A comparison of normative data for the Trail Making Test from several countries: Equivalence of norms and considerations for interpretation

Abstract

The Trail Making Test may not be equivalent across cultures, i.e., differences in the scores across different cultures may not reveal real differences in the ability of the subjects on the construct being measured. In order to assess this hypothesis, normative samples from ten different countries were compared. Age decade subgroups across samples were ranked based on mean time taken to complete each part of the task. Large Z scores differences were found between these samples when comparing the first with the second, and the last in the rank. These differences were significant even when age and education were comparable across samples. Following Van de Vijver & Tanzer (1997), several possible sources of bias were identified. Incomparability of samples and administration differences were the most likely factors accounting for differences. Because of the lack of validity studies in the countries considered, no firm conclusions could be obtained regarding construct bias. Although the TMT may be measuring visual scanning, psychomotor speed and mental flexibility, normative data from different countries and cultures are not equivalent which might lead to serious diagnostic errors.

Trail Making Test: Normative data for the Latin American Spanish speaking adult population

“…As relatively few individuals were included in certain cells of this normative study (e.g., only 9 participants over 60 years old with high level of education) generalizability of the findings may be somewhat limited. Even in the normative data obtained in Western countries, there is a great deal of variability, such that depending upon the norms used, an otherwise normal performance could be classified as pathological, and vice versa (Fernández & Marcopulos, 2008). The present study aims to establish normative data, stratified by age and educational level, for 11 countries in Latin America.…”

“…While gender showed little relation with performance in adults (Tombaugh, 2004), increased age and lower education are related to lower test scores (Bornstein & Suga, 1988;Periañez et al, 2007;Wecker, Kramer, Wisniewski, Delis, & Kaplan, 2000;Woods, Wyma, Herron, & Yund, 2015). Ethnicity, cultural background, and degree of acculturation have also been linked to performance on the TMT (Ardila, 2001;Fernández & Marcopulos, 2008).…”

The Trail Making Test in Morocco: Normative Data Stratified by Age and Level of Education

“…According to Bezdicek et al [37], educational effects may go far beyond years of education and can possibly be a driving force in sociocultural differences in test performance. We accept Fernandez & Marcopulus hypothesis [35] that in TMT studies the most likely source of variability in international normative values is method bias. Incomparability of samples and administration differences may be the main reason the norms are not comparable, and do not reflect real differences in the underlying construct [35].…”

Overgeneral Memory in Binge Eating Disorder is Linked to Binge Frequency

“…Even though AM retrieval seems to be unrelated to general cognitive deficits, levels of IQ and education (Baddeley, Emslie, & Nimmo-Smith, 1992;Park, Goodyer, & Teasdale, 2002;Wessel, Merckelbach, & Dekkers, 2002), we administered this neuropsychological screening instrument to capture mental tracking (Fernandez & Marcopulos, 2008) and motor speed (Levine, Miller, Becker, Selnes, & Cohen, 2004). It requires subjects to connect as quickly and as correctly as possible 25 encircled numbers in ascending order distributed on a sheet of paper.…”

“…It requires subjects to connect as quickly and as correctly as possible 25 encircled numbers in ascending order distributed on a sheet of paper. The instrument was used to ensure that participants have comparable cognitive functioning, as it has proven to be sensitive to various forms of neuro-cognitive deficits and brain injuries (Fernandez & Marcopulos, 2008;Reitan & Wolfson, 2004). Reported reliability coefficients are around .80 (Spreen & Strauss, 1998).…”