Attention Kids AULA
Report Interpretation Guide
Table of contents
INTRODUCTION:............................................................................................................................................. 3
PREVIOUS NOTES AND SUBSEQUENT NOTES: ........................................................................................... 4
CLINIC ADDRESS AND LOGO: ..................................................................................................................... 4
TYPES OF SCORES ....................................................................................................................................... 4
Raw (Raw scores): .................................................................................................................................. 5
PC (Percentiles): ..................................................................................................................................... 5
T-Scores:................................................................................................................................................. 5
EVI (Embedded Validity Indicator) ................................................................................................................. 6
GENERAL INDEXES: ........................................................................................................................................ 8
DESCRIPTION OF THE GENERAL INDEXES .................................................................................................. 9
EXPERIMENTAL CONDITIONS ......................................................................................................................10
PRESENCE AND ABSENCE OF DISTRACTORS ............................................................................................10
INHIBITION TASK AND VIGILANCE TASK ..................................................................................................11
AUDITORY / VISUAL .................................................................................................................................13
MOTOR ACTIVITY .........................................................................................................................................14
DISTRACTORS ...........................................................................................................................................15
MOVEMENT MAP ....................................................................................................................................15
HEADS ......................................................................................................................................................17
QUALITY OF THE FOCUS OF ATTENTION .....................................................................................................18
SUMMARY TABLE .........................................................................................................................................19
INTRODUCTION:
The Attention Kids AULA report is aimed at mental health professionals who, through virtual reality,
provide objective information for diagnostic and differential support on different variables.
This is a performance test, so a recommendation when interpreting the results is to imagine oneself doing
the test in such a way as to obtain those results (faster, slower, making mistakes of one kind or another,
performing better in one experimental condition than in another) and also try to evoke the reason that
leads the evaluated person to obtain those results, since it is not a test of content, but of effort in different
capacities, the results will depend on the performance possibilities of the person and their disposition
when facing the tasks.
The different cognitive abilities that AULA assesses are measured through specific scores that are
generated as a result of reacting to different stimuli in a certain way. The added value of AULA is seen in
the experimental conditions, which will give us a perspective on the same scores, allowing us to compare,
depending on the experimental condition, the performance in different situations with the same type of
score.
The clinical interest marked in the exploration of possible pathologies leads us to study the errors
committed during the execution, so that, throughout the report, we will understand that the higher the
score -> the worse the performance.
Through this guide we will study the different scores, their experimental conditions and interesting
aspects of the report to consider.
PREVIOUS NOTES AND SUBSEQUENT NOTES:
This section of the cover page is configured from the user control console, the purpose of it is to allow the
clinician to add editable information to the report to complete it or point out details that they believe
pertinent.
CLINIC ADDRESS AND LOGO:
These are found as a header on all pages of the AULA report starting from the cover page. This header is
editable and allows you to customize the report with the clinic's logo and name, also having the possibility
to add the address or a reference phone number.
You can edit it from your client space by accessing https://app.nesplora.com or by following this direct
link once you are logged in https://app.nesplora.com/es/user/customize-report.
TYPES OF SCORES
The scores of the AULA assessment are constituted by the reaction to the 360 items that compose the
test, and the motor activity of the child.
The raw scores of 1326 children aged 6 to 16 years were calculated to examine the average performance
of the population by age and sex, so that we know what the "normal" performance on the test is. When
we suspect that there is some kind of disturbance in the abilities measured by AULA, we will know, in
comparison with the normative sample, whether that performance is average, below average or above
average.
Raw (Raw scores):
These are the raw scores. It is the direct count of the scores obtained on the different variables we
measure.
Getting a 51 on omissions in overall indices would mean that the child committed 26 omission failures in
the whole test, while getting 21 on Omissions in the presence of distractors would mean that they
committed 21 omission failures only when there were distractors.
Interpreting these scores is complicated because cognitive abilities vary with age and it is difficult to know
without a normative study whether it is appropriate for an 8-year-old boy to score 26 on omissions
compared to the same score for a 10-year-old girl.
PC (Percentiles):
This is a score calculated as a result of the normative study, it positions the child over the total of his
population in the execution of the test. The results in percentiles will always be between 1 and 99 and will
be interpreted as a lower position when obtaining the score (1) or a higher position when obtaining the
score (99).
If a child scores 80 in omissions in general indexes it would mean that the test taker has committed more
omissions than 80% of the population in the total test, while obtaining 85 in omissions in the presence of
distractors would mean that the test taker has committed more omissions than 85% of the population in
the total test during the presence of distractors.
This positioning will place the evaluated person in the total group, it is usual that the extreme positions
are uncommon and are explained by possible difficulties.
T-Scores:
This is a score calculated as a result of the normative study, it reflects the performance of the child over
the total population in the execution of the test. The results in typical scores will always be between 20
and 80, with 50 being the average and 10 being the standard deviation. The standard deviation accounts
for a significant difference in performance every 10 points away from its arithmetic mean (50).
This means that, if we consider that the average performance is 50, we could also consider average 40 -
60; from 60 to 70 low performance, from 40 to 30 high performance; from 70 to 80 very low performance,
from 30 to 20 very high performance.
If a child scores 59 in omissions in general indexes it would mean that they present a normative
performance in omissions in the total of the test in comparison with their population, while obtaining 60
in omissions in the presence of distractors would mean that the child presents a low performance in
comparison with their population during the presence of distractors in the total of the test.
The performance clearly expresses their performance in the abilities we measure.
EVI (Embedded Validity Indicator)
The EVI is section 2 of the report, being a cognitive performance assessment, the results are expected to
depend on cognitive performance. However, our classification algorithms can detect performances whose
results are due to problems external to cognitive performance (Instruction misunderstanding, test
opposition, hardware problems...). For more information, please refer to the manual.
There are 4 EVI possibilities:
1. In the case of Markel, this assessment meets the requirements to be considered valid in its
execution and the results can be analysed.
The results, whatever their direct scores, be it extreme or habitual positioning or performance of any kind,
seem to correspond to a performance whose outcome is a consequence of cognitive abilities.
2. In the case of Markel, the performance in the second task is questionable and should be taken into
account when analysing the results.
You may retest from (Date of the evaluation + two weeks).
The results seem to correspond to an execution of the second task whose result does not seem to depend
on the cognitive capacity but on external factors.
This would indicate that the first task seems to have been performed normally while in the second one,
for example, the instructions may have been misunderstood.
The following is a suggested retest to try to obtain a valid performance. It is suggested that the test can
be taken again after 2 weeks, which is when, according to our studies, there is no learning effect.
3. In the case of Markel, the performance in the first task is questionable and should be taken into
account when analysing the results.
You may retest from (Date of the evaluation + two weeks).
The results seem to correspond to an execution of the first task whose result does not seem to depend
on the cognitive capacity but on external factors.
The following is a suggestion for a retest to try to obtain a valid performance.
4. In the case of Markel, the performance in both tasks is questionable and should be taken into
account when analysing the results.
You may retest from (Date of the evaluation + two weeks).
The results seem to correspond to an execution of the first task whose result does not seem to depend
on the cognitive capacity but on external factors.
Below, a retest suggestion is appreciated to try to obtain a valid performance.
GENERAL INDEXES:
This is the third section of the report, where the scores obtained in the total of the test are shown,
regardless of the different experimental conditions. Here an overall assessment of performance will be
interpreted.
It is possible to obtain an average performance by averaging the two parts of the test and their different
experimental conditions.
It is possible to obtain an average performance, obtaining a very high performance in the first task and
very low in the second task, very high in one experimental condition and very low in another.
The general indexes are very useful to start from the general, however, caution must be taken when
interpreting them, it is recommended to consult the rest of the information to evaluate them.
DESCRIPTION OF THE GENERAL INDEXES
EXPERIMENTAL CONDITIONS
As an added value, the total number of items (360) is further divided into items with distractors/without
distractors, differentiating the items from the inhibition/vigilance task and the response to the
visual/auditory items.
Assessing of the items in their opposite conditions allows us to assess the results in comparison with its
population in that condition (intersubject), however, it also allows us to compare the subject with respect
to themselves in the different experimental conditions (intrasubject).
The intersubject interpretation is very useful to observe if the subject will perform in a similar way to the
average in the different cognitive abilities or if, on the contrary, they may have advantages or difficulties
in this respect.
However, intrasubject interpretation allows us to assess in which experimental condition the child does
better than themself, ignoring the performance of the others. This type of interpretation can be especially
useful in pedagogical adaptations or diagnosis in situations of exceptionality (giftedness), since giftedness
places the child outside their average group, so that, in an intersubject manner, an attentional deficit can
go unnoticed by being compensated with other abilities.
PRESENCE AND ABSENCE OF DISTRACTORS
This condition tests the effect of external stimulation to the task (distractors) during task performance.
In general, 3 situations can occur along the different variables (omissions, commissions, response time,
response time deviation and motor activity).
a. Performance on both tasks is similar, regardless of whether it is low, medium or high. This would
be interpreted to mean that external stimulation does not affect performance.
b. Performance in the presence of distractors is worse than in the absence of distractors. This would
mean that external stimulation affects the child by impoverishing the outcome.
c. Performance in the presence of distractors is better than in their absence. The absence of external
stimulation affects the child and the attention worsens.
One possible interpretation would be in a case in which the hits by pressing perform better in the absence
of distractors. This would mean that distractors divert attention from the task causing more omissions
when there are no distractors.
In the opposite case, when the performance is worse in the absence of distractors, we could interpret that
the child fails to maintain attention and the distractors stimulate them by helping them to concentrate
after the distractors. This paradox may also be due to internal distractors in the absence of external
distractors.
INHIBITION TASK AND VIGILANCE TASK
The manual describes both tasks and how Barkley's regulation model explains the adaptation of one to
the other.
As mentioned in the introduction, if we imagine ourselves solving the tasks, we will probably find
ourselves in the inhibition task (the first task, do not press with the target stimulus but press with all the
others) staring at the board and pressing the button with high frequency (many types of stimuli have the
instruction to press while only one should not avoid pressing) and resisting pressing when the target
stimulus appears (control and inhibition).
Whereas, in the vigilance task (second task, do not press with any stimulus, only press with the target
stimulus) we will probably be waiting for the exact moment to press the button, but the lower target rate
will make it difficult to maintain attention (sustained attention).
What should we interpret here?
On the one hand, it is important to look at performance individually in each task, and on the other hand,
in addition to a comparative perspective, it is very important to keep in mind that the second task
happens after the first one. This may seem like a no-brainer, but while visual/auditory and distractor/non-
distractor items occur during both tasks, task 1 and 2 items occur separately.
Another of the consequences on attention and executive function may be cognitive fatigue, which can
cause a worsening of overall performance due to attrition in the second task.
In this case, we can observe a worse performance in commissions and motor activity in the first task. We
could interpret it as an excess of activation at the beginning of the test, when switching to a vigilance task,
this excess of activation seems to be regulated a little bit reducing the motor activity and commissions,
however, also increasing the response time.
It is possible that this is a case of over-activation.
In another case, where the omissions and response time deviation are worse in the second task, we could
interpret it as attentional fatigue or a loss of attention in low stimulation situations.
AUDITORY / VISUAL
This condition allows us to interpret different aspects, on the one hand, if the attentional pathways are
intact in their different modalities (visual and auditory), if there is a visual or auditory deficit (the
difference with the first case would be, in the visual case, to have a visual deficit (myopia) or a neurological
alteration (visual neglect)); or if it means an attentional overload to pay attention to two attentional
pathways (sensory integration).
The interpretation of these results should be made with caution since, according to the literature, human
beings have better visual response times than auditory ones, in addition to the fact that we are
accustomed to or trained to process visual information.
That means that, for example, it is common to obtain raw scores in the visual condition lower in times
than auditory, and, even so, with respect to the average of the population, perform better auditorily and
that the score appears better positioned than the visual when the reality is that in the raw scores you can
be faster visually than auditorily.
However, in other cases, you may find a greater number of visual commissions. Recall that commissions
and response times are closely related to traits of impulsivity or inhibitory control capacity.
MOTOR ACTIVITY
One of the great advantages of AULA is the virtual reality hardware that administers the test. For virtual
reality to occur, it is important that when you turn your head or move, you move around the virtual
environment, or it shifts. The virtual environment is 360°, so in order to know where you are looking at or
where you are moving, the headset has speedometers and cameras. This generates direction vectors that
allow quantification of the amount of motor activity in a single number. This is an excellent predictor of
hyperactivity, sterile motor activity, and can also signal signs of motor inhibition.
This variable is the only one that is not measured through the items, but in a linear way throughout the
test.
DISTRACTORS
In the test, the time and when more or less score has been obtained throughout the test is recorded so,
being divided into 2 tasks and having consciously programmed the different distractors, we can divide
motor activity in the presence or absence of distractors, and during inhibition or vigilance tasks.
In this case, we can see that the greatest amount of motor activity is generated during the presence of
visual distractors.
Another example of interpretation could be that the peaks and valleys of the graph increase as the test
progresses. This may indicate cognitive fatigue in inhibitory control.
MOVEMENT MAP
Being a 360º environment (a 3D sphere), this would be a 2D map of it. A simile in our daily life could be a
world map, that is, a 2D rectangular representation of a 3D object (the earth). In addition, before starting
the test and after putting on the headset, we always hold down the control button that centres the screen
at degree 0, 0 with your visual focus.
So that: Looking toward 0, 0º would be looking at the centre of the board. Looking at 90º would be turning
your head perpendicularly to the right, while, at -90º would be looking with your head to the left.
The degrees -180 and +180 would be the same direction, that is, the opposite of 0º, or what is the same,
looking turned backwards in a 180º turn.
What can we interpret here? Let’s imagine ourselves again moving our head to shade different areas.
As the report itself explains, to perform the task it is important to be looking at the blackboard (green
frame), looking away to the yellow frame, we continue to see the blackboard, although it is possible to be
distracted by something else, since the blackboard is in our horopter (visual field), but not in our visual
focus.
If the child tends to look above degree 0 on the X-axis (horizontal, red lines), it is possible that they are
excited or stimulated, causing them to place their visual focus above the midline from which they start.
Conversely, if they tend to look below grade 0 on the X-axis, it is possible that the child is leaning back in
the chair, indicating boredom or seeking comfort.
If the shading is ONLY to the right or ONLY to the left of degree 0 (Y-axis, blue lines) we may find a motor
limitation to the opposite side.
HEADS
The calculation of the angles and motion vectors allows us to know what path the head has taken at all
times, giving us the total turning amplitude in each possible type of movement.
In this case, no movement limitations are detected; on the contrary, it has looked in all directions, either
by exploration or distraction.
QUALITY OF THE FOCUS OF ATTENTION
Thanks to the system's knowledge of where the visual frame is located, we know whether the errors in
VISUAL ITEMS have been committed by looking at the items or by looking in another direction.
This is very important since both are caused by deviating from the task, however, in the case of visualising
the items we can interpret a problem of selective attention, or great internal distractibility.
In the case of committing them without seeing the item, we can assume that it is due to lack of effort in
looking at the blackboard or lack of control over attention or motor activity to keep looking at the
blackboard.
SUMMARY TABLE
Finally, this table shows all the variables in their different classifications by experimental condition in order
to summarize at a glance everything presented in the report.
