Archivesof ClinicalNeuropsychology.Vol.1I, No.4, pp. 339-344.

1996
Pergamon Copyright 1996NationalAcademyof Neuropsychology
Printedin the USA.All rightsreserved
0887-6177/96$15.00+ .00
SSDI 0887-6177(95)00032-1

The Digit Vigilance Test: Reliability, Validity, and

Sensitivity to Diazepam
Donna Z. Kelland

Manchester, New Hampshire

Ronald F. Lewis
Center for Forensic Psychiatry, Ann Arbor, Michigan

The Digit Vigilance Test (DVT), a measure of sustained attention and psychomotor speed, was eval-
uated in terms of test-retest and alternate-form reliability as well as sensitivity to a single dose of
diazepam (10 rag). A one-page version was compared to the standard two-page format. Forty
undergraduates, randomly assigned in a double-blind manner to either drug or placebo condition,
were tested three times in two sessions (1 week apart). Both Page I and Total Time scores were
found to be highly reliable across time and forms. Repeated measures ANOVAs revealed the Total
Time score, but not the Page I score, to be significant in discriminating diazepam from placebo
across time, supporting the use of the complete D V T f o r measuring drug effects. Findings based on
convergent measures also help to validate the D VT as a measure of sastained attention.

The Digit Vigilance test (DVT; Lewis & Rennick, 1979) is a test of sustained attention and
psychomotor speed for which extensive norms are available (Heaton, Grant, & Matthews,
1991; Lewis, Kelland, & Kupke, 1990). The DVT has been used widely to study a number of
neurological conditions (e.g., Grant, Prigatano, Heaton, McSweeney, Wright, & Adams,
1987; Rosene, Copass, Kastner, Nolan, & Eschenbach, 1982), including different stages of
HIV infection (Heaton et al., 1995), and psychotropic interventions (e.g., Novelly, Schwartz,
Mattson, & Cramer, 1986; Samquist, Schoene, Hackett, & Townes, 1986; Townes, Dikmen,
Bledsoe, Hornbein, Martin, & Janesheski, 1986). In an earlier report on the same study, we
described the inability of the DVT, as part of a larger battery, to significantly discriminate
diazepam versus placebo on the basis of an end-point measurement (Kelland & Lewis,
1994). This was disappointing in that numerous studies have identified the negative influence

The authors thank Dr. David Gurevitch for his medical supervision and overall assistance in this project.
The Digit Vigilance Test (1995) is available for purchase from Psychological Assessment Resources,
Inc., Odessa, FL 33556. National norms for the Digit Vigilance Test (Heaton, Grant, & Matthews, 1991)
are also available from Psychological Assessment Resources, Inc.
Address correspondence to: Ronald E Lewis, Center for Forensic Psychiatry, P.O. Box 2060, Ann
Arbor, MI 48106.

339
340 D. Z. Kelland and R. E Lewis

of diazepam on psychomotor performance, cognition, attention, and learning and memory

(e.g., Ghoneim, Mewaldt, & Hinrichs, 1984; Mewaldt, Ghoneim, & Hinrichs, 1986). Rich
and Brown (1992) reported a significant within-subject decrement in Digit Vigilance, using a
modified administration format, in subjects who received oral diazepam as compared to
those who received placebo.
In contribution toward further understanding of the psychometric properties of the DVT,
the present study reports additional data and examines the ability of the DVT to discrimi-
nate a single, clinically relevant dose of diazepam (10 mg) from placebo in a repeated mea-
sures format. Subjects were tested three times in two session, 1 week apart, and randomly
assigned in a double-blind manner to either placebo or drug condition to manipulate arousal
level for the final DVT administration.
The present study also compares the reliability and sensitivity data for the standard two-
page test with that of an abbreviated one-page version. In addition, we are expanding on the
earlier report by further examining the sex effect reported on the DVT. Previously, we
described a significant sex by session effect for the DVT in terms of errors; that is, females
made more errors with practice (baseline to predrug trial) and males made less errors
(Kelland, Lewis, & Kupke, 1994). Furthermore, in the current report, convergent validity is
assessed with tasks previously demonstrated to be sensitive to diazepam: namely, the
Discriminant Reaction Time Test (DRAT) and Visual Analogue Sedation Ratings (VASRs;
Berchou & Block, 1983).

METHOD

Subjects

The sample consisted of 40 (20 female) healthy, paid volunteers, aged 18-30 years,
recruited from a large urban university. Those who responded were contacted for a tele-
phone screening interview prior to acceptance into the study. This self-report served to
screen out subjects who were taking medication, who had a history of alcohol or drug
abuse, or whose medical history contraindicated use of CNS-depressant drugs. Subjects
were free from any history of neurological, cardiac, renal, or hepatic disease, as well as
from psychiatric illness. Because differences in caffeine consumption levels can affect task
performance and modify effects of diazepam, a caffeine survey of potential volunteers was
used to select moderate caffeine users. Subjects who typically drank more than two cups of
coffee each day were not accepted. The subjects were matched for sex and randomly
assigned in a double-blind manner to either diazepam or placebo condition for the final test
administration. These groups were comparable (Student's t-test) in terms of mean years of
age (diazepam = 19.7; SD = 1.4; placebo = 20.0; SD = 2.8), years of education (diazepam =
13.3; SD = 1.3; placebo = 13.1; SD = 1.3), and weight in kilograms (diazepam = 73.3;
SD = 15.1; placebo = 69.6; SD = 9.9).

Tasks

The DVT was presented as part of a larger battery of attention/psychomotor tests (the
Repeatable Cognitive-Perceptual-Motor Battery; Lewis & Rennick, 1979). Subjects were
asked to cross out as quickly as possible a specific target number (6 or 9) that appears ran-
domly within 59 rows of 35 single digits on two pages. The examiner observes the subject's
performance on the demonstration rows and then on the first five rows of the test to deter-
mine whether corrective feedback is required to discourage an inefficient or poorly motivat-
 Evaluation of the DVT 341

ed response style (e.g., going too fast and missing numbers or going too slow and focusing
attention on each individual number). Total time and errors o f omission were recorded. For
the first (practice) administration, all subjects were asked to complete the standard format
(target = 6). Half o f the subjects (n = 20) were administered form 6 for the second adminis-
tration and form 9 for the third; the other half were administered forms 9 and 6, respectively.
For the Visual Analogue Sedation Rating (VASR), each subject was presented with a 100
m m line scale labeled ALERT at one end and D R O W S Y at the other. They were instructed
to indicate the current strength of their feeling of alertness or drowsiness by placing a mark
at any point along the line. The position of this mark (in millimeters from the left end of the
scale) was measured. In a similar manner, ratings were recorded for a MENTALLY SLOW/
MENTALLY Q U I C K continuum.
The Discriminant Reaction Time Test (DRAT; Lewis & Rennick, 1979) is a computer-
controlled measure of sustained attention and discriminant reaction time. Single digits (1 to
7) are presented in a rapid, random sequence over a 50-second interval. The subject is
instructed to press a key whenever the digit "4" is presented. Stimulus presentation is
adjusted based on performance, resulting in a rapidly obtained threshold-type measure.

Procedure

Each subject was tested three times in two sessions separated by 1 week and conducted
at the same time of day to avoid within-subject diurnal variation in performance. The DVT
was administered once in the first session to reduce practice effects and to provide a base-
line for reliability data. Subjects first completed the VASRs, and then the DVT as part of the
larger battery identified above. The beginning of the second session was identical to the
first: subjects completed the VASR and then the DVT. Then, subjects orally ingested 10 mg
diazepam or a placebo capsule identical in appearance. Half the subjects received diazepam
and half received placebo. Following a 30-minute intermission, subjects again completed
the VASR, and then in counterbalanced order the DVT, DRAT, and various other tests.

RESULTS

Results indicate high test-retest reliability (1-week interval) of the DVT for both the total
time (n = 40; R = .91, p < .01) as well as for page 1 time (n = 40; r = .80, p < .01). Alternate
form reliability was also significantly high for both scores (n = 20; total time: r = .90,
p < .01; page 1 time: r = .93, p < .01). Likewise, test-retest reliability coefficients of error
scores were also significantly high (n = 40; total errors: r = .66, p < .01; page 1 errors:
r = .61, p < .01).
Repeated measures ANOVA of practice effects across the three DVT administrations for
the placebo subjects (see Table 1) was significant (F = 11.74, p < .01), with repeated con-
trasts revealing a significant decrease in total time between trial 1 and trial 2 (F = 20.39,
p < .01), but not between trial 2 and trial 3 ( F = 2.14,p = .16).
As shown in Figure 1, repeated measures A N O V A s indicated a significant group
(diazepam versus placebo) by session (pre- vs. postdrug) interaction (F = 4.62, p < .05) for
the total time, but not for page 1 time (F = 2.72, p = . 11). That is, total time score was more
sensitive to the sedative effects of diazepam than was page 1 time. Furthermore, repeated
measures ANOVAs of error scores revealed no significant group by session interaction for
either page 1 errors (F = .38, p = .54) or for total errors (F = .77, p = .39), suggesting the rela-
tive insensitivity of DVT error scores to psychotropic effects. There were no significant sex
by administration interactions for either the total time (F = 1.13, p = .30) or error (F = 2.10,
342 D. 7.. Kelland and R. E Lewis

TABLE 1
Mean DVT Total Time Score Across Adminhtrations
(n = 20, Placebo Subjects)

Administration
I II HI

DVT total time

Mean 314.6 289.0" 292.1
SD 57.2 49.1 68.2
*p < .01 vs. administrationI; n.s. differvs. administrationIlL

p = .16) scores. Furthermore, there were no significant group by sex interactions for either the
time (F = .43, p = .65) or error (F = 1.05, p = .36) scores.
Although the DRAT, which was administered in the final postdrug session only, did not
significantly correlate with DVT page 1 (r = .38) or total time (r = .18), it did correlate sig-
nificantly with DVT total errors (r = .503, p < .01). Furthermore, the DRAT significantly
discriminated the diazepam from placebo group (t = 2.13, p < .05). Finally, similar to the
DVT total time score, the Alert/Drowsy VASR (F = 23.44, p < .01) and the Mentally
SlowfMentally Quick VASR (F = 6.81, p < .01) significantly discriminated between placebo
and drug conditions across administrations.

DISCUSSION

In summary, the DVT was found to be highly reliable with respect to both test-retest and
alternate form reliability for both page 1 and total time scores. Error scores were also found
to be reliable. Of these variables, however, only the DVT total time score significantly dis-
criminated a clinically relevant dose of diazepam from placebo across time. The finding that
DVT total time discriminated the drug conditions, but page 1 time did not, supports the use of
the complete test for measuring drug effects and also helps to validate the DVT as a measure
of sustained attention or vigilance. This identification of a significant reduction in sensitivity
from original to short version may serve to increase awareness of the potential generalizabili-
ty of this trend in the use of other neuropsychological tests with a significant attentional com-
ponent. Similar to the current fmdings, Heaton et al. (1995) reported the DVT total time score
- - but not the DVT error score - - to significantly discriminate earlier stages of HIV infection
from a later stage. The sex by administration difference found between administrations 1 and
2 was not observed between administrations 2 and 3, suggesting either that. the effect did not
persist beyond the second administration or that the effect was spurious.
Other measures previously found sensitive to diazepam - - DRAT and VASRs (Berchou &
Block, 1983) - - were again sensitive to diazepam and supported the convergent validity of the
DVT as a measure of psychotropic effects. In fact, VASR measurements were very sensitive to
the sedative effects of diazepam. The sensitivity of these quick and easily obtained rating mea-
surements warrant further investigation, especially because these cost-effective subjective
measures have been largely overlooked by both clinical and research neuropsychologists.
In contrast to the DVT, the DRAT significantly discriminated the groups based on an end-
point administration. It may be, however, that the ability of the DRAT to discern between drug
conditions depended on its novelty, whereas the DVT had been administered twice previously.
On the one hand, it is true that an initial practice session or, more generally, a repeated measures
format, may minimize practice effects and intersubject variability. On the other hand, repeated
administration may serve to reduce the novelty and sensitivity of the neuropsychological task.
 Evaluation of the D VT 343

DIGIT VIGILANCE
Page 1
180-
@--@ placebo
A--A diazepam
170-

160.

e3 150.
~D
E 1#0-
FT-
130.

120
II III
Administration

13
DIGIT VIGILANCE
Total
320"
Q--@ placebo
A--A diozepam
510"
13
0
0
.500"

E
1=
290-

A
280
II III
Ad m[n ist ratio n

FIGURE 1. (A) Mean DVT Page 1 score did not significantly discriminate groups across admin~tratlom.
01) The diazepam group demonstrated a significant increase in mean DVT total time as compared to the
placebo group.

This inherent trade-off may be worthy of empirical exploration as well as being an important
consideration in the design of studies of drug responsiveness or changes in other psychoU-opic
factors. Leaving aside these more abstract considerations, we can conclude that the current study
provides support for the DVT as a measure of change for sustained attention/psychomotor speed.

REFERENCES

Berchou, R., & Block, R. I. (1983). Use of computerized psychomotor testing in determining CNS effects of drugs.
Perceptual and Motor Skills, 57, 691-700.
344 D. Z. Kelland and R. E Lewis

Ghoneim, M. M., Mewaldt, S. P., & Hinrichs, J. C. (1984). Dose-response analysis of the behavioral effects of
diazepam II: Psychomotor performance, cognition and mood. Psychopharmacology (Berlin), 82, 296-300.
Grant, I., Prigatano, G. P., Heaton, R. K., McSweeney, A. J., Wright, E. C., & Adams, K. M. (1987). Progressive
neuropsychologic impairment and hypoxemia. Archives of General Psychiatry, 44, 999-1006.
Heaton, R. K., Grant, I., Butters, N., White, D. A., Kirson, D., Atldnson, J. H., McCutchen, J. A., Taylor, M. J.,
Kelly, M. D., Ellis, R. J. Wolfson, T., Velin, R. Marcotte, T. D., Hesselink, J. R., Jernigan, T. L., Chandler, J.
Wallace, M. Abramson, I., and The HNRC Group. (1995). The HNRC 500 - - Neuropsychology of HIV infec-
tion at differenct disease stages. Journal of International Nearopsychological Society, 1, 231-251.
Heaton, R. K., Grant, I., & Matthews, C. G. (1991). Comprehensive norms for an Extended Halstead-Reitan battery:
Demographic corrections, researchfindings, and clinical applications. Odessa, FL: Psychological Assessment
Resources, Inc.
Kelland, D. Z., & Lewis, R. E (1994). Evaluation of the reliability and validity of the Repeatable Cognitive-
Perceptual-Motor Battery. The Clinical Nearopsychologist, 8, 295-308.
Kelland, D. Z., Lewis, R. E, & Kupke, T. (1994). Sex differences on first and second administrations of the
Repeatable Cognitive-Perceptual-Motor Battery. Archives ofClihical Neuropsychology, 9, 148.
Lewis, R. E, Kelland, D. Z., & Kupke, T. (1990). A normative study of the Repeatable Cognitive-Perceptual-Motor
Battery. Archives of Clinical Neuropsychology, 5, 201.
Lewis, R., & Rennick, P. M. (I 979). Manual for the Repeatable Cognitive-Perceptual-Motor Battery. Grosse Point,
MI: Axon.
Mewaldt, S. P., Ghoneim, M. M., & Hinrichs, J. V. (1986). The behavioral actions of diazepam and oxazepam are
similar. Psychopharmacology (Berlin), 88, 165-171.
Novelly, R. A., Schwartz, M. M., Mattson, R. H., & Cramer, J. A. (1986). Behavioral toxicity associated with
antiepileptic drugs: Concepts and methods of assessment. Epilepsia, 27, 331-340.
Rich, J., & Brown, G. G. (1992). Selective dissociations of sedation and amnesia following ingestion of diazepam.
Psychopharmacology, 106, 346-350.
Rosene, K. A., Copass, M. K., Kastner, L. S., Nolan, C. M., & Eschenbach, D. A. 0982). Persistent neuropsycho-
logical sequelae of toxic shock syndrome. Annals of Internal Medicine, 96, 865-870.
Sarnquist, E H., Schoene, R. B., Haekett, P. H., & Townes, B. D. (1986). Hemodilution of polycythemic moan-
taineers: Effects on exercise and mental function. Aviation, Space, and Environmental Medicine, 57, 313-317.
Townes, B. D., Dikmen, S. S., Bledsoe, S. W., Hornbein, T. E, Martin, D. C., and Janesheski, J. A. (1986).
Neuropsychological changes in a young, healthy population after controlled hypotensive anesthesia. Anesthesia
and Analgesia, 65, 955-959.