Using the NIH Toolbox to Assess Cognition in Adolescents and Young Adults with Autism Spectrum Disorders
- PMID: 33006263
- PMCID: PMC8106946
- DOI: 10.1002/aur.2399
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.
Keywords: NIH Toolbox; adolescents; adults; cognitive control; executive control; executive functions; latent profile analysis; phenotypes; subtypes of ASD; young adults.
© 2020 International Society for Autism Research and Wiley Periodicals LLC.
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



Similar articles
-
Exploring links between language and cognition in autism spectrum disorders: Complement sentences, false belief, and executive functioning.J Commun Disord. 2015 Mar-Apr;54:15-31. doi: 10.1016/j.jcomdis.2014.12.001. Epub 2015 Jan 6. J Commun Disord. 2015. PMID: 25637130
-
Identifying cognitive profiles in children with neurodevelopmental disorders using online cognitive testing.Clin Child Psychol Psychiatry. 2024 Apr;29(2):591-607. doi: 10.1177/13591045241228889. Epub 2024 Jan 28. Clin Child Psychol Psychiatry. 2024. PMID: 38282296 Free PMC article.
-
Executive function predicts the visuospatial working memory in autism spectrum disorder and attention-deficit/hyperactivity disorder.Autism Res. 2018 Aug;11(8):1148-1156. doi: 10.1002/aur.1967. Epub 2018 Aug 10. Autism Res. 2018. PMID: 30095242
-
Development of Planning in Children with High-Functioning Autism Spectrum Disorders and/or Attention Deficit/Hyperactivity Disorder.Autism Res. 2016 Jul;9(7):739-51. doi: 10.1002/aur.1574. Epub 2015 Oct 7. Autism Res. 2016. PMID: 26442805 Review.
-
Do ASD and ADHD Have Distinct Executive Function Deficits? A Systematic Review and Meta-Analysis of Direct Comparison Studies.J Atten Disord. 2023 Dec;27(14):1571-1582. doi: 10.1177/10870547231190494. Epub 2023 Aug 11. J Atten Disord. 2023. PMID: 37565325 Free PMC article.
Cited by
-
Evaluating the Feasibility of The NIH Toolbox Cognition Battery for Autistic Children and Adolescents.J Autism Dev Disord. 2022 Feb;52(2):689-699. doi: 10.1007/s10803-021-04965-2. Epub 2021 Mar 24. J Autism Dev Disord. 2022. PMID: 33761062 Free PMC article.
-
Assessment of Executive and Cognitive Functions in Children with Restless Sleep Disorder: A Pilot Study.Brain Sci. 2022 Sep 24;12(10):1289. doi: 10.3390/brainsci12101289. Brain Sci. 2022. PMID: 36291223 Free PMC article.
-
Acute Vagus Nerve Stimulation Facilitates Short Term Memory and Cognitive Flexibility in Rats.Brain Sci. 2022 Aug 26;12(9):1137. doi: 10.3390/brainsci12091137. Brain Sci. 2022. PMID: 36138873 Free PMC article.
-
A Systematic Review and Meta-Analysis of the Use of the National Institutes of Health Toolbox Cognition Battery in Clinical Populations.Neuropsychol Rev. 2025 Jul 7. doi: 10.1007/s11065-025-09669-3. Online ahead of print. Neuropsychol Rev. 2025. PMID: 40622488 Review.
-
Distinct Neurocognitive Profiles and Clinical Phenotypes Associated with Copy Number Variation at the 22q11.2 Locus.medRxiv [Preprint]. 2023 May 16:2023.05.12.23289905. doi: 10.1101/2023.05.12.23289905. medRxiv. 2023. Update in: Autism Res. 2023 Dec;16(12):2247-2262. doi: 10.1002/aur.3049. PMID: 37292882 Free PMC article. Updated. Preprint.
References
-
- 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.
-
- Achenbach TM, & Rescorla LA (2003). Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families.
-
- Ben Shalom D (2003). Memory in autism: Review and synthesis. Cortex, 39(4–5), 1129–1138. - PubMed
-
- 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