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A unified online test battery for cognitive impulsivity reveals relationships with real-world impulsive behaviours

Nature Human Behaviour volume 5, pages 1562–1577 (2021)Cite this article

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Abstract

Impulsive behaviours are a major contributor to the global burden of disease, but existing measures of cognitive impulsivity have suboptimal reliability and validity. Here, we introduce the Cognitive Impulsivity Suite, comprising three computerized/online tasks using a gamified interface. We conceptualize rapid-response impulsive behaviours (disinhibition) as arising from the failure of three distinct cognitive mechanisms: attentional control, information gathering and monitoring/shifting. We demonstrate the construct and criterion validity of the Cognitive Impulsivity Suite in an online community sample (N = 1,056), show test–retest reliability and between-subjects variability in a face-to-face community sample (N = 63), and replicate the results in a community and clinical sample (N = 578). The results support the theoretical architecture of the attentional control, information gathering and monitoring/shifting constructs. The Cognitive Impulsivity Suite demonstrated incremental criterion validity for prediction of real-world, addiction-related problems and is a promising tool for large-scale research on cognitive impulsivity.

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Fig. 1: The three tasks that form the CIS.
Fig. 2: Correlated three-factor measurement model of the CIS.
Fig. 3: Addiction problems factor regressed onto the monitoring/shifting factor in the AMT calibration subsample.
Fig. 4: Addiction problems factor regressed onto the information gathering and attentional control factors in the community and clinical sample.
Fig. 5: Total variance separated into between-subjects, within-subjects and error variance, for performance variables of the CIS.

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Data Availability

Data obtained from cognitive testing and self-report and analysed for this manuscript can be accessed via the Open Science Framework (https://osf.io/7qrv5/).

Code Availability

Interested researchers can gain access to the CIS by contacting the corresponding author (A.V.-G.). Mplus 8.3 code used to estimate the structural equation models presented in this manuscript can be accessed via the Open Science Framework (https://osf.io/jqbs5/).

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Acknowledgements

This study was funded by the Australian Research Council through grants LP150100770 and DP180100145 (chief investigators: A.V.-G., M.A.B., and D.I.L.). A.V.-G. was funded by an Australian Medical Research Future Fund Career Development Fellowship (level 2, MRF1141214). J.T. was supported by National Health and Medical Research Council (NHMRC) project grants 1002458 and 1046054. M.A.B. was funded by an NHMRC Senior Research Fellowship (level B). Torus Games designed the CIS as a contractor, but they have also provided in-kind support and ideas, and the authors thank K. MacIntosh (Torus Games Head of Production) for support.

Author information

Authors and Affiliations

  1. School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia

    Antonio Verdejo-Garcia, Jeggan Tiego, Naomi Kakoschke, Neda Moskovsky, Katharina Voigt, Alexandra Anderson, Julia Koutoulogenis & Mark A. Bellgrove

  2. Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

    Dan I. Lubman

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  1. Antonio Verdejo-Garcia
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Contributions

A.V.-G., M.A.B. and D.I.L. conceptualized the study designs. N.K., N.M., A.A. and J.K. collected the data. J.T., N.M., N.K. and K.V. analysed the data. J.T., N.K. and N.M. prepared the figures and tables. A.V.-G., J.T., N.K. and N.M. wrote the initial manuscript draft. All authors contributed to writing and revising the manuscript.

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Correspondence to Antonio Verdejo-Garcia.

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Peer review information Nature Human Behaviour thanks Robert Leeman and A. Zeynep Enkavi for their contributions to the peer review of this work.

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Extended data

Extended Data Fig. 1

Relative frequencies of enjoyment ratings for the three CIS tasks.

Extended Data Fig. 2

Relative frequencies of engagement ratings for the three CIS tasks.

Extended Data Fig. 3

Relative frequencies of duration ratings for the three CIS tasks.

Extended Data Fig. 4

Relative frequencies of difficulty ratings for the three CIS tasks.

Extended Data Fig. 5

Relative frequencies of clarity ratings for instructions for the three CIS tasks.

Extended Data Fig. 6 Confirmatory factor analysis model of latent correlation between the three cognitive constructs measured by the CIS and performance on the SART.

Model fit statistics were χ2(77) = 101.010, p = .129; RMSEA = .032 [90%CI = .009, .049]; CFI = .982; SRMR = .038. Note. NoGo50= Commission errors on no-go trials on Bounty Hunter with 50 ms stimulus onset asynchrony; NoGo200= Commission errors on no-go trials on Bounty Hunter with 200 ms stimulus onset asynchrony; NoGo1200= Commission errors on no-go trials on Bounty Hunter with 1200 ms stimulus onset asynchrony; NoGo3000= Commission errors on no-go trials on Bounty Hunter with 3000 ms stimulus onset asynchrony; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 2 = Fast identification errors on Caravan Spotter Block 2; Errors Block 3 = Fast identification errors on Caravan Spotter Block 3; Errors Block 4 = Fast identification errors on Caravan Spotter Block 4. PEBa Positive = Perseverative errors on Prospector’s Gamble basic positive feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced positive feedback on previous trial; PEBa Negative = Perseverative errors on Prospector’s Gamble basic negative feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced negative feedback on previous trial. SART = sustained attention to response task. No-Go = successful inhibitions on no-go trials of the SART. Factor scaling was performed using the reference variable method. Standardised estimates appear in bold typeface. Unstandardised estimates are in normal typeface below. Bootstrapped standard errors (10,000 posterior draws) appear in brackets. Threshold for statistical significance for associations between SART No-Go Commission Errors and the CIS factors using the Adjusted Bonferroni procedure (AB2;\(\alpha _{per\,test} = \frac{{\alpha _{familywise}}}{{k^{1 - \sqrt {\left| {\overline {r_j} } \right|} }}}\)) was α < .025.

Extended Data Fig. 7 Confirmatory factor analysis model of latent correlation between the three cognitive constructs measured by the CIS and performance on the IGT.

Model fit statistics were χ2(78) = 95.073, p = .351; RMSEA = .027 [90%CI = .000, .044]; CFI = .988; SRMR = .034. Note. NoGo50= Commission errors on no-go trials on Bounty Hunter with 50 ms stimulus onset asynchrony; NoGo200= Commission errors on no-go trials on Bounty Hunter with 200 ms stimulus onset asynchrony; NoGo1200= Commission errors on no-go trials on Bounty Hunter with 1200 ms stimulus onset asynchrony; NoGo3000= Commission errors on no-go trials on Bounty Hunter with 3000 ms stimulus onset asynchrony; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 2 = Fast identification errors on Caravan Spotter Block 2; Errors Block 3 = Fast identification errors on Caravan Spotter Block 3; Errors Block 4 = Fast identification errors on Caravan Spotter Block 4. PEBa Positive = Perseverative errors on Prospector’s Gamble basic positive feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced positive feedback on previous trial; PEBa Negative = Perseverative errors on Prospector’s Gamble basic negative feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced negative feedback on previous trial. IGT = Iowa gambling task. IGT net score = number of ‘safe deck’ choices subtracted from ‘risky deck’ choices. Factor scaling was performed using the reference variable method. Standardised estimates appear in bold typeface. Unstandardised estimates are in normal typeface below. Bootstrapped standard errors (10,000 posterior draws) appear in brackets. Threshold for statistical significance for associations between IGT Net Score and the other latent variables using the Adjusted Bonferroni procedure (AB2; \(\alpha _{per\,test} = \frac{{\alpha _{familywise}}}{{k^{1 - \sqrt {\left| {\overline {r_j} } \right|} }}}\)was α < .027.

Extended Data Fig. 8 Confirmatory factor analysis model of latent correlation between the three cognitive constructs measured by the CIS and performance on the JTC task.

Model fit statistics were χ2(77) = 102.834, p = .069; RMSEA = .033 [90%CI = .012, .049]; CFI = .978; SRMR = .044. Note. NoGo50= Commission errors on no-go trials on Bounty Hunter with 50 ms stimulus onset asynchrony; NoGo200= Commission errors on no-go trials on Bounty Hunter with 200 ms stimulus onset asynchrony; NoGo1200= Commission errors on no-go trials on Bounty Hunter with 1200 ms stimulus onset asynchrony; NoGo3000= Commission errors on no-go trials on Bounty Hunter with 3000 ms stimulus onset asynchrony; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 1 = Fast identification errors on Caravan Spotter Block 1; Errors Block 2 = Fast identification errors on Caravan Spotter Block 2; Errors Block 3 = Fast identification errors on Caravan Spotter Block 3; Errors Block 4 = Fast identification errors on Caravan Spotter Block 4. PEBa Positive = Perseverative errors on Prospector’s Gamble basic positive feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced positive feedback on previous trial; PEBa Negative = Perseverative errors on Prospector’s Gamble basic negative feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced negative feedback on previous trial. JTC = Jumping to conclusions task. Median Beads = median number of beads drawn before a decision is made (aggregated across blocks with probabilities 85:15 and 60:40). Factor scaling was performed using the reference variable method. Standardised estimates appear in bold typeface. Unstandardised estimates are in normal typeface below. Bootstrapped standard errors (10,000 posterior draws) appear in brackets. Threshold for statistical significance for associations with the median beads drawn on the JTC tasks and the other latent variables using the Adjusted Bonferroni procedure (AB2; \(\alpha _{per\,test} = \frac{{\alpha _{familywise}}}{{k^{1 - \sqrt {\left| {\overline {r_j} } \right|} }}}\) was α < .024.

Extended Data Fig. 9 Incremental criterion validity model with Addiction Problems factor regressed onto four of the five UPPS-P impulsivity factors and the CIS Monitoring / Shifting factor in the AMT calibration subsample.

Model fit statistics were χ2(107) = 125.537, p = .330; RMSEA = .018 [90%CI = .000, .030]; CFI = .995; SRMR = .033. n = 510. R2 = .266, SE = .052, one-tailed p < .001; ΔR2 = .013. Note. N_URGE = Negative Urgency raw scores from the UPPS-P; P_URGE = Positive Urgency raw scores from the UPPS-P; PREM = Lack of Premeditation raw scores from the UPPS-P; SENS = Sensation Seeking raw scores from the UPPS-P; PERSEV = Lack of Perseverance raw scores from the UPPS-P; PEBa Positive = Perseverative errors on Prospector’s Gamble basic positive feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced positive feedback on previous trial; PEBa Negative = Perseverative errors on Prospector’s Gamble basic negative feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced negative feedback on previous trial. AUDIT = Alcohol Use Disorder Identification Test raw scores logarithmic transformed; DUDIT = Drug Use Disorder Identification Test raw scores logarithmic transformed; PGSI = Problem Gambling Severity Index raw scores logarithmic transformed. Factor scaling was performed using the reference variable method. Standardised estimates appear in bold typeface. Unstandardised estimates are in normal typeface below. Bootstrapped standard errors (10,000 posterior draws) appear in brackets. The probability value of the standardised beta coefficient for the regression of Addiction Problems on Lack of Perseverance was p = .111. The latent correlations between the Monitoring / Shifting factor and the five self-reported impulsivity factors have been omitted from the figure for clarity. These were Negative Urgency (ϕ = -.134, SE = .038, [95%BCI = -.201, -.050], p < .001); Lack of Perseverance (ϕ = -.037, SE = .041, [95%BCI = -.128, .036], p = .377); Lack of Premeditation (ϕ = -.154, SE = .039, [95%BCI = -.228, -.071], p < .001); Sensation Seeking (ϕ = -.110, SE = .040, [95%BCI = -.185, -.028], p = .006); Positive Urgency (ϕ = -.278, SE = .037, [95%BCI = -.348, -.204], p < .001).

Extended Data Fig. 10 Incremental criterion validity model with Addiction Problems factor regressed onto Negative Urgency, Lack of Premeditation, and Sensation Seeking and Information Gathering factor in the community and clinical sample.

Model fit statistics were χ2(39) = 57.482, p = .082; RMSEA = .029 [90%CI = .010, .044]; CFI = .988; SRMR = .028. n = 578. R2 = .460, SE = .057, one-tailed p < .001; ΔR2 = .028. The latent correlations between the Information Gathering factor and the five self-reported impulsivity factors have been omitted from the figure for clarity. These were Negative Urgency (ϕ = -.172, SE = .054, [95%BCI = -.272, -.059], p = .001); Lack of Perseverance (ϕ = -.080, SE = .056, [95%BCI = -192, -.029], p = .155); Lack of Premeditation (ϕ = -.195, SE = .049, [95%BCI = -.284, -.093], p < .001), Sensation Seeking (ϕ = -.215, SE = .057, [95%BCI = -.320, -.099], p < .001); and Positive Urgency (ϕ = -.205, SE = .058, [95%BCI = -.315, -.087], p < .001). Note. N_URGE = Negative Urgency raw scores from the UPPS-P; P_URGE = Positive Urgency raw scores from the UPPS-P; PREM = Lack of Premeditation raw scores from the UPPS-P; SENS = Sensation Seeking raw scores from the UPPS-P; PERSEV = Lack of Perseverance raw scores from the UPPS-P; PEBa Positive = Perseverative errors on Prospector’s Gamble basic positive feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced positive feedback on previous trial; PEBa Negative = Perseverative errors on Prospector’s Gamble basic negative feedback on previous trial; PEEn Positive = Perseverative errors on Prospector’s Gamble enhanced negative feedback on previous trial. AUDIT = Alcohol Use Disorder Identification Test raw scores logarithmic transformed; DUDIT = Drug Use Disorder Identification Test raw scores logarithmic transformed; PGSI = Problem Gambling Severity Index raw scores logarithmic transformed. Factor scaling was performed using the reference variable method. Standardised estimates appear in bold typeface. Unstandardised estimates are in normal typeface below. Bootstrapped standard errors (10,000 posterior draws) appear in brackets.

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Verdejo-Garcia, A., Tiego, J., Kakoschke, N. et al. A unified online test battery for cognitive impulsivity reveals relationships with real-world impulsive behaviours. Nat Hum Behav 5, 1562–1577 (2021). https://doi.org/10.1038/s41562-021-01127-3

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