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The Dice Trails Test: A modified Trail Making Test for children and adults with Down Syndrome
Katja Sandkühler1, Elisabeth Wlasich1, Hannah Stadler1
1Department of Neurology, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany.
Background:
Psychometrically sound instruments to assess cognitive flexibility in people with Down Syndrome (DS) are lacking. The Trail Making Test (TMT) is well-established but requires reading letters and numerals, limiting its applicability for people with DS.
Aims:
To evaluate the psychometric properties and developmental sensitivity of a newly developed TMT adaptation without letters and numerals - the Dice Trails Test (DTT).
Methods:
The DTT was administered to 39 children (8-14 years, 46 % female) and 57 adults (18-57 years, 47 % female) with DS. We evaluated feasibility (proportion of participants completing the task), distributional properties, construct validity, developmental sensitivity, and split-half reliability. Nineteen individuals were reassessed for test-retest reliability. Individuals with DS were compared to typically developing (TD) groups matched on chronological and mental age.
Results:
The DTT showed adequate feasibility (≥ 80 %) for individuals with DS and mild intellectual disability (ID), no relevant floor effects, acceptable construct validity, developmental sensitivity, good split-half reliability, and preliminary evidence for good test-retest reliability in DS. DTT performance differed between DS and TD individuals matched on chronological age, but not when matched on mental age.
Conclusions:
Although limited in applicability for individuals with DS and moderate ID, the DTT shows potential as a direct measure of cognitive flexibility in DS across a broad age range.
