A Review of the Stereotype Threat Literature and Its Application in a Neurological Population

Investigating low intelligence stereotype threat in adults with developmental dyslexia

Stereotype threat (ST) is a phenomenon that leads to decreased test performance and occurs when one deals with added pressure of being judged on the basis of stereotyped group membership. The ST effect has been previously investigated in many contexts but not in individuals with dyslexia who are often stereotyped as less intelligent. Prevalent use of intelligence tests in job selection processes and employment gap between people with dyslexia and those without warrants this investigation. Sixty-three participants (30 with dyslexia and 33 without dyslexia; mean age = 33.7; SD = 13.7; 47 F, 13 M, three non-binary) were asked to complete intelligence test typically used in selection processes. All participants were randomly assigned to one of three test instruction conditions: (1) they were told the test was diagnostic of their intelligence (ST triggering instruction); (2) test was a measure of their problem-solving skills (reduced threat); (3) or they were simply asked to take the test (control). Results showed that participants with dyslexia in ST condition performed poorer than those in other conditions and those in the same condition who did not have dyslexia. This study provides preliminary evidence for diminishing effects of ST in individuals with dyslexia.

How Negative Is Negative Information

Daily, we face a plenty of negative information that can profoundly affect our perception and behavior. During devastating events such as the current COVID-19 pandemic, negative messages may hinder reasoning at individual level and social decisions in the society at large. These effects vary across genders in neurotypical populations (being more evident in women) and may be even more pronounced in individuals with neuropsychiatric disorders such as depression. Here, we examine how negative information impacts reasoning on a social perception task in females with breast cancer, a life-threatening disease. Two groups of patients and two groups of matched controls (N_TOTAL = 80; median age, 50 years) accomplished a psychometrically standardized social cognition and reasoning task receiving either the standard instruction solely or additional negative information. Performance substantially dropped in patients and matched controls who received negative information compared to those who did not. Moreover, patients with negative information scored much lower not only compared with controls but also with patients without negative information. We suggest the effects of negative information are mediated by the distributed brain networks involved in affective processing and emotional memory. The findings offer novel insights on the impact of negative information on social perception and decision making during life-threatening events, fostering better understanding of its neurobiological underpinnings.

A scoping review of stereotype threat for BIPOC: cognitive effects and intervention strategies for the field of neuropsychology

OBJECTIVE

Abundant evidence documents stereotype threat's (ST) detrimental effect on test performance across identities and contexts (i.e., eliciting underperformance). Review of the literature shows varied aspects of both stereotyped identities and cognition are inconsistently explored across studies. Only a portion of the literature focuses on ST's impact on Black, Indigenous, and People of Color (BIPOC). It is important to understand and learn to mitigate ST, particularly for historically marginalized and systemically oppressed BIPOC patients. Relevance exists for neuropsychologists, who engage in activities (i.e., assessments) that may activate ST, and should be aware of additional factors impacting testing results and clinical decision making.

METHOD

Using scoping review criteria (Peters et al., 2015) and Preferred Reporting Item for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we reviewed literature across multiple databases (Google Scholar, PubMed, PsychINFO) on ST and cognition with a focus on BIPOC.

RESULTS

The current literature suggests that race-based ST may be implicated in underperformance for executive functioning and separately working memory. There is limited research on the effects of ST for memory, language, attention, and visuospatial skills.

CONCLUSION

Research on ST requires additional attention to establish interventions to mitigate negative effects in practice. These results provide 1) an overview of the cognitive implications of ST, 2) address the scope of this impact for BIPOC, and 3) provide possible intervention and training strategies for neuropsychologists and other clinicians to work to mitigate the effects of ST on BIPOC.

Ageing stereotypes and prodromal Alzheimer's disease (AGING): study protocol for an ongoing randomised clinical study

INTRODUCTION

The number of older people diagnosed with amnestic mild cognitive impairment (aMCI), the prodromal state of Alzheimer's disease (AD), is increasing worldwide. However, some patients with aMCI never convert to the AD type of dementia, with some remaining stable and others reverting to normal. This overdiagnosis bias has been largely overlooked and gone unexplained. There is ample evidence in the laboratory that negative ageing stereotypes (eg, the culturally shared belief that ageing inescapably causes severe cognitive decline) contribute to the deteriorating cognitive performances of healthy older adults, leading them to perform below their true abilities. The study described here is intended to test for the first time whether such stereotypes also impair patients' cognitive performances during neuropsychological examinations in memory clinics, resulting in overdiagnosis of aMCI.

METHODS AND ANALYSIS

The ongoing study is a 4-year randomised clinical trial comparing patients' physiological stress and cognitive performances during neuropsychological testing in memory clinics. A total of 260 patients attending their first cognitive evaluation will be randomised to either a standard condition of test administration, assumed here to implicitly activate negative ageing stereotypes or a reduced-threat instruction condition designed to alleviate the anxiety arising from these stereotypes. Both groups will be tested with the same test battery and stress biomarkers. For 30 patients diagnosed with aMCI in each group (n=60), biomarkers of neurodegeneration and amyloidopathy will be used to distinguish between aMCI with normal versus abnormal AD biomarkers. A 9-month follow-up will be performed on all patients to identify those whose cognitive performances remain stable, deteriorate or improve.

ETHICS AND DISSEMINATION

This protocol has been approved by the French National Agency for Medicines and Health Products Safety and the Sud-Est I French Ethics Committee (2017-A00946-47). Results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03138018.

Are ADHD Screeners Safe to Use?

Objective: To investigate whether administration of a common ADHD screener followed by generic feedback would affect college students' subsequent symptom reports and cognitive performance. Method: Participants were 157 college students randomly assigned to an experimental group-which completed the World Health Organization Adult ADHD Self-Report Scale screener and received standard generic feedback-or a control group. All participants then completed a battery of cognitive tasks and a long-form symptom rating scale. Results: The experimental and control groups did not differ significantly in terms of their subsequent symptom reports or their performance on any cognitive tasks. These null results remained after considering possibilities such as unequal group variances and interactions between screening effects and gender. Conclusion: When administered judiciously alongside generic feedback in a group setting, this common ADHD screener does not appear to affect college students' self-perceptions or cognitive abilities.

Respond, don't react: The influence of mindfulness training on performance monitoring in older adults

A sizeable body of literature demonstrates positive effects of mindfulness training on brain, behavior, and psychological processes in both novice and expert practitioners as compared to non-meditators. However, only more recently has research begun to examine the specific mechanisms by which mindfulness exerts these effects. In the current study, we used event-related potentials (error-related negativity (ERN), error positivity (Pe)) to test the hypothesis that performance monitoring is one such mechanism. We conducted a randomized controlled trial in healthy older adults (n = 36), relevant because markers of performance monitoring are known to decline with normal aging. Compared to an active control condition, mindfulness participants showed an increase in the ERN, without an increase in the Pe. Participants in both groups reported a reduction in self-report of anxiety and self-judgment of one's own mental functioning, indicating the subjective impression of benefit from each intervention type. The current results are important insofar as they support the purported self-regulatory functions of mindfulness (i.e., learning to respond, not react), as well as demonstrating that such positive effects can be obtained in an older adult sample, both of which have important implications for intervention.

Neurocognitive deficits in schizophrenia. Are we making mountains out of molehills?

BACKGROUND

Most original studies and all meta-analyses conducted to date converge on the conclusion that patients with schizophrenia display rather generalized neurocognitive deficits. For the present study, we reopen this seemingly closed chapter and examine whether important influences, such as lack of motivation and negative attitudes towards cognitive assessment, result in poorer secondary neuropsychological performance.

METHOD

A sample of 50 patients with an established diagnosis of schizophrenia were tested for routine neurocognitive assessment and compared to 60 nonclinical volunteers. Before and after the assessment, subjective momentary influences were examined (e.g. motivation, concerns about assessment, fear about poor outcome) for their impact on performance using a new questionnaire called the Momentary Influences, Attitudes and Motivation Impact (MIAMI) on Cognitive Performance Scale.

RESULTS

As expected, patients performed significantly worse than controls on all neurocognitive domains tested (large effect size, on average). However, patients also displayed more subjective momentary impairment, as well as more fears about the outcome and less motivation than controls. Mediation analyses indicated that these influences contributed to (secondary) poorer neurocognitive performance. Differences in neurocognitive scores shrank to a medium effect size, on average, when MIAMI scores were accounted for.

CONCLUSIONS

The data argue that performance on measures of neurocognition in schizophrenia are to a considerable extent due to secondary factors. Poor motivation, fears and momentary impairments distinguished patients from controls and these variables heavily impacted performance. Before concluding that neurocognitive deficits in psychiatric patients are present, clinicians should take these confounding influences into account. Although patients with schizophrenia achieved, on average, worse test scores than controls, a large subgroup displayed spared performance.

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

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.

Expectation influences the interruptive function of pain: Behavioural and neural findings

BACKGROUND

Expectations can dramatically influence the perception of pain, as has been shown in placebo analgesia or nocebo hyperalgesia. Here, we investigated the role of expectation on the interruptive function of pain - the negative consequences of pain on cognitive task performance - in 42 healthy human subjects.

METHODS

Verbal and written instructions were used to manipulate the subjects' expectation of how pain would influence their task performance in an established visual categorization task which was performed with or without concomitant painful thermal stimulation during 3T fMRI scanning. The categorization task was followed by a surprise recognition task.

RESULTS

We observed a significant interaction between stimulation (pain/no pain) and expectancy (positive expectation/negative expectation): categorization accuracy decreased during painful stimulation in the negative expectancy group (N = 21), while no difference was observed in the positive expectancy group (N = 21). On the neural level, the positive expectancy group showed stronger activity in the anterior cingulate cortex (ACC) and hippocampus during painful stimulation compared to the negative group. Moreover, we detected a decrease in connectivity between ACC and fusiform gyrus during painful stimulation in the negative expectancy group, which was absent in the positive expectancy group.

CONCLUSION

Taken together, our data show that expectation can modulate the effect of pain on task performance and that these expectancy effects on the interruptive function of pain are mediated by activity and connectivity changes in brain areas involved in pain processing and task performance. The possibility of changing cognitive task performance by verbal information in clinical population warrants further investigation.

SIGNIFICANCE

We show that the interruptive function of pain on concurrent visual task performance is influenced by expectation. Positive expectation can abolish the detrimental effects of pain on cognition. These expectancy effects on the interruptive function of pain are mediated by changes in functional connectivity between rostral ACC, posterior fusiform cortex and the hippocampus.

[Formula: see text] Effects of screening for postconcussive syndrome (PCS) on PCS symptom self-report and neuropsychological test performance

OBJECTIVE

Many non-neurological factors are related to postconcussive syndrome (PCS) symptom report and neuropsychological test performance in mild traumatic brain injury (mTBI). Use of mTBI screening instruments may also contribute to report of PCS symptoms and neuropsychological performance. We examined the impact of randomized PCS screening feedback on PCS symptom report and neuropsychological performance in 152 young adults with no history of mTBI.

METHOD

Participants were 158 undergraduates attending a medium-sized Midwestern university who completed the Postconcussive Syndrome Questionnaire (PCSQ) prior to the study and were randomly assigned to one of three conditions. Participants were either given feedback that they endorsed more symptoms than average, feedback that they endorsed fewer symptoms than average, or neutral information. Participants then completed the PCSQ for a second time as well as the Auditory Verbal Learning Test and Paced Auditory Serial Addition Test.

RESULTS

Contrary to expectations, participants receiving feedback that they endorsed more symptoms than average did not endorse more PCSQ symptoms post-feedback than participants in other conditions (p = .12); however, consistent with expectations, they demonstrated poorer verbal learning (p = .005) and delayed recall (p = .04) than participants in the below average feedback condition and reported higher rates of retrospective recall of prior mTBI than participants in the neutral condition (p = .01).

CONCLUSION

Results suggest that feedback from screening measures can influence individuals' performance and retrospective recall of their personal TBI history. Findings have implications for use of screening measures for PCS in clinical and research settings.

Experimental pain impairs recognition memory irrespective of pain predictability

BACKGROUND

Pain is hardwired to signal threat and tissue damage and therefore automatically attracts attention to initiate withdrawal or defensive behaviour. This well-known interruptive function of pain interferes with cognitive functioning and is modulated by bottom-up and top-down variables. Here, we applied predictable or unpredictable painful heat stimuli simultaneously to the presentation of neutral images to investigate (I) whether the predictability of pain modulated its effect on the encoding of images (episodic memory) and (II) whether subjects remember that certain images have been previously presented with pain (source memory).

METHODS

Twenty-four healthy subjects performed a categorization task in which 80 images had to be categorized into living or non-living objects. We compared the processing and encoding of these images during cued and non-cued pain trials as well as cued and non-cued pain-free trials. Effects on recognition performance and source memory for pain were immediately tested using a surprise recognition task.

RESULTS

Painful thermal stimulation impaired recognition accuracy (d', recollection, familiarity). This negative effect of pain was positively correlated with the individual expectation of pain interference and the attentional avoidance of pain-related words. However, the interruptive effect of pain was not modulated by the predictability of pain. Source memory for painful stimulation was at chance level, indicating that subjects did not explicitly remember that images had been paired with pain.

CONCLUSIONS

Targeting negative expectations and a maladaptive attentional bias for pain-related material might help reducing frequently reported pain-induced cognitive impairments.

Phasic and tonic pain differentially impact the interruptive function of pain

The interruptive effect of painful experimental stimulation on cognitive processes is a well-known phenomenon. This study investigated the influence of pain duration on the negative effects of pain on cognition. Thirty-four healthy volunteers performed a rapid serial visual presentation task (RSVP) in which subjects had to detect (visual detection task) and count the occurrence of a target letter (working memory task) in two separate sessions while being stimulated on the left volar forearm with either short (2 sec) or long (18 sec) painful heat stimuli of equal subjective intensity. The results show that subjects performed significantly worse in the long pain session as indexed by decreased detection and counting performance. Interestingly, this effect on performance was also observed during control trials of the long pain session in which participants did not receive any painful stimulation. Moreover, subjects expected long painful stimulation to have a greater impact on their performance and individual expectation correlated with working memory performance. These findings suggest that not only the length of painful stimulation but also its expected ability to impair cognitive functioning might influence the interruptive function of pain. The exact relevance of expectation for the detrimental effects of pain on cognitive processes needs to be explored in more detail in future studies.

Gender stereotype susceptibility

Gender affects performance on a variety of cognitive tasks, and this impact may stem from socio-cultural factors such as gender stereotyping. Here we systematically manipulated gender stereotype messages on a social cognition task on which no initial gender gap has been documented. The outcome reveals: (i) Stereotyping affects both females and males, with a more pronounced impact on females. Yet an explicit negative message for males elicits a striking paradoxical deterioration in performance of females. (ii) Irrespective of gender and directness of message, valence of stereotype message affects performance: negative messages have stronger influence than positive ones. (iii) Directness of stereotype message differentially impacts performance of females and males: females tend to be stronger affected by implicit than explicit negative messages, whereas in males this relationship is opposite. The data are discussed in the light of neural networks underlying gender stereotyping. The findings provide novel insights into the sources of gender related fluctuations in cognition and behavior.

Predictors of neurobehavioral symptoms in a university population: a multivariate approach using a postconcussive symptom questionnaire

Several factors have been linked to severity of postconcussive-type (neurobehavioral) symptoms. In this study, predictors of neurobehavioral symptoms were examined using multivariate methods to determine the relative importance of each. Data regarding demographics, symptoms, current alcohol use, history of traumatic brain injury (TBI), orthopedic injuries, and psychiatric/developmental diagnoses were collected via questionnaire from 3027 university students. The most prominent predictors of symptoms were gender, history of depression or anxiety, history of attention-deficit/hyperactivity disorder or learning disability diagnosis, and frequency of alcohol use. Prior mild TBI was significantly related to overall symptoms, but this effect was small in comparison to other predictors. These results provide further evidence that neurobehavioral symptoms are multi-determined phenomena, and highlight the importance of psychiatric comorbidity, demographic factors, and health behaviors to neurobehavioral symptom presentation after mild TBI.

Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks

To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors-blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24's (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) sub-scales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup-albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.

An exploration of diagnosis threat and group identification following concussion injury

Cognitive performance can be impacted by many non-neurological factors, including preexisting expectations. The phenomenon of stereotype threat, or reduced cognitive performance due to preexisting beliefs, can apply to individuals following neurological injury (i.e., ‘‘diagnosis threat’’). We examined the effect of diagnosis threat on cognitive performance and symptom reporting following concussions while accounting for group identification (i.e., extent to which one’s identity is tied to being concussed). We also examined gender stereotype threat (i.e., women and math ability) to understand how these two related threat effects compare. Participants with a history of concussion were randomly assigned to one of three instructional sets emphasizing concussion history or gender, or neutral instructions. Individuals without a history of concussion served as a comparison group. Results revealed an effect of diagnosis threat on cognitive performance after group identification was taken into account, but only in male participants. In contrast, an underlying gender stereotype threat was observed in females across conditions, which was counteracted in the gender stereotype condition (i.e., stereotype reactance effect) due to the type of threat cues used. Also, controls exhibited greater symptom reporting than individuals with a concussion. Our findings highlight the importance of considering non-neurological factors impacting cognitive performance.

Stereotype Threat Strengthens Automatic Recall and Undermines Controlled Processes in Older Adults

The threat of being judged stereotypically (stereotype threat) may impair memory performance in older adults, thereby producing inflated age differences in memory tasks. However, the underlying mechanisms of stereotype threat in older adults or other stigmatized groups remain poorly understood. Here, we offer evidence that stereotype threat consumes working memory resources in older adults. More important, using a process-dissociation procedure, we found, for the first time, that stereotype threat undermines the controlled use of memory and simultaneously intensifies automatic response tendencies. These findings indicate that competing models of stereotype threat are actually compatible and offer further reasons for researchers and practitioners to pay special attention to age-related stereotypes during standardized neuropsychological testing.

Can Stereotype Threat Explain the Gender Gap in Mathematics Performance and Achievement?

Men and women score similarly in most areas of mathematics, but a gap favoring men is consistently found at the high end of performance. One explanation for this gap, stereotype threat, was first proposed by Spencer, Steele, and Quinn (1999) and has received much attention. We discuss merits and shortcomings of this study and review replication attempts. Only 55% of the articles with experimental designs that could have replicated the original results did so. But half of these were confounded by statistical adjustment of preexisting mathematics exam scores. Of the unconfounded experiments, only 30% replicated the original. A meta-analysis of these effects confirmed that only the group of studies with adjusted mathematics scores displayed the stereotype threat effect. We conclude that although stereotype threat may affect some women, the existing state of knowledge does not support the current level of enthusiasm for this as a mechanism underlying the gender gap in mathematics. We argue there are many reasons to close this gap, and that too much weight on the stereotype explanation may hamper research and implementation of effective interventions.

Explaining differences in episodic memory performance among older African Americans and Whites: the roles of factors related to cognitive reserve and test bias

Older African Americans tend to perform poorly in comparison with older Whites on episodic memory tests. Observed group differences may reflect some combination of biological differences, measurement bias, and other confounding factors that differ across groups. Cognitive reserve refers to the hypothesis that factors, such as years of education, cognitive activity, and socioeconomic status, promote brain resilience in the face of pathological threats to brain integrity in late life. Educational quality, measured by reading test performance, has been postulated as an important aspect of cognitive reserve. Previous studies have not concurrently evaluated test bias and other explanations for observed differences between older African Americans and Whites. We combined data from two studies to address this question. We analyzed data from 273 African American and 720 White older adults. We assessed DIF using an item response theory/ordinal logistic regression approach. DIF and factors associated with cognitive reserve did not explain the relationship between race, and age- and sex-adjusted episodic memory test performance. However, reading level did explain this relationship. The results reinforce the importance of considering education quality, as measured by reading level, when assessing cognition among diverse older adults.

Perception of intentions and actions: gender stereotype susceptibility

Gender differences are evident in the comprehension of social signals, but the underlying basis for these differences is unclear. There is some indication that gender effects have neurobiological sources. Here we manipulated stereotype messages about gender differences in a social cognition task, on which no gender gap has previously been documented. The outcome indicates that manipulation of stereotype messages elicits gender effects. A positive message enhances performance, whereas a negative message diminishes it. Furthermore, this effect is more pronounced in females, with a greater force of a negative stereotype message. The study provides novel insights into the possible sources of gender related fluctuations in social cognition. The findings are discussed in terms of behavioral components and brain mechanisms underpinning gender effects in social cognition.