Token Test

Background

The Token Test is a widely used neuropsychological assessment designed to evaluate receptive language disorders (auditory comprehension), first introduced in 1962 by Ennio De Renzi and L.A. Vignolo to assess patients with aphasia due to strokes and brain damage. The test requires subjects to follow increasingly complex verbal commands to identify and manipulate plastic tokens of different shapes, sizes, and colors (e.g. "Touch the red circle" or "Touch the red square before the blue circle"). It is highly regarded for its ability to detect subtle auditory comprehension issues, as the commands are non-redundant and force the user to decode each word, removing the environmental context clues typically present in normal communication.

The Millisecond Token Test is a computerized adaptation of the original Renzi & Vignolo (1962) procedure. The default setup runs five phases that increase in difficulty.

1. Phase 1: Presents two rows of 4 large, colorful shapes each (row1: squares; row2: circles) and gives simple instructions such as 'Touch the yellow square'.
2. Phase 2: Adds two additional rows to the display. These additional rows present the same shapes as in phase1 in smaller sizes. Instructions increase in difficulty by referencing the specific size of the shape to touch, e.g. 'Touch the small yellow square'.
3. Phase3: Present the same display as in phase1 but increases the difficulty of the instructions by specifying two shapes that need to be touched, e.g. 'Touch the yellow square and the blue circle'.
4. Phase4: Presents the more complex display used in phase2. The instructions increase in difficulty by referencing the specific sizes of the stimuli that should be touched, e.g. 'Touch the small yellow square and the large blue circle'.
5. Phase5: This is the most difficult phase. It uses the display of phase1 and only presents large shapes. Instructions include complex requests such as presents two rows of 4 colorful shapes each (row1: squares; row2: circles) and gives complex instructions such as 'Drop the yellow circle on the red square'.

Each of these phases runs 10 trials each. By default the trial instructions are given verbally. The Millisecond Token Test is best played on touchscreen devices that avoid mouse clicking.

Task Procedure

Participants work through all five phases in sequence. After a short introduction, the display for the current phase is presented for 1000ms before the verbal first 'command' such as 'Touch the red square' is played. Once the audio file concludes playing, participants can respond by touching the shapes. Each phase has specific pre-determined timeouts that help to move the test along even if participants don't respond. Participants get the chance to repeat trials with error responses once. Points are assigned as follows: each correct response given the first time is awarded 2 points (for a total of 100 points). Each correct response given during a 2nd attempt is awarded 1 point. If a participants makes more than two consecutive incorrect responses, the test simply moves on to the next trial. Each phase runs 10 commands in a random order. The color assignment to the shapes within their rows is also randomized for each phase (but stays consistent throughout a phase).

What it Measures

The Token Test is a measure of (auditory) language comprehension

Psychological domains

• Receptive Language & Auditory Processing: The ability to decode specific linguistic markers (color, shape, size) without the help of environmental context.
• Working Memory: Ability to keep all the relevant linguistic information in working memory
• Executive Functioning: Ability to shift from one command to the next
• Visuospatial Perception: Ability to discriminate between attributes like "large vs. small" or "circle vs. square" and locate them within a physical field.
• **Attention & Concentration: Maintaining focus over 50 increasingly complex commands requires sustained attention.

Main Performance Metrics

• Total Score: The total score obtained (out of a possible 100) as the main measure of language comprehension

Psychiatric Conditions

Performance on the Token Test tends to be impaired in patients with the following conditions.

• Aphasia
• Dementia
• Pediatric Delays

References

Search Google Scholar for peer-reviewed, published research using the Inquisit Token Test.

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DeRenzi, E. & Vignolo, L.A. (1962). The Token Test: A Sensitive Test to detect Receptive disturbances in Aphasiacs, Brain, 85, 665-678.

Whitehouse, C. (1983). Token test performance by dyslexic adolescents. Brain and Language, 18(2), 224-35.

MLA (7th edition) Citation Aram, D., & Ekelman, B. (1987). Unilateral brain lesions in childhood: Performance on the Revised Token Test. Brain and Language, 32(1), 137-58.

D'Arcy, R., & Connolly, J. (1999). An event-related brain potential study of receptive speech comprehension using a modified Token Test. Neuropsychologia, 37(13), 1477-89.

Paula, J., Bertola, L., Nicolato, R., Moraes, E., & Malloy-Diniz, L. (n.d.). Evaluating Language Comprehension in Alzheimer's disease: The use of the Token Test. 70(6), 435-440.