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. 2021 Mar;14(3):500-511.
doi: 10.1002/aur.2399. Epub 2020 Oct 2.

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

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

Marjorie Solomon et al. Autism Res. 2021 Mar.

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.

Keywords: NIH Toolbox; adolescents; adults; cognitive control; executive control; executive functions; latent profile analysis; phenotypes; subtypes of ASD; young adults.

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Conflict of interest statement

Conflict of Interest

Drs. Solomon, Gordon, Iosif, Krug, Mundy, & Hessl and Raphael Geddert report no biomedical financial interests or potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Scores on fluid and crystalized composite indices split by diagnosis group. Error bars represent 95% confidence intervals. ASD: autism spectrum disorder; TD: typical development.
Figure 2.
Figure 2.
Scatterplot illustrating the relationship between Crystallized (A) and Fluid (B) Cognition and age in months for both diagnostic groups. ASD: autism spectrum disorder; TD: typical development.
Figure 3.
Figure 3.
Profiles of the four executive control groups across subtests of the Cognitive Function Battery tests of the NIH Toolbox.

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References

    1. Achenbach TM, & Rescorla LA (2001). Manual for the ASEBA school-age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
    1. Achenbach TM, & Rescorla LA (2003). Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families.
    1. Akshoomoff N, Newman E, Thompson WK, McCabe C, Bloss CS, Chang L, … Jernigan TL (2014). The NIH Toolbox Cognition Battery: Results from a large normative developmental sample (PING). Neuropsychology, 28(1), 1–10. 10.1037/neu0000001 - DOI - PMC - PubMed
    1. Ben Shalom D (2003). Memory in autism: Review and synthesis. Cortex, 39(4–5), 1129–1138. - PubMed
    1. Berenguer C, Rosello B, Colomer C, Baixauli I, & Miranda A (2018). Children with autism and attention deficit hyperactivity disorder. Relationships between symptoms and executive function, theory of mind, and behavioral problems. Research in Developmental Disabilities, 83, 260–269. 10.1016/j.ridd.2018.10.001 - DOI - PubMed

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