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Objective: While assessment of effort is necessary in pediatric neuropsychological evaluations, few standalone measures have been validated for use in clinically referred children. Earlier studies have demonstrated that the Dot Counting Test (DCT) can detect suboptimal effort in older clinical groups. This study aims to evaluate its effectiveness for assessing effort in clinically-referred children. Method: 44 clinically-referred patients (ages 6–17; M = 11.93; SD = 3.16; 59% males) were administered the DCT, TOMM and Reliable Digit Span (RDS); the majority were referred for assessment of learning disability, ADHD, or language disorder whereas a smaller subset (n = 18) had epilepsy. Established cutoffs were utilized for RDS and TOMM. For DCT, An E-score of ≥ 17 (Boone, 2002) was used. Failure on both RDS and TOMM constituted poor effort. Results: Failure rates for our sample were TOMM (13%), RDS (23%) and DCT (27%). Of the four participants who failed both RDS and TOMM, three also DCT. Overall, the epilepsy group had poorer DCT scores (t(42) = 2.08, p = .04), ungrouped DCT times (t(42) = 2.88, p = .006), and failure rate (38%). Furthermore, the DCT failure group had lower IQ estimates and academic achievement scores (IQ t(42) = 2.61, p = .012; Reading t(27) = 2.61, p = .015; Math t(41) = 4.14, p < .001). When controlling for IQ, DCT was negatively correlated with word reading and calculation skills (Reading r(12) = −.788, p = .001; Math r(12) = −.845, p < .001). Conclusion: The DCT E-score of ≥ 17 produced an unacceptably high false positive rate in a sample of clinically referred children. This was particularly true in children with epilepsy. DCT is strongly correlated with IQ and academic abilities; thus, it may not be an appropriate measure of effort in clinically referred children.
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