94 Equivalence of In-person and Virtual Administration of the Delis-Kaplan Executive Function System’s Color-Word Interference Subtest in Youth Recovered from Concussion and Controls

Abstract

Objective:Virtual testing can reduce cost and burdens, as well as increase access to clinical care. Few studies have examined the equivalency of virtual and in-person administration of standardized measures of executive functioning in children. During the COVID-19 pandemic, we utilized virtual administration of the Delis-Kaplan Executive Function System, Color-Word Interference Test (DKEFS-CW) in our ongoing longitudinal research study exploring outcomes in children clinically recovered from concussion compared to never-concussed peers. In the current study, we explore the equivalence of scores obtained via in-person and virtual administration of the DKEFS-CW in youth recovered from concussion and never-concussed controls.Participants and Methods:Participants included 112 youth ages 10-18 (Mage=14.05 years, SD=2.296; 53.5 % Male) who completed the DKEFS-CW in-person (n=63) or virtually (n=49) as part of their involvement in the parent study. Of these, 38 were recovered from concussion (Mdays since injury— 91.21, SD=88.91), and 74 were never-injured controls. Virtual administration was done via Zoom by presenting digital scans of the DKEFS stimulus book using the screen-sharing function. Participants set up and joined the Zoom call from a secondary device (cell phone) that was set in a stable position to provide a view of their screen, mouse and keyboard setup. Group (in-person vs remote) differences in DKEFS-CW scores were examined using independent-samples t-tests for all subtest conditions (color naming, word reading, inhibition, and inhibition/switching). T-tests/chi-square tests were used to examine between-group differences in demographic variables (i.e., age, sex maternal education, IQ, concussion history). Demographic variables that were significantly different by group were then included as covariates in ANCOVA models examining the effect of administration context on performance.Results:There were no significant differences in DKEFS-CW scaled scores between those who were administered the measure in-person or virtually (Color Naming: Min-person=10.78, Mvirtual=10.08, t(110)=1.634, p=.105; Word Reading: Min-person=11.25, Mvirtual=10.92, t(110)=.877, p=.382; Inhibition: M in-person= 11.70, Mvirtual=11.24, t(110)=1.182, p=.240; Inhibition/Switching: Mi n-person= 11.29, Mvirtual=10.82, t(110)=1.114, p=.268). There were no significant between-group differences in concussion history, sex, maternal education or IQ. However, those who were administered the DKEFS-CW in-person (Mage=13.55) were significantly younger than those who were administered the measure virtually (Mage=14.69), t(110)=-2.777, p=.006. After controlling for age, there remained no significant relationship between administration context (in-person vs. virtual) and DKEFS-CW performance for any subtest condition (Color Naming: F(1,30)=.016, p=.889; Word Reading: F(1,76)=.655, p=.421; Inhibition: F(1,30)=.038, p=.847; Inhibition/Switching: F(1,30)=.015, p=.902).Conclusions:The recommended practice for remote administration of DKEFS-CW is to have test stimuli presented flat on a table by a trained facilitator present with the examinees. Here, we provide preliminary evidence of equivalence between DKEFS-CW scores from tests completed in-person and those completed virtually with stimuli presented on a computer screen. Future studies are needed to replicate these findings in clinical populations with greater variability in executive function. Some clinical populations may also require more in-person support. Likewise, future studies may examine the role of trained facilitators or caregivers in the virtual testing process.