Megan Fresson

Stereotype contrast effect on neuropsychological assessment of contact-sport players: The moderating role of locus of control

ABSTRACT Introduction: Diagnosis threat has been shown to produce detrimental effects on neuropsychological performance in individuals with mild traumatic brain injury (mTBI). Focusing on contact-sport players who are at great risk of mTBI, our study was designed to examine the moderating role of internal locus of control. Specifically, we predicted that following diagnosis threat (reminder of their risk of sustaining mTBI and of its consequences), low-internal contact-sport players would underperform (assimilation to the stereotype), while their high-internal counterparts would outperform (contrast effect). We predicted that effort and anxiety would mediate these effects. Method: Contact-sport players and non-contact-sport players (“control” group) were randomly assigned to one condition (diagnosis threat or neutral) and then completed attention, executive, episodic memory, and working memory tasks. Regarding mediating and moderating variables, participants rated their effort and anxiety (self-report measures) and completed the Levenson (1974) locus of control scale. Regression-based path analyses were carried out to examine the direct and indirect effects. Results: As expected, there was no effect of condition on the control group’s performance. Contact-sport players with moderate and high levels of internal control outperformed (contrast effect) on executive and episodic memory tasks following diagnosis threat compared to the neutral condition. Additionally, the less anxiety moderate- and high-internal contact-sport participants felt, the better they performed on episodic memory and executive tasks. However, contact-sport players low in internal control did not underperform (assimilation effect) under diagnosis threat. Conclusions: Our results suggest that diagnosis threat instructions may have challenged moderate- and high-internal contact-sport participants, leading them to outperform compared to the neutral condition. Individuals who have moderate and high levels of internal locus of control may have higher performance under diagnosis threat compared to the neutral condition because of their feeling of control over their cognitive performance.

Diagnosis threat and underperformance: The threat must be relevant and implicit

ABSTRACT Introduction: The diagnosis threat (DT) phenomenon shows that, in some cases, reminding people with mild traumatic brain injury (mTBI) about their past neurological history diminishes subsequent cognitive performance. The aim of the present study was to investigate the role of personal relevance (i.e., domain identification) and type of threat (i.e., implicit vs. explicit) as moderating variables. We investigated intrusive thoughts as a potential mediator. Method: Control (non-mTBI) and mTBI participants were recruited and completed a domain identification questionnaire. Under either an implicit or an explicit DT condition, they completed neuropsychological tasks assessing working memory, episodic memory, and executive processing, as well as measures of intrusive thoughts. Results: As expected, the main results showed that, for working memory and episodic memory, high identifier mTBI participants scored worse in the implicit DT condition than in the explicit condition. The implicit DT condition also led high identifier mTBI participants to score worse than low identifiers for working memory. Conversely, the explicit DT condition led high identifier mTBI participants to perform better than low identifiers for both working and episodic memory. Unexpectedly, low identifier mTBI participants scored better on working memory tasks in the implicit DT condition than in the explicit condition. We found no evidence of mediation by intrusive thoughts. Conclusions: Domain identification and the explicit or implicit nature of the DT must be taken into account, as they can impact mTBI participants’ cognitive performance. This study suggests the influence of DT as a factor biasing neuropsychological assessment.

Influence of diagnosis threat and illness cognitions on the cognitive performance of people with acquired brain injury

ABSTRACT Illness cognitions – cognitive representations of illness – have been found to influence health outcomes in chronic diseases: more adaptive illness cognitions generally lead to better outcomes. Concomitantly, diagnosis threat (DT) is a phenomenon whereby participants with acquired brain injury (ABI) underperform on neuropsychological tasks due to stereotype activation. This randomised study examined the impact of illness cognitions and DT on cognitive performance. People with ABI completed the Illness Cognitions Questionnaire and were then exposed to either a DT condition or a reduced DT condition (in which stereotype cues were reduced). They then completed memory and attentional tasks. Control participants performed only the tasks under one of the two conditions. Under the reduced DT condition, higher adaptive illness cognitions were associated with better memory and attentional performance. However, the DT condition diminished memory (but not attentional) performance in participants with a high level of adaptive illness cognitions, often leading to performance at the pathological level. This study confirms the detrimental impact of DT in people with ABI and highlights the necessity for clinicians to consider psychosocial influences when assessing and treating this population.

Impact of Diagnosis Threat on Neuropsychological Assessment of People with Acquired Brain Injury: Evidence of Mediation by Negative Emotions

Objective Some studies have shown that diagnosis threat (DT) could negatively impact the cognitive performance of undergraduate students who had sustained a mild traumatic brain injury. This study was designed to examine DT in people with acquired brain injury (ABI). As a second goal, we investigated the effect of stereotype lift as a way to overcome DTs harmful impact. The purpose of this study was also to examine the mechanisms mediating stereotype effects. Method People with ABI and control participants were assigned to one of three conditions: DT, cognitive-neutral (in which the cognitive status of participants with ABI and the cognitive characteristics of the tasks were deemphasized), and stereotype lift (in which a downward comparison was made with another neurological group). Participants then completed neuropsychological tasks. Negative emotions, intrusive thoughts, task expectancy, and self-efficacy were assessed for mediation analyses. Results Instructions impacted the performance of people with ABI, but not control participants. Compared to the cognitive-neutral condition, participants with ABI in the DT condition performed worse on memory and executive tasks (but not on attention tasks). These effects were mediated by negative emotions. There was no increase in performance in the stereotype lift condition compared to the DT condition. Conclusions This study showed that DT can aggravate the cognitive difficulties of people with ABI during neuropsychological assessment. The mediating role of negative emotions and the selective impact of DT on tasks that rely heavily on executive functioning are discussed in the light of the stereotype threat model.

Overdiagnosis of ADHD in boys: Stereotype impact on neuropsychological assessment

ABSTRACT There is vigorous debate regarding the possibility that ADHD is overdiagnosed in boys. We investigated the impact of the gender stereotype depicting boys as inattentive and impulsive on neuropsychological assessment (observation of psychology students and child’s cognitive performance). In experiment 1, after the stereotype was activated, psychology students rated a “boy,” a “girl,” or a “child” on a behavioral assessment scale. In experiment 2, 103 children (boys and girls) completed neuropsychological tasks under stereotype threat or neutral conditions. The gender stereotype led psychology students to assess a child’s behaviors more negatively if they thought the child was a boy. Boys’ performance on one cognitive score declined following stereotype threat. Regression path analyses suggested moderation by stigma consciousness. Additionally, there were mediating and suppressing (through stereotype endorsement) effects. Our results suggest that the gender stereotype might contribute to the overdiagnosis of ADHD in boys.

The Role of Self-Transcendence and Cognitive Processes in the Response Expectancy Effect

Neuropsychological assessment is known to be influenced by expectancy effects, which can either enhance (placebo) or diminish (nocebo) cognitive performance. Research suggests that the response expectancy effect is influenced by various individual and situational factors and that the placebo effect results in an increase in monitoring processes as measured indirectly. However, the impact on monitoring processes has not yet been studied by direct measures such as Judgement Of Learning (JOL). This study aimed to investigate the response expectancy effect on various neuropsychological tasks, including a task that directly assesses monitoring capacities (JOL). In addition to determining which cognitive functions are influenced by the expectancy effect, this study examined the moderating role of the self-transcendence dimension of personality. Eighty healthy subjects were exposed to three bogus conditions presented as allegedly having a positive, negative, or no impact on cognitive capacities. Then they completed, in random order, three blocks of tasks (executive, attentional, and memory), one in each condition. Results showed an effect of negative instructions on flexibility (poorer performance) and memory (better performance) scores. Furthermore, positive instructions led to better explicit monitoring capacities (JOL) than the neutral condition. These effects were moderated by self-transcendence, as only participants with moderate or high self-transcendence exhibited these effects. Overall, our results showed that the response expectancy effect emerges from a combination of individual and cognitive factors.

The Effect of Stereotype Threat on Older People’s Clinical Cognitive Outcomes: Investigating the Moderating Role of Dementia Worry

Abstract Objective: Numerous studies have shown that stereotype threat (ST) reduces older people’s cognitive performance, but few have studied its impact on clinical cognitive outcomes. Our study was designed to further examine the impact of ST on the clinical assessment of older subjects’ cognitive functioning, as well as the moderating role of fear of Alzheimer’s Disease (AD) (or ‘dementia worry’). Method: Seventy-two neurologically normal (MMSE > 26) participants aged between 59 and 70 completed a set of neuropsychological tasks in either an ST or a positive condition (condition in which negative stereotypes were invalidated). Results: Regression-based path analyses showed that only participants who expressed moderate or high fear of AD underperformed on executive tasks in the ST condition compared to their counterparts in the positive condition. Moreover, in the ST condition, participants’ performance on executive tasks was more impaired (relative to normative data) than in the positive condition. However, ST had no effect on memory and attention performance. Discussion: Our results showed that ST can cause older people to perform at pathological levels on executive tasks. Results highlight the need for clinicians to be cautious when conducting neuropsychological assessments of older people who express high levels of dementia worry.