A-222 Efficacy of D–KEFS Trail Making Test Conditions 1–5 Using Age-Corrected Scaled Score Cutoffs as Embedded Validity Indicators in a Sample of Youth Athletes

Abstract

Abstract Objective Embedded validity indicators (EVI) assist in the evaluation of performance validity across a neuropsychological battery without increasing the time or cognitive demand on patients during testing. Erdodi et al. (2018) evaluated Delis–Kaplan Executive Function System (D–KEFS) Trail Making Test Conditions 1–5 (TMT1–5) as EVIs in adults using age-corrected scaled score (ACSS) cutoffs, demonstrating adequate specificity but inadequate sensitivity. This study assessed the TMT1–5 as EVIs in children using a specificity threshold of > .89 (Boone, 2013). Method Youth athletes (n = 134, M age = 12.2) completed a two-hour neuropsychological battery that included TMT1–5 and TOMM during a larger sport-related concussion clinical research evaluation. Specificity, sensitivity, and area under the curve (AUC) were calculated for TMT1–5 using ACSS cutoffs to predict TOMM Trial 2 (TOMM2) pass/fail performance. Results When predicting TOMM2 (cutoff.89) and inadequate sensitivity (.00), with TMT3 and TMT4 having the highest AUC (.81 and .74, respectively). The following ACSS cutoffs met the specificity threshold (>.89): TMT1 ACSS < 7, TMT2 < 9, TMT3 < 6, TMT4 < 7, and TMT5.79, we increased sensitivity for TMT1–3 (.33). Conclusion D–KEFS TMT1–5 achieved excellent specificity (>.89) when predicting TOMM2 performance but demonstrated inadequate sensitivity. Lowering the specificity threshold slightly still yielded low sensitivity. These data suggest that D–KEFS TMT3 and TMT4 were most effective at detecting adequate effort, but should be supported with other validity measures when assessing performance validity across a neuropsychological battery.