The Dice Trails Test: A modified Trail Making Test for children and adults with Down Syndrome

Abstract

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.