*4.3. Assessments with Low Feasibility*

Because the NEPSY-II Affect Recognition had feasibility that fell below a priori criterion, follow-up post hoc sensitivity and specificity analyses were used to describe who the measure is appropriate for within the sample of children and adolescents with DS. There was a clear pattern that less restrictive guidelines led to more sensitivity, correctly identifying any participant who could complete the task. More restrictive guidelines led to more precision and greater confidence that those in the high IQ ranges could complete the measure (i.e., specificity). It is ideal to have a balance of both high sensitivity and specificity to avoid missing participants who could complete the task but also to be administering a task appropriate for the individuals in a study or clinical trial. The current study's benchmark of ABIQ deviation scores ≥ 30 had the greatest balance between sensitivity and specificity probabilities and would be appropriate for inclusion/exclusion criteria if the NEPSY-II Affect Recognition were a required measure for a testing battery. However, there are limitations to this benchmark, as there were some participants below the ABIQ deviation score of 30 who were able to complete the measure.
