NIH Toolbox executive function measures with developmental extensions: Reliability and validity with preschoolers in emergency housing

The Role of Executive Function at 6 Years in the Association between Behavioral Inhibition at 5 Years and Anxiety at 7 Years

EF skills play a central role in the etiology and maintenance of anxiety, but it is unclear whether they act as moderators or mediators in the relation between early behavioral inhibition (BI) and later anxiety. The current study tested two models by examining whether two executive functions (EF) skills (cognitive flexibility and working memory) assessed at age 6 acted as moderators or mediators in the relation between BI at 5 years and anxiety symptoms at 7 years. The sample consisted of 422 children from the Quebec Longitudinal Study of Child Development. We tested the moderation model, main and interaction effects using hierarchical multiple regression analyses and the mediation model with the product of coefficients test. Results showed that higher BI at 5 years predicted high anxiety at 7 years only at low levels of cognitive flexibility or working memory at 6 years. This suggests that high levels of cognitive flexibility or working memory at 6 years may act as protective factors. In contrast, neither cognitive flexibility nor working memory at age 6 acted as mediators in the association between BI at 5 years and anxiety at 7 years. Results support the hypothesis that goal-driven cognitive control processes act as moderators and promote adaptive functioning by dampening the effect of early BI on later anxiety.

Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program

Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.

A short executive functioning questionnaire in the context of early childhood screening: psychometric properties

Early childhood executive functioning (EF) predicts later adjustment and academic achievement. However, measuring EF consistently and efficiently across settings in early childhood can be challenging. Most researchers use task-based measures of EF, but these methods present practical challenges that impede implementation in some settings. The current study of 380 3-5-year-old children in the United States evaluated the psychometric properties of a new 14-item parent-reported measure of EF in a diverse urban school district. This questionnaire aimed to capture a normative range of EF skills in ecologically valid contexts. There was evidence for two specific subscales - one that measures children's EF challenges and another that measures children's EF skills. Results suggested that several items demonstrated differential item functioning by age and race. After adjusting for measurement differences across demographic groups and controlling for age at screening, the EF challenges subscale was more strongly related to task-based measures of EF than was the EF skills subscale. EF challenges predicted third-grade math achievement, controlling for demographic variables and a performance-based measure of children's early cognitive and academic skills. Results suggest that this parent report of EF could be a useful and effective early childhood screening tool.

Cognitive deficits and enhancements in youth from adverse conditions: An integrative assessment using Drift Diffusion Modeling in the ABCD study

Childhood adversity can lead to cognitive deficits or enhancements, depending on many factors. Though progress has been made, two challenges prevent us from integrating and better understanding these patterns. First, studies commonly use and interpret raw performance differences, such as response times, which conflate different stages of cognitive processing. Second, most studies either isolate or aggregate abilities, obscuring the degree to which individual differences reflect task-general (shared) or task-specific (unique) processes. We addressed these challenges using Drift Diffusion Modeling (DDM) and structural equation modeling (SEM). Leveraging a large, representative sample of 9-10 year-olds from the Adolescent Brain Cognitive Development (ABCD) study, we examined how two forms of adversity-material deprivation and household threat-were associated with performance on tasks measuring processing speed, inhibition, attention shifting, and mental rotation. Using DDM, we decomposed performance on each task into three distinct stages of processing: speed of information uptake, response caution, and stimulus encoding/response execution. Using SEM, we isolated task-general and task-specific variances in each processing stage and estimated their associations with the two forms of adversity. Youth with more exposure to household threat (but not material deprivation) showed slower task-general processing speed, but showed intact task-specific abilities. In addition, youth with more exposure to household threat tended to respond more cautiously in general. These findings suggest that traditional assessments might overestimate the extent to which childhood adversity reduces specific abilities. By combining DDM and SEM approaches, we can develop a more nuanced understanding of how adversity affects different aspects of youth's cognitive performance. RESEARCH HIGHLIGHT: To understand how childhood adversity shapes cognitive abilities, the field needs analytical approaches that can jointly document and explain patterns of lowered and enhanced performance. Using Drift Diffusion Modeling and Structural Equation Modeling, we analyzed associations between adversity and processing speed, inhibition, attention shifting, and mental rotation. Household threat, but not material deprivation, was mostly associated with slower task-general processing speed and more response caution. In contrast, task-specific abilities were largely intact. Researchers might overestimate the impact of childhood adversity on specific abilities and underestimate the impact on general processing speed and response caution using traditional measures.

Predictive Validity of the NIH Toolbox Executive Function Measures with Developmental Extensions from Early Childhood to Third Grade Achievement

   The National Institutes of Health Toolbox includes two executive function measures: the Dimensional Change Card Sort (DCCS) and the Flanker Inhibitory Control and Attention Test. Developmental extension (Dext) versions were created with easier levels for younger and more disadvantaged children. Although research on early (E-Prime) and later (iPad) versions of the Dext measures demonstrated their short-term validity, this study investigated their longer-term predictive validity. Participants included 402 children (Mage = 55.02 months) who completed the DCCS-Dext and Flanker-Dext (E-Prime) during early childhood screening and achievement tests in the third grade. Both measures significantly predicted math and reading scores among diverse groups of children.

How do 3-year-olds do on the NIH Toolbox Cognitive Battery?

The NIH Toolbox includes a cognitive battery that provides an Early Childhood Composite score for children age 3-7. However, very few studies have evaluated feasibility when it is used in the youngest segment of this age range-3-year-olds. The current study evaluated performance on the four cognitive subtests composing the early childhood composite, two of which assess executive function, in a large sample of 3-year-olds enrolled in a Vanguard pilot of the National Children's Study. Results found that in a cohort of 609 3-year-olds (mean age = 39.6 months, SD = 1.6, 53% male, 64% White, 87% Non-Hispanic) who were administered four subtests included in the Early Childhood Composite, up to approximately 30% were unable to pass practice items on the Flanker, Dimensional Change Card Sort, and Picture Sequence Memory, whereas only approximately 3% were unable to pass practice items on the Picture Vocabulary Test. Furthermore, of those that did pass practice and achieve scores on the subtests, approximately 70% and 80% performed at or below chance level on the executive function tasks (Flanker and Dimensional Change Card Sort) and Picture Sequence Memory, respectively. Ultimately, the average 3-year-old has difficulty with three of the four NIH Toolbox tasks composing the Early Childhood Composite and may not yet have developed the requisite skills. These findings indicate that changes compatible with the developmental level of preschoolers are recommended to increase the feasibility and effectiveness of the NIH Toolbox in measuring individual cognition differences in 3-year-old children.

Using the Flanker Task to Examine Genetic and Environmental Contributions in Inhibitory Control Across the Preschool Period

The limited research exploring genetic and environmental influences on inhibitory control (IC) in preschoolers has relied on parent ratings or simple delay tasks and has produced mixed results. The present study uses a cognitively-challenging Flanker task to examine genetic and environmental contributions to the development of early IC in a longitudinal sample of 310 same-sex twin pairs (123 MZ; 187 DZ; 51% female) assessed at ages 3, 4 and 5 years. IC was significantly heritable at each age (a²: age 3 = .36; age 4 = .36; age 5 = .35). Stability was entirely accounted for by genetic influences, and change was explained by genetic and nonshared environmental factors. No significant shared environmental influences were observed.

Child Cognitive Flexibility and Maternal Control: A First Step toward Untangling Genetic and Environmental Contributions

Executive functions (EF) play an essential role in many spheres of child development. Therefore, it is crucial to get a better understanding of their etiology. Using a genetic design that involved 934 twins (400 monozygotic), this study examined the etiology of cognitive flexibility, a component of EF, at 5 years of age and its phenotypic and etiological associations with maternal control. Cognitive flexibility was measured in a laboratory setting at 5 years of age using a well-known EF-task, i.e. the Dimensional Change Card Sort (DCCS). Maternal control was measured using a self-report questionnaire. The univariate genetic model demonstrated that environmental factors mainly explained individual differences in preschoolers' performance on the DCCS task. A bivariate genetic model demonstrated that non-shared environmental mechanisms mainly explained the association (r = .-13) between maternal control and children's performance on the DCCS task. This study represents a preliminary step toward a better understanding of the genetic and environmental contributions underlying the relation between parenting behaviors and children's EF.

Neurocognitive monitoring in congenital central hypoventilation syndrome with the NIH Toolbox®

Congenital central hypoventilation syndrome (CCHS) is a rare neurocristopathy, caused by mutations in the paired-like homeobox gene PHOX2B, which alters control of breathing and autonomic nervous system regulation, necessitating artificial ventilation as life-support. A broad range of neurocognitive performance has been reported in CCHS, including an array of cognitive deficits. We administered the NIH Toolbox® Cognition Battery (NTCB), a novel technology comprised of seven tasks presented via an interactive computer tablet application, to a CCHS cohort and studied its convergent and divergent validity relative to traditional clinical neurocognitive measures. The NTCB was administered to 51 CCHS participants, including a subcohort of 24 who also received traditional clinical neurocognitive testing (Wechsler Intelligence Scales). Age-corrected NTCB scores from the overall sample and subcohort were compared to population norms. Associations between NTCB indices and Wechsler Intelligence scores were studied to determine the convergent and divergent validity of the NTCB. NTCB test results indicated reduced Fluid Cognition, which measures new learning and speeded information processing (p < 0.001), but intact Crystallized Cognition, which measures past learning, in CCHS relative to population norms. Moderate to strong associations (r > 0.60) were found between age-corrected NTCB Fluid and Crystallized indices and comparable Wechsler indices, supporting the convergent and discriminant validity of the NTCB. Results reveal deficits of Fluid Cognition in individuals with CCHS and indicate that the NTCB is a valid and sensitive measure of cognitive outcomes in this population. Our findings suggest that the NTCB may play a useful role in tracking neurocognition in CCHS.

Measurement of Cognition for the National Children's Study

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 plan for measuring specific skills at different ages. Given the need for well-validated, direct behavioral measures of cognition that can be used in large-scale longitudinal studies, especially from birth to age 3 years, we also initiated three projects focused on the development of new measures.