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

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.