Examining normative values using the Cambridge neuropsychological test automated battery and developmental traits of executive functions among elementary school-aged children in Japan

Abstract

The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized and child-friendly neuropsychological assessment battery that includes subtests aimed at evaluating some aspects of executive functions. Using the CANTAB, this study aims to establish normative values based on the aspects of executive functions among school-aged children in Japan. The participants included 234 children (135 boys and 99 girls aged 6-12 years) enrolled in regular classes, without any clinical records of developmental disorders or educational support. The participants were grouped according to age (6-7, 8-9, and 10-12 years). Four CANTAB subtests, including spatial working memory (SWM) to assess spatial working memory, Stockings of Cambridge (SOC) to evaluate planning, intra/extradimensional set shift (IED) to evaluate attentional set shifting and flexibility, and stop signal task (SST) to evaluate inhibition, were administered to each participant. The results showed that performance in all the CANTAB subtests administered changed with age. Among the subtests, compared with performances in the SOC and IED, those in the SWM and SST improved earlier, thereby indicating that spatial working memory and inhibition develop earlier than planning as well as attentional set shifting and flexibility. Additionally, in the SST subtest, girls made fewer errors than boys did in the 6-7 years group. This study presents normative data of four CANTAB subtests according to age and sex among school-aged children in Japan. We expect that the findings will be used to develop effective tools for the early detection of and support for children with executive dysfunction.

Keywords: attentional set shifting and flexibility; inhibition; neuropsychological assessment; planning; spatial working memory.

Figure 1

Photographs of the four CANTAB subtests. The photographs represent (A) the SWM task, (B) the SOC task, (C) the IED task, and (D) the SST subtest, respectively. SWM, spatial working memory; SOC, Stockings of Cambridge; IED, intra/extradimensional set shift; SST, stop signal task. Adapted with permission from Cambridge Cognition.

Figure 2

Between errors and strategy in the SWM task. Between errors in the four-box (A) and six-box (B) problems as well as strategy score (D) in the SWM task. The box plot represents the score for each age group (A,B,D). *p < 0.017, **p < 0.003. Score of between errors in the eight-box problem (C) for the SWM task. Error bars indicate the standard error of the mean. *p < 0.05, ***p < 0.001. SWM, spatial working memory.

Figure 3

Problems solved in minimum moves in the SOC task. The box plot represents the score for each age group. **p < 0.003. SOC, Stockings of Cambridge.

Figure 4

Number of stages completed and EDS errors in the IED task. Number of stages completed (A) and EDS errors (B) in the IED task. The box plot presents the score for each age group (A,B). *p < 0.017, **p < 0.003. IED, intra/extradimensional set shift.

Figure 5

Direction errors and proportion of successful stops in the SST subtest. The box plot shows the score of direction errors for each age group (A) and that for the age and sex groups (B). *p < 0.017, **p < 0.003. Proportion of successful stops for each age group (C). Estimated marginal means represent the mean value for each category after adjusting the covariates. Error bars indicate the standard error of the mean. *p < 0.05, ***p < 0.001. SST, stop signal task.

Figure 6

Comparison between previously reported normative values. Comparison of our data regarding between errors in the four-box (A), six-box (B), and eight-box problems (C), strategy (D) in the SWM, problems solved using the minimum moves possible (E) in the SOC, and stages completed (F) in the IED task, compared to the normative values presented by Luciana and Nelson (2002). Error bars indicate the standard error of the mean. *p < 0.01. Solid circle: our study, open circle: modified from Luciana and Nelson (2002); SWM: spatial working memory; SOC: Stockings of Cambridge; IED: intra/extradimensional set shift.