When should I use the Start Point Override feature?

In NIH Toolbox V3, Start Point Override is an optional field in the Participant Demographics that applies to 5 tests in the Cognition domain: List Sorting Working Memory, Oral Reading Recognition, Picture Sequence Memory, Picture Vocabulary, and Visual Reasoning. This feature can be used if a participant is expected to be at a significantly higher or lower functioning level than would be expected by their age (for participants ages 3 to 18) or education level (for individuals 19 years and older). This function should be used judiciously and only in cases where you have prior evidence of lower or higher participant functioning. If a value is selected in this field, all administrations of the 5 tests listed above will present age-appropriate instructions and practice items, but the live items will begin at the selected start point level.

For example, if a participant is 30 years old and you have evidence the participant functions at a 10 year old level, select “Age 10” in the Start Point Override dropdown. The instructions and practice items appropriate for adults will still be shown, but the live items will begin at a 10 year old level. In another example, if a participant is 15 years old and they have completed college-level coursework, you can select “Ages 19+: Some College” in the Start Point Override dropdown. In a third example, if an older adult has had a traumatic brain injury (TBI) or is experiencing cognitive impairment, you might select “Ages 19+: Less than HS”.