95% of researchers rate our articles as excellent or good
Learn more about the work of our research integrity team to safeguard the quality of each article we publish.
Find out more
ORIGINAL RESEARCH article
Front. Psychol.
Sec. Neuropsychology
Volume 16 - 2025 | doi: 10.3389/fpsyg.2025.1473095
Cognitive Weaknesses or Impairments on the NIH Toolbox Cognition Battery in Children and Adolescents: Base Rates in a Normative Sample and Proposed Methods for Classification
Provisionally accepted- 1 Massachusetts General Hospital, Harvard Medical School, Boston, United States
- 2 Harvard Medical School, Boston, Massachusetts, United States
- 3 University of Kentucky, Lexington, Kentucky, United States
The National Institutes of Health Toolbox for Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB) is a brief neuropsychological battery for the assessment of crystalized (i.e., vocabulary and word reading) and fluid cognition (i.e., working memory, visual episodic memory, processing speed, and executive functions). This study examined the frequency of low NIHTB-CB scores and proposes flexible algorithms for identifying cognitive weaknesses and impairment among youth.Participants were 1,269 youth from the NIHTB-CB normative sample who did not have a neurodevelopmental, psychiatric, or medical problem that might be associated with cognitive difficulties (53% boys and 47% girls; M=11.8 years-old, SD=3.0, range 7-17). The sample included the following racial and ethnic composition: 58.1% White, 17.8% Black or African American, 16.8% Hispanic, 1.7% Asian, 3.1% multiracial and ethnic identities, and 2.6% not provided. The frequency of obtaining low scores falling at or below several cutoffs were calculated and stratified by gender, age, and crystalized intellectual ability.Considering the five fluid tests, nearly two-thirds of children and adolescents obtained one or more scores ≤25th percentile, half obtained one or more scores ≤16th percentile, between a third and a fourth obtained one or more scores ≤9th percentile, and nearly a fifth obtained one or more scores ≤5th percentile. We propose flexible, psychometrically derived criteria for identifying a cognitive weakness or impairment.Discussion: Referencing the base rates of low scores will help researchers and clinicians enhance the interpretation of NIHTB-CB performance among children with cognitive weakness or impairments that are neurodevelopmental or acquired.
Keywords: Cognition, Neuropsychological Tests, Psychometrics, Cognitive Dysfunction Word Count: 4,786 Number of Figures: 1 Number of Tables: 3 Frontiers in Psychology, Neuropsychology Section pediatric neuropsychology, cognitive assessment, base rates, fluid intelligence
Received: 30 Jul 2024; Accepted: 18 Mar 2025.
Copyright: © 2025 Cook, Iverson and Karr. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nathan E. Cook, Massachusetts General Hospital, Harvard Medical School, Boston, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.