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Archives of Clinical Neuropsychology 23 (2008) 351–358

Sensitivity of the comprehensive trail making test to traumatic brain injury in adolescents
Christina M. Armstrong a , Daniel N. Allen a,∗ , Bradley Donohue a , Joan Mayfield b

Department of Psychology, University of Nevada Las Vegas, USA b Our Children’s House at Baylor, USA Accepted 23 November 2007

Abstract The current studyexamined the sensitivity of the Comprehensive Trail Making Test (CTMT Reynolds) to neurocognitive deficits in adolescents with traumatic brain injury (TBI). Participants included 60 adolescents, 30 who had sustained TBI and 30 healthy controls (HC) that were individually matched to the TBI sample on age, gender, ethnicity, and geographical region. For both the TBI and HC groups the mean age was 15.0years (S.D. = 2.3 years, range = 11–19). The TBI group had a mean IQ of 81.7 (S.D. = 14.9), had sustained moderate to severe brain injury, and was assessed an average of 21.1 months (S.D. = 20.7) following injury. The TBI group performed approximately 2 standard deviations below the control sample mean on each of the five CTMT trails as well as on the composite index and these differences weresignificant (p < .001). Significant correlations were present between the CTMT trails and clinical variables associated with brain injury severity. Finally, receiver operating characteristic analyses indicated good classification of the TBI and control cases for the CTMT, although some variability in classification accuracy was present among the various trails. Results suggest that the CTMT is sensitiveto TBI in adolescents but continued research is needed with larger samples of individuals with TBI and other types of neurological disorders to further establish the present findings. © 2007 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
Keywords: Comprehensive Trail Making Test; Traumatic brain injury; Adolescents; Sensitivity; ROC analysis

It is estimatedthat over 1.4 million people in the United States sustain mild to severe traumatic brain injuries (TBI) each year, with at least 500,000 of those individuals being children or adolescents (Langlois, Rutland-Brown, & Thomas, 2004). Approximately 30,000 of these children will have permanent disabilities at an estimated life-time cost of up to four million dollars per person (Max, MacKenzie, & Rice,1991; Langlois, Thurman, Alverson, Dunn, Guerrero, & Sniezek, 1999). Motor and sensory deficits are common following TBI, as are neurocognitive deficits. The most consistent neurocognitive finding is slowed information processing, although deficits in attention and concentration are also common (Felmingham, Baguley, & Green, 2004). These neurocognitive deficits can create great challenges forrehabilitation and educational placement (Kraemer & Blancher, 1997; Lowther & Mayfield, 2004) and as such, there is increased demand for instruments that can reliably assess disturbances in complex cognitive abilities in adolescents with TBI. There are a growing number of nationally standardized neuropsychological tests that have become available
∗ Corresponding author at: Neuropsychology Research Program,Department of Psychology, University of Nevada Las Vegas, 4505 Maryland Parkway, Las Vegas, NV 89154-5030, USA. Tel.: +1 702 895 1379; fax: +1 702 895 0195. E-mail address: daniel.allen@unlv.edu (D.N. Allen).

0887-6177/$ – see front matter © 2007 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.acn.2007.11.004


C.M. Armstrong et al. /Archives of Clinical Neuropsychology 23 (2008) 351–358

in recent years for adolescents. However, many lack appropriate evaluation in clinical populations that would help to establish their sensitivity to brain damage and criterion validity in various neurological disorders. The Comprehensive Trail Making Test (CTMT; Reynolds, 2002), based on the Trail Making Test (TMT), offers particular...
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