Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr 22:12:631536.
doi: 10.3389/fpsyg.2021.631536. eCollection 2021.

Computerized Symbol Digit Modalities Test in a Swiss Pediatric Cohort Part 1: Validation

Céline Hochstrasser  1 , Sarah Rieder  1 , Ursina Jufer-Riedi  1 , Marie-Noëlle Klein  1 , Anthony Feinstein  2 , Brenda L Banwell  3 , Michelle Steiner  1 , Li Mei Cao  1 , Karen Lidzba  1 , Sandra Bigi  1   4   5
Affiliations

Computerized Symbol Digit Modalities Test in a Swiss Pediatric Cohort Part 1: Validation

Céline Hochstrasser et al. Front Psychol. .

Abstract

Objective: The objective of this study was to validate the computerized Symbol Digit Modalities Test (c-SDMT) in a Swiss pediatric cohort, in comparing the Swiss sample to the Canadian norms. Secondly, we evaluated sex effects, age-effects, and test-retest reliability of the c-SDMT in comparison to values obtained for the paper and pencil version of the Symbol Digit Modalities Test (SDMT).

Methods: This longitudinal observational study was conducted in a single-center setting at the University Children's Hospital of Bern. Our cohort consisted of 86 children (45 male and 41 female) aged from 8 to 16 years. The cohort included both healthy participants (n = 38) and patients (n = 48) hospitalized for a non-neurological disease. Forty eight participants were assessed during two testing sessions with the SDMT and the c-SDMT.

Results: Test-retest reliability was high in both tests (SDMT: ICC = 0.89, c-SDMT: ICC = 0.90). A reliable change index was calculated for the SDMT (RCIp = -3.18, 14.01) and the c-SDMT (RCIp = -5.45, 1.46) corrected for practice effects. While a significant age effect on information processing speed was observed, no such effect was found for sex. When data on the c-SDMT performance of the Swiss cohort was compared with that from a Canadian cohort, no significant difference was found for the mean time per trial in any age group. Norm values for age groups between 8 and 16 years in the Swiss cohort were established.

Conclusion: Norms for the c-SDMT between the Swiss and the Canadian cohort were comparable. The c-SDMT is a valid alternative to the SDMT. It is a feasible and easy to administer bedside tool due to high reliability and the lack of motor demands.

Keywords: SDMT; age-effect; c-SDMT; information processing speed; norms; practice effects; sex-effect; test-retest reliability.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Screen capture of the c-SDMT with the key shown above and the first line of testing below. Participants are tasked with matching each symbol to the corresponding digit.
FIGURE 2
FIGURE 2
Comparison of c-SDMT mean time per trial and standard deviation of the Swiss and Canadian Cohort.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Akbar N., Honarmand K., Kou N., Feinstein A. (2011). Validity of a computerized version of the Symbol Digit Modalities Test in multiple sclerosis. J. Neurol. 258 373–379. 10.1007/s00415-010-5760-8 - DOI - PubMed
    1. Benedict R. H., Smerbeck A., Parikh R., Rodgers J., Cadavid D., Erlanger D. (2012). Reliability and equivalence of alternate forms for the Symbol Digit Modalities Test: implications for multiple sclerosis clinical trials. Mult. scler. 18 1320–1325. 10.1177/1352458511435717 - DOI - PubMed
    1. Bigi S., Marrie R. A., Till C., Yeh E. A., Akbar N., Feinstein A., et al. (2017). The computer-based Symbol Digit Modalities Test: establishing age-expected performance in healthy controls and evaluation of pediatric MS patients. Neurol. Sci. 38 635–642. 10.1007/s10072-017-2813-0 - DOI - PubMed
    1. Birren J. E., Fisher L. M. (1995). Aging and speed of behavior: possible consequences for psychological functioning. Annu. Rev. Psychol. 46 329–353. 10.1146/annurev.ps.46.020195.001553 - DOI - PubMed
    1. Bowler R., Sudia S., Mergler D., Harrison R., Cone J. (1992). Comparison of digit symbol and symbol digit modalities tests for assessing neurotoxic exposure. Clin. Neuropsychol. 6 103–104. 10.1080/13854049208404123 - DOI