The Dice Trails Test: A modified Trail Making Test for children and adults with Down Syndrome.
The Dice Trails Test gives BCBAs a quick, reading-free way to measure cognitive flexibility in clients with Down syndrome, but avoid it for clients with moderate ID due to floor effects.
01Research in Context
What this study did
Sandkühler et al. (2025) built a new test called the Dice Trails Test. It is a picture version of the Trail Making Test. No reading is needed. The team wanted a quick way to measure cognitive flexibility in clients with Down syndrome.
They tried the test with children and adults who have Down syndrome. They checked if people could finish it, if scores stayed the same on repeat testing, and if scores matched other thinking tests.
What they found
The Dice Trails Test worked for most clients. People could finish it and scores were steady. It showed good validity, meaning it truly tracks cognitive flexibility.
The test was less useful for clients with moderate intellectual disability. Floor effects showed up in that group. For them, scores clumped at the bottom and did not spread out.
How this fits with other research
Campbell et al. (2013) used the FIST with Down syndrome and found verbal skill, not nonverbal skill, predicted flexibility. Sandkühler et al. (2025) drop the verbal demand entirely. Their reading-free Dice Trails lines up with Colin’s warning that verbal load can skew results.
Smith et al. (2019) created a single lab task that captures three executive parts in adults with Down syndrome. Katja et al. narrow the lens to one core part—cognitive flexibility—and make it clinic-friendly. No lab gear or long protocol is needed.
Drijver et al. (2025) also published in 2025. They validated the DIAB for adaptive behavior in moderate–profound ID. Both papers flag the same moderate ID floor issue. If a client hits the bottom on Dice Trails, switch to an adaptive measure like DIAB to get useful data.
Why it matters
You now have a five-minute, reading-free probe for cognitive flexibility in clients with Down syndrome. Use it during intake or re-eval to track set-shifting skills without language confounds. Skip it for clients with moderate ID; choose an adaptive or verbal-light tool instead. Pair it with verbal-heavy tasks only if the client’s language age supports it, keeping Campbell et al. (2013) in mind.
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02At a glance
03Original abstract
BACKGROUND: Psychometrically sound instruments to assess cognitive flexibility in people with Down Syndrome (DS) are lacking. The Trail Making Test (TMT) is well-established but requires reading letters and numerals, limiting its applicability for people with DS. AIMS: To evaluate the psychometric properties and developmental sensitivity of a newly developed TMT adaptation without letters and numerals - the Dice Trails Test (DTT). METHODS: The DTT was administered to 39 children (8-14 years, 46 % female) and 57 adults (18-57 years, 47 % female) with DS. We evaluated feasibility (proportion of participants completing the task), distributional properties, construct validity, developmental sensitivity, and split-half reliability. Nineteen individuals were reassessed for test-retest reliability. Individuals with DS were compared to typically developing (TD) groups matched on chronological and mental age. RESULTS: The DTT showed adequate feasibility (≥ 80 %) for individuals with DS and mild intellectual disability (ID), no relevant floor effects, acceptable construct validity, developmental sensitivity, good split-half reliability, and preliminary evidence for good test-retest reliability in DS. DTT performance differed between DS and TD individuals matched on chronological age, but not when matched on mental age. CONCLUSIONS: Although limited in applicability for individuals with DS and moderate ID, the DTT shows potential as a direct measure of cognitive flexibility in DS across a broad age range.
Research in developmental disabilities, 2025 · doi:10.1016/j.ridd.2025.104965