Cognitive flexibility assessment in youth with Down syndrome: Reliability, practice effects, and validity

Area of Science:

• Neuroscience
• Developmental Psychology
• Clinical Psychology

Background:

• Cognitive flexibility, the ability to switch mental sets, is often impaired in individuals with Down syndrome (DS).
• Existing measures of cognitive flexibility lack the psychometric soundness needed for research in DS.
• Reliable measures are crucial for clinical trials and interventions targeting cognitive challenges in DS.

Purpose of the Study:

• To evaluate the psychometric properties of three cognitive flexibility measures: Rule-Shift, Weigl Sorting, and KiTAP Flexibility.
• To assess the feasibility, reliability, and validity of these measures in youth with DS.
• To identify suitable cognitive flexibility assessments for use in research with the DS population.

Main Methods:

• Evaluated 97 youth with DS (aged 6-17) using Rule-Shift, Weigl Sorting, and KiTAP Flexibility.
• Collected data at two time points, two weeks apart, to assess test-retest reliability.
• Included parent questionnaires on adaptive behavior and cognitive flexibility, alongside child cognitive and language assessments.

Main Results:

• Weigl Sorting showed adequate feasibility but did not meet criteria for reliability and convergent validity.
• Rule-Shift and KiTAP Flexibility had insufficient feasibility for broad use.
• Rule-Shift showed potential utility for a subset of participants based on sensitivity and specificity.

Conclusions:

• None of the evaluated cognitive flexibility measures met all psychometric criteria for individuals with DS.
• Additional research and development are required to establish valid and reliable cognitive flexibility assessments for this population.
• Improved measures are essential for advancing clinical trials and interventions for cognitive challenges in Down syndrome.