The NIH Toolbox: Assessment of function across the lifespan

1. The NIH Toolbox: Assessment of function across the lifespan Nathan Fox, Ph.DUniversity of Maryland This study is funded in whole or in part with Federal funds from the Blueprint for Neuroscience Research, National Institutes of Health under Contract No. HHS-N-260-2006-00007-C

2. The NIH Toolbox, part of the NIH Neuroscience Blueprint initiative, seeks to develop brief yet comprehensive assessment tools measuring motor, cognitive, sensory, and emotional function. Upon completion, the Toolbox will be available for use in longitudinal epidemiologic studies and prevention or intervention trials for people ages 3-85. PURPOSE OF THE NIH TOOLBOX

3. • Enable cross-study comparisons and integration of data from multiple studies by providing a standard set of brief, well-validated measures • Dynamic/adaptable over time • Utilize state-of-the-art psychometric and technological approaches including computerized adaptive testing (CAT) and computer assisted evaluation ADDITIONAL OBJECTIVES OF THE TOOLBOX

4. • Cover the full range of normal function (not disease states) • Be used as the basis for detecting at-risk populations • Be minimally burdensome to subjects and investigators ADDITIONAL OBJECTIVES OF TOOLBOX

5. Executive Function Episodic Memory Working Memory Processing Speed Language Attention COGNITIVE DOMAIN

6. Negative Affect Psychological Well-Being Stress & Self-Efficacy Social Relationships SOCIO-EMOTIONAL HEALTH DOMAIN

7. Locomotion Strength Non-Vestibular Balance Endurance Dexterity MOTOR DOMAIN

8. Vision Audition Vestibular Balance Somatosensation Taste Olfaction SENSORY DOMAIN

9. Episodic Memory Picture Sequence Memory Executive Function- Cognitive Flexibility Dimensional Change Card Sort Executive Function –Inhibitory Control Flanker Language-Vocabulary Comprehension Picture Vocabulary Comp Adap Processing Speed Pattern Comparison Working Memory List Sorting Language- Reading Oral Reading Recognition SUB-DOMAINS OF COGNITION AND INSTRUMENTS

10. Working Memory: Complex Span Task

11. DOG HORSE

12. RABBIT

13. THREE ITEM FLASHING PRACTICE

14. RABBIT

15. SHEEP

16. ELEPHANT

17. Language: Reading

18. cucurbitaceous forisfamiliate prevarications circumlocutory imparidigitate

19. is

20. art

21. dodecahedral

22. Attention/Executive Function: Choice Reaction Time (Flanker)

23. Look at all the fish!

24. Let’s practice! Try to focus on the + sign in the middle of the screen. Press the green light when you’re ready to start

25. Processing Speed: Pattern Comparison

28. Executive Function: Dimensional Change Card Sort (DCCS)

33. Executive Function:Self-Ordered Pointing Task

34. Now look at these pictures. Press the one you want to pick

35. Now look at these pictures. Press the one you want to pick

36. Language: Vocabulary

37. Executive Function: 3 to 6 Years

38. Executive Function: 8 to 85 Years

39. Pediatric Option: A Brief Review • The initial NIH toolbox contract included assessment of children (starting at age 3) • Identification of domains and measures included those that could be used with children as young as age 3 (for the most part) • NIH directors approved the Pediatric Option---additional funding for the norming and validation of measures with children • Domain managers and consultants identified measures that can be used with young children (for the most part) • Committee organized to identify principles for pediatric assessment (chaired by Nathan Fox)

40. Marilyn Jager Adams, Ph.D.Brown University Patricia Bauer, Ph.D.Emory University  David Blitz, M.A.CORE Helena CorreiaCORE Scott Debb, M.A.CORE Nathan Fox, Ph.D.University of Maryland Richard Gershon, Ph.D.CORE Jean Berko Gleason, Ph.D.Boston University Roberta Golinkoff, Ph.D.University of Delaware Kathy Hirsh-Pasek, Ph.D.Temple University Jin-Shei Lai, Ph.D.CORE GiglianaMelzi, Ph.D.New York University Kathleen Wallner-Allen, Ph.D.Westat Phil Zelazo, Ph.D.University of Minnesota Nick Zill, Ph.D.Westat Pediatric Working Group Members CORE: Center on Outcomes, Research and Education

41. Principles of Pediatric Assessment • Importance of having an examiner present • Clarity of instructions • Importance of practice trials to insure that children understand task • Importance of feedback after practice trials and during task performance • Importance of engaging child and motivating performance • Pace of assessment to be monitored

42. Cross-domain Issues with Pediatric Assessment • Age-Appropriateness of Instrument • Construct Appropriateness • Instructions • Equipment • Child’s Perspective • Flexibility

43. Cross-domain Issues with Pediatric Assessment • Age-Appropriateness of Instrument • Can a 3-year-old do it? If not, are there minor adaptations to make it appropriate? • Construct Appropriateness • Will it be valid? Will it measure the same construct that the task measures for an adult? Is it a meaningful construct for children? • Instructions • Are the instructions clear for young children? • Can they be repeated? Should they be administered automatically (via voice or on screen) or by examiner?

44. Cross-domain Issues in Pediatric Assessment • Equipment • Appropriately-sized and comfortable to perform best • Child-size chairs, tables • Feet flat on the ground when sitting back in chair • Can reach comfortably to respond • Non-threatening

45. Cross-domain Issues in Pediatric Assessment • Child’s Perspective • Will it be fun, scary? • Will I be able to do it? • Will it be boring? • What do I get out of it?

46. Cross-domain Issues in Pediatric Assessment • Flexibility: Tasks, equipment, computer-interfaces must be flexible ---by design. • One size does not fit all. Children are • Less predictable than adults • Less capable of regulating behavior and attention to task • Less able to remember or understand instructions • Be prepared, anticipate behavior, but expect the unexpected. Schedule adaptations will be necessary. • Children may need to go back to a particular screen or task • They may need breaks during the testing session.

47. Cross-domain Issues in Pediatric Assessment • Flexibility: Tasks, equipment, computer-interfaces must be flexible ---by design. • To optimize a child’s performance • Must actively create an environment that supports the child • Must be sensitive to the needs of the child • Must keep the child engaged and motivated

48. Flexibility in testing • Flexibility • Schedule, interface, and examiner need to be flexible to be sensitive to the child and to try to optimize performance • Obviously, flexibility must occur within pre-defined boundaries • Balance between child’s needs, practical considerations and needs for standardization of administration.

49. Human-Computer Interface • Ergonomic Design • Type of equipment • “Workstation” (appropriately sized table, chair, screen at comfortable angle, comfortable reach to respond)

50. Human-Computer Interface • Software Design -- Flexibility Important • Even with (or especially with) extremely complex and expensive tasks there is a need to balance practical and child considerations. • Need repeat or clarify instructions, pause in the middle of a task (as appropriate), easily move from one task to another, modify task order