Trail Making Test (TMT) in a sample of Brazilian adults, and to investigate the effects of age and education on test performance. Method A total of 313 (TMT) and 364 (Hayling) individuals with age ranges of 19-39, 40-59, and 60-75 years, and with at least 5 years of formal education, participated in this study. The tests were administered as part of a large battery of a normative project. Individuals were evaluated individually in silent, ventilated rooms at a university clinic. Instrument protocols were scored by trained research assistants and double-checked to ensure data reliability. Results There were major effects of age on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Errors B/15, B/45), and major effects of education on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Time A, Errors B/15, B/45). Interaction effects were found in Time B and B-A for the Hayling Test and in Time A for the TMT. Conclusions Age and education were critical for performance on both verbal and non-verbal executive functions.

Resumo Objetivos Descrever dados normativos do Teste Hayling e do Teste de Trilhas em uma amostra de adultos brasileiros e investigar os efeitos de idade e escolaridade no desempenho das tarefas. Método Participaram deste estudo um total de 313 (TMT) e 364 (Hayling) indivíduos com idades nos intervalos de 19-39, 40-59 e 60-75 anos e com pelo menos 5 anos de escolaridade formal. Os testes foram administrados como parte de uma bateria maior de um projeto de normatização. Os indivíduos foram avaliados individualmente em salas silenciosas e ventiladas em uma clínica universitária. As pontuações dos protocolos foram realizadas por assistentes de pesquisa treinados e foram checadas duplamente para garantir a fidedignidade dos dados. Resultados Foram encontrados efeitos principais de idade no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Erros B/15 e B/45), e efeitos principais de educação no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Tempo A, Erros B/15 e B/45). Foram encontrados efeitos de interação entre variáveis nos Tempos B e B-A do Teste Hayling e no Tempo A do TMT. Conclusões Idade e escolaridade foram fatores críticos para o desempenho em ambos os testes verbal e não-verbal de avaliação das funções executivas.

Development of the Brazilian version of the Child Hayling Test / Desenvolvimento da versão brasileira do Teste Hayling Infantil

Abstract Introduction: The Hayling Test assesses the components of initiation, inhibition, cognitive flexibility and verbal speed by means of a sentence completion task. This study presents the process of developing the Brazilian version of the Child Hayling Test (CHT) and reports evidence of its content validity. Methods: 139 people took part in the study. The adaptation was performed by seven translators and 12 specialist judges. An initial sample of 92 healthy children was recruited to test a selection of sentences adapted from previous adult and pediatric versions of the instrument, and a sample of 28 healthy children was recruited for pilot testing of the final version. The instrument was developed in seven stages: 1) translation, 2) back-translation, 3) comparison of translated versions, 4) preparation of new stimuli, 5) data collection with healthy children to analyze comprehension of the stimuli and analyses by the authors against the psycholinguistic criteria adopted, 6) analyses conducted by judges who are specialists in neuropsychology or linguistics, and 7) the pilot study. Results: Twenty-four of the 72 sentences constructed were selected on the basis of 70-100% agreement between judges evaluating what they assessed and level of comprehensibility. The pilot study revealed better performance by older children, providing evidence of the instrument's sensitivity to developmental factors. Conclusions: Future studies employing this version of CHT with clinical pediatric populations who have frontal lesions and dysfunctions and in related areas are needed to test functional and differential diagnoses of preserved or impaired executive functions.

Resumo Introdução: O Teste Hayling avalia os componentes iniciação, controle inibitório, flexibilidade cognitiva e velocidade verbal por meio de uma tarefa de completar frases. Este estudo apresenta o processo de desenvolvimento do Teste Hayling Infantil (THI) em português brasileiro, bem como evidências de validade de seu conteúdo. Métodos: Participaram 139 sujeitos: A adaptação foi realizada por sete tradutores e 12 juízes especialistas. Uma amostra inicial de 92 crianças saudáveis foi recrutada para testar uma seleção de sentenças adaptadas de versões anteriores para adultos e crianças, e uma amostra de 28 crianças saudáveis foi recrutada para testar a versão final num estudo piloto. Sete etapas foram conduzidas: 1) tradução, 2) retrotradução, 3) comparação entre versões traduzidas, 4) desenvolvimento de novos estímulos, 5) coleta com crianças saudáveis para análise da compreensão dos estímulos e análise dos autores quanto aos critérios psicolinguísticos, 6) análise de juízes especialistas em neuropsicologia e linguística, e 7) estudo piloto. Resultados: Das 72 frases construídas, selecionaram-se 24 que tiveram concordância de 70 a 100% entre juízes quanto aos construtos que avaliam e quanto ao grau de compreensibilidade. O estudo piloto revelou melhor desempenho nas crianças mais velhas, dando indícios da sensibilidade do instrumento aos fatores desenvolvimentais. Conclusões: Estudos futuros que utilizem esta versão do THI em populações clínicas infantis que apresentem lesões e disfunções frontais e em áreas relacionadas tornam-se necessários para fins de diagnóstico funcional e diferencial de dificuldades executivas preservadas ou afetadas.

The Hayling Test: Development and Normalization of the Spanish Version.

OBJECTIVE: The Hayling Sentence Completion Test evaluates the ability to inhibit an automatic response. It has also been suggested for the assessment of orbitofrontal cortex function. The aim of the study was to develop a Spanish version of the Hayling test and to obtain normative data. METHOD: Responses to 60 sentences from 50 healthy controls were used to develop the task. Additionally, 185 healthy controls aged between 18 and 99 years were examined with the test in order to obtain normative data. The overlapping interval strategy was used to maximize the sample size. Age- and education-adjusted scores were obtained using linear regression analysis. RESULTS: Age and educational level had a significant effect on the different scores. Good internal reliability and inter-rater variability were observed. CONCLUSIONS: We provide normative data adjusted for age and education. Our results enable the use of this test for clinical and research purposes in the field of neuropsychological assessment.

When does a strategy intervention overcome a failure of inhibition? Evidence from two left frontal brain tumour cases.

INTRODUCTION: Initiation and inhibition of responses are crucial for appropriate behaviour across different settings. Initiation and inhibition difficulties are well documented following frontal damage, although task differences have limited our understanding. The Hayling Sentence Completion Test was designed to assess verbal initiation and inhibition within the same task. This study investigates the ability of two patients with left frontal tumours (KI: high grade glioma; PM: meningioma) to use a strategy to overcome profound suppression failures on the Hayling Test. METHOD: KI and PM completed the Hayling Test and two experimental tasks. The Selection Investigation assessed verbal initiation on a sentence completion task that varied selection demands (high/low). The Suppression and Strategy Investigation assessed ability to implement four strategies aimed to override a suppression failure and facilitate production of an unconnected word. RESULTS: On the Hayling Test, KI and PM initiated responses to complete high constraint sentences, in contrast to impaired suppression. KI benefitted minimally from strategies to overcome suppression failure although one strategy (object naming) was partially successful. KI's errors revealed fast suppression errors, in contrast to slow no responses, and selection ability was also impaired for verbal initiation. PM, however, implemented each strategy 100% to overcome a suppression failure and had no difficulty completing sentences meaningfully, regardless of selection demands. CONCLUSION: This first investigation of strategy implementation to overcome profound suppression impairments provides insights into verbal initiation, inhibition, selection and strategy mechanisms, which has implications for neurorehabilitation. Specifically, both patients had profound inhibition deficits but KI also presented with a selection deficit and was unable to implement a strategy. By contrast, PM's selection ability was intact but she was unable to generate, rather than implement, a strategy. We suggest that KI has both fast, uncontrolled semantic output and response inhibition difficulty, whereas PM's difficulty is underpinned by motivational factors.

Verbal suppression and strategy use: a role for the right lateral prefrontal cortex?

Verbal initiation, suppression and strategy generation/use are cognitive processes widely held to be supported by the frontal cortex. The Hayling Test was designed to tap these cognitive processes within the same sentence completion task. There are few studies specifically investigating the neural correlates of the Hayling Test but it has been primarily used to detect frontal lobe damage. This study investigates the components of the Hayling Test in a large sample of patients with unselected focal frontal (n = 60) and posterior (n = 30) lesions. Patients and controls (n = 40) matched for education, age and sex were administered the Hayling Test as well as background cognitive tests. The standard Hayling Test clinical measures (initiation response time, suppression response time, suppression errors and overall score), composite errors scores and strategy-based responses were calculated. Lesions were analysed by classical frontal/posterior subdivisions as well as a finer-grained frontal localization method and a specific contrast method that is somewhat analogous to voxel-based lesion mapping methods. Thus, patients with right lateral, left lateral and superior medial lesions were compared to controls and patients with right lateral lesions were compared to all other patients. The results show that all four standard Hayling Test clinical measures are sensitive to frontal lobe damage although only the suppression error and overall scores were specific to the frontal region. Although all frontal patients produced blatant suppression errors, a specific right lateral frontal effect was revealed for producing errors that were subtly wrong. In addition, frontal patients overall produced fewer correct responses indicative of developing an appropriate strategy but only the right lateral group showed a significant deficit. This problem in strategy attainment and implementation could explain, at least in part, the suppression error impairment. Contrary to previous studies there was no specific frontal effect for verbal initiation. Overall, our results support a role for the right lateral frontal region in verbal suppression and, for the first time, in strategy generation/use.

Executive function in psychopathy: the Tower of London, Brixton Spatial Anticipation and the Hayling Sentence Completion Tests.

Executive dysfunction in those high on traits of psychopathy has often been reported, with many disagreements as to the nature of the dysfunction. We aimed to see if tests of planning and rule acquisition/adherence would discriminate those high on psychopathic traits. A battery of executive function tests (Tower of London, Brixton Spatial Anticipation, and Hayling Sentence Completion Tasks) was given to 28 British male prisoners. Psychopathy was measured using the Psychopathy Checklist-Revised. High psychopathy was related to reduced planning in the Tower of London Test and poor rule-adherence on the Brixton Test. Other tests of executive function were not related to psychopathy. The results appear supportive of the notion that function of the orbitofrontal cortex (OFC) is dysfunctional in psychopathy whilst that of the dorsolateral prefrontal cortex (DLPFC) is normal and suggest that impulsivity in those high on psychopathy traits impedes planning and rule following. We suggest the adapted Tower of London Test and the Brixton Test could be useful objective measures of this type of impulsivity in offenders which could help identify key treatment goals.

Hayling Test - adult version: applicability in the assessment of executive functions in children

Childhood neuropsychology is a growing scientific area in Brazil. Regarding cognitive function in infancy, executive function (EF) has been the main focus of several studies because of its importance for and complexity in human cognition and behavior. Executive functions can be considered a set of cognitive processes related to control and integration devoted to the execution of goal-directed behaviors. Research has shown that these abilities begin in infancy and progressively develop until adulthood. Although some studies on EF development in children have already been conducted, our knowledge on this topic is still incipient. Because of the relevant role of age in cognition and EF development, the present study investigated whether differences exist between children aged 6 to 12 years concerning their performance on the Hayling test-adult version, an instrument that assesses the EF components of initiation and inhibition. Pilot data are presented that verify the applicability of this test to children. Significant differences were found between comparable age groups only in three of the seven main Hayling test scores, suggesting that the adult version may not be appropriate for children, and an adaptation of the test for child assessment is necessary. The study may lead to an initial reflection on the development of these components and thus contribute to improvements in the field of child neuropsychology

Hayling Test - adult version: applicability in the assessment of executive functions in children

Childhood neuropsychology is a growing scientific area in Brazil. Regarding cognitive function in infancy, executive function (EF) has been the main focus of several studies because of its importance for and complexity in human cognition and behavior. Executive functions can be considered a set of cognitive processes related to control and integration devoted to the execution of goal-directed behaviors. Research has shown that these abilities begin in infancy and progressively develop until adulthood. Although some studies on EF development in children have already been conducted, our knowledge on this topic is still incipient. Because of the relevant role of age in cognition and EF development, the present study investigated whether differences exist between children aged 6 to 12 years concerning their performance on the Hayling test-adult version, an instrument that assesses the EF components of initiation and inhibition. Pilot data are presented that verify the applicability of this test to children. Significant differences were found between comparable age groups only in three of the seven main Hayling test scores, suggesting that the adult version may not be appropriate for children, and an adaptation of the test for child assessment is necessary. The study may lead to an initial reflection on the development of these components and thus contribute to improvements in the field of child neuropsychology.(AU)