Color Trails test performance in a culturally diverse White sample: applicability of manual norms for Europeans

The Color Trails Test (CTT), designed as a culture-fair measure of visual attention and executive function, is commonly used to assess individuals from diverse backgrounds. This exploratory study evaluates the applicability of CTT manual norms in a multicultural White European sample by: (1) comparing normative scores of White European and American (U.S.) adults; (2) examining the contribution of culture-specific Individualism (IDV; Hofstede, 2001) to CTT performance; and (3) exploring generational effects within European cohorts.

Demographically adjusted CTT1 and CTT2 standard scores (SS) from 903 healthy adults (mean age = 50 [SD = 20.3]; mean education = 13 years [SD = 3.5]; 55% women), compiled from seven cross-cultural studies, were compared across four European regions and the U.S., which served as the reference in unadjusted and IDV-adjusted ANCOVA models. Additional analyses compared SS across three European cohorts: young (<45), middle-aged (45-64), and older (≥65) adults.

CTT1 and CTT2 SS were significantly correlated with IDV. Unadjusted models showed significantly lower scores for all European regions versus the U.S. After adjusting for IDV, differences were no longer significant for CTT1 but remained for CTT2. CTT1 SS did not significantly differ across European age cohorts; CTT2 SS were significantly lower in older adults compared to younger groups.

Despite the culture-fair intent of CTT, the findings demonstrate significant cross-cultural differences among participants classified within the White category, even after demographic adjustment. Hence, neuropsychologists should interpret CTT results with caution when working with culturally dissimilar individuals, regardless of their ethnicity.