Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

Area of Science:

• Psychological assessment
• Neuroscience
• Military health

Background:

• Large-scale intelligence screening is crucial for military conscription.
• Existing methods may lack efficiency and cost-effectiveness.
• Identifying intellectual disability (ID) early is essential for military placement.

Purpose of the Study:

• To apply a novel two-stage screening method for large-scale intelligence screening of military conscripts.
• To evaluate the efficacy of the Wisconsin Card Sorting Test (WCST) in identifying intellectual disability.
• To compare the accuracy and cost-effectiveness of different screening approaches.

Main Methods:

• 99 military conscripts with limited educational backgrounds participated.
• Participants underwent the Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale-Revised (WAIS-R).
• Logistic regression and receiver operating characteristic (ROC) curve analysis were employed.

Main Results:

• The conceptual level responses (CLR) index of the WCST significantly predicted intellectual disability (ID; FIQ ≤ 84).
• An optimal CLR cut-off point of 66 was identified, with two cut-off points at 49 and 66.
• Two-stage window screening demonstrated increased area under the curve and positive predictive value compared to two-stage positive screening.
• Cost reduction of 59% was observed with the two-stage window screening method.

Conclusions:

• The two-stage window screening method is superior in accuracy and economy compared to two-stage positive screening.
• The WCST shows potential as a replacement for the WAIS-R in future large-scale ID screenings.
• This study provides a model for implementing efficient two-stage screening protocols in military populations.