(CTMT-2) Comprehensive Trail-Making Test, Second Edition

The CTMT-2 is a standardized assessment that uses five visual search and sequencing tasks, called trails, that are heavily influenced by attention, concentration, resistance to distraction, and cognitive flexibility (or set shifting). The basic task of the trails is to connect a series of stimuli (numbers, expressed as numerals or in word form, and letters) in a specified order as quickly as possible. The test’s primary uses include the evaluation and diagnosis of brain injury and other forms of central nervous system compromise. 

Other purposes include detection of frontal lobe deficits; problems with psychomotor speed, visual search and sequencing, and attention; and impairments in set shifting along with monitoring recovery from concussion and other forms of TBI. Neuropsychologists; clinical, counseling, school, and pediatric psychologists; occupational therapists; speech and language professionals; physical therapists; and others interested in objective testing of functionality in brain–behavior relationships would all benefit from using the CTMT-2.

New Features

The following are included in the CTMT-2:

•       An updated normative sample reflective of 2017 U.S. Census data for ages 8 to 79 years.
•       Two new composite indexes, Inhibitory Control (composed of Trails 1–3) and Set Shifting (Trails 4–5), in addition to the Total Composite Index (Trails 1–5). These indexes add clinical richness and assist both clinicians and researchers in evaluating the source and implications of low scores on the CTMT-2.
•       Validity data relating the CTMT-2 to the Wechsler intelligence scales’ indexes.
•       Enhanced validity data related to CTMT-2 performance of persons with traumatic brain injury and the degree of initial injury as measured by the Glasgow Coma Scale.
•       Diagnostic accuracy analyses, which are considered the most rigorous techniques for establishing a test’s validity. These analyses involve the computation of sensitivity and specificity indexes and receiver operating characteristic/area under the curve (ROC/AUC) statistics.

Technical and Statistical Characteristics

The CTMT-2 was normed on a sample of 1,904 participants from 38 states. Its raw scores (the time it takes complete each trail in seconds) are converted to T-scores having a mean of 50 and a standard deviation of 10. The three composite scores can be derived by pooling the T-scores from the individual trails. The Examiner’s Manual includes a discussion of the test’s theoretical and research-based foundation, standardization, administration and scoring procedures, normative tables, and extensive reliability and validity data.

The CTMT-2’s internal consistency reliability coefficients are .89 for the Inhibitory Control Index, .79 for the Set-Shifting Index, and .92 for the Total Composite Index. Validity studies demonstrate the test’s ability to differentiate participants with a history of traumatic brain injury from those without, even in post-rehabilitation samples where use of just the Total Composite Index (TCI) resulted in sensitivity of .73, specificity of .71, and a ROC/AUC of .82.