Concerning Cognitive Testing over the Internet

Concerning Cognitive Testing over the Internet

Cognitive testing over the Internet must be performed in controlled environments


Until fairly recently, all cognitive ability testing was done by professionals in their offices. It usually went without saying that the person being tested was not distracted, interrupted, or coached by anyone during testing. Recently, the Internet has created the possibility of testing people wherever they are and recently a variety of computer-assisted test procedures have claimed to be valid substitutes for in-person testing in a controlled environment.

Internet-based testing jeopardizes the validity and reliability of results.

Even though the Internet may appear to give the advantage of availability and ease of access — especially to physically disabled or home-bound people — the validity and reliability of Internet-based tests is markedly compromised by two unavoidable human factors: distractions and coaching.

The person setting up the tests is usually the child or spouse of the person being tested. Typically this means testing is being done at home. There may be grandchildren running around. The television may be on in the background. The person being tested may be distracted by any number of things, or might simply leave the test to use the bathroom. Of particular concern is that in seeing a parent struggle with the assessment, the child or spouse often cannot resist helping in ways that distort the results. For all these reasons, tests performed outside of a controlled environment have to be considered invalid.

Testing in a controlled environment is always necessary.

The following is a highly illustrative example of the distortions introduced by lending assistance. In the cognitive report shown below four testing sessions had been retrieved over an 8-month period.

When the patient is as impaired as this person was — as shown on his first test — Screen, Inc. recommends re-testing every 3 months. In the third test (August 27, 2014) this patient’s results were so distinctly different from the first two sessions that the Screen, Inc. report writer called the testing facility and asked if there had been anything different about the testing environment for that session. The support staff member said, “No. Well… his wife was in the testing room with him this time”. A re-testing was requested, with instructions to make sure that no test-taking assistance was possible. The results in the fourth session returned to the expected range.

In conclusion, computer-administered tests should be given by a neutral tester in a controlled environment — preferably a designated quiet room in a medical office. And even then, no assistance can be allowed.

Emory Hill, Ph.D.
Founder of Screen Inc., Dr. Hill has a PhD in Clinical Psychology, State University of New York at Buffalo. Later he completed an Informatics Fellowship (post-PhD) at the VA where he studied interface design, multimedia programming, user resistance, evaluation of adaptations to new medical record systems, and the implementation of automated medical records. A trained psychologist and psychometric specialist, Emory was in private practice for nearly 20 years. Before that, he served as an Assistant Professor of Psychology at SUNY, Brockport, NY.