Using the NIH Toolbox to Assess Cognition in Adolescents and Young Adults with Autism Spectrum Disorders

Abstract

Despite the clinically significant impact of executive dysfunction on the outcomes of adolescents and young adults with autism spectrum disorders (ASD), we lack a clear understanding of its prevalence, profile, and development. To address this gap, we administered the NIH Toolbox Cognition Battery to a cross‐sectional Intelligence Quotient (IQ) case‐matched cohort with ASD (n = 66) and typical development (TD; n = 66) ages 12–22. We used a general linear model framework to examine group differences in task performance and their associations with age. Latent profile analysis (LPA) was used to identify subgroups of individuals with similar cognitive profiles. Compared to IQ case‐matched controls, ASD demonstrated poorer performance on inhibitory control (P < 0.001), cognitive flexibility (P < 0.001), episodic memory (P < 0.02), and processing speed (P < 0.001) (components of Fluid Cognition), but not on vocabulary or word reading (components of Crystallized Cognition). There was a significant positive association between age and Crystallized and Fluid Cognition in both groups. For Fluid (but not Crystallized) Cognition, ASD performed more poorly than TD at all ages. A four‐group LPA model based on subtest scores best fit the data. Eighty percent of ASD belonged to two groups that exhibited relatively stronger Crystallized versus Fluid Cognition. Attention deficits were not associated with Toolbox subtest scores, but were lowest in the group with the lowest proportion of autistic participants. Adaptive functioning was poorer in the groups with the greatest proportion of autistic participants. Autistic persons are especially impaired on Fluid Cognition, and this more flexible form of thinking remains poorer in the ASD group through adolescence. Lay Summary A set of brief tests of cognitive functioning called the NIH Toolbox Cognition Battery was administered to adolescents and young adults with autism spectrum disorders (ASD; n = 66) and typical development (TD; n = 66) ages 12–22 years. Compared to TD, ASD showed poorer performance in inhibiting responses, acting flexibly, memorizing events, and processing information quickly (Fluid Cognition). Groups did not differ on vocabulary or word reading (Crystallized Cognition). Crystallized and Fluid Cognition increased with age in both groups, but the ASD group showed lower Fluid, but not Crystallized, Cognition than TD at all ages. A categorization analysis including all participants showed that most participants with ASD fell into one of two categories: a group characterized by poor performance across all tasks, or a group characterized by relatively stronger Crystallized compared to Fluid Cognition. Adaptive functioning was poorer for participants in these groups, which consisted of mostly individuals with ASD, while ADHD symptoms were lowest in the group with the greatest proportion of TD participants.

Assessment of Executive and Cognitive Functions in Children with Restless Sleep Disorder: A Pilot Study

“…It is worth mentioning that the lowest scores in these studies were between the mean and 1 standard deviation below [ 35 ]. In contrast to these findings, adolescents with Tourette’s syndrome did not show average results below the 50th percentile, with the lowest scores in list sorting working memory [ 34 ], which have also been corroborated in other studies [ 36 ]. These studies exemplify that the neurocognitive batteries can show discrete patterns of subtle deficits in areas that can be disorder specific.…”

“…The NIH toolbox has been used to assess neurocognitive function in children and adolescents with other conditions and has also found pattern deficiencies that seem to be condition specific. For instance, adolescents and young adults with autism spectrum have demonstrated that, among the other tests, the lowest scores have been found in pattern comparison processing speed [ 34 ], findings that have been corroborated in adults [ 35 ]. Slower processing speed can contribute to some aspects of psychosocial functioning found in patients with autism.…”

Acute Vagus Nerve Stimulation Facilitates Short Term Memory and Cognitive Flexibility in Rats

“…Combining VNS with the CMRST provides a way to further explore the mechanisms through which vagal afferents can modulate cognitive flexibility. Behavioral rigidity and perseveration occur in a number of neuropsychiatric disorders, including schizophrenia, substance use disorders, obsessive compulsive disorder, and autism [ 57 , 58 , 59 , 60 ]. Therapeutic strategies that enhance cognitive flexibility could therefore have important clinical implications.…”

Distinct neurocognitive profiles and clinical phenotypes associated with copy number variation at the 22q11.2 locus

“…Neurocognitive profiles are of clinical importance for individuals with neurodevelopmental disorders, as cognitive performance has been shown to relate to severity of communication and social difficulties (Demetriou et al, 2018; Leung et al, 2016; Oliveras‐Rentas et al, 2012) and repetitive behaviors (Mostert‐Kerckhoffs et al, 2015), can differentiate individuals with autism spectrum disorders (ASD) (Doi et al, 2022; Nader et al, 2015; Solomon et al, 2021), potentially predict behavioral challenges, and is often used to aid diagnoses (Nader et al, 2015). As such, classifying individuals based on neurocognitive profiles could provide a framework for uncovering genetic and neurobiological differences associated with autism phenotypes, allowing for improved diagnosis and clinical outcomes.…”