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Impact of Factors that Affect Reading Skill Level on King–Devick Baseline Performance Time

  • Special Issue on the NCAA-DoD CARE Consortium Research
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The King–Devick (K–D) test is often used as part of a multimodal assessment to screen for sport-related concussion. However, the test involves reading numbers, and little is known about variation in baseline performance on the K–D by reading skill level. We conducted a cross-sectional study analyzing data from the Concussion Assessment, Research and Education (CARE) Consortium to assess differences in baseline performance on the K–D associated with factors that impact reading skill level (learning disorder [LD] and primary home language other than English [PHLOTE]), while controlling for covariates (gender, type of sport, attentional issues, history of concussion and modality of administration). We had a sample of 2311 student-athletes (47% female), and multivariate regression indicated an average K–D performance time of 40.4 s. Presence of LD was associated with a 3.3 s slower K–D time (95% CI 1.9–4.7, p < 0.001), and PHLOTE was associated with a 2.6 s slower K–D time (95% CI 1.2–4.0, p < 0.001), after controlling for other covariates. These results suggest caution in the use of normative data with the K–D. Future studies should explore the impact of factors associated with reading skill level on sensitivity of the K–D in detecting concussion.

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Learning disorder


Primary home language other than English


Confidence interval

CARE study:

Concussion Assessment, Research and Education


Department of Defense


National Collegiate Athletic Association


Human Research Protection Office


Attention deficit hyperactivity disorder


Standard deviation


  1. Alsalaheen, B., J. Haines, A. Yorke, and J. Diebold. King–Devick test reference values and associations with balance measures in high school American football players. Scand. J. Med. Sci. Sports 26:235–239, 2016.

    Article  CAS  Google Scholar 

  2. Ardila, A., B. Bernal, and M. Rosselli. How localized are language brain areas? A review of brodmann areas involvement in oral language. Arch. Clin. Neuropsychol. 31:112–122, 2016.

    Article  Google Scholar 

  3. Balcer, L. J., J. Raynowska, L. Hasanaj, I. Zhang, L. Serrano, J. Birkemeier, R. Nolan, N. Webb, A. Silverio, J. Rucker, and S. L. Galetta. Annals of sports medicine and research agreement of the spiral-bound and computerized tablet versions of the King-Devick test of rapid number naming for sports related concussion. Ann Sport. Med. Res. 2, 2015.

  4. Beitchman, J. H., and A. R. Young. Learning disorders with a special emphasis on reading disorders: a review of the past 10 years. J. Am. Acad. Child Adolesc. Psychiatry 36:1020–1032, 1997.

    Article  CAS  Google Scholar 

  5. Broglio, S. P., et al. Test-retest reliability and interpretation of common concussion assessment tools. Sport Med. 2017.

    Article  Google Scholar 

  6. Broglio, S. P., et al. A national study on the effects of concussion in collegiate athletes and US Military Service Academy members: the NCAA–DoD Concussion Assessment, Research and Education (CARE) consortium structure and methods. Sport. Med. 47:1437–1451, 2017.

    Article  Google Scholar 

  7. Dodick, D., A. J. Starling, J. Wethe, Y. Pang, L. V. Messner, C. Smith, C. L. Master, R. B. Halker-Singh, B. B. Vargas, J. M. Bogle, J. Mandrekar, A. Talaber, and D. Leong. The effect of in-school saccadic training on reading fluency and comprehension in first and second grade students. J. Child Neurol. 32:104–111, 2017.

    Article  Google Scholar 

  8. Galetta, K. M., J. Barrett, M. Allen, F. Madda, D. Delicata, A. T. Tennant, C. C. Branas, M. G. Maguire, L. V. Messner, S. Devick, S. L. Galetta, and L. J. Balcer. The King–Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology 76:1456–1462, 2011.

    Article  CAS  Google Scholar 

  9. Galetta, K. M., M. Liu, D. F. Leong, R. E. Ventura, S. L. Galetta, and L. J. Balcer. The King–Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion 1:cnc.15.8, 2016.

    Article  Google Scholar 

  10. Galetta, K. M., J. Morganroth, N. Moehringer, B. Mueller, L. Hasanaj, N. Webb, C. Civitano, D. A. Cardone, A. Silverio, S. L. Galetta, and L. J. Balcer. Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes. J Neuroophthalmol. 35(3):235–241, 2015.

    Article  PubMed  Google Scholar 

  11. Howitt, S., R. Brommer, J. Fowler, L. Gerwing, J. Payne, and C. DeGraauw. The utility of the King–Devick test as a sideline assessment tool for sport-related concussions: a narrative review. J. Can. Chiropr. Assoc. 60:322–329, 2016.

    PubMed  PubMed Central  Google Scholar 

  12. Ischebeck, A. Differences between digit naming and number word reading in a flanker task. Mem. Cognit. 31:529–537, 2003.

    Article  Google Scholar 

  13. King, D., C. Gissane, P. A. Hume, and M. Flaws. The King–Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand. J. Neurol. Sci. 351(1–2):58–64, 2015.

    Article  CAS  PubMed  Google Scholar 

  14. King, D., P. Hume, C. Gissane, and T. Clark. Use of the King–Devick test for sideline concussion screening in junior rugby league. J. Neurol. Sci. 357:75–79, 2015.

    Article  CAS  Google Scholar 

  15. Kulp, M. T., and P. P. Schmidt. Reliability of the NYSOA King–Devick saccadic eye movement test in kindergartners and first graders. J. Am. Optom. Assoc. 68:589–594, 1997.

    CAS  PubMed  Google Scholar 

  16. Kulp, M. T., and P. P. Schmidt. Relationship between visual skills and performance on saccadic eye movement testing. Optom. Vis. Sci. 75:284–287, 1998.

    Article  CAS  Google Scholar 

  17. Langlois, J. A., W. Rutland-Brown, and M. M. Wald. The epidemiology and impact of traumatic brain injury: a brief overview. J. Head Trauma Rehabil. 21:375–378, 2006.

    Article  Google Scholar 

  18. Leong, D. F., L. J. Balcer, S. L. Galetta, G. Evans, M. Gimre, and D. Watt. The King–Devick test for sideline concussion screening in collegiate football. J. Optom. 8:131–139, 2015.

    Article  Google Scholar 

  19. Leong, D. F., C. L. Master, L. V. Messner, Y. Pang, C. Smith, and A. J. Starling. The effect of saccadic training on early reading fluency. Clin. Pediatr. (Phila) 53:858–864, 2014.

    Article  Google Scholar 

  20. Lieberman, S., A. H. Cohen, and J. Rubin. NYSOA K-D test. J. Am. Optom. Assoc. 54:631–637, 1983.

    CAS  PubMed  Google Scholar 

  21. Lukasova, K., I. P. Silva, and E. C. Macedo. Impaired oculomotor behavior of children with developmental dyslexia in antisaccades and predictive saccades tasks. Front. Psychol. 7:987, 2016.

    Article  Google Scholar 

  22. Marinides, Z., K. M. Galetta, C. N. Andrews, J. A. Wilson, D. C. Herman, C. D. Robinson, M. S. Smith, B. C. Bentley, S. L. Galetta, L. J. Balcer, and J. R. Clugston. Vision testing is additive to the sideline assessment of sports-related concussion. Neurol. Clin. Pract. 5:25–34, 2015.

    Article  Google Scholar 

  23. Oberlander, T. J., B. L. Olson, and L. Weidauer. Test-retest reliability of the king-devick test in an adolescent population. J. Athl. Train. 52:439–445, 2017.

    Article  Google Scholar 

  24. Proverbio, A. M., M. Bianco, and F. De Benedetto. Distinct neural mechanisms for reading Arabic vs. verbal numbers: an ERP study. Eur. J. Neurosci. 2018.

    Article  PubMed  Google Scholar 

  25. Seassau, M., C. L. Gérard, E. Bui-Quoc, and M. P. Bucci. Binocular saccade coordination in reading and visual search: a developmental study in typical reader and dyslexic children. Front. Integr. Neurosci. 8:85, 2014.

    Article  Google Scholar 

  26. Seidman, D. H., J. Burlingame, L. R. Yousif, X. P. Donahue, J. Krier, L. J. Rayes, R. Young, M. Lilla, R. Mazurek, K. Hittle, C. McCloskey, S. Misra, and M. K. Shaw. Evaluation of the King–Devick test as a concussion screening tool in high school football players. J. Neurol. Sci. 2015.

    Article  PubMed  Google Scholar 

  27. Shum, J., D. Hermes, B. L. Foster, M. Dastjerdi, V. Rangarajan, J. Winawer, K. J. Miller, and J. Parvizi. A brain area for visual numerals. J. Neurosci. 33:6709–6715, 2013.

    Article  CAS  Google Scholar 

  28. Vartiainen, M. V., A. Holm, K. Peltonen, T. M. Luoto, G. L. Iverson, and L. Hokkanen. King–Devick test normative reference values for professional male ice hockey players. Scand. J. Med. Sci. Sports 25:e327–e330, 2015.

    Article  CAS  Google Scholar 

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This publication was made possible in part with support from the Grand Alliance Concussion Assessment, Research, and Education (CARE) Consortium, funded, by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014 is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH-14-2- 0151. Opinions, interpretations, conclusions and recommendations are those of the author(s) and are not necessarily endorsed by the Department of Defense or the NCAA.

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Correspondence to S. P. D. Chrisman.

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Associate Editor Stefan Duma oversaw the review of this article.

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Chrisman, S.P.D., Harmon, K.G., Schmidt, J.D. et al. Impact of Factors that Affect Reading Skill Level on King–Devick Baseline Performance Time. Ann Biomed Eng 47, 2122–2127 (2019).

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