Differential Sensitivity of TOMAL Subtests and Index Scores to Pediatric Traumatic Brain Injury

Abstract

The objective of the present study was to examine and compare the subtest, index, and factor scores of the Test of Memory and Learning (TOMAL), using receiver-operating characteristic curves, to investigate their sensitivity and specificity to traumatic brain injury (TBI) in children and adolescents. One hundred and fifty participants who had sustained TBI were compared to 150 controls matched on age and gender from the TOMAL's standardization sample. Results indicated that the greatest area under the curve (AUC) was for the Object Recall (OR) subtest score, the Composite Memory Index (CMI), and the attention factor score. The optimal CMI cutoff score for a TBI diagnosis was 83. When factor scores were compared, the attention factor and two verbal factors had significantly larger AUCs than the three nonverbal factors. These findings suggest that the OR subtest and CMI are most sensitive to TBI, and that when components were broken into factors with no overlapping subtests, attention and verbal memory were optimal for classifying TBI.

Key words:

• memory
• pediatric
• ROC
• TBI
• TOMAL

ACKNOWLEDGEMENTS

Normal comparison data were from the TOMAL standardization sample. Copyright 1994 by PRO-ED, Austin, TX. Used with permission. All rights reserved. We thank the TOMAL publisher for allowing access to the standardization data.

Notes

*Bonferroni correction p < .0023 for significance at the .05 level.

OR = Object Recall; MFSD = Memory for Stories Delayed; VSR = Visual Selective Reminding; LF = Letters Forward; DF = Digits Forward; FM = Facial Memory.

VMI = Verbal Memory Index; NMI = Nonverbal Memory Index; CMI = Composite Memory Index; DRI = Delayed Recall Index; ACI = Attention/Concentration Index.

CMI = Composite Memory Index; Sn = Sensitivity; Sp = Specificity; TP = True Positives; TN = True Negatives; FP = False Positives; FN = False Negatives.

Specificity and sensitivity are reported in decimal form, while TP, TN, FP, and FN are the number of individuals in the TBI group (n = 150) or control group (n = 160) who are correctly or incorrectly classified.

AF = Attention Factor; VF = Verbal Factor; MFSF = Memory for Stories Factor; NLF = Nonverbal Learning Factor; FMF = Facial Memory Factor; ANF = Abstract Nonverbal Factor.