Comprehensive Trail-Making Test (CTMT)

Cecil R. Reynolds, PhD

CTMT is a new assessment based on time-tested techniques. The CTMT is a standardized set of five visual search and sequencing tasks that are heavily influenced by attention, concentration, resistance to distraction, and cognitive flexibility (or set-shifting). Its primary uses include the evaluation and diagnosis of brain injury and other forms of central nervous system compromise. More specific purposes include the detection of frontal lobe deficits; problems with psychomotor speed, visual search and sequencing, and attention; and impairments in set-shifting.

The CTMT is for individuals ranging in age from 8 years through 74 years. Administration is timed and takes approximately 5 to 12 minutes. Scoring typically requires less than 5 minutes. Normative scores are provided in the form of T-scores, having a mean of 50 and a standard deviation of 10, along with their accompanying percentile ranks.

The basic task of trail-making is to connect a series of stimuli (numbers, expressed as numerals or in word form, and letters) in a specified order as fast as possible. The score derived for each trail is the number of seconds required to complete the task. The composite score is obtained by pooling the T-scores from the individual trails. The five trails are similar but also are different in some significant way. This easily administered set of tasks is remarkably sensitive to neuropsychological deficits of many types.

The Five Trails:

• The examinee draws a line to connect the numbers 1 through 25 in order. Each numeral is contained in a plain circle.
• The examinee draws a line to connect the numbers 1 through 25 in order. Each numeral is contained in a plain circle. Twenty-nine empty distractor circles appear on the same page.
• The examinee draws a line to connect in the numbers 1 through 25 in order. Each is contained in a plain circle. Thirteen empty distractor circles and 19 distractor circles containing irrelevant line drawings appear on the same page.
• The examinee draws a line to connect the numbers 1 through 20 in order . Eleven of the numbers are presented as Arabic numerals, (e.g., 1, 7); nine numbers are spelled out (e.g., Ten, Four).

• The examinee draws a line to connect in alternating sequence the numbers 1 through 13 and the letters A through L. The examinee begins with 1 and then draws a line to A, then proceeds to 2, then B, and so on until all the numbers and letters are connected. Fifteen empty distractor circles appear on the same page.

The CTMT is standardized on a nationwide sample of 1,664 persons whose demographic characteristics match the United States 2000 census data. Reliability of scores for each individual trail is high and the composite score has a reliability coefficient of .90 or higher at all ages.

The CTMT is extremely sensitive to neurological insult, disease, injury, or dysfunction, including the subtle neuropsychological dysfunction often present in individuals with learning disabilities. The Examiner's Manual includes discussion of the test's theoretical and researched-based foundation, administration and scoring procedures, and more extensive reliability and validity data.