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Research Interests: Psychology and Cognition
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BackgroundDifferentiating normal from pathological cognitive change in adults is essential for both preventing and treating abnormal cognitive decline. The Mobile Toolbox (MTB) is an app‐based research platform and expandable test library... more
BackgroundDifferentiating normal from pathological cognitive change in adults is essential for both preventing and treating abnormal cognitive decline. The Mobile Toolbox (MTB) is an app‐based research platform and expandable test library enabling remote assessment of cognition using participants’ own smartphones (iOS and Android). MTB facilitates conduct of diverse types of cognitive research with a broad range of participants, including those who may be hard to reach. However, evidence for MTB test validity, including demonstration of expected age‐related changes in adulthood, is needed to support MTB use. We present findings on associations between age and MTB performance.Method1,120 English‐speaking participants, ages 18–90, were recruited by a market research company as part of a larger study. Participants completed MTB remote measures of executive function, episodic and working memory, processing speed, and language on their smartphones. Measure order was fixed ((Vocabulary, M...
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Background Early detection of cognitive decline in older individuals can be accomplished with brief, computerized measures in diverse settings. The goal of the ARMADA study is to validate the NIH Toolbox for Assessment of Neurological and... more
Background Early detection of cognitive decline in older individuals can be accomplished with brief, computerized measures in diverse settings. The goal of the ARMADA study is to validate the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) in the neurological aging spectrum from cognitively normal to dementia, and to extend the age range to allow for longitudinal assessment of the oldest individuals. Here, we present baseline data from general population individuals over 85 years of age without cognitive impairment compared with those 65 to 85. Method ARMADA is a multi-site study recruiting participants from established research cohorts. Participants included cognitively average-for-age individuals between the ages of 65–85 (n = 82) and another group 86 and older (n = 105). Baseline characteristics and preliminary data are presented for the Cognition, Emotion, Motor and Sensation modules of the NIHTB. Results Analysis of preliminary baseline data revealed ...
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Upper extremity transplantation offers the promise of restored function and regained quality of life (QOL) for individuals who have sustained hand or arm amputation. However, a major challenge for this procedure becoming an accessible... more
Upper extremity transplantation offers the promise of restored function and regained quality of life (QOL) for individuals who have sustained hand or arm amputation. However, a major challenge for this procedure becoming an accessible treatment option for patients is the lack of standard measures to document benefits to QOL. Patient-reported outcomes (PRO) measures are well-suited for this kind of intervention, where the perspective of the patient is central to defining treatment success. To date, qualitative work with experts, clinicians, and patients has been used to identify the most important domains of QOL for PRO item development. Specifically, our group’s qualitative work has identified several domains of QOL that are unique to individuals who have received upper extremity transplants, which are distinct from topics covered by existing PRO measures. These include emotional and social aspects of upper extremity transplant, such as Expectations and Perceived Outcomes, Integrati...
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A challenge for longitudinal studies is combining individual assessments into visits that are scientifically logical, not burdensome for participants, well-choreographed, and operationally feasible. The visits then need to be sequenced... more
A challenge for longitudinal studies is combining individual assessments into visits that are scientifically logical, not burdensome for participants, well-choreographed, and operationally feasible. The visits then need to be sequenced and spaced to address the scientific goals and generate a data archive that is sufficiently robust and well-documented to support subsequent analyses. This paper summarizes comprehensive multi-disciplinary activities that were coordinated to design the content, format, and structure of the National Children's Study and concurrently serve as a model and resource for other studies.
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Objective:Hispanics/Latinos are the largest and fastest-growing minority population in the United States. To facilitate appropriate outcome assessment of this expanding population, the NIH Toolbox for Assessment of Neurological and... more
Objective:Hispanics/Latinos are the largest and fastest-growing minority population in the United States. To facilitate appropriate outcome assessment of this expanding population, the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIH Toolbox®) was developed with particular attention paid to the cultural and linguistic needs of English- and Spanish-speaking Hispanics/Latinos.Methods:A Cultural Working Group ensured that all included measures were appropriate for use with Hispanics/Latinos in both English and Spanish. In addition, a Spanish Language Working Group assessed all English-language NIH Toolbox measures for translatability.Results:Measures were translated following the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology for instances where language interpretation could impact scores, or a modified version thereof for more simplified translations. The Spanish versions of the NIH Toolbox Cognition Battery language measures (...
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Objective The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) was developed under contract from the National Institutes of Health to create a set of easy-to-administer neuropsychological measures, for use across... more
Objective The NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) was developed under contract from the National Institutes of Health to create a set of easy-to-administer neuropsychological measures, for use across the lifespan (ages 3-85). The NIHTB Cognition Battery (NIHTB-CB) includes two language measures that were developed, calibrated, and normed separately in English and Spanish. This analysis presents the test-retest reliability and construct validity of the Spanish-language picture vocabulary test (S-PVT) and oral reading recognition test (S-ORRT) among adults. Participants and Method Participants were adults age 18-85 who took part in the NIHTB norming study in Spanish (N = 408, Age: M = 44.1, SD = 16.7; Education: M = 10.7, SD = 4.3; 65.0% female). Of these, 48 repeated the battery 1 week later. Both the S-PVT and the S-ORRT were administered using computer adaptive testing and scored using item response theory. Spearman’s correlations were used to...
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The objective of this study is to evaluate the construct validity of the NIH Neurobehavioral Toolbox Cognitive Health Battery (NIHTB-CHB) in adults. Confirmatory factor analysis was used to evaluate the dimensional structure underlying... more
The objective of this study is to evaluate the construct validity of the NIH Neurobehavioral Toolbox Cognitive Health Battery (NIHTB-CHB) in adults. Confirmatory factor analysis was used to evaluate the dimensional structure underlying the NIHTB-CHB and Gold Standard tests chosen to serve as concurrent validity criteria for the NIHTB-CHB. These results were used to evaluate the convergent and discriminant validity of the NIHTB-CHB in adults ranging from 20 to 85 years of age. Five dimensions were found to explain the correlations among NIHTB-CHB and Gold Standard tests: Vocabulary, Reading, Episodic Memory, Working Memory and Executive Function/Processing Speed. NIHTB-CHB measures and their Gold Standard analogues defined factors in a pattern that broadly supported the convergent and discriminant validity of the NIHTB-CHB tests. This 5-factor structure was found to be invariant across 20–60 year old (N=159) and 65–85 year old (N=109) age groups that were included in the current vali...
Research Interests: Psychology, Cognition, Medicine, Discriminant Analysis, Humans, and 13 moreUnited States, Female, Male, Young Adult, Aged, Middle Aged, Adult, Age Factors, Reproducibility of Results, Neuropsychological Tests, Validation Studies as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
This study introduces a special series on validity studies of the Cognition Battery (CB) from the U.S. National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) (Gershon, Wagster et al.,... more
This study introduces a special series on validity studies of the Cognition Battery (CB) from the U.S. National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) (Gershon, Wagster et al., 2013) in an adult sample. This first study in the series describes the sample, each of the seven instruments in the NIHTB-CB briefly, and the general approach to data analysis. Data are provided on test–retest reliability and practice effects, and raw scores (mean, standard deviation, range) are presented for each instrument and the gold standard instruments used to measure construct validity. Accompanying papers provide details on each instrument, including information about instrument development, psychometric properties, age and education effects on performance, and convergent and discriminant construct validity. One study in the series is devoted to a factor analysis of the NIHTB-CB in adults and another describes the psychometric properties of thre...
Research Interests: Psychology, Psychometrics, Cognition, Behavior, Adolescent, and 15 moreHumans, Child, United States, Female, Male, Young Adult, Aged, Middle Aged, Adult, Language Test, Reproducibility of Results, Neuropsychological Tests, Child preschool, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Supplemental material, Spanish_NIHTB_Reliability_and_Validity_RR2_Supplemental_Table for Reliability and Validity of the Spanish-Language Version of the NIH Toolbox by Rina S. Fox, Jennifer J. Manly, Jerry Slotkin, John Devin Peipert and... more
Supplemental material, Spanish_NIHTB_Reliability_and_Validity_RR2_Supplemental_Table for Reliability and Validity of the Spanish-Language Version of the NIH Toolbox by Rina S. Fox, Jennifer J. Manly, Jerry Slotkin, John Devin Peipert and Richard C. Gershon in Assessment
The NIH Toolbox Cognitive Function Battery (CFB) includes 7 tests covering 8 cognitive abilities considered to be important in adaptive functioning across the lifespan (from early childhood to late adulthood). Here we present data on... more
The NIH Toolbox Cognitive Function Battery (CFB) includes 7 tests covering 8 cognitive abilities considered to be important in adaptive functioning across the lifespan (from early childhood to late adulthood). Here we present data on psychometric characteristics in children (N = 208; ages 3–15 years) of a total summary score and composite scores reflecting two major types of cognitive abilities: “crystallized” (more dependent upon past learning experiences) and “fluid” (capacity for new learning and information processing in novel situations). Both types of cognition are considered important in everyday functioning, but are thought to be differently affected by brain health status throughout life, from early childhood through older adulthood. All three Toolbox composite scores showed excellent test-retest reliability, robust developmental effects across the childhood age range considered here, and strong correlations with established, “gold standard” measures of similar abilities. A...
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The National Children's Study Cognitive Health Domain Team developed detailed plans for assessing cognition longitudinally from infancy to early adulthood. These plans identify high-priority aspects of cognition that can be measured... more
The National Children's Study Cognitive Health Domain Team developed detailed plans for assessing cognition longitudinally from infancy to early adulthood. These plans identify high-priority aspects of cognition that can be measured efficiently and effectively, and we believe they can serve as a model for future large-scale longitudinal research. For infancy and toddlerhood, we proposed several paradigms that collectively allowed us to assess six broad cognitive constructs: (1) executive function skills, (2) episodic memory, (3) language, (4) processing speed, (5) spatial and numerical processing, and (6) social cognition. In some cases, different trial sequences within a paradigm allow for the simultaneous assessment of multiple cognitive skills (e.g., executive function skills and processing speed). We define each construct, summarize its significance for understanding developmental outcomes, discuss the feasibility of its assessment throughout development, and present our pla...
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The psychometric properties of the English-language NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) have been examined in numerous populations. This study evaluated the reliability and validity of the... more
The psychometric properties of the English-language NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) have been examined in numerous populations. This study evaluated the reliability and validity of the Spanish-language NIH Toolbox. Participants were children aged 3 to 7 years and adults aged 18 to 85 years who took part in the NIH Toolbox norming study in Spanish. Results supported the internal consistency reliability of included measures. Test–retest reliability was strong for most tests, though it was weaker for the test of olfaction among children and the test of locomotion among adults. Spearman’s correlations and general linear models showed Spanish tests were often associated with age, sex, and education. Convergent validity for the two language measures that underwent more intensive development, evaluated via Spearman’s correlations with legacy measures, was strong. Results support using the Spanish-language NIH Toolbox to measure neurological ...
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Metrics to estimate premorbid cognitive ability, such as word reading tests, are important for clinical determination of cognitive changes following brain injury. In the present study, reading adjusted scores for the National Institutes... more
Metrics to estimate premorbid cognitive ability, such as word reading tests, are important for clinical determination of cognitive changes following brain injury. In the present study, reading adjusted scores for the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) fluid tests were developed and validated with a sample of individuals with traumatic brain injury (TBI), to evaluate the clinical utility of reading-adjusted scores. Research Method/Design: The development sample included 843 adult participants, ages 20-85, from the NIHTB-CB standardization sample. A sample of 158 participants with complicated mild or moderate TBI (n = 74) or severe TBI (n = 84) were administered the NIHTB-CB, and comprised the validation sample. Scores were derived for the five fluid tests using four adjustment models: age-only, demographic-only, age-and-reading, and demographic-and-reading referenced scores. Estimated premorbid ability varies depending on the reference model. Scores fr...
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The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function Cognition Battery is comprised of seven cognitive tests, including two tests measuring crystallized cognitive ability (i.e., vocabulary and... more
The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function Cognition Battery is comprised of seven cognitive tests, including two tests measuring crystallized cognitive ability (i.e., vocabulary and reading) and five tests measuring fluid cognitive functioning (i.e., working memory, memory, speed of processing, and executive functioning). This study presents comprehensive base rate tables for the frequency of low scores in adults and older adults from the normative sample. Participants were 843 adults, ages 20-85, from the NIH Toolbox standardization sample who completed all seven cognition tests. Rates of low scores were derived for standard age-adjusted and fully-demographically-adjusted scores at multiple cut-scores. Base rates were stratified by education, crystallized intellectual ability, and cognitive domain. Using the five demographically-adjusted fluid cognitive test scores, 45.9% of adults obtained one or more scores at or below the 16...
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Research Interests: Psychometrics, Adolescent, Visual acuity, Humans, Child, and 15 moreUnited States, Female, Male, Newspaper, Young Adult, Clinical Sciences, Aged, Middle Aged, Vision screening, Adult, Reproducibility of Results, Sensitivity and Specificity, Child preschool, Vestibular function tests, and mass Screening
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Research Interests: Psychology, Cognition, Adolescent, Social Studies, Teaching, and 14 moreHumans, Personality Assessment Inventory, Female, Male, Depressive Disorder, Mothers, Social Adjustment, Multiple Regression, Abnormal Child Psychology, Abnormal, Social Functioning, Cognitive Function, Maternal Depression, and Personality Inventory
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Language facilitates communication and efficient encoding of thought and experience. Because of its essential role in early childhood development, in educational achievement and in subsequent life adaptation, language was included as one... more
Language facilitates communication and efficient encoding of thought and experience. Because of its essential role in early childhood development, in educational achievement and in subsequent life adaptation, language was included as one of the subdomains in the NIH Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). There are many different components of language functioning, including syntactic processing (i.e., morphology and grammar) and lexical semantics. For purposes of the NIHTB-CB, two tests of language--a picture vocabulary test and a reading recognition test--were selected by consensus based on literature reviews, iterative expert input, and a desire to assess in English and Spanish. NIHTB-CB's picture vocabulary and reading recognition tests are administered using computer adaptive testing and scored using item response theory. Data are presented from the validation of the English versions in a sample of adults ages 20-85 y...
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Episodic memory is one of the most important cognitive domains that involves acquiring, storing and recalling new information. In this article, we describe a new measure developed for the NIH Toolbox, called the Picture Sequence Memory... more
Episodic memory is one of the most important cognitive domains that involves acquiring, storing and recalling new information. In this article, we describe a new measure developed for the NIH Toolbox, called the Picture Sequence Memory Test (PSMT) that is the first to examine episodic memory across the age range from 3 to 85. We describe the development of the measure and present validation data for ages 20 to 85. The PSMT involves presentation of sequences of pictured objects and activities in a fixed order on a computer screen and simultaneously verbally described, that the participant must remember and then reproduce over three learning trials. The results indicate good test-retest reliability and construct validity. Performance is strongly related to well-established "gold standard" measures of episodic memory and, as expected, much less well correlated with those of a measure of vocabulary. It shows clear decline with aging in parallel with a gold standard summary mea...
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This study describes psychometric properties of the NIH Toolbox Cognition Battery (NIHTB-CB) Composite Scores in an adult sample. The NIHTB-CB was designed for use in epidemiologic studies and clinical trials for ages 3 to 85. A total of... more
This study describes psychometric properties of the NIH Toolbox Cognition Battery (NIHTB-CB) Composite Scores in an adult sample. The NIHTB-CB was designed for use in epidemiologic studies and clinical trials for ages 3 to 85. A total of 268 self-described healthy adults were recruited at four university-based sites, using stratified sampling guidelines to target demographic variability for age (20-85 years), gender, education, and ethnicity. The NIHTB-CB contains seven computer-based instruments assessing five cognitive sub-domains: Language, Executive Function, Episodic Memory, Processing Speed, and Working Memory. Participants completed the NIHTB-CB, corresponding gold standard validation measures selected to tap the same cognitive abilities, and sociodemographic questionnaires. Three Composite Scores were derived for both the NIHTB-CB and gold standard batteries: "Crystallized Cognition Composite," "Fluid Cognition Composite," and "Total Cognition Composite" scores. NIHTB Composite Scores showed acceptable internal consistency (Cronbach's alphas=0.84 Crystallized, 0.83 Fluid, 0.77 Total), excellent test-retest reliability (r: 0.86-0.92), strong convergent (r: 0.78-0.90) and discriminant (r: 0.19-0.39) validities versus gold standard composites, and expected age effects (r=0.18 crystallized, r=-0.68 fluid, r=-0.26 total). Significant relationships with self-reported prior school difficulties and current health status, employment, and presence of a disability provided evidence of external validity. The NIH Toolbox Cognition Battery Composite Scores have excellent reliability and validity, suggesting they can be used effectively in epidemiologic and clinical studies.