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Digit Span

Chapter · January 2017

DOI: 10.1007/978-3-319-56782-2_1288-2

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Book Title Encyclopedia of Clinical Neuropsychology

Copyright Year 2010
Copyright Holder Springer-Verlag
Chapter Title Digit Span
Copyright Year 2010
Copyright Holder Springer-Verlag
Author Family Name Wambach
Particle
Given Name Denene
Suffix
Division Department of Neurology
Organization Drexel University College of Medicine
Address Philadelphia, PA, USA
Email
Author Family Name Lamar
Particle
Given Name Melissa
Suffix
Division Institiute for Psychiatry
Organization King’s College London
Address London, UK
Email
Author Family Name Swenson
Particle
Given Name Rod
Suffix
Division Department of Neuroscience
Organization University of North Dakota Medical School
Address Fargo, ND, USA
Email
Author Family Name Penney
Particle
Given Name Dana L.
Suffix
Division Department of Neurology
Organization The Lahey Clinic
Address Burlington, MA, USA
Email
Author Family Name Kaplan
Particle
Given Name Edith
Suffix
 Division Department of Psychology
Organization Suffolk University
Address Boston, MA, USA
Email
Author Family Name Libon
Particle
Given Name David J.
Suffix
Division Department of Neurology
Organization Drexel University College of Medicine
Address Philadelphia, PA, USA
Email
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D
construct date from the work Gottfried Leibniz
Digit Span (1646–1716). Leibniz suggested that individuals have a
finite capacity to prospectively process or hold in mind
D ENENE WAMBACH 1, M ELISSA L AMAR 2, R OD S WENSON 3, the information from the environment. He termed this
DANA L. P ENNEY 4, E DITH K APLAN 5, DAVID J. L IBON 6 capacity the span of apperception.
1
Department of Neurology In the nineteenth century, Herman Ebbinghaus
Drexel University College of Medicine (1850–1909; 1885/1964 cited in Richardson, 2007) was
Philadelphia, PA, USA the first cognitive scientist to show how span could be
2
Institiute for Psychiatry used as an experimental paradigm to investigate memory
King’s College London and learning. In America, Oliver Wendell Homes pater
London, UK (1809–1894; 1871 cited in Richardson, 2007)2 made
3
Department of Neuroscience cogent observations on the parameters of digit span as a
University of North Dakota Medical School method to assess span of apperception, i.e., ‘‘in uttering
Fargo, ND, USA distinctly a series of unconnected numbers or letters
4
Department of Neurology before a succession of careful listeners, I have been
The Lahey Clinic surprised to find how generally they break down, in trying
Burlington, MA, USA to repeat them, between seven and ten figures or letters’’
5
Department of Psychology (Holmes, 1871, p. 32, cited in Richardson, 2007). Several
Suffolk University years later, Ebbinghaus made a similar observation
Boston, MA, USA commenting, ‘‘the question can be asked, what number
6
Department of Neurology or syllables can be correctly recited after only one read-
Drexel University College of Medicine ing. . . for me the number is usually seven’’, (p. 47, 1885,
Philadelphia, PA, USA cited in Richardson, 2007). Thus, more than 80 years
before George Miller’s seminal paper (1956) ‘‘The magical
number seven, plus or minus two: Some limits on our
Synonyms capacity for processing information’’, the basic paradigm
of span as a psychological method had already been
Backward digit task; The digit span test examined.
The second and more frequently used meaning of
the term digit span is as the name of psychological
Historical Background1
2
The term digit span encompasses several important Oliver Wendell Holmes, Sr., M.D., a resident of Cambridge,
constructs and names of tests designed to measure these Massachusetts, was a very influential nineteenth century physician. In
addition to his achievements as Dean of Harvard Medical School,
constructs. First and foremost digit span, along with
Dr. Holmes popularized the use of the stethoscope as medical instrument.
reaction time, may be viewed as one of the two original Equally impressive were Dr. Holmes’ literary achievements. Admired by
paradigms used by experimental psychologists to investi- Edgar Allan Poe, Dr. Holmes was a member of an illustrious group of
gate cognition. The origins of digit span as a psychological Boston literati and could count as his friends such individuals as Ralph
Waldo Emerson and Henry Wadsworth Longfellow. Known for his essays
and poetry, Dr. Holmes was a founder of the Atlantic Monthly magazine. In
addition to his other achievements Dr. Holmes is credited for naming the
1
Much of the historical information reviewed in this essay is drawn city of Boston The Hub of the Universe. Holmes’ son, Oliver Wendell
from JTE Richardson’s paper: Measurements of short-term memory: Holmes, Jr., was a well known jurist and was appointed Associate Justice
A historical review. Cortex, 43, 635–650, 2007. to the Supreme Court by President Theodore Roosevelt.

# Springer-Verlag Berlin Heidelberg 2010

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2 D Digit Span

tests to assess working memory and/or the ability to samples of children and adolescents using a protocol of
retain and keep in mind a circumscribed amount of tests requiring the repetition of sequences of digits and
information for a short period of time (Wechsler, 1997). letters both forwards and backwards. An analysis of for-
As a psychological test, digit span and other techniques ward and backward test scores using principal component
to measure span of apperception have long history. analysis found that forward and backward span loaded on
James McKeen Cattell (1860–1944; 1890)3, who worked different factors. These researchers therefore concluded
in Wilhelm Wundt’s laboratory in Leipzig, included a test that the forward and backward span should not be com-
of span for consonants in his compendium of mental bined and reflect distinct underlying cognitive processes.
tests. In addition, span was included as part of the intelli- Weinberg, Diller, Gerstman, and Schulman (1972)
gence tests devised by Binet and Simon (1905; cited in studied patients with visual scanning deficits associated
Richardson, 2007). In this version, up to three trials were with right hemisphere pathology and noted differential
administered for each digit sequence. Terman (1916) also impairment on digits backwards versus digits forward.
included a digit span test in the Stanford revision of the These researchers advanced the notion that repeating
Binet–Simon scales, but in Terman’s version, digit digits backward may rely on a capacity to form and keep
sequences both forward and backward were administered. in mind a visual image of the digit sequence. Successful
performance on digits backward may be viewed in terms
of the ability to keep this visual image in mind while
Psychometric Data: Digits Forward/ peeling numbers off in reverse order. Rudel and Denckla
Digits Backward (1974) retrospectively studied digit forward and
backwards test performance in children with learning
From the beginning, a digit span subtest has been at least disabilities. Children with evidence of left hemisphere
included in virtually all Wechsler intelligence and memory dysfunction produced particularly reduced scores on
scales for both children and adults. Wechsler combined digits forward. Children with evidence of right
performance on the digits forward and digits backward hemisphere dysfunction appeared disadvantaged when
tasks into a single score on the basis of psychometric asked to repeat digits backward. Rudel and Denckla
considerations. However, clinical observations have long (1974) believed that their data suggested the successful
demonstrated the value of treating each procedure as a performance for digits forward is governed by a left
separate test as combining forward and backward test hemisphere-mediated cognitive construct involving
performance potentially obscures the value of each test auditory storage/ rehearsal while successful performance
condition to measure related, but separate psychological for digit backwards is governed by a right hemisphere
constructs. mediated construct involving visual imagery operations.
A lively debate has centered on the cognitive con- The value of separating forward from backwards test
structs that underlie successful performance for both conditions is acknowledged in the latest version of
digits forward and backward test conditions. Indeed, Wechsler’s IQ test (WAIS-IV) wherein separate scale
Kaplan and colleagues (1991) tend to view the digits scores are now provided for digits forward and backward.
forward test condition as a means for measuring span or
how many bits of information can be held in mind,
whereas the digits backwards test condition is viewed as Clinical Uses
a test of mental manipulation. In this context, the obser-
vations of Kaplan and colleagues (1991) are consistent Wechsler’s Digit Span Task
with the constructs put forth by Baddeley and Hitch
(1974) regarding working memory. Other researchers This task is most often associated with the corpus of
have made similar observations. For example, Ramsey intelligence tests authored by David Wechsler. Wechsler’s
and Reynolds (1995) and Reynolds (1997) studied large Digit Span subtest comprises of two parts – digits forward,
where the examinee is asked to repeat increasing spans of
digits in the order they were presented; and digits back-
3
After being fired from Columbia University for his opposition to World wards, where the examinee is asked to repeat increasing
War I, Cattell, along with Robert Woodward and Edward Lee Thorndike,
spans of digits in reverse order. In both test conditions,
founded the Psychological Corporation in 1921 in New York City. In
1939, Woodward’s former student, David Wechsler, published the first
two trials are administered for each span length. Each
version of the intelligence test that has so very much influenced the condition is discontinued when the examinee fails both
science and practice of psychology. trials for a given span. The raw score is the sum of trials
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Digit Span D 3

correctly repeated. This raw score is converted into an creation of The Backwards Digits Test (BDT; Lamar &
age-corrected scale score. Developed as part of the origi- colleagues, 2007, 2008) described below.
nal Bellevue Intelligence Tests (Wechsler, 1939), Wechsler Kaplan (1988) and Kaplan and colleagues (1991) also
writes ‘‘there is perhaps no test that has been so universally call our attention to the variety of errors patients make on
used in scales of intelligence as that of Memory Span for the digit span test.
Digits’’ (Wechsler, 1944, p. 83). Wechsler acknowledges Omission – Refers to responses characterized by a
that ‘‘low scores on the Memory Span for Digits Test are missing digit. On the digits forwards task, an omission
frequently associated with attention deficits’’ (Wechsler, error occurs if a four-digit response of 6-8-2-1 is given to
1944, p. 84). He further states that the problems with the five-digit stimulus 6-8-2-5-1. Interpretation of
attention and concentration as measured with his Memory omission errors typically considers the length of the num-
Span for Digits Test are often associated with differen- ber sequence: whether this kind of error occurs on shorter
tially poor repetition for digits backward, writing ‘‘this (4-span) versus longer (7 or 8-span) digit sequences.
deficiency is often referred to by psychologists as a lack Addition – Refers to responses characterized by added
of mental control ’’ (Wechsler, 1944, p. 84). Wechsler’s use digits. On the digits forward task, an addition error occurs
of the term mental control is consistent with what is now if a five-digit response for 4-7-2-3-1 is given to the
understood as working memory. Thus, although Wechsler four-digit stimulus 4-7-2-3. One type of addition error
combined forward and backward digit test performance, is an automatized addition error. An automatized addition
he was certainly cognizant that his combined scale score error occurs when the added number is sequential, i.e.,
could be fractionated to measure a variety of cognitive 7-4-5-3 repeated as 7-3-4-5-6. Automatized addition errors
functions. suggest an executive control or frontal system problem.
Kaplan and colleagues (1991) have suggested a num- Perseveration – A perseveration refers to a number
ber of additional administration and scoring techniques duplication error. Perseveration errors occur within
to complement the traditional administration of the and/or between trials. When noting a perseveration, one
Wechsler Digit Span Test. First, Kaplan and colleagues should observe whether the perseverated responses were
(1991) suggest the investigator administer test trials captured within or between test trials.
until the examinee fails to repeat the exact number of Substitution – A substitution error refers to a unique
digits that were administered, rather than discontinuing number that is contained in the digit response string that
after failure within a pair of trials within a particular span, replaces an original number and does not change the
regardless of whether the examinee’s response is correct or original digit string length. This differs from the addition
not. By following this procedure, particularly for the errors described previously, because addition errors
digits forward test condition, one is able to assess the change the digit string length. This is coded when any
patient’s span of apperception, or the number of bits of digit is given instead of a digit contain on the stimulus.
information the patient is able to keep in mind. Moreover, Sequence Error – A sequence error refers to a correctly
for some brain damaged patients where attention, con- repeated digit that is simply misordered, but does not
centration, and working memory may be compromised change the number string length.
or fluctuate it is possible that despite, say, failing both Capture Error – A type of sequence error that is
5-span test trials, a patient could be successful on one or characterized by the grouping of contiguous numbers
more 6-span test trials or on even longer span lengths. together.
Kaplan (personal communication)4 has also said that a
better scoring procedure for the Digit Span Test would be
to tally the number of digits correctly recalled, rather than The Backwards Digit Test (BDT)
the number of successful trials. The interpretation of a
juxtaposition of two digits in the middle of a trial could be Lamar and colleagues (2007, 2008) devised The Backward
very different compared to instances of omissions or Digits Test (BDT), a digit backward paradigm designed
obvious perseverations. The idea of tallying the number specifically to assess for working memory deficits in
of digits correctly recalled was the impetus for the dementia. This test consists of seven trials of 3, 4, and
5-digit span lengths for a total of 21 trials. All 4 and
5-span trials were constructed so that contiguous
numbers were placed in strategic positions. For example,
4
Dr. Kaplan is well known for saying: ‘‘If they want numbers, give them in 4-span trials contiguous numbers were placed in either
numbers that are meaningful.’’ the first and third or second and fourth digit positions,
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4 D Digit Span

e.g., 5269 or 1493. In 5-span trials contiguous numbers ORDER recall, suggesting that span, storage, and rehearsal
were placed in the three middle digits positions, e.g., mechanisms did not differ between these dementia
16579. Three-span test trials were not constructed in this groups. However, significant differences were found for
fashion because of the primacy and recency effects. This SERIAL ORDER recall suggesting differential working
placement strategy was devised to examine the capacity of memory impairment for dementia patients who had
patients to resist the temptation to produce ‘capture’ errors significant subcortical white matter disease, a finding
or to erroneously group contiguous numbers together, well documented in the literature (see Lamar et al., in
e.g., 15679 incorrectly reported backward as ‘‘96751’’. press; Libon, Price, Garrett, & Giovannetti, 2004 for
The BDT is administered using standardized Wechsler reviews). A series of step-wise regression analyses found
procedures except that there is no discontinuation. All that ANY ORDER recall was primarily related to perfor-
21 trials are administered. The two major indices derived mance on the MMSE or dementia severity. By contrast,
from this test are percent of digits recalled in ANY SERIAL RECALL was related to performance on wide
ORDER and percent of digits recalled in SERIAL ORDER. number of other executive tests including letter fluency,
Percent Correct ANY-ORDER – This score reflects the The Boston Revision of the Wechsler Memory Scale Men-
sum total of digits correctly recalled regardless of their tal Control Test (Lamar et al., 2002), and clock drawing
serial position, divided by the total possible correct, mul- errors (Cosentino, Jefferson, Chute, Kaplan, & Libon,
tiplied by 100, [(total number of correct digits ANY- 2004). In a follow-up study, Lamar and colleagues
ORDER)/ (total possible correct)]  100. By eliminating (2008) examined regional MRI white disease and perfor-
the importance of serial position, this measure is believed mance on ANY and SERIAL order recall and found that
to reflect less complex aspects of working memory char- reduced SERIAL ORDER recall was related to left inferior
acterized mainly by short term or immediate storage and parietal white matter disease. These data are consistent
rehearsal mechanisms. with ideas put forth by Rudel and Denckla (1974), sug-
Percent Correct SERIAL-ORDER – This score reflects gesting that a visual imagery mechanism may underlie
the total number of digits correctly recalled in exact serial successful backward digit span performance. The impor-
position, divided by the total possible correct, multiplied tance of number sequencing is acknowledged in the latest
by 100, [(total number correct digits SERIAL-ORDER)/ version of Wechsler’s IQ test (WAIS-IV) wherein a sepa-
(total possible correct)]  100. This measure is believed to rate score is now calculated for the longest digit string
assess the more executively demanding aspects of working correctly sequenced.
memory that are associated with mental manipulation, Digit span is one of the original paradigms used to
such as disengagement and temporal reordering. investigate cognitive psychology. Attention to error type,
In addition to ANY and SERIAL ORDER recall, the i.e., the act of focusing on the process by which the scaled
BDT affords an opportunity to examine for capture errors score is obtained (Kaplan, 1988), particularly where errors
or the tendency of patients to erroneously group contigu- occur and differential performance on forward versus
ous numbers together. Two major types of capture errors backward recall, can yield a wealth of information about
are scored (see Kaplan, Fein, Morris, & Delis, 1991, p. 25). cognitive disorders in brain-injured patients. After more
Within Trial Capture Errors – This error is coded on than a century, a seemingly simple task of digit repetition
4 and 5-span trials when the capture error is confined remains an important construct in the understanding and
to digits within the trial at hand, i.e., 1493–‘3491’; assessment of cognition.
16579–‘95671’.
Between Trial Capture Errors – This error is coded on
3, 4 and 5-span test trials when participants ‘pull down’ or References and Readings
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