[Article Review] Evaluating the NIH Toolbox for Measuring Cognitive Change in Individuals with Intellectual Disabilities

Evaluating the NIH Toolbox for Cognitive Change in Intellectual Disabilities

Shields et al. (2023) examined the effectiveness of the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) in identifying cognitive development and changes in individuals with intellectual disabilities (ID). The study focused on groups with fragile X syndrome (FXS), Down syndrome (DS), and other forms of intellectual disability (OID), offering evidence for its potential as a reliable tool in clinical trials and intervention studies.

Background

The NIHTB-CB was developed as a standardized measure of cognitive function across multiple domains. It has been used widely in general populations but requires further validation for individuals with ID. This study aimed to determine whether the NIHTB-CB could detect developmental changes over time in specific ID populations and compare its sensitivity with a well-established assessment, the Stanford-Binet Intelligence Scales, Fifth Edition (SB5).

Key Insights

• Study Design: Researchers tested 256 participants aged 6 to 27 years with FXS, DS, and OID. Both the NIHTB-CB and SB5 were administered initially and again after two years. Latent change score models analyzed group-level growth in cognitive domains over this period.
• Findings Across Groups: The NIHTB-CB detected developmental gains comparable to or greater than the SB5. OID participants showed significant gains across most domains at younger ages (10 years), with continued growth at 16 years and stability into early adulthood (22 years).
• Group-Specific Patterns: FXS participants showed delayed improvements in attention and inhibitory control. DS participants had slower growth in receptive vocabulary but exhibited notable gains in working memory and attention/inhibitory control during early adulthood.

Significance

The results highlight the sensitivity of the NIHTB-CB in detecting cognitive changes over time, making it a valuable tool for assessing developmental trajectories in individuals with ID. By providing comparable or superior sensitivity to the SB5, the NIHTB-CB holds promise for use in clinical research targeting interventions or treatments for ID populations. Additionally, the group-specific findings emphasize the importance of tailored assessment approaches to account for different developmental patterns.

Future Directions

The study authors recommend further research to evaluate the NIHTB-CB’s ability to measure treatment-induced cognitive changes and to establish thresholds for clinically meaningful improvements in daily functioning. Understanding these links could enhance the tool’s application in practical and therapeutic contexts.

Conclusion

Shields et al. (2023) provide compelling evidence for the utility of the NIHTB-CB in tracking cognitive development in individuals with ID. By identifying both its strengths and areas for further exploration, this research lays the groundwork for its expanded use in clinical trials and intervention studies. This tool shows promise as a reliable and sensitive measure, particularly for diverse ID populations.

Reference:
Shields, R. H., Kaat, A., Sansone, S. M., Michalak, C., Coleman, J., Thompson, T., McKenzie, F. J., Dakopolos, A., Riley, K., Berry-Kravis, E., Widaman, K. F., Gershon, R. C., & Hessl, D. (2023). Sensitivity of the NIH Toolbox to detect cognitive change in individuals with intellectual and developmental disability. Neurology, 100(8), e778-e789. https://doi.org/10.1212/WNL.0000000000201528