D-KEFS trail making test as an embedded performance validity measure

ABSTRACT

Objective

The Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test (TMT) is a commonly used measure of processing speed and executive functioning that may also be useful as an embedded performance validity test (PVT). We evaluated the utility of several multi-condition indices on the D-KEFS TMT in three independent samples to determine an optimal multi-condition index and cutoff on the D-KEFS TMT.

Method

Classification accuracy statistics for multiple multi-condition indices on the D-KEFS TMT were evaluated in three independent samples, including a sample with history of mild traumatic brain injury (TBI; n = 267) classified into psychometrically defined performance-valid and performance-invalid subgroups, the D-KEFS national normative sample (n = 1713), and a sample of middle- and older-aged adults diagnosed with mild cognitive impairment (MCI; n = 70).

Results

The D-KEFS TMT Conditions 1–5 summation index maximized sensitivity at .31 while maintaining adequate specificity at ≥.9. This index also had acceptable classification accuracy in both the D-KEFS national normative and MCI cross-validation samples, with the exception of the oldest subgroup of the national norming sample (i.e., individuals’ ages 80–89), in which the observed failure rates for all multi-condition indices tested were greater than 10%.

Conclusion

Our study provides support for the use the D-KEFS TMT Conditions 1–5 summation index as an embedded PVT among individuals younger than 80 years-old and from a range of conditions spanning from cognitively normal to mildly impaired; however, further validation is necessary.

KEYWORDS:

• Performance validity
• processing speed
• effort
• TBI
• D-KEFS

Acknowledgments

The views, opinions and/or findings contained in this article are those of the authors and should not be construed as an official Veterans Affairs or Department of Defense position, policy or decision, unless so designated by other official documentation.

Disclosure statement

Dr Delis is a co-author of the Trail Making Test and receives royalties for this test. Dr Bondi receives royalties from Oxford University Press.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13803395.2022.2073334.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.