Abstract:
The Stroop paradigm is widely used in the executive functions assessment. This
study investigated the use of tasks based on the Stroop paradigm in national
studies published between 2000 and 2022 by doing a scoping review. Empirical
studies were selected in the following databases: Pubmed, Scielo Brazil, LILACS,
Pepsic, Index Psi Periódicos, Index-Psi teses, Biblioteca Digital Brasileira de
Teses e Dissertações (BDTD) and Portal CAPES de Teses e Dissertações. From the
initial 1448 studies found, 147 were selected (90 theses/dissertations and 57
articles). Most articles were published in psychology and psychiatry journals,
and the construct most targeted by the tasks was inhibitory control. Four
versions were identified, and the classic Stroop Color and Word test was the
most used (124 studies). Different scores were reported. There were few
psychometric studies and few studies with task norms. Computerized versions are
still infrequently used. The review helps to outline the versions used in the
national context.
Keywords: Stroop, inhibitory control, neuropsychological assessment, executive functions, neuropsychology.
Resumo:
O paradigma de Stroop é amplamente utilizado na avaliação das funções executivas.
Este estudo investigou o uso de tarefas baseadas no paradigma de Stroop em
estudos nacionais publicados entre 2000 e 2022, por meio de uma revisão de
escopo. Buscaram-se estudos empíricos nas bases de dados: PubMed, SciELO Brasil,
LILACS, PePSIC, Index Psi Periódicos, Index Psi Teses, Biblioteca Digital
Brasileira de Teses e Dissertações (BDTD) e Portal Capes de Teses e
Dissertações. Do montante inicial de 1.448 estudos, 147 foram selecionados (90
teses/dissertações e 57 artigos). Publicou-se a maioria dos artigos em revistas
de psicologia e psiquiatria, e o controle inibitório foi o constructo mais
mencionado como alvo das tarefas. Identificaram-se quatro versões, sendo a mais
utilizada o Stroop de Cores e Palavras clássico (124 estudos). Diferentes
escores/índices foram relatados. Houve poucos estudos psicométricos e com normas
das tarefas. Versões computadorizas ainda são pouco utilizadas. A revisão
colabora para o mapeamento das versões utilizadas no âmbito nacional.
Palavras-chave: Stroop, controle inibitório, avaliação neuropsicológica, funções executivas, neuropsicologia.
Resumen:
El paradigma de Stroop se usa ampliamente en la evaluación de las funciones
ejecutivas. Este estudio investigó el uso de tareas basadas en esto paradigma en
estudios nacionales publicados entre 2000 y 2022, haciendo una revisión de
alcance. Los estudios empíricos fueron seleccionados en las bases de datos:
Pubmed, Scielo Brasil, LILACS, Pepsic, Index Psi Periódicos, Index-Psi teses,
Biblioteca Digital Brasileira de Teses e Dissertações (BDTD) y el Portal CAPES
de Teses e Dissertações. De los 1448 estudios iniciales encontrados, se
seleccionaron 147 (90 tesis / disertaciones y 57 artículos). La mayoría de los
artículos se publicaron en revistas de psicología y psiquiatría, y el constructo
más citado de las tareas fue el control inhibitorio. Se identificaron cuatro
versiones, siendo la prueba clásica Stroop Colores y Palavras la más utilizada
(124 estudios). Se informaron diferentes puntuaciones. Hubo pocos estudios
psicométricos y pocos estudios con normas de tareas. Las versiones
computarizadas todavía se utilizan poco. La revisión ayuda a identificar las
versiones utilizadas a nivel nacional.
Palabras clave: Stroop, control inhibitorio, evaluación neuropsicológica, funciones ejecutivas, neuropsicología.
Carátula del artículo
The Stroop Paradigm in Brazilian Studies: A Scoping
Review
O paradigma de Stroop nos estudos brasileiros: uma revisão de escopo
El paradigma de stroop en los estudios brasileños: una revisión del alcance
Maria Eduarda de Oliveira Martins psi.eduardamartins@gmail.com
Universidade Federal de Santa Catarina, Brazil
Caio Marcos Garcia Tosi
Universidade Federal de Santa Catarina, Brazil
Bernardo Peressoni Luz
Universidade Federal de Santa Catarina, Brazil
Luiz Henrique Toresan
Universidade Federal de Santa Catarina, Brazil
Chrissie Ferreira de Carvalho
Universidade Federal de Santa Catarina, Brazil
Natália Martins Dias
Universidade Federal de Santa Catarina, Brazil
Psicologia: Teoria e Prática, vol. 25, no. 2, ePTPCP14766, 2023
Universidade Presbiteriana Mackenzie
Received: 25 October 2021
Accepted: 30 June 2022
Neuropsychology is an interdisciplinary area of science; the primary practices are the
Neuropsychological Assessment (ANP – Brazilian abbreviation for Avaliação
neuropsicológica) and intervention. The pillars of the ANP are the
interview, observation, scales, and neuropsychological tests (or tasks). The application
of instruments, namely neuropsychological testing, is part of the process and allows the
detailed investigation and quantification of measures of specific components of human
cognition (e.g., attention, memory, executive functions) (Bertrand et al., 2019; Dias & Seabra,
2019; Goldstein & Mcneil, 2013;
Malloy-Diniz et al., 2016).
For assessment quality, it is essential to construct and use adequate neuropsychological
tests (Bilder & Reise, 2019; Dias & Seabra, 2019). The ANP is being
consolidated with the help of psychometrics, which contributes to the quality of
measurement instruments. The current neuropsychological practice results from
significant advances in recent decades, using different assessment approaches,
contributions from psychometrics, and, more recently, a growing trend toward
computerized tests (Bilder & Reise, 2019;
Casaletto & Heaton, 2017). However, there
is still some resistance to integrating technology into the area (Bilder & Reise, 2019; Miller
& Barr, 2017).
Among the most used neuropsychological tests, those based on classical paradigms stand
out, with one example being the Stroop Paradigm, which assesses cognitive control by
keeping a goal in mind and suppressing a dominant response to perform a less habitual
response (Strauss et al., 2006). When reviewing
the national production related to the ANP, Ramos and
Hamdan (2016) identified that the Stroop Color-Word Test version was the
10th most used instrument, mentioned by 34 of the 241 studies that made
up the review. There are many tasks based on this paradigm, first described in an
article published by John Stroop in 1935, in which he presented the classic version of
the task (Lezak et al., 2012; Scarpina & Tagini, 2017; Strauss et al., 2006).
The original Color-Word version consists of three parts. First, the participant must read
the words ‘green,’ ‘red,’ ‘blue,’ and ‘yellow’ printed in black on a card. Secondly, the
participant says the name of these colors printed in colored circles or rectangles.
Finally, in the third, the names of the colors printed incongruously with the written
words appear, and the participant has to name the color of the word instead of reading
the word. For example, the word “red” colored in blue must be called ‘blue.’ The “Stroop
Effect” occurs in the third part, where there is cognitive interference since reading
processing is automatic. It is necessary to inhibit this tendency to name the printed
color. The Stroop test is one of the instruments most used for assessing executive
functions (EF) (Campanholo, 2018). More
specifically, it considers inhibitory control and selective attention (Silva et al., 2017); however, the literature also
suggests its application to assess processing speed, cognitive flexibility, and working
memory (Strauss et al., 2006).
The Stroop is widely used in research and ANP practice (Ramos & Hamdan, 2016; Santana et al.,
2019). Reviews and surveys have been conducted since the 1930s and highlight
the increasing use of neuropsychological testing instruments in clinical, hospital,
school, and psychiatric contexts (Rabin et al.,
2005). The review by Rabin et al.
(2005) represented the most significant review of the neuropsychological
practice performed so far, examining aspects of the instruments that had not been
considered, such as their frequency of use and correction. The study collected data from
747 North American professionals who performed ANP. The results indicated that the most
frequently assessed construct was attention, with Stroop ranking 4th among the
instruments most used to assess this construct.
A review of Italian studies also investigated the types of measures (indexes) used in
assessing the Stroop Effect (Scarpina & Tagini,
2017). The authors verified various methods for evaluating its effect by
analyzing studies that proposed normative data for the tasks based on the Paradigm.
However, the review reported that none of the versions presented in the literature
represented an effective way of measuring the Stroop Effect, which highlighted the need
to strengthen normative references that jointly consider the speed and accuracy of the
response in the congruent and incongruent stages of the test (Scarpina & Tagini, 2017).
More recently, the systematic review performed by Santana
et al. (2019) investigated which instruments were used to assess EF, in
national and international contexts, between 2010 and 2016. The study also outlined the
characteristics of the methodological designs of the empirical studies that used these
instruments for EF assessment, the frequency of publications in the area, the objectives
of the selected studies, the psychometric parameters of the instruments identified, and
the populations most frequently investigated in these publications. A total of 35
articles were analyzed. The main instruments used were the Wisconsin Card Sorting Test,
the Trail Making Test, the Wechsler Intelligence Scales, and the Stroop Test. The
summary of the findings suggested that, although numerous versions of tests and tasks of
classical paradigms are commonly used in the national context, there is still a need for
the provision of performance standards and a demand for the construction and validation
of new instruments in Brazil.
There are several versions of Stroop tasks. One of the most used is the Victoria version,
which also uses color and words and has the advantage of being shorter than the original
version of the Stroop, with only 24 stimuli in each card/part of the task (Silva et al., 2017; Strauss et al., 2006). There are also versions explicitly developed for
preschool children, such as versions with shapes or figures (Carlson, 2005), and others that use numbers, such as the Five Digit
Test (Sedó, 2004), which also do not require
reading. The literature mentions computerized versions as well (Campanholo, 2018).
Given the wide use in neuropsychological and clinical research and the number of versions
available, this review aimed to map the use of tasks based on the Stroop paradigm in
Brazilian empirical studies over the last 22 years (from 2000 to the present).
Specifically, this review investigated: 1) the contexts in which the instruments based
on the Stroop paradigm (age groups and clinical conditions) are used; 2) the skills that
are assessed (as reported by the studies selected for the review); 3) the versions used,
and 4) the scores and indexes used.
A scoping review is suitable for this purpose. Its objectives include mapping and
examining how research is conducted in a determined area and identifying the primary
evidence and characteristics associated with a topic, area, or concept (Munn et al., 2018). This study aimed to provide
information about the Stroop task versions used and to support the growth of the ANP in
the national context.
Method
This scoping review was prepared based on the recommendations of the PRISMA extension
for Scoping Reviews—Prisma-ScR (Tricco et al.,
2018).
Eligibility Criteria
For the initial survey of studies in this review process, the following inclusion
criteria were used: a) being an empirical study; b) being a Brazilian study; c)
having used an instrument based on the Stroop Paradigm for evaluation purposes;
d) using a typical or atypical sample of participants from any age group of the
life cycle (human studies); e) having been published between 2000 and 2022 (see
below the topic about updating the search), and f) published in the Portuguese,
English or Spanish languages. As exclusion criteria, the following were
considered: a) review studies or theoretical studies; b) studies that did not
use any assessment instrument based on the Stroop Paradigm; and c) studies
conducted with foreign populations.
Databases and search strategies
The initial searches were conducted in June 2020 jointly by two authors (CMGT and
MEOM). The PubMed, SciELO Brazil, LILACS, PePSIC, and INDEX PSI PERIODIC
databases were consulted to locate studies published in article format. The
INDEX PSI TESES databases, the Brazilian Digital Library of Theses and
Dissertations (BDBTD), and the CAPES Theses & Dissertations Portal were
consulted to identify studies published as theses and dissertations (T&D).
As a search strategy, the following string was used in all databases, filtering
for studies published between 2000 and 2020 and searching in all indexes:
Assessment AND (Stroop OR “executive function” OR “inhibitory control” OR
inhibition OR “selective attention” OR “interference control” OR “cognitive
conflict” OR self-control).
In the PubMed database, another part was inserted in this string to select only
studies with Brazilian populations: ...AND (Brazil OR
Brazilian). In addition to searching the databases, other studies were
included based on checking lists of references and from the authors’ previous
knowledge (CFC and NMD).
Selection of studies
The first selection stage (screening) took place through reading titles and
abstracts. It was conducted independently by two authors (CMGT and MEOM), with
100% agreement regarding the T&D. Concerning the articles, there was only
one disagreement, which was resolved through discussion between the authors.
After the screening, the selection stage began with the studies being read in
full, again performed by two authors (CMGT and MEOM). There were discrepancies
in 4.65% of the articles and 7.07% of the T&D, which were later resolved
through the analysis of a third judge (role played by NMD and CFC). All reasons
for exclusion were recorded at this stage.
Data extraction
From the reading of the studies in full, the authors extracted the following
information from the included studies: a) General information (i.e., title,
authors’ names, year of publication, journal in which it was published, or
university in which it was defended); b) main objective; c) the total number of
people who composed the sample analyzed (typical or atypical); d) the age
group/mean age of the participants; and e) other sample data (e.g., whether or
not the study used a clinical sample and what type of clinical condition made up
the sample studied).
Regarding the tasks based on the Stroop Paradigm, the authors extracted the
following information from the studies: f) the name of the test used; g) the
version the test used was based on (if the information was available); h)
whether or not the version used in the study was computerized; i) the references
of the Brazilian version and the original version (on which the test was based);
j) description of the instrument, in terms of (j1) the type of stimulus and (j2)
the scores used; and k) the skill assessed by the instrument, according to the
authors of the studies.
The studies were also classified as to whether or not they were ‘psychometric,’
that is, whether their objective was to provide data on reliability, validity,
or normative task data. Data extraction was performed by four authors (CMGT,
MEOM, BPL, and LHT), with supervision and verification by other team members
(CMGT, MEOM, and NMD), and was carried out using an Excel spreadsheet.
The search update and study selection stage
The search was updated at two moments, using the same procedure and search
strategy in each database: 1) in August 2021 to identify new studies published
during the year 2020; and 2) in May 2022, covering the entire period from 2021
to the date of the search update (May 11th, 2022). The selection from this new
material followed the same procedures described above.
Results
Selection of studies
After performing searches in the databases as mentioned earlier using the strings
presented, 868 articles were identified (PubMed = 184; SciELO Brasil = 182;
LILACS = 459; PePSIC = 25; Index Psi Periodicals = 18) and 576 T&D (Index
Psi Theses = 5; BDBTD = 530; CAPES Theses & Dissertations Portal = 41); in
addition to these, one thesis and three articles were included based on the
authors’ indication (prior knowledge/checking of reference lists). After
removing duplicate studies, the sample included 745 articles and 544 T&D,
totaling 1289 studies that went on to the selection stage with reading the
titles and abstracts. After this screening step, 1088 studies (649 articles and
439 T&D) were excluded from the analysis as they did not fulfill the
inclusion criteria of this review.
Two hundred-one studies (96 articles and 105 T&D) were then assessed for
eligibility. After reading the studies, 54 were excluded (39 papers and 15
T&D) due to fulfilling any exclusion criteria, as identified in Figure 1. In studies without access to the
full text, attempts were made to contact the authors to request the respective
materials. There was no response in any of the cases. At the end of the
eligibility stage, 147 studies were included in the review (90 T&D and 57
articles). Figure 1 presents the process
flowchart.
Figure 1
Flowchart of study selection steps (PRISMA-ScR)
Characteristics of the studies
Due to the inclusion criteria adopted, all studies selected for this manuscript
were published between 2000 and 2021. A greater concentration of studies was
published between 2011 and 2016 (n = 83), with 17 studies
published in 2015 and 18 published in 2016. In subsequent years, there was a
decrease in the number of productions (29 between 2017 and 2019), with 7 in
2020, 2 in 2021 and no study published in 2022. Among the articles analyzed, 28
articles were published in psychology journals, 15 in psychiatry journals, and
14 in journals from other areas.
The T&D was conducted in graduate programs in Medical Sciences and subfields
(44), Psychology and subfields (26), Biological Sciences and subfields (5),
Developmental Disorders (5), Health Sciences (3), Physical Education (3), Speech
Therapy (1), Pharmacology (1), Education (1) and Community Development (1).
Regarding location, the T&D was conducted at universities located in the
states of São Paulo (57), Rio Grande do Sul (7), Minas Gerais (6), Rio de
Janeiro (4), Rio Grande do Norte (3), Alagoas (3), Ceará (2), Pernambuco (1),
Paraná (1), Paraíba (1), Mato Grosso do Sul (1), Goiás (1), Bahia (1), and
Distrito Federal (1).
Of the total number of studies, 15 (10.2%) were characterized as psychometric, as
they described among their objectives the adaptation, construction, and survey
of validity evidence, reliability, or provision of normative data from
instruments to assess aspects of executive functions. Three (2.04%) studies
provided normative data.
Summary of studies
Regarding the contexts of the Stroop tasks used, the 147 studies were conducted
with varied age groups, with emphasis on the 40-59 age group, which was present
in 42.18% of the studies, followed by almost 40% with the age range of 18-39
years and 38.78% with the 60-69 age group. One study included a three-year or
less sample (Table 1). In 14 of the
studies, there was no information on the age range. In these cases, the mean age
reported was considered (e.g., in one study, the mean age was 36.55 ± 11.34.
Therefore, this study was computed to cover the age group of 18 to 39
years).
Table 1
The Age Range of the Samples of the Studies Analyzed
Note: The sum and % exceed the total number of the
reviewed studies, as some included more than one of the delimited
age groups.
Individuals with typical development composed the sample in 40% of the studies
(Table 2), which refers to studies
that did not investigate clinical samples. Most of the studies surveyed
individuals with some clinical condition, with emphasis on people with some
general physical health conditions (22 studies), dementia (17 studies), ADHD (10
studies), and abusive users of alcohol and other drugs (8 studies).
Table 2
Characterization of the Samples of the Studies Reviewed according to
the Clinical Conditions
*General health conditions: diabetics, HIV, rheumatoid arthritis,
bariatric patients, writer’s cramp, cirrhosis, myotonic dystrophy
type 1, peripheral arterial disease, Wilson’s disease, basilar
artery occlusive disease, chronic kidney disease, chronic pain,
chronic hepatitis c, hyperphenylalaninemia, hypothyroidism, chronic
occupational mercurialism, obesity, perimenopausal women,
toxoplasmosis and breast cancer. *Dementia: Alzheimer’s disease, Parkinson’s disease, frontotemporal
lumbar degeneration, dementia, infectious parasitic dementia, and
Machado-Joseph disease (ataxia). *Learning difficulties: attention, language, reading, writing,
psychomotor aspects difficulties. *Neurological injuries and accidents: delayed diffuse axonal injury,
hemorrhagic cerebrovascular disease, central neuropathic pain, and
HTLV-1-associated myelopathy *Anxiety Disorders: agoraphobia, anxiety disorder, and panic
disorder. *Eating disorders: anorexia and binge eating disorder. The sum and % exceed the total number of the reviewed studies, as
some included more than one of the delimited samples.
Table 3 details the number and percentage
of studies that reported the cognitive constructs measured using paradigm-based
instruments. Concerning the cognitive skills assessed by the tasks, inhibitory
control was the most mentioned (70.74%), followed by attention (65.98%). One
study did not report which skill was assessed by the task based on the Stroop
paradigm.
Table 3
Skills/Constructs Assessed Using the Stroop Paradigm-Based
Instruments in the Studies Selected
Note: The sum and % exceed the total number of the
reviewed studies, as some listed more than one construct assessed by
the measure.
Table 4 categorizes the instruments
surveyed by type/version, describes the names used by the authors, the type of
stimulus, and whether the format was conventional (generally using printed
cards) or computerized. Among the versions used, the most frequent was the
Stroop Color-Word Test version (124 studies; 125 tasks), followed by the Stroop
Figures Test (14), the Stroop Numerical Test (7), and the Stroop Emotional Test
(2). One study did not provide enough information to allow the proper
identification of the instrument, version or stimuli used. Regarding the number
of versions/tasks, 22.14% were computerized (used in 22.44% of the studies),
emphasizing the Stroop Figures Test version in which all tasks were
computerized.
Table 4
Instruments/Versions Used in the Studies Reviewed
Note: The sum and % exceed the total number of the
reviewed studies, as two used more than one instrument based on the
Stroop paradigm. *Percentage calculated based on the number of studies (n=147) – ex:
85.03% of the studies used the Stroop Color-Word version.
Of the 124 studies that specified the type as the “traditional” Stroop Color-Word
Test, 90 indicated the version with references and description, and the
remaining 34 did not specify the version. Among those that defined the version
that served as the basis for adapting the task used in their study, 55 reported
using the Victoria version and 9 using the Golden version. It should be noted
that even considering the tasks based on the same version, there was
heterogeneity among the descriptions. For example, considering the Victoria
version, nine different descriptions were identified in terms of the number of
stimuli (generally 24, however, some studies did not provide this information),
types of stimuli (rectangles or circles), colors used, types of words used
(among names of colors or neutral words or both) and even the order of the
steps.
This lack of uniformity is even more evident when considering the measures and
indexes used, with 17 different performance measures identified and studies that
did not specify the index used. Approximately 60% of the studies recorded the
completion time per stage. The number of errors per stage varied in 42.86% of
the studies, therefore being the most commonly observed measure (Table 5). Indexes with reaction times were
relatively infrequent since the measure’s specificity requires computerized
versions.
Table 5
Scores Used, as Reported by the Reviewed Studies
Note: The sum and % exceed the total number of the
reviewed studies, as they may use more than one type of index or
measure (score or time) of performance. *(Completion time in seconds in the incongruent
step) - (Completion time in seconds in the congruent step). **(Reaction Time in milliseconds in the incongruent
step) - (Reaction Time in milliseconds in the congruent step). ***(Total number of correct responses in the
incongruous step) - (Total number of correct responses in the
congruent step).
Discussion
This study aimed to survey the use of tasks based on the Stroop paradigm in Brazilian
empirical studies from 2000 to 2022. The scoping review identified that the paradigm
had been used with different age groups, with typical development and various
clinical conditions, with the predominance of the classic Stroop Color-Word Test
version, not computerized, to assess inhibitory control and attention.
Regarding the age groups of the studies reviewed, there was a higher concentration of
Stroop use among older adults and adults, with less use in children and adolescents.
Although the development and maturation of executive functions have their highest
peak in childhood and adolescence, few studies with this age group were found. Among
these, the study by Duncan (2006) assessed
132 adolescents aged between 12 and 14 years and provided norms for that age for the
Victoria version. With children, studies with semantic Stroop paradigms stand out,
such as the one by Elage (2016), which
evaluated 51 children using the day-night/boy-girl conflict, and the one by Martins (2020), with 780 children using animals
(body/head conflict), both in the age group between 4 and 10 years. One aspect that
could explain the smaller number of studies with children may be that the most used
version is based on the automation of the reading process (Silva et al., 2017) and that clinical studies are also more
present in adulthood (substance use, dementia, neurological damage).
It was found that the traditional Stroop Color-Word Test version was the most used
(in 85.03% of the studies), followed by the Stroop Figures, the Stroop Numerical,
and the Stroop Emotional Tests versions. This data corroborates the literature that
indicates a wide use of the original Color-Word version (Campanholo, 2018; Ramos &
Hamdan, 2016; Santana et al.,
2019; Silva et al., 2017) while
highlighting the heterogeneity of the versions derived from it. The presentation of
the items in the studies was quite varied, even in the Stroop Color-Word Test
version. The items presented rectangles, circles, and words (neutral or color names)
in black, different colors, and varied configurations and orders. This is an aspect
to be considered since using other versions, or stimulus
configurations/presentations of the same version may compromise the comparability
among findings from different studies, with some standardization being
desirable.
The availability of a standardized version (and its respective psychometric studies
and standards) remains a requirement for researchers working with the instrument.
Other versions are also popular in the literature and seek to exclude stimuli with
reading demands, using mainly numbers (De Paula et
al., 2017) or semantic knowledge conflicts, such as the Stroop Day and
Night Test (Carlson, 2005), also identified
in the review. These versions offer alternatives for the assessment of illiterate
children or even adults.
There was significant heterogeneity in the skills assessed, despite inhibitory
control and attention and its subcomponents being the constructs most mentioned, as
found by other authors (Silva et al., 2017).
This heterogeneity is predictable, considering the range of cognitive processes
involved in performing the Stroop and even the different versions that may require
specific cognitive demands. Although widely described for the assessment of
“aspects” of executive functions (Campanholo,
2018; Cazassa et al., 2020; Guerra et al., 2021; Klein et al., 2010), there are also descriptions of the
paradigm, including the assessment of executive function components, such as working
memory, cognitive flexibility and even processing speed (Strauss et al., 2006). For example, there are versions, such as
the Five Digit Test, a type of Stroop Numerical Test (De Paula et al., 2017; Sedó,
2004), in which there is an alternation of the rule and the demand when
faced with the specificities of the stimulus presentation (e.g., count the digits
presented in the box, but, in those with a border, change the rule and read the
digits), engaging processes of flexibility beyond inhibition.
Heterogeneity was also observed in the number of clinical conditions composing the
samples, suggesting that the Stroop is versatile and can be applied in research and
professional practice and different contexts with different types of demands
(developmental disorders, general physical health conditions, chronic diseases,
dementia, substance use, neurological injuries, etc.). These aspects show that the
instrument continues to be widely used in the ANP (Rabin et al., 2005; Ramos & Hamdan,
2016; Santana et al., 2019),
including in samples of people with typical development, among them samples of
children and adolescents. This shows that, although in smaller numbers, there is an
engagement of research groups in expanding studies on the NEPSY of children, a
requirement highlighted in previous reviews.
Considering technological advances and the tendency to use computerized tests (Casaletto & Heaton, 2017) and despite the
advantages that this type of version can provide to the assessment process, such as
better control in task administration, easier and more accurate collection of scores
and reaction and execution time measurements (Casaletto & Heaton, 2017; Parsey
& Schmitter-Edgecombe, 2013) and easier data export for analysis
(Schatz & Browndyke, 2002),
computerized versions were used in a limited percentage (22.44%) of the selected
studies. However, this application seems to be increasing, especially in assessing
children using versions of the Stroop Figures Test (e.g., Elage, 2016; Martins,
2020). Years earlier, this trend was also observed in a study with North
American psychologists, with the participation of 512 neuropsychologists who
collected information on the use of 693 instruments, with only 40 being
computerized. Although computerized instruments are less used, the study showed that
younger psychologists with fewer years of experience are likelier to use them (Rabin et al., 2014). Although there has been
increased use of computerized instruments in recent decades in the international
scenario, especially in the North American context, conventional tests continue to
be used more (Hewitt et al., 2022).
The still-nascent use of computerized versions in Brazil can be associated with
numerous factors, including the lack of resources for programming tasks. However, a
possible resistance to incorporating technology into the neuropsychological practice
must also be considered, with this being a phenomenon identified internationally
(Miller & Barr, 2017). There are
initiatives in Brazil to develop platforms for online assessment (e.g., Serpa et al., 2019), a practice that would make
teleneuropsychology possible, which would be very useful in times of restricted
social contact, as is still the case due to the pandemic. The psychometric
properties of these computerized measures should be investigated, and equivalence to
the pencil and paper versions should not be inferred a priori (Bauer et al., 2012). This review is a relevant finding,
highlighting the need for investments in studies with computerized instruments,
which are still scarce in the national scenario.
A point to emphasize is that there were few studies with psychometric objectives
(10.20%), that is, studies in which the authors adapted, constructed, or
investigated evidence of validity, reliability, or provided norms for the instrument
(e.g., Albertini, 2015; Brandelero & de Toni, 2015; Bueno, 2013; Campos et al., 2016;
Canali et al., 2011; De Paula et al., 2017; Dias,
2009; Duncan, 2006; Elage, 2016; Fonseca et al., 2015; Guerra et al.,
2021; Martins, 2020; Natale et al., 2008; Oliveira et al., 2016; Zimmermann et al., 2015). Of these, only three studies provided norms
for elementary school children/adolescents (Duncan,
2006), for the 7 to 14 years age group (Oliveira et al., 2016) and the 19 to 75 years age group (Zimmermann et al., 2015).
There was also variability in the types of scores recorded by the studies. The most
recorded were the completion time per step (59.86%) and the number of errors
(42.86%). Only about 10% of the studies recorded reaction time associated with the
limited use of computerized versions. Similar results were reported in the review by
Scapina and Tangini (2017), showing that the Stroop Color-Word Test mainly
considered the parameters of speed and accuracy. However, the form of measurement
varied greatly among Italian studies. The authors suggest that effective measures of
the Stroop Color-Word Test should include: 1) the time and accuracy (correct
responses) in each condition and 2) a global index calculated to relate the
performance in the incongruent condition with word reading and color naming skills.
The second aspect highlighted by the authors was not considered in the indexes
found.
As a limitation of this study, it is possible that the survey of articles and T&D
did not cover all the national scientific production since some journals are not
indexed in the databases, and T&D may not be included in the used digital
repositories. Furthermore, it was impossible to access some of the studies, despite
attempts to obtain them from the authors (with no responses, as mentioned earlier in
the Method section). Finally, the arbitrariness of the time frame should be noted,
even though this criterion is necessary for the viability of the work. On the other
hand, including T&D in the review increased the number of studies and the
possibility of a more reliable mapping of the instrument usage in national
research.
The findings of this review enabled the use of the Stroop paradigm in Brazilian
research to be mapped. However, in line with the objective of a scoping review,
these results do not provide indicators of the quality or sensitivity of the measure
and its versions (Munn et al., 2018).
Considering the versions identified, the indexes used, and the populations included
in these studies as a starting point, future systematic reviews may deepen the
understanding of more specific issues, such as the usefulness of the measure in the
assessment of inhibitory control/attention in certain clinical conditions or the
sensitivity of different types of indexes derived from their scores or time
measures.
Final considerations
The studies in this review show significant heterogeneity in using the Stroop
instruments in national research. There are different versions, with more studies
published concerning the 18 to 79 age group, mainly assessing inhibitory control and
attention and its subcomponents. The scores especially involve time and correct
responses/errors per stage, and the studies focus on typical development and various
clinical conditions. The computerized paradigm is recent and still little used in
Brazil, with this being a vast field for development and research in the area.
Furthermore, few psychometric studies have provided data on the validity and
reliability of the tasks. The gap is even more significant concerning the
availability of norms, virtually nonexistent for some age groups, posing a pressing
demand for future ANP investigations.
The results of this review may guide future studies into the use of the Stroop
instruments and ANP-related research and practice. It is necessary to deepen the
research on the usefulness of the instrument’s different versions and
measures/indexes in the different contexts in which the paradigm is used. There is
scope to advance in the development and use of computerized versions. Finally, it is
necessary to address the lack of psychometric studies, especially regarding the
normative data for the Brazilian population, which limit the clinical use of the
task.
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Notes
Notes
Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)—NMD
Scientific Research Scholarship and Institutional Scientific Initiation
Scholarship Program (PIBIC, BPL, & LHT).
CAPES—Support Code no. 8887.488781/2020-00 and no. 88887.502949/2020-00—Master’s
Funding Scholarship (MEOM and CMGT).
Author notes
Section editor: Natalia Becker.
Correspondence concerning this article should be addressed to Maria
Eduarda de Oliveira Martins, A/C Cidade Universitária. Universidade Federal de
Santa Catarina, campus Trindade. CFH, Bloco C – sala 15ª. 88040-900.
Florianópolis/SC. Email: psi.eduardamartins@gmail.com
