Review of European Studies; Vol. 8, No.

4; 2016
ISSN 1918-7173 E-ISSN 1918-7181
Published by Canadian Center of Science and Education

Computerized Finger Tapping Task in Adult Unipolar Depressed

Patients and Healthy Subjects: Influence of Age, Gender, Education,
and Hand Dominance
Marco Moniz1,2,3,4, Saul Neves de Jesus3,4, Andreia Pacheco1,5, Eduardo Gonçalves1 & João Viseu3,4
1
Department of Psychiatry and Mental Health, Hospital Center of Algarve, Faro, Portugal
2
António Silva Leal Foundation, Lisboa, Portugal
3
Faculty of Human and Social Sciences, University of Algarve, Faro, Portugal
4
Research Centre for Spatial and Organization Dynamics (CIEO), Faro, Portugal
5
Centre for Biomedical Research (CBMR), Faro, Portugal
Correspondence: Marco Moniz, Centro Hospitalar do Algarve, Departamento de Psiquiatria e Saúde Mental, Rua
Leão Penedo, 8000-386 Faro, Portugal. E-mail: [email protected]

Received: June 8, 2016 Accepted: July 14, 2016 Online Published: July 26, 2016
doi:10.5539/res.v8n4p1 URL: http://dx.doi.org/10.5539/res.v8n4p1

Abstract
Introduction: Current diagnostic criteria for depression include psychomotor retardation, being the Finger
Tapping Test (FTT) as one of the most utilized instruments to assess fine psychomotor performance.
Method: This study aimed to compare the performance of a sample of 51 unipolar depressed patients (30 women
and 21 men, with a mean age of 45.12 years old [SD = 14.09]) with 51 healthy controls (29 women and 22 men,
with a mean age of 44.49 years old [SD = 15.59]) in a computerized version of the Finger Tapping Test (FTT)
from the Psychology Experiment Building Language (PEBL). Another objective was to test this version’s
validity in comparison to other FTTs.
Results: We found significant differences between depressed patients and healthy controls. Significant effects of
age and gender were found.
Conclusion: Results allowed us to identify differences in performance between the two groups, therefore this
version of the FTT revealed adequate reliability values, one instrument accessible to all clinicians.
Keywords: unipolar depression, fine psychomotor performance, Finger Tapping Test, normative data
1. Introduction
Given that motor retardation is a common feature of depression (American Psychiatry Association, 2013;
Caligiuri & Ellwanger, 2000), tests of fine psychomotor performance, such as the Finger Tapping Test (FTT),
have been widely utilized in several studies on depression (Arnold et al., 2005; Bashir, Khade, Kosaraju, Kumar,
& Rani, 2013; Caligiuri & Ellwanger, 2000; Hill, Keshavan, Thase, & Sweeney, 2004; Hueng et al., 2011;
Kertzman et al., 2010; Lampe, Sitskoorn, & Heeren, 2004; Meyer et al., 2006; Rohling, Green, Allen, & Iverson,
2002; Schrijvers, Hulstijn, & Sabbe, 2008; Swann, Katz, Bowden, Berman, & Stokes, 1999) proving to be
reliable to access impairments and discard malingering (Arnold et al., 2005; Rohling et al., 2002).
The FTT was developed as part of the Halstead-Reitan Battery (Halstead, 1947) and consists in a test of fine
psychomotor performance, measured through self-directed manual motor speed and control (Christianson &
Leathem, 2004; Strauss, Sherman, & Spreen, 2006), recurrently employed to assess impairment resulting from
traumas, diseases, and other clinical conditions, such as brain injury (Arnold et al., 2005; Hubel, Yund, Herron,
& Woods, 2013a; Kane, Roebuck-Spencer, Short, Kabat, & Wilken, 2007), Alzheimer’s disease (Arnold et al.,
2005; Dwolatzky et al., 2003, 2004; Kane et al., 2007), Parkinson’s disease (Kane et al., 2007; Shimoyama,
Ninchoji, & Uemura, 1990), multiple sclerosis (Kane et al., 2007; Wilken et al., 2003), mild cognitive
impairment (Dwolatzky et al., 2003, 2004; Schweiger, Doniger, Dwolatzky, Jaffe, & Simon, 2003), and mental
retardation (Arnold et al., 2005).

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Several researchers have utilized it to assess psychomotor effects of some drugs, like antiepileptics (Aldenkamp,
Van Meel, Baker, Brooks, & Hendriks, 2002), chemotherapy (Stewart, Bielajew, Collins, Parkinson, & Tomiak,
2006), and antidepressants (Bashir et al., 2013). Furthermore, many find it resourceful to detect fake symptoms
in forensic contexts (Arnold et al., 2005; Hubel et al., 2013a; Rohling et al., 2002), having also been used to
study the relationship between manual dexterity and performance, in order to draw inferences about the
functional integrity of the two cerebral hemispheres (Hervé, Mazoyer, Crivello, Perchey, & Tzourio-Mazoyer,
2005; Peters, 1980; Schmidt, Oliveira, Krahe, & Filgueiras, 2000; Strauss et al., 2006).
The original manual of the FTT utilized a mechanical counter and a stopwatch (Christianson & Leathem, 2004):
many limitations were pointed out, as it could take several hours, needing additional time for scoring and
presenting results, and was exhausting for patients and too laborious for examiners (Hubel et al., 2013a).
However, its efficacy still justifies its place among the most used instruments (Strauss et al., 2006). Therefore,
recently, in an attempt to overcome such limitations, several computerized versions have emerged, which are
able to measure the response time more precisely, requiring less time to administer, and generating instant
scoring (Wilken et al., 2003). The FTT is now part of several recent batteries, such as the Computerized
Neurocognitive Battery (Coleman, Moberg, Ragland, & Gur, 1997; Gur et al., 2010), the Automated
Neuropsychological Assessment Metrics-ANAM4tm (Kane et al., 2007; Reeves, Winter, Bleiberg, & Kane, 2007;
Wilken et al., 2003), the FePsy (Aldenkamp et al., 2002; Stewart et al., 2006), and the NeurotraxTM
MindstreamsTM (Dwolatzky et al., 2003, 2004; Schweiger et al., 2003).
Our aim was to study the fine psychomotor performance of depressed patients, regarding effects of age, gender,
education, and hand dominance. A computerized version of the FTT from the Psychology Experiment Building
Language (PEBL) (Mueller, 2013), a free access battery, was used. Another objective was to test this version’s
validity, comparing our results to others obtained by Christianson and Leathem (2004) and Hubel and colleagues
(2013b).
According to the literature, in FTT men tap faster, younger subjects show faster tapping rates; education is
related to faster motor speed, and the dominant hand performs better. Our research hypotheses are based upon
these premises, as well as in the prediction that depressed patients are slower than healthy controls.
2. Method
2.1 Participants
Both studied samples, experimental and control groups, were comprised of 51 subjects each. The experimental
(patients’) group was composed of 30 women and 21 men, with a mean age of 45.12 years old (SD = 14.09), and
a mean of 8.29 (SD = 3.72) years of education. The participants from this group were recruited in the city of Faro
(Portugal), more precisely from the Department of Psychiatry and Mental Health of Hospital Center of Algarve
(a state owned entity). With analogous characteristics, healthy controls comprised 29 women and 22 men, with a
mean age of 44.49 years old (SD = 15.59), and a mean of 9.50 (SD = 3.63) years of education. Patients and
controls did not differ significantly regarding gender (χ2 = .040, df = 1, p = .841), age (t = .213, df = 100, p
= .832, d = .042), and education (t = -1.668, df = 100, p = .099, d = -.330). In respect to gender, there are no
differences in age in the patients group (t = -.816, df = 49, p = .419, d = -.225) and in the healthy controls group
(t = .627, df = 49, p = .534, d = .172).
Statistically, participants were divided into three age groups: (a) 17-40; (b) 41-50; and (c) more than 51 years old.
Regarding education, participants were also divided into three groups: (a) up to 6 years of education; (b) 9 years
of education; and (c) 12 or more years of education. We only considered the completed cycles of education (i.e.,
4th grade, 6th grade, 9th grade, 12th grade, and university), but then, only three groups were considered, since there
were very few elements with 4 years of education, as well as with higher education. All participants were
Caucasians and Portuguese speakers.
2.2 Measures
The computerized Finger Taping Task (Mueller, 2013), a free software from PEBL Test Battery (Mueller & Piper,
2014), was performed with the left and right index fingers: five consecutive trials in each hand, with a brief rest
following each trial (10-seconds), and a longer one (30-seconds) every five trials. The mean of taps was
averaged over five trials for each hand.

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2.3 Procedures
Each participant completed a health and demographic questionnaire and depression diagnoses were confirmed
through the MINI (Mini International Neuropsychiatric Interview) (Sheehan et al., 1997) and the BSI (Brief
Symptom Inventory) (Canavarro, 2007). Those with current or prior history of bipolar disorders, schizophrenia,
major psychosis, or who met criteria for dementia, substance abuse, neurologic disease, including head injury
involving a loss of consciousness, and subjects who did not complete the full 50-second tapping period for both
fingers or reported having a problem with their hands or indicators were excluded. To discard malingering, Rey
15-Item Memory Test (15-IMT) was used (Simões et al., 2010).
This study was approved by the Hospital Center of Algarve Ethics Committee, in conformity with the Helsinki
declaration. After being provided with all the information about the study, all the participants signed an informed
consent statement.
All analyzes were conducted using the Statistical Package for the Social Sciences (SPSS) version 20.0. The level
of significance was set at p ˂ .05.
3. Results
We confirmed effects of slowing over in depressed patients, and, for both groups, significant effects of hand
dominance (faster tapping in the dominant hand), gender (faster tapping in men), and age (slower tapping on
participants over 51 years old).
Results showed statistically differences between total scores for depressed subjects and healthy controls,
concerning both dominant (D) (t = -4.040, df = 100, p = .001, d = -.800) and Non-Dominant (ND) hands (t =
-.2.873, df = 100, p = .005, d = -.569). A one-way analysis of variance (ANOVA) showed significant group
differences regarding education (depression D: F(2,48) = 8.78, p = .001, = .268; ND: F(2,48) = 4.91, p
= .011, = .170. vs. healthy D: F(2,48) = 7.06, p = .002, = .227; ND: F(2,48) = 7.06, p = .002, = .228)
and age (depression D: F(2,48) = 5.91, p = .005, = .198; ND: F(2,48) = 2.96, p = .061, =.110. vs.
healthy D: F(2,48) = 8.39, p = .001, = .259; ND: F(2,48) = 7.91, p = .001, = .248). T-tests demonstrated
significant group differences concerning gender (depression D: t = .2.167, df = 49, p = .035, d = .608; ND: t
= .2.721, df = 49, p = .009, d = .750 vs. healthy D: t = .2.167, df = 49, p = .012, d = .743; ND: t = .2.274, df = 49,
p = .027, d = .629) (Table 1).

Table 1. Descriptive statistics (N = 102)

Dominant Non-dominant
a b
Depression Healthy Depressiona Healthyb

M (SD) M (SD) M (SD) M (SD)

Age

17-40 56.82 (7.85) 62.57 (5.14) 48.94 (9.51) 53.94 (6.87)

41-50 50.35 (9.64) 56.56 (7.94) 44.47 (9.54) 49.43 (6.81)

+51 46.70 (8.46) 54.12 (5.74) 41.29 (8.50) 45.12 (5.84)

F 5.915 8.394 2.963 7.911

p .005 .001 .061 .001

.198 .259 .110 .248

Education (grades)

≤ 6th 46.04 (9.35) 53.13 (6.33) 40.65 (9.25) 45.46 (5.33)

th
9 54.21 (7.66) 58.52 (6.18) 47.57 (8.94) 48.88 (6.64)
th
≥ 12 57.00 (6.88) 61.47 (6.78) 49.21 (8.16) 53.94 (7.49)

F 8.781 7.061 4.910 7.068

P .001 .002 .011 .002

.268 .227 .170 .228

Gender

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Men 54.61 (9.90) 60.90 (6.63) 49.00 (10.72) 52.36 (8.28)

Women 48.96 (8.62) 55.86 (6.94) 42.03 (7.58) 47.79 (6.07)

t 2.167 2.621 2.721 2.274

p .035 .012 .009 .027

d .608 .743 .750 .629

Total Score 51.29 (9.50) 58.03 (7.19) 44.90 (9.55) 49.76 (7.39)

t (BS) -4.040 -2.873

p .000 .005
d -.800 -.569
a b
Note. n = 51, n = 51, BS = Between Samples.

For demographic variables, a shared variance of 49% to both hands was found for healthy subjects (ND: R2
= .495, F(3, 47) = 15.38, p = .001; D: R2 = .493, F(3, 47) = 15.25, p = .001) and 35% to non-dominant hand, and
42% to dominand hand for patients with depression (ND: R2 = .357, F(3, 47) = 8.70, p = .001; D: R2 = .429, F(3,
47) = 11.77, p = .001) (Table 2).

Table 2. Percentage of variance accounted for by demographic variables

Depressiona Healthyb

(% of variance)

Age Educ Sex Comb BSI-D Comb Age Educ Sex Comb
1 1 2 1 2 2 1 1 2
Dominant 24 26 8 42 23 53 22 25 12 491

Non-dominant 142 191 132 351 342 622 241 261 92 491

Note. an = 51, bn = 51, 1p ≤ .001, 2p ˂ .05, BSI-D = Depression scale from Brief Symptom Inventory; Educ = Education; Comb = Combined.

Christianson and Leathem (2004) compared four versions of the FTT, involving minor differences in procedures
and response devices, namely the Halstead-Reitan manual FTT (Halstead, 1947), the Massey University manual
FTT, the Western Psychological Services Digital FTT, and a Computer FTT, having verified high correlations
between the tapping scores of all four instruments, confirming the construct validity of the latter. Likewise,
Hubel and colleagues (2013b) tested the validity of a novel FTT from the California Cognitive Assessment
Battery (CCAB), obtaining analogous results through the comparison to the Halstead-Retain FTT, the
Computerized Finger Tapping, the T3 Computer-assisted Finger Tapping Task, the Western Psychological
Services Electronic Tapping Test, and the Computerized Neurocognitive Scanning Vital Signs (CNSVS).
Similarly, aiming to validate the FTT from the PEBL Test Battery (Mueller, 2013; Mueller & Piper, 2014), we
compared our study’s results with those obtained by Christianson and Leathem (2004) and Hubel and colleagues
(2013b) and confirmed similar results regarding mean tapping rates in three studies (ANOVA D: F = .890, df = 2,
1.653, p = .411; ND: F = .502, df = 2, 1.653, p = .606) (Table 3).

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Table 3. Comparison of the FTT from PEBL to other tapping test data
Dominant Non-dominant
a b a
Current Study Christianson (2004) Current Study Christianson (2004)b

M (SD) M (SD) M (SD) M (SD)

Total Score 58.03 (7.19) 56 (7.1) 49.76 (7.39) 49.6 (5.4)

t 1.610 .145

p .109 .884

d .284 .024
a c a
Current Study Hubel (2013b) Current Study Hubel (2013b)c

M (SD) M (SD)d M (SD) M (SD)d

Total Score 58.03 (7.19) 56.3 (9.6) 49.76 (7.39) 50.4 (8.5)

t 1.274 .531

p .202 .595

d .203 -.080
a b c d st
Note. n = 51, n = 86, n = 1.519, 1 10-sec. average.

4. Discussion
As in previous studies, men tapped faster than women (Arnold et al., 2005; Ashendorf, Vanderslice-Barr, &
McCaffrey, 2009; Bornstein, 1985; Christianson & Leathem, 2004; Coleman et al., 1997; Elias, Robbins, Walter,
& Schultz, 1993; Gur et al., 2010; Heaton, Miller, Taylor, & Grant, 2004; Hubel et al., 2013a, 2013b; Mitrushina,
Boone, Razani, & D’Elia, 2005; Peters, 1980; Peters & Campagnaro, 1996; Ruff & Parker; 1993; Schmidt et al.,
2000; Ylikoski et al., 1998), outperforming women by three to five taps (Ashendorf et al., 2009; Mitrushina et al.,
2005). Heaton and colleagues (2004) reported that about 16% to 20% of the test scores were accounted for by
gender. Our results showed gender differences for depression and healthy groups. Nicholson and Kimura (1996)
analyzed gender differences regarding manual speed and concluded that men’s speed advantage might be
explained by a relative gain in the amount of fast-twitch muscle at puberty. Ruff and Parker (1993) suggested
that gender differences in FTT performance may also be a reflection of different age effects, hypothesis
contradicted with our study because in our sample there are no age differences between genders.
The FTT has been reported to be sensitive to changes related to aging (Ylikoski et al., 1998). Better performance
is usually associated with younger age, as many studies have shown older subjects tend to have significantly
slower tapping rates (Aoki & Fukuoka, 2010; Ashendorf et al., 2009; Bartzokis et al., 2010; Bornstein, 1985;
Elias et al., 1993; Gur et al., 2010; Hubel et al., 2013a, 2013b; Ruff & Parker, 1993; Shimoyama et al., 1990;
Turgeon, Wing, & Taylor, 2011; Ylikoski et al., 1998). To Bartzokis and colleagues (2010), age-related trajectory
of finger tapping speed can be associated with brain myelin integrity, reaching its peak in mid-life and declining
in older age, eventually leading to psychomotor slowing. Heaton and colleagues (2004) reported in their large
normative sample (aged 20-85 years) that about 16% to 18% of the variance in finger tapping scores was
accounted for by age. We also verified age-related effects, with older subjects performing poorly, with variance
in the scores between 14% to 24% in both samples (depression and healthy groups).
We noticed effects of education on tapping speed. Nevertheless, according to Strauss and colleagues (2006),
results on motor tasks have a propensity to be very modestly influenced, if at all, by such factors. Heaton and
colleagues (2004) verified that education accounts for only about 2% to 4% of the variance in tapping scores.
Still, as reported by other studies, best performances are often associated with more years of education,
concerning not only higher levels of formal instruction (Ashendorf et al., 2009; Bornstein, 1985; Gur et al., 2010;
Ruff & Parker, 1993), but also parental education (Gur et al., 2010).
Consistent with many reports (Hervé et al., 2005; Hubel et al., 2013a, 2013b; Peters, 1980; Schmidt et al., 2000;
Teixeira, 2008; Todor & Smiley-Oyen, 1987), we corroborated considerable differences between the dominant
and the non-dominant hands regarding both groups. Tapping performance has been employed as an indicator of
hand dominance (Ashendorf et al., 2009; Hervé et al., 2005; Hubel et al., 2013a, 2013b; Peters, 1980; Ruff &
Parker, 1993; Schmidt et al., 2000; Teixeira, 2008; Todor & Smiley-Oyen, 1987), with the dominant index finger

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typically producing approximately 10% more taps (Ashendorf et al., 2009; Hubel et al., 2013b). In the FTT, the
preferred hand tends to perform more quickly, and regularly (Peters, 1980), and precisely (Todor & Smiley-Oyen,
1987). This may be explained by differential effects of fatigue (Peters, 1980).
Also comma as expected (Bashir et al., 2013; Hill et al., 2004; Hueng et al., 2011; Kertzman et al., 2010; Lampe
et al., 2004; Rohling et al., 2002; Swann et al., 1999), we found significant impairment in psychomotor speed
between unipolar depressed subjects and controls. Psychomotor performance in depressed subjects may be
further influenced by other factors, such as hospitalization status/duration, severity, subtype and duration of
depression, and medication (Bashir et al., 2013). Many studies have addressed specifically effects of medication
on psychomotor speed (Aldenkamp et al., 2002; Bashir et al., 2013; Stewart et al., 2006). First-line medication
for depression often includes substances (e.g., fluoxetine, venlafaxine, and paroxetine) liable to affect cognitive
and function performance (Bashir et al., 2013). Bashir and colleagues (2013) verified a significant speed
impairment regarding patients on antidepressants. Therefore, there are researchers (e.g., Hueng et al., 2011;
Meyer et al., 2006; Swann et al., 1999) who chose to study only drug-free depressive subjects to access more
precisely the actual impact of the illness itself on psychomotor function. This may represent a limitation to our
study, but, for ethical reasons, we could not assess the clinical sample of medications.
In order to share these initial data, we present a percentile tables of the present sample, healthy subjects (Table 4)
and depressive subjects (Table 5).

Table 4. Percentile of healthy subjects by age and gender

Dominant Non-dominant

Age Gender Age Gender

More More
17-40 41-50 than 51 M W 17-40 41-50 than 51 M W
years years

5 53.00 40.00 45.00 49.15 42.50 41.00 37.00 38.00 40.00 37.50 5

10 54.00 47.00 47.80 50.00 49.00 47.00 40.50 39.40 40.60 41.00 10

25 60.00 52.00 50.00 56.25 52.00 48.00 44.50 42.00 44.00 43.00 25

50 63.00 55.00 53.00 62.00 54.00 53.00 48.50 43.50 53.00 47.00 50

75 64.00 62.50 59.50 63.25 60.50 58.00 55.50 49.25 59.25 52.00 75

90 71.00 70.60 63.90 70.70 66.00 66.00 59.60 55.10 64.50 58.00 90

95 - - - 73.55 70.00 - - - 66.85 59.50 95

Note. n = 51.

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Table 5. Percentile of depressed subjects by age and gender

Dominant Non-dominant

Age Gender Age Gender

More More
17-40 41-50 than 51 M F 17-40 41-50 than 51 M F
years years

5 44.00 33.00 31.00 33.90 31.55 33.00 29.00 26.00 30.60 27.65 5

10 48.00 33.80 31.80 43.20 33.10 38.60 33.00 29.20 36.20 30.30 10

25 51.50 45.00 43.50 48.50 45.00 43.50 37.00 36.50 41.00 36.75 25

50 55.00 50.00 48.00 51.00 49.50 47.00 43.00 40.00 48.00 42.00 50

75 61.50 56.50 52.00 61.00 55.00 53.00 50.00 47.00 55.50 47.50 75

90 73.00 67.00 58.40 71.80 60.90 68.60 60.40 54.60 67.60 51.90 90

95 - - - 73.00 62.00 - - - 70.70 54.80 95

Note. n = 51.

Acknowledgments
We thank all participants of this study.
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