What do the main reported findings from the 20-item Dysexecutive Questionnaire (DEX) tell us? The valence-bias hypothesis

The valence-bias hypothesis refers to the tendency of some respondents to answer according to the positive/negative polarity of a question (its valence) rather than its specific content, potentially reducing the specificity of psychological and neuropsychological questionnaires, and increase correlations across different questionnaires and within items of the same questionnaire. This work examines the likelihood of valence-bias using findings from the 20-item Dysexecutive Questionnaire (DEX). We searched PubMed and Web of Science using the keyword "dysexecutive questionnaire" and selected studies reporting findings relevant to evaluating the valence-bias hypothesis. Included studies described the DEX's factorial structure and its correlations with performance-based executive function (EF) and other self-reported questionnaires. Subject-completed DEX (DEX-S total score) correlated positively with self-reported depression, anxiety, poor subjective quality-of-life, heightened self-awareness of difficulties, and personality traits associated with symptom reporting (high neuroticism, low conscientiousness). DEX-S correlated negatively with positive affect. Findings on the DEX's factorial structure were variable, but its reliability was consistently good to excellent. Correlations between DEX-S and performance-based EF were generally weak or non-significant, but significant when the DEX was completed by professionals. Overall, findings support the valence-bias hypothesis. While problematic for group-level studies, it may offer advantages for individualized clinical assessment and rehabilitation.