GOOD MORNING EVERYONE.
WELCOME TO THE NIH TOOLBOX
ASSESSMENT CONFERENCE.
I'M MOLLY WAGSTER AND I'LL BE
THE MASTER OF CEREMONIES.
WE'RE GOING TO START WITH
OPENING REMARKS FROM LEADERSHIP
OF SOME OF THE INSTITUTES THAT
ARE INVOLVED WITH THE NIH
BLUEPRINT FOR NEUROSCIENCE
RESEARCH SUPPORTING THE
CONFERENCE AND SUPPORTING THE
DEVELOPMENT OF TWO THE
MEASUREMENT SYSTEMS FEATURED IN
THE NEXT TWO DAYS.
IT'S MY PLEASURE TO INTRODUCE
DR. WALTER KOROSHETZ DIRECTOR
THE NATIONAL INSTITUTE OF
NEUROLOGICAL DISORDERS AND
STROKES FOR OPENING REMARKS.
DR. KOROSHETZ.
I'M
>> I'M HERE TO WELCOME TO YOU TO
THE IMPORTANT WORKSHOP AND
SYMPOSIUM AND TALKING ON BEHALF
OF THE BLUEPRINT FOR
NEUROSCIENCE A GROUP OF ABOUT 12
INSTITUTES AND CENTERS AT NIH
INVOLVED IN NEUROSCIENCE
RESEARCH STARTED IN 2004.
IN 2012 THE GROUP DECIDED IT WAS
IMPORTANT FOR ALL INSTITUTES AND
NEUROSCIENCE RESEARCH TO DEVELOP
PSYCHO METRICALLY SOUND POOLS TO
EVALUATE NEURO AND BEHAVIORAL
FUNCTION.
THAT WAS THE BIRTH OF THE
TOOLBOX AND THE TOOLBOX HAS
PROGRESSED SINCE.
YOU'LL HERE THE USES AND IN THE
POPULATIONS AND THE PURPOSES IS
TO DEVELOP A SET OF GRIEF, EASY
TO ADMINISTER TESTS OF MOTOR,
SENSORY AND FUNCTION AND
IMPORTANTLY THESE TOOLS ARE
VALIDATED IN LARGE NUMBERS OF
NORMAL INDIVIDUALS SO THAT WHEN
ONE DOES A STUDY YOU CAN SEE
WHERE YOUR RESULTS FIT ON THE
SPECTRUM OF NORMAL RESULTS OF
NORMAL INDIVIDUALS, AND GIVEN
THE FACT THEY'RE ALL SO WIDELY
USED ONE CAN SEE WHERE YOUR
RESULTS COMPARE TO THOSE OF
OTHERS INVESTIGATED DIFFERENT
POPULATIONS OR EVEN SIMILAR
POPULATIONS.
AND POPULATION VERSUS CONTROL
GROUP YOU DON'T REALLY
UNDERSTAND THE VARIANTS AND
WHETHER YOUR RESULTS ARE REALLY
WITHIN THE NORMAL VARIATION OR
NOT.
BUT THE TOOLBOX IS PARTICULARLY
RELEVANT HERE BECAUSE IT'S
VALIDATED IN LARGE NUMBERS OF
INDIVIDUALS.
WHAT WE THINK IS A CURRENCY
ACROSS NIH RESEARCH AND OTHER
RESEARCH WHERE ONE CAN HAVE A
NORTH STAR FOR THE RESULTS IN
COGNITION, SENSORY AND MOTOR
FUNCTION.
THIS IS BEEN TAKEN UP BY OVER 14
CURRENT SUBSCRIBERS TO THE APP,
900 PUBLICATIONS FROM COME FROM
THE TOOLBOX AND 460 TRIALS AND
CENTRAL TRIALS ARE CURRENTLY
LISTED AS USING THE NIH TOOLBOX.
NOW, ONE APPLICATION OF THESE
TYPES OF TESTING IS IN THE
DETECTION OF COGNITIVE
IMPAIRMENT.
COGNITION IS NOT STATIC.
IT CHANGES OVER THE LIFE SPAN SO
IT'S IMPORTANT TO UNDERSTAND
WHAT IS THE NORMAL VARIATION OF
COGNITION OVER THE LIFE SPAN.
THIS IMPORTANCE IS EMPHASIZED
MORE NOW THAT THERE ARE ADVANCED
IN THE TREATMENT OF DEMENTIA
PARTICULARLY ALZHEIMER'S
DISEASE.
SO THE ALZHEIMER'S AND
ALZHEIMER'S RELATED SUMMITS THAT
GIVE INFORMATION ON PROGRAMS
THAT ARE IMPORTANT TO TRY AND
DEVELOP BETTER TREATMENTS AND
THOUGHT OUT THE NEED FOR TESTING
TO DETECT THE EARLIEST CHANGES
THAT MIGHT BE RELATED SO THE
NEURO DEGENERATIVE CONDITIONS
AND APPLIED TO THESE POPULATIONS
AND YOU'LL HEAR ABOUT MY TIME
COMING TODAY WHICH WAS IN SOME
SENSE BROUGHT TO THE FOREFRONT
BY INVESTIGATORS WHO ARE
INVOLVED IN THE TOOLBOX WHO USES
THE TECHNIQUES AND OTHER GROUPS
ARE WORK ON A SIMILAR TYPE OF
APPLICATIONS TO DETECT COGNITIVE
IMPAIRMENT IN PATIENTS AS THEY
AGE.
I WANT TO THANK ALL THE WORK
DONE BY THE TOOL BOX GROUP OVER
THE DECADE AND A HOPE WE LEARN A
LOT TODAY PARTICULARLY FROM THE
USERS OF THE TOOLBOX TO
CONTINUOUSLY WORK TO MAKE IT A
MORE EFFECTIVE RESOURCE FOR ALL
IN CLINICAL NEUROSCIENCE.
WITH THAT, THANK YOU VERY MUCH
AND I THINK I CAN HAND IT OVER
NOW TO DR. HODES.
>> THANK YOU, WALTER.
I'M RICHARD HODES DIRECTOR OF
THE NATIONAL AGING IN THE LAST
50 YEARS AND NIAA HAS TAKEN THE
LEAD IN GENETIC, MOLECULAR AND
CLINICAL AND SOCIAL ABOUT AGING
AND LIFE COURSE.
IN THAT CONTEXT AS WALTER SO
WELL INTRODUCED THE TOOLBOX HAS
BEEN CRITICAL.
I WAS WITHIN A PART OF THE
NEUROSCIENCE BLUEPRINT WHICH IN
2012 APPROVED, FINALIZED SOME OF
THE WORK ON EMERGING NOW
CONTINUING WORK ON TOOLBOX.
ONE OF THE FIRST PRODUCTS OF
BLUEPRINT.
THIS SERVES ENORMOUSLY IMPORTANT
ROLE IN PROVIDING A COMMON AND
COMPARABLE LANGUAGE FOR A
MULTITUDE OF STUDIES EXAMINING
END POINTS IN THE BEHAVIORAL AND
COGNITIVE AREAS AND ALLOWING
COMPARISONS AND LEVERAGES AND
COMPARABILITY AMONG THEM AND
THERE'S A MOBILE TOOLBOX.
AS WE MOVE FROM PAPER AND PENCIL
TO iPADS AND NOW APPS ON PHONES
INCREASING THE AVAILABILITY OF
BROADER POPULATIONS TO
PARTICIPATE AND HELP IN
GENERATING THE KINDS OF
STANDARDS FOR EVALUATION OF
NORMAL AND ABNORMAL BEHAVIORS
THAT ALLOW EARLY DIAGNOSIS AND
TREATMENT AND INTERVENTION.
I SHARE WITH WALTER A WARM
WELCOME TO ALL OF YOU AND
EXPECTATION OVER THE NEXT COUPLE
DAYS WE'LL LEARN MORE ABOUT THE
EXPERIENCE AND IT WILL CATALYZE
GREATER PENETRATION IN USE OF
THE TOOLBOX SUITE.
I'LL TURN IT OVER TO ALISON
NEXT.
>> THAT'S RIGHT.
THANK YOU, DR. KOROSHETZ AND
DR. HODES.
AND NOW WE HAVE ALISON CERNICH
DEPUTY DIRECTOR OF THE EUNICE
KENNEDY SHRIVER TO TALK MORE
ABOUT THE TOOLBOX.
>> THANK YOU FOR COMING IN
PERSON PAP IT'S EXCITING TO SEE
PEOPLE BACK IN THE CONFERENCE
ROOMS ARE AND TALKING AND
PRESENTING POSTERS AND I'M
LOOKING FORWARD TO BEING HERE
THIS MORNING IN PERSON AND
EXCITED TO JOIN DR. KOROSHETZ
AND HODES IN WELCOMING YOU TO
THE NIH TOOLBOX ASSESSMENT
CONFERENCE.
I THINK THIS AREA OF RESEARCH
HAS A NEURO PSYCHOLOGIST MYSELF
IS INCREDIBLY EXCITING.
I'VE BEEN WORK IN COMPUTERIZED
NEURO PSYCHOLOGICAL ASSESSMENT
MY ENTIRE CAREER AND TO WATCH
THE TOOLS DEVELOP IS THRILLING.
I WANT TO SAY THANKS TO
DR. MOLLY WAGSTER FROM THE
NATIONAL INSTITUTE OF AGE WHO
WILL FIRST CONCEIVED THE
CONFERENCE.
THE NIH BLUEPRINT FOR
NEUROSCIENCE RESEARCH PROGRAM
WHO PROVIDED AND THE TOOLBOX
PLANNING COMMITTEE WHOSE LISTED
MEMBERS ARE TOO MUCH AND I'D BE
REMISS TO NOT MENTION DR. MANN
KEOPKE WHO LEADS THE EFFORT AND
THE DEVELOPERS WHO HAVE BEEN
EXTRAORDINARILY HELPFUL PLANNING
AND PLAYING AN ESSENTIAL ROLE TO
THE TWO-DAY MEETING.
MISSION IS TO LEAD RESEARCH AND
TRAINING TO UNDERSTAND HUMAN
DEVELOPMENT IMPROVE REPRODUCTIVE
HEALTH, IMPROVE THE LIVES OF
CHILDREN AND ADOLESCENTS AND
OPTIMALABILITY AND DEVELOPING
NEW INNOVATIVE MEASUREMENTS,
TOOLS, TECHNOLOGIES AND SYSTEMS
JUST LIKE THE NIH TOOLBOX.
THESE TOOLS CAN HELP SUPPORT A
WIDE VARIETY OF RESEARCH STUDIES
AND HONESTLY MENTIONED BY
DOCTORS HODES AND KOROSHETZ,
LEADERSHIP RECOGNIZE IN THE
BLUEPRINT THE SCIENTIFIC VALUE
OF SHARED MEASURES ACROSS
STUDIES AND WE UNDERSTOOD
EXTRAALLY THE MEASUREMENT FOR
COGNITIVE, EMOTIONAL AND SENSORY
FUNCTION ACROSS THE LIFE SPAN.
FUNDING THE NIH TOOLBOX
ASSESSMENTS FOR AGES 3-85 WAS AN
INITIATIVE TO FIRST ADDRESS
THIS.
WE IN THE PROFIT WE AT NIH AND
YOU IN THE SCIENTIFIC COMMUNITY
WED NEED TO INCORPORATE
ASSESSMENTS FOR YOUNGER CHILDREN
AND WHEN THEY DEVELOPED THE NIH
BABY TOOLBOX AS AN EXTENSION OF
THE NIH TOOLBOX TO FILL THIS
GAP.
AND AS SOMEONE WHO HAS
DEVELOPMENT ASSESSMENTS IN THE
PRESCHOOL SETTING BEFORE I
REALIZED HOW COMPLEX THIS IS.
THE NIH BABY TOOLBOX IS A BRIEF
STANDARDIZED TOOL THAT INCLUDES
NEURO PSYCHOLOGICAL AND
COGNITIVE AND SOCIAL ASSESSMENT
FOR USE WITH INFANTS AND
TODDLERS AGES 1 TO 42 MONTHS AND
THE DEVELOPERS DETERMINED THEIR
NEEDS AND DESIGN THE TOOL IN A
RIGOROUS DEVELOPMENT AND
ASSESSMENT COMPONENTS FOR EACH
TARGETED AGE GROUP WERE TESTED
TO DEMONSTRATE THE RELIABILITY
AND VALIDITY OF THE VALIDITY
COMPONENT AGAINST GOLD STANDARDS
AND CONDUCTING AND PUBLISHING
STUDY TO ENSURE THE MEASURES
PRODUCED VALID AND RELIABLE
DATA.
THE STUDY DATA WILL BE DE POS
PITTED IN A REPOSITORY TO SHIRE
WITH RESEARCHERS FOR SECONDARY
ANALYSIS AND INDEPENDENT
INVESTIGATORS USING TOOLBOX DATA
CAN SHARE WITH THE SAME
REPOSITORY FURTHER AIDING
COLLABORATION.
WHILE THE BABY TOOLBOX WAS A
VITAL THING IT WAS ALSO REALLY
DESIGNED EASY TO BE ADMINISTER
AND OPTIMIZE FOR USE WITH MOBILE
TECHNOLOGIES.
MAKING THE TOOLBOX MORE
ACCESSIBLE AND EASILY
ADMINISTERED IN A VARIETY OF
SETTINGS INCLUDING PARTICIPANTS
HOMES AND FOR ANY OF YOU WHO
HAVE EVER TRIED TO ADMINISTER A
SCREENING IN A PRESCHOOL AND/OR
IN A PEDIATRICIAN'S OFFICE
YOU'LL RECOGNIZE HOW VALUABLE
THAT IS.
I THINK THE OTHER PIECE THAT'S
EXCITING IS WE HAVE THE
PERFORMANCE-BASED MEASURES WITH
COMPUTER ASSISTANCE AND HAVE
UNBIASSED ASSESSMENT AND THIS IS
CRITICAL FOR ASSESSMENT OF
PRE-VERBAL AND NON-VERBAL
ASSESSMENTS AND WE'RE TRYING TO
CUT DOWN THE BURDENS IN SURVEYS.
WE WANT TO BE RESPECTFUL OF
PEOPLE'S TIME.
THIS CAN BE USED IN A LIMITED
TIME FRAME, 30 MINUTES FOR A
1-MONTH-OLD OR 40 MINUTES FOR
OLDER AND THERE'S THE HEALTHY
BRAIN AND CHILD DEVELOPMENT
STUDY BECAUSE OF THE INCREASED
DEFICIENCY.
I'M EXCITED FOR THE TOOLBOX AS A
WHOLE.
THESE TOOLS PROVIDE THE
OPPORTUNITY FOR COMMON DATA
POINTS ACROSS MANY STUDIES
HELPING FACILITATE THE ABILITY
TO AGGREGATE DATA AND COMPARE
THEM INCREASING THE POWER OF
RESEARCH WE CONDUCT.
NOT ONLY THAT, USING
DEVELOPMENTALLY APPROPRIATE
ASSESSMENTS CAN HELP US TAKE IT
TO THE STREETS AS IT WERE.
WE CAN DO REAL TIME DATA CAPTURE
THAT CAN HELP US DO THINGS LIKE
DETECT AND INTERVENE EARLIER FOR
DEVELOPMENT DELAYS IN
DISABILITIES, TRACK DEVELOPMENT
OVER TIME AND UNDERSTAND THE
COMPLEXITIES OF MULTIPLE
MODALITIES WITH GREATER CLARITY
AND NUANCE THAN BEFORE WHILE
LINKING DATA INTO ELECTRONIC
HEALTH RECORD IN A STREAMLINED,
EFFICIENT MANNER MAINTAINING
PRIVACY AND CONFIDENTIALITY.
SO I HAVE LOOKED AT THE AGENDA
TODAY AND WHILE I WON'T BE ABLE
TO BE HERE ALL DAY IN PERSON,
I'M REALLY EXCITED TO WATCH SOME
OF THESE SESSIONS LATER AND I'M
REALLY EXCITE ABOUT THE AMAZING
BEGINNING YOU ALL HAVE MADE AS A
COMMUNITY AND GET EXCITE ABOUT
THE USE OF THE TOOLS LAYING THE
FOUNDATION FOR SCIENCE IN THE
AREA.
THANK YOU FOR ALL YOU'VE DONE
AND ALL YOU'LL CONTINUE TO DO
FROM HERE.
I APPRECIATE YOUR WORK.
THANK YOU.
>> ALL RIGHT.
WE'RE A LITTLE AHEAD OF
SCHEDULE.
THAT'S ALWAYS A GOOD THING IN MY
BOOK.
SO I APPRECIATE THE LEADERSHIP
OF NINDS AND OF NIA AND NICHD
AND IMPORTANT WORDS WE
APPRECIATE IN TERMS OF HOW
IMPORTANT THE MEASURES ARE.
AND THE TIME AND EFFORT THAT IT
TAKES TO GOING INTO THE
DEVELOPMENT OF THEM AND TO
ENSURE SOUND, VALID MEASURES
THAT CAN BE USED IN A VARIETY OF
SETTINGS.
SO WE'RE NOW GOING TO MOVE TO
THE KEYNOTE ADDRESSES.
I'M GOING TO BE INTRODUCING THE
FIRST SPEAKER, THE FIRST TALK ON
THE NIH TOOLBOX AND JUST TO GIVE
YOU BACKGROUND, BACK IN THE
EARLY 2000s, NIA, NIMHD AND
NINDS UNDERTOOK A RESOURCE
BUILDING EFFORT WE DUBBED THE
COGNITIVE AND EMOTIONAL HEALTH
PROJECT OR THE HEALTHY BRAIN TO
LOOK AT DEMOGRAPHIC, SOCIAL AND
BIOLOGIC DETERMINATES OF HEALTH
IN ADULTS AND THE PATHWAYS AND
RE-KIPRY -- RECIPROCALLY
PATHWAYS AND A BLUE RIBBON PANEL
WAS MADE AND THERE WAS A
PUBLICATION OF THEIR FINDINGS IN
THE JOURNAL OF ALZHEIMER'S AND
DEMENTIA IN 2006.
IN THEIR REPORT THEY POST
SEVERAL SUGGESTIONS.
ONE OF WHICH WAS THE CLEAR NEED
FOR DEVELOPMENT OF A STANDARD
QUESTIONNAIRE TO MEASURE
COGNITIVE AND EMOTIONAL HEALTH.
IN THEIR LITERATURE REVIEW, THEY
FOUND IT WAS CLEAR THAT LITTLE
UNIFORMITY CURRENTLY EXISTS IN
MEASURES USED TO CAPTURE
RESULTS.
THIS HINDERS NOT ONLY THE
ABILITY TO SHARE AND INTEGRATE
BUT ALSO TO INTERPRET RESULTS AS
I'M SURE ALL OF YOU KNOW.
SO WITH THE ENCOURAGE OF THE
THREE INSTITUTE DIRECTORS AND
STAFF AND NINDS AND NIMHD
CREATED A TOOL FOR ASSESSING FOR
THE NEUROSCIENCE RESEARCH.
THE SUPPORT FOR THIS CONCEPT WAS
UNANIMOUS AMONG THE INSTITUTE
AND CENTER DIRECTORS AND IN LATE
2006 A CONTRACT WAS ISSUED FOR
THE DEVELOPMENT OF WHAT IS NOW
KNOWN AS THE NIH TOOLBOX.
THE GOALS OF THE TOOLBOX WERE
CLEAR, TO MAXIMIZE THE YIELD
FROM OUR RESEARCH INVESTMENT,
BRIEF, MEASURES WERE NEEDED FOR
DATA COLLECTION AND ADVANCE OUR
KNOWLEDGE OF BRAIN HEALTH AND
NORMAL FUNCTION.
AND AT THE SAME TIME, WE WANTED
TO AVOID THE PITFALL OF WHAT
MANY PEOPLE GOING BEFORE HAD
DONE WHICH WAS RESORT TO THE USE
OF DIAGNOSTIC TOOLS AND
SCREENERS, MEASURES FOR DISORDER
AND DISEASE TO ASSESS HEALTHY
BEHAVIORAL PERFORMANCE.
SO WE WANTED TO PROVIDE
INDIVIDUALS WITH A MEANS WHICH
THEY NO LONGER NEEDED TO RESORT
TO THOSE TYPES OF MEASURES.
12 YEARS AFTER THE ROLLOUT OF
THE NIH TOOLBOX THEY'VE NOT ONLY
STOOD THE TEST OF TIME BUT
EVOLVED TO KEEP THE MEASUREMENT
SYSTEM DYNAMIC AND ABLE TO MEET
THE CHANGING DEMANDS OF
ASSESSMENT AND PROVIDING
CONTINUITY AND COMPARISON OF
DATA.
SO WITH US TODAY TO DESCRIBE THE
DEVELOPMENT AND FEATURES OF THE
NIH TOOLBOX IS DR. RICHARD
GERSHON VICE CHAIR OF RESEARCH
AND PROFESSOR OF THE DEPARTMENT
OF MEDICAL AND SOCIAL SCIENCES
AND PROFESSOR IN PREVENTIVE
MEDICINE, HEALTH AND BIO MEDICAL
INFORMATICS AT THE NORTHWESTERN
UNIVERSITY FEINBERG SCHOOL OF
MEDICINE AND SERVED AS THE
PRINCIPLE INVESTIGATOR FOR THE
CONTRACT TO DEVELOP THE TOOLBOX.
DR. GERSHON.
>> THANK YOU, SO MUCH, MOLLY.
IT'S A PLEASURE BEING HERE.
LOTS OF THES TOWARDS THE END AND
OTHER PLACE TO THANK PEOPLE.
THE 15 INSTITUTES AND CENTERS
FORMED THIS COALITION THE
BLUEPRINT FOR NEUROSCIENCE
RESEARCH.
THE CONTRACT WAS AWARDED TO
NORTHWESTERN.
WE GOT TOGETHER WITH 250 FRIENDS
FROM AROUND THE WORLD IN 80
ACADEMIC INSTITUTIONS TO BE A
WORLDWIDE EFFORT TO DETERMINE
WHAT WE WANTED TO HAVE AND PUT
THE BEST OF PEOPLE FROM AROUND
THE WORLD DEVELOPING THE
INDIVIDUAL MEASURES AND WE
RELEASED ORIGINALLY IN 2012 AT A
MEETING SIMILAR TO THIS AT THE
NEUROSCIENCE CENTER AND THEN
CLOSE TO 10 YEARS LATER, WE
RELEASED VERSION 3 OF THE
TOOLBOX WHICH WAS FULLY UPDATED
AND WE'LL TALK ABOUT THAT IN A
FEW MINUTES.
ORIGINALLY WHEN THE BLUEPRINT
GOT TOGETHER I THINK THERE WAS
THOUGHT WE SHOULDN'T BE
ASSESSING COGNITION WITHOUT
EMOTION AND THERE'S TWO MEANINGS
OF THE WORLD WORD DE
PRESENTATION AND DEPRESSION
DEPRESSES COGNITIVE FUNCTIONING
AND MOTOR WAS ADDED AND WANTED
TO ADD MEASURES.
WE WANTED THINGS TO BE FAMILIAR
TO THE RESEARCH COMMUNITY.
WE WANTED TO AVOID DUPLICATION
OF EFFORT.
WE WOULD DEVELOP NOVEL MEASURES
WHERE NEEDED AND HAVE APPROACHES
AND METHODS.
SO THE FIRST THING WE DID I
THINK WALTER WENT THROUGH AND
DID AN EXPERT SURVEY OF
SELECTION CRITERIA AND WHAT DID
PEOPLE WANT AND HOW LONG DID
PEOPLE WANT TO TEST.
WHAT WERE THE CHARACTERISTICS OF
THE MEASUREMENT AND THEN HAD
FOCUS GROUP INTERVIEWS WITH
PATIENTS, EXPERT INTERVIEWS WITH
PEOPLE WHO HAD USED THE SYSTEM
AND WE DID SURVEYS I THINK 200
PEOPLE TO NOMINATE RANK SUB
DOMAINS AND CONSTRUCTS AND HOW
MUCH WOULD PEOPLE BE WILLING TO
PAY AND HOW LONG WOULD THEY TAKE
TO DO IT.
I THINK TIME CONSTRAINTS ARE
PROBABLY THE NUMBER ONE GUIDANCE
FOR HOW YOU DEVELOP AND PICK A
MEASURE.
WE HAD A CONSENSUS MEETING AND
HAD INSTRUMENT TO INCLUDE IN THE
TOOLBOX.
WE BROKE NA A LOT OF WORKING
TEAMS.
WE HAD NINE DOMAIN TEAMS AND
OTHER WORKING TEAMS AND SPANISH
LANGUAGE AND MULTI-CULTURAL AND
SCORING AND ACCESSIBILITY.
THEY WERE INVOLVED IN THE TEAM'S
CROSS MET TO MAKE SURE THEY WERE
ACROSS AGES 3 TO 85 IS QUITE THE
RANGE.
IT BRINGS US TO TODAY WHERE THE
TOOLBOX IS IN USE IN OVER 1100
IS ITS ON iPADS AND 40 DIFFERENT
COUNTRIES.
AND V3 WE CHANGED HOW THIS
WORKS.
AS AN UPDATE FOR THOSE WHO
HAVEN'T USED THE TOOLBOX IT'S
USEFUL FOR AN UNLIMITED OF
ADMINISTRATIONS AND 50 TESTS
THAT MAKE UP THE TOOLBOX ARE
THERE.
MOST TEST UNDER SEVEN MINUTES.
MANY ARE NOW UNDER 40 SECONDS
AND GET CLINICAL, RELIABILITY IN
CERTAIN AREAS IN 40 SECONDS.
IT'S OFFLINE, WE RENORMED IT FOR
AGES 3 TO 85.
WE'LL TALK ABOUT THAT LATER IN
SESSIONS TODAY.
FLEXIBLE TEST ADMINISTRATION AND
EVERYTHING'S AUTOMATICALLY
SCORED BY THE TIME IT'S OVER.
I'D LIKE TO SPEND TWO HOURS ON
THIS SLIGHT AND I'LL SPEND 30
SECONDS OR A MINUTE BUT THE NIH
TOOLBOX COVERS FOUR DIFFERENT
AREAS, COGNITION, WHICH IS THE
MOST WIDELY USED BATTERY WE
HAVE.
FOLLOWED BY EMOTION WHICH HAS A
SERIES OF MEASURES PEOPLE USE
FOR VARIOUS STUDIES AND HAVE A
VERY RICH MOTOR BATTERY USED
NOWHERE NEAR AS MUCH BUT SPENT
TIME COMING UP WITH MOTOR
FUNCTIONS AND WE HAVE ALL THESE
MEASURES.
AND I'LL SPEND TIME ON THE
COGNITION TEST.
EVERYTHING WE DID WE DECIDED
IT'S A TRADITION IN NEURAL
ASSESSMENT TO UP DATE AND REFORM
TESTS EVERY 10 YEARS.
THE LAST THREE OR FOUR YEARS WE
UPDATED THE TEST AND WENT
THROUGH THE SAMPLE SIZE.
AS A REFRESHER IT'S ONLY
AVAILABLE FOR USE ON THE iPAD.
WHEN I FIRST SAW AN iPAD I
THOUGHT MY GOODNESS IF I
STRUCTURE AND WRITE DOWN WHAT
FEATURES WE'D WANT IN A HARDWARE
DEVICE FOR TESTING THE iPAD WAS
IT.
IT'S A SOLID DEVICE AND MACHINED
FROM A SINGLE PIECE OF ALUMINUM.
IT'S STRONG, IT HAS NEURAL PSYCH
CALVERT TIMERS AND NEW FEATURES
WE'RE ABLE TO TAKE ADVANTAGE OF
BUT OUR TESTS ARE HEAR AND I'LL
EXPLAIN LATER AND WE UPDATED THE
ORAL SYMBOL DIGIT TEST AND
DIMENSIONAL CHANGE AND APPEARS
TO THE TARGET AND AGES FOUR PLUS
AND FOR THE MOST PART THEY'RE
MORE SO USING ALMOST THE EXACT
SAME TESTS FOR 3-YEAR-OLDS AS
WE'RE USING FOR NOW WE
DEMONSTRATED THE MEASURES FOR
USE SUCH AS AGE 95 AND IT ALLOWS
FOR VERY EASY COMPARISONS OF
SCORES AND YOU CAN WATCH
DEVELOPMENT TRAJECTORIES.
IN SOME CASES WE BROUGHT THE
OLDER VERSIONS OF THE TEST DOWN
TO KITS AND WE TOOK THE
THREE-YEAR-OLD VERSION AND NOW
75-YEAR-OLD USING IT.
AND THERE'S STARTING POINTS
DEPENDING ON AGE AND
AVAILABILITY.
AND THERE'S VARIOUS STANDARDS
TESTS OF FUNCTION.
THIS TEST IMPROVED ALL OF OUR
TIME TESTS AND IMPROVED IN V3
BECAUSE THE SENSITIVITY OF THE
TIMER IN THE iPAD IS GREATER
THAN THE ORIGINAL HARDWARE WE
DID THIS ON.
SO WE'RE ABLE TO GET THE
EQUIVALENT OF TESTING WHERE
PEOPLE WERE FASTER THAN SOME OF
US HAD TIMERS THERE AND YOU
COULD PRESS A BUTTON AND GET
FANCY LEVEL TIMING AND THE iPAD
IS DOING THAT SO IT KNOWS
EXACTLY HOW MUCH TIME IT'S TAKEN
AND RECORDS IT WITH EACH ITEM.
THE WORKING MEMORY TEST.
ANOTHER TEST REVISED FOR USE IN
V3.
WE LEARNED OVER TIME WE THOUGHT
WE HAD WHOLE TEAMS THAT
CONCENTRATED ON DIVERSITY AND ON
CULTURAL EQUITY AND NOBODY
SEEMED TO CATCH 12 YEARS AGO A
BLUE BERRY IS AN UNKNOWN FRUIT
OUTSIDE THE UNITED STATES AND NO
ONE KNOWS WHAT SIZE IT IS.
SIMILARLY A PUMPKIN IN THE
UNITED STATES IS THIS BIG BUT IN
EUROPE IT'S THIS BIG AND THINGS
WE REMOVED FROM THE TOOLBOX TO
MAKE IT MORE APPLICABLE
WORLDWIDE.
AND WE HAVE A TEST THAT'S HIGHLY
SENSITIVE TO ASSESSING
ACCOUNTING IMPROVEMENT AND
COGNITIVE DECLINE AND THE
INCREASED IMPROVEMENT IN
SENSITIVITY OF THE TIMER.
WE LOWERED THE FLOOR AND RAISED
THE CEILING ON THESE TESTS.
AND OUR ORAL READING RECOGNITION
TEST CONTINUES TO BE A COMPUTER
ADAPTIVE TEST.
ZEROS IN ON A PERSON'S READING
ABILITY LEVEL IN A COUPLE
MINUTES.
AND OUR VOCABULARY INTELLIGENCE
TEST WE PADDED WORDS AT THE
LOWER END TO USE IT FOR THE BABY
TOOLBOX AS WELL SO WE EXTENDED
THE RANGE.
WE ADDED TEST SENSITIVE SCORES
AND CONTINUES TO BE A HIGHLY
SENSITIVE TEST OF
CRYSTALIZABILITY AND WE DIDN'T
JUST HAVE A DELAYED VERSION.
THIS WAS A SUPPLEMENTAL TEST IN
THE VERSION 3.
IT'S NOW BEEN UPDATED TO GIVE
THE ORIGINAL TEST AND USE IT
WHERE MANY USE IN CLINICAL
STUDIES.
THERE'S A NEW TEST WE'LL TALK
ABOUT LATER AND DEVELOPED BY
GRANTS OUTSIDE THE NIH TOOLBOX
THE LAST THREE YEARS WE ADDED AS
AN EXECUTIVE FUNCTIONING TEST
THAT'S MORE APPLICABLE IN THE 3
TO 6-YEAR-OLD RANK.
-- RANGE AND VISIBLE REASONING
TEST FOR AGES 4 AND UP.
THERE'S A CALL FOR VISUAL
REASONING ON SEVERAL STUDIES AND
WE ADDED IT IN.
THIS LOOKS SO NICE AND EASY BUT
IT'S ACTUALLY ONE OF OUR MORE
DIFFICULT TESTS AND WILL DO A
GOOD JOB OF ASSETING GIFTINESS
EVEN THROUGH 8th GRADE.
AND BASED AND ASSOCIATION MEMORY
TEST FOR TEENS HAVE USED THE
TEST TO AS A DIGITAL BIOMEDICAL
TO ASSESS AMYLOID BUILD UP AND
IT'S AVAILABLE ON NUMEROUS
PLATFORMS AND DOREEN'S TEAM
HELPED AND WE'VE NOW ADDED IT TO
THE TOOLBOX AND I SHOULD PUT OUT
THE DEVELOPMENT OF THE ORIGINAL
NIH TOOLBOX WAS ONLY MEASURES
FOR 3 TO 85 WHICH LEFT SOME
SHALL WE SAY LIGHT AT THE
YOUNGEST AGES BECAUSE WE NEEDED
TESTS THAT WE HAD IN ADULTHOOD
AND AT THE UPPER AGE THE
CONSTRUCTS WEREN'T NEEDED
YOUNGER SO INVERSION 3 WE ADDED
MEASURES OF BOTH ENDS OF THE
SPECTRUM.
I COULD SPEND ONE SLIGHT ON EACH
OF THESE AREAS BUT THIS IS
EMOTIONAL DOMAIN FRAMEWORK.
UNDER D3 WE RELEASED THE TESTS
AS FOUR ITEM TEST CLINICAL
RELIABILITY IN THE CLINICAL
RANGE OF INTEREST FOR ALL THESE
TESTS ITEMS 35, 40 SECONDS USING
COMPUTER TEST.
THERE'S SEPARATE TESTS.
THEY'RE SEPARATELY AVAILABLE AT
ANY RED CAP INSTALLATIONS AROUND
THE WORLD.
MOTOR DOMAIN TEST WE DEVELOPED
GRIP TEST STRENGTH AND THEY
REALIZED STAND AND BALANCE TEST
I THINK IS ONE OF THE NEATEST
THINGS WE'VE DONE.
WE DESIGN IT FOR USE WITH AN
iPOD WHICH YOU CAN NO LONGER BUY
AND WE MOVED IT TO THE iPHONE
AND CAN DEVELOP A HIGHLY PRECISE
MEASURE OF BALANCE, SIX, SEVEN
MINUTES.
AND THEN THE TWO-MINUTE TEST
WHICH WAS JUST -- DEVELOPED BY
PEOPLE WHEN USE THE SIX-MINUTE
WALK TEST BUT IN THE EFFORT TO
DECREASE BURDEN WE HAVE
CORRELATION WITH THE 90s IN THE
FOUR METER WALK GAIT TEST AS
WELL.
IN THE SENSATION DOMAIN, WORD OF
NOISE TEST AND AFTER MANY YEARS
WE'VE COME UP AND VALIDATED NEW
TESTS TO INCLUDE THAT AND WE SAW
IDENTIFICATION TESTS WHICH
BECAME POPULAR EARLY IN COVID
WHEN IT WAS THOUGHT THE ONLY WAY
TO GET TEAM BACK TO WORK WAS TO
DETERMINE IF PEOPLE REGAINED
THEIR SENSE OF SMELL AS A WAY OF
DETECTING COVID AND THE SAME
TEST PEOPLE IN THE DEVELOPMENT
TEAM WHO DEVELOPED THE 30 AND
40-DOLLAR TESTS AND THE CARDS
WERE ABOUT $2.50 EARLY IN COVID
AND A GOT A CALL ABOUT WHAT
WOULD IT BE FOR 30 MILLION AND
FOR VISUAL ACUITY WE HAD A
DISTANCE ACUITY TEST AND
RECENTLY ADDED AND TURNS OUT A
LOT OF PEOPLE HAD LESS
PRESCRIPTION SO WE'RE MEASURING
THE COGNITIVE END BUT THEY CAN'T
FOCUS ON THE SCREEN IN FRONT OF
THEM AND THE OTHER TWO
SENSATIONAL DOMAIN TESTS ARE
PAIN INTENSITY SURVEY AND D3
WILL HAVE A GROWING NUMBER OF
COMPOSITE SCORES AND TOTAL
COGNITION COMPOSITE AND THESE
COMPOSITE SCORES SCORE HIGHLY
WITH THE IT VERSION 2 TEST.
SOME OF THE UNDERLYING TESTS WE
IMPROVED -- APPROVED THE TEST
THAT DOESN'T CORRELATE AS WELL
WITH THE OLD TESTS AND LOWERING
THE FLOOR AND RAISING THE
CEILING DON'T CORRELATE AND IT'S
STILL A BETTER TEST AND THE
COMPOSITE'S STILL THERE AND AGES
4 TO 6 COMPOSITE MADE OF A
SHORTER BATTERY.
OUR TRANSLATIONS PERSON DIDN'T
SHOW UP BUT WE CURRENTLY HAVE
FOR VERSION 3 SPANISH ARABIC,
HEBREW, FRENCH AND ITALIAN.
INVERSION 2 WE HAVE SAUDI ARABIA
AND SPANISH AND FRENCH AND
ITALIAN AND WE'RE AWARE PEOPLE
AND PEOPLE ARE USING THE TOOLBOX
WITH THE SOUND TURNED OFF IN
STUDIES AROUND THE WORLD AND
WE'RE TRYING TO ADD LANGUAGE
VERSIONS.
AND FOR THE MOST PART VERY EARLY
INDEBTED TO THE PHARMACEUTICAL
INDUSTRY WHO USE THE TOOLBOX IN
PLACES THROUGHOUT EUROPE TO HAVE
NORMATIVE VALUES.
SO V3 NORMING AND VALIDATION
CLOSE TO 4,000 INDIVIDUALS TOOK
PLACE A YEAR AND A HALF AGO AND
1700 ADULTS AND AND WHILE
THERE'S BEEN HUNDREDS OF
CLINICAL STUDIES WITH THE NIH
TOOLBOX WE THOUGHT TO BRING V3
OUT WE SHOULD CONDUCT STUDIES SO
WE DON'T WAIT FOR THE COMMUNITY
TO DO THAT AND DID THAT IN ADHD
AND LEARNING DISABILITIES IN
LEARNING AND CONCUSSION AND DID
STUDIES COMPARING V2 TO V3 AND
IT WOULD COME OUT FULLY USABLE
AND READY FOR USE.
IN THE PUBLICATIONS DEPARTMENT,
350 PLUS VALIDATION STUDIES.
I WAS ASKED TO SPEAK ABOUT SIX,
SEVEN YEARS AGO, SOMEBODY SAID
COULD YOU SPEAK ABOUT THE
CLINICAL USES AND CLINICAL
VALIDATIONS OF THE TOOLBOX AND A
SAID SURE AND I TURNED TO A
STUDENT AND SAID DO WE HAVE ANY
AND TURNED OUT WE HAD 250 AND WE
USED THEM FOR SMALL STUDIES
INTERNALLY BUT DIFFERENT
SUBPOPULATIONS GET THAT AND AS
DR. KOROSHETZ POINTED OUT WE'RE
IN A LOT OF CLINICAL TRIALS.
THE JOURNAL ARTICLES ARE HALF OF
WHAT'S OUT AND AVAILABLE.
VALIDATION STUDIES IN THE
LITERATURE, I THINK THIS IS
AMAZING.
THESE ARE NOT OURS -- I HAVE
ANOTHER SLIDE ON NEUROLOGICAL
AND PSYCHOLOGICAL DISORDERS AND
ADULT AND PEDIATRIC CANCER AND
TRACKING A CHILD RECOVERING FROM
CANCER IS BROUGHT IN ANNUALLY TO
SEE HAS THEIR COGNITIVE
FUNCTIONING BEEN IMPACTED AND
CARDIOVASCULAR DISEASE AND AUTO
IMMUNE IT'S ACROSS THE GAMUT OF
SCIENTIFIC AREAS AND THE NEURAL
AREA AND EARLY STAGE ALZHEIMER'S
DISEASE AND PARKINSON'S DISEASE,
ALL OVER.
I'VE BEEN COUNTING -- I ALMOST
BROUGHT ANOTHER ARTICLE
PUBLISHED THIS MORNING WE'RE
RUNNING AN ARTICLE AND THREE TO
FOUR A WEEK AT THIS POINT OF
STUDIES USING THE NIH TOOLBOX.
DEVELOPED DURING COVID AND I PUT
LIMITED RELEASE BECAUSE WE'RE
NOT QUITE SURE HOW WIDELY WE
WANT TO SUPPORT THIS BUT WE
NEEDED SOMETHING THAT WOULD
MAINTAIN THE RELIABILITY AND
VALIDITY OF THE TOOLBOX DURING
COVID AND THE CHILD HEALTH
OUTCOMES ECHO STUDY.
WE CREATED A VERSION WHERE YOU
CAN SEE THE PARTICIPANT AND GET
AN iPAD TO THE PARTICIPANT AND
YOU CAN TALK THROUGH THE -- WE
TRIED ZOOM EARLY ON.
THERE'S DELAYS, WE SENT OUT AN
iPAD TO A SUBJECT AND THEY CAN
SEE THE TEST ADMINISTRATOR AND
THEY CAN SEE THEM.
WE LOSE NONE OF THE RELIABILITY
AND THE RESULTS ARE COMMUNICATED
BACK IN REAL TIME TO THE TEST
ADMINISTRATORS iPAD AND THERE'S
NO DATA FLOW AND NIH.org HAS
BEEN OUR WEBSITE FOR A LONG
TIME.
WE HAVE A NEW WEBSITE AND THANKS
TO MANY IN THE ROOM.
THIS IS REALLY THE ADDRESS TO
LEARN ABOUT ALL THE TESTING
SYSTEMS THOUGH THE NIH TOOLBOX
IS THE MOST DEEPLY EMBEDDED AND
TRAINING HOW TO GET THE APP AND
DESCRIPTIONS OF THE MEASURES.
SO THERE'S CURATED CONTENT AND
COMPOSITE SCORES, ETCETERA.
YOU CAN FIND PUBLICATIONS THOUGH
WE'RE TRYING TO LIST ALL OF THEM
AND THEY'RE COMING OUT SO FAST.
GOOGLE IS STILL A GOOD RESOURCE.
WE HAVE WHAT PAPERS AND ALL THE
TRAINING VIDEOS, E-LEARNING,
ETCETERA.
ALL THE FAQs WE ADDED IN
ARTIFICIAL INTELLIGENCE CHAT BOX
AND SEND IN A QUESTION, IF YOU
CAN'T FIND THE ANSWER WE'LL TELL
YOU WHAT THE ANSWER LIKELY IS
AND WHAT I HEAR A HUNDRED TIMES
IN THE LAST FEW MONTHS IS YOU
DIDN'T HAVE TO WAIT FOR SOMEBODY
TO GET BACK TO YOU AND IF SO WE
HAVE SOMEONE TO SEND YOU AN
E-MAIL BACK.
I'D LIKE TO THANK THE ORIGINAL
PROJECT OFFICER TEAM.
SEVERAL HAVE COME BACK AND SOME
HAVE MOVED ON TO OTHER
INSTITUTES AND IT'S A VERY LARGE
TEAM FROM THE NIH THAT
PARTICIPATED IN THE ORIGINAL NIH
TOOLBOX AND MANY STILL CHECK IN
ON A REGULAR BASIS.
CURRENT SCIENTIFIC REVIEW BOARD
AND IN THE INTEREST OF TIME I
WON'T READ ALL THE TIMES BUT
PEOPLE ARE KEEPING US HONEST AND
CHECK IN ON WHAT WE'RE DOING.
THE V3 DEVELOPMENT TEAM.
I REALIZE THE ORIGINAL TEAM WAS
250 SOME ODD PEOPLE.
I THINK WE'RE ROLLING NAMES AND
THANK YOUS TO EVERYBODY ON THE
MEASUREMENT SYSTEMS OVER THE
LUNCH HOUR.
WON'T EAT LUNCH IF YOU SEE EVERY
SINGLE NAME SCROLL BY BUT THE
EFFORTS TAKE A LOT OF EFFORTS
AND MY PERSONAL THANKS TO
EVERYBODY WHO HAS DONE THIS.
IT'S NOT A RICHARD GERSHON
EFFORT IT'S A LOT OF PEOPLE
EFFORT AND THANK YOU VERY MUCH.
>> GOOD MORNING.
I'M HERE TO INTRODUCE DR. MIKE
WOLF TO TALK ABOUT THE
DEVELOPMENT AND FEATURES OF THE
MY COG PROGRAM OF THE NIH
TOOLBOX.
BEFORE TURNING THE STAGE OVER
MIKE I'LL START WITH A BIT OF
CONTEXT.
THE EARLY DETECTION HAS BEEN
SEEN AS A HEALTH CARE PRIORITY
IN THE UNITED STATES.
DETECTING COGNITIVE IMPAIRMENT
IS A REQUIRED COMPONENT OF THE
WELLNESS VISIT AND A NUMBER OF
ASSESSMENT TOOLS ARE ALREADY
READILY AVAILABLE.
HOWEVER, DESPITE THE
AVAILABILITY OF TOOLS, COGNITIVE
IMPAIRMENT REMAIN UNDER
RECOGNIZED AND DIAGNOSED.
THE REASONS ARE MULTIFACTORIAL
AND ONE BARRIER HAS BEEN THE
ABILITY TO INTEGRATE THE
COGNITIVE ASSESSMENT IN THE
PRIMARY HEALTH CARE WORK FLOW
AND ELECTRONIC HEALTH RECORD.
IN 2017 IN DIRECT RESPONSE TO
ALZHEIMER'S DISEASE RELATED
DEMENTIA MILESTONES TO ADDRESS
ALZHEIMER'S DISEASE FOR
DEMENTIAS AND HEALTH
DISPARITIES, NIH ISSUED A
OPPORTUNITY CALLING FOR THE
CREATION OF A RESEARCH
CONSORTIUM TO ESTABLISH TEST AND
VALIDATE PAIR TIMES FOR
DETECTING COGNITIVE IMPAIRMENT
IN DEMENTIA WHEN A PATIENT,
RELATIVE OR CARE PROVIDER
INDICATES CONCERN IN A PRIMARY
CARE SETTING AND EVERYDAY FORMS
OF CLINICAL PRACTICE.
THE VALIDATION OF MY COG WAS ONE
OF THREE AWARDS AS PART OF THE
DETECT CID CONSORTIUM AND IT'S
IN ITS SECOND CYCLE AND BEING
EVALUATED AS A PART OF A
PRAGMATIC CLINICAL TRIAL IN
DETECTING COGNITIVE IMPAIRMENT
IN DEMENTIA IN THOSE IN A
NETWORK OF CLINICS THAT SERVE
PATIENTS OF DIVERSE BACKGROUND
AND NOW DR. WOLF AND THE
DIRECTOR OF THE INSTITUTE FOR
PUBLIC HEALTH AND MEDICINE AT
THE CENTER FOR APPLIED RESEARCH
ON AGING.
HE'LL TELL YOU MORE AND HOW WE
GOT TO WHERE WE ARE TODAY.
THANK YOU.
>> GOOD MORNING.
AS SAID I'LL PRESENT ON MY COG
WE'VE BEEN WORKING ON SINCE
2017.
FIRST, I WAS GOING TO TALK ABOUT
MY COG STORY AND HU -- HOW
WE'RE RESPONDING AND IS THE
SUMMIT NINDS PUT ON FOR SOME
TIME THE WORK CITED IS WHAT MY
COG IS ONE OF THE THREE AWARDS
WE'RE TRYING TO TACKLE IN
UNDRESSING THE PUBLIC HEALTH
PRIORITY AND LEADING TO PRIORITY
ONE FOR THE ETIOLOGIES DEMENTIA
SUBCOMMITTEE FOCUSSED ON
PRAGMATIC APPROACHES TO DETECT
COGNITIVE IMPARENT AND LINKING
TO CARE -- IMPAIRMENT AND
LINKING TO CARE AND WHEN THERE'S
A REPORT OF COGNITIVE FUNCTIONS
IT'S A TOP PRIORITY ISSUED SINCE
2016 AND CONTINUES TO THE MOST
RECENT VERSION OF THE SUMMIT IN
2022.
AND THAT LED TO THE CONSORTIUM
THAT REBECCA AND NINDS HAVE LED
AND WE'VE BEEN FORTUNATE TO BE A
PART OF SINCE 2017 WHEN IT GOT
KICKED OFF AND DETECTS THE
CONSORTIA FOR DETECTION OF
DEMENTIA HAS BEEN A PARTNERSHIP
WITH OUR COLLEAGUES AND
OURSELVES IN TERMS OF EINSTEIN
AND UCSF.
I WANT TO HIGHLIGHT THE GREAT
WORK THEY'RE ALL DOING AS WELL.
THE JUSTIFICATION FOR THE
CONSORTIUM IS WE NEED TO FOCUS
ON MOBILIZING PRIMARY CARE
SETTINGS BECAUSE THEY'RE WELL
POSITIONED TO DETECT COGNITIVE
DECLINE AND PRACTICES INCREDIBLY
BUSY THAT HAVE LOTS OF TARGETS
ON THEIR BACK IN TERMS OF WHAT
ELSE CAN WE BE DOING TO CAPTURE
NOT JUST COGNITIVE DECLINE BUT
OTHER FACTORS SINCE THEY'RE ON
THE FRONT LINES AND THE FOCUS
HAS BEEN JUSTIFIED THAT THERE'S
DESPITE THE OPPORTUNITIES OF THE
ANNUAL WELLNESS VISIT AND WE
HAVE PATIENTS COMING IN AND
WHERE THERE'S A COGNITIVE
ASSESSMENT SINCE 2011 REQUIRED
TO BE INCLUDE IN THAT VISIT.
WHAT WE DO KNOW IS PHYSICIANS
FAIL TO RECOGNIZE COGNITIVE
DECLINE AND SOME ARE MISSED
DURING THE VISITS AND THE ROOT
CAUSES AS YOU'D EXPECT ARE MANY
INCLUDING MORE IMPORTANTLY
RESOURCE AND TIME CONSTRAINTS WE
HEARD QUITE A BIT ABOUT AND LACK
OF TRAINING ON COGNITIVE
IMPAIRMENT AND LIMITATIONS OF
ASSESSMENTS IN THE PRESENCE OF
COMORBIDITIES AND HOW THAT PLAYS
INTO IT.
I WILL SAY DURING THE PAST
SEVERAL YEARS WORKING ON THE
PROJECT WE ARE TALKED TO SO MANY
PRIMARY CARE PHYSICIANS AND ONE
THING I THOUGHT WAS INTERESTING
WAS MINI COG AS OTHER TESTS
COMMONLY USED IN THE PRACTICE
AND THE ONE THING WE HEARD FROM
MANY PHYSICIANS IS AS PATIENTS
LEAVE ANNUAL WELLNESS VISITS AND
WHAT THEY FIND THEM DOING IN THE
WAITING AREA IS WHISPERING THE
RECALL WORDS TO THE PATIENTS
WAITING.
THE NOTION OF CHEATING ON THE
COGNITIVE ASSESSMENT WAS NEW TO
ME DURING THIS PROCESS.
THERE'S A NEED FOR BRIEFLY
ADMINISTRATABLE TOOLS WITH TURN
KEY RECOMMENDATIONS THE LINK TO
QUALITY CARE THAT IMPORTANT FOR
ENSURING FOLLOW-UP AND CARE
MANAGEMENT.
FROM OUR COLLEGIATE USF AND
THERE WAS A GREAT PAPER THAT
HIGHLIGHTS THERE'S A MAJOR
EMPHASIS TO NOT FURTHER DRIVE
HEALTH INEQUITIES AND THERE'S
DATA FROM CALIFORNIA THAT
SHOWING ASIAN, BLACK AND LATINO
RESULT LESS LIKELY TO RECEIVE A
TIMELY DIAGNOSIS AND ELDERLY
FEWER EVALUATION ELEMENTS.
THE IDEA THAT WHEN WE THINK
ABOUT THE CONSORTIUM AND THE
WORK WE'RE DOING WE WANT TO
FOCUS ON HEALTH DISPARATE
POPULATIONS IS KEY AS WELL.
THERE'S BEEN THREE PROGRAMS
MENTIONED INCLUDING
NORTHWESTERN'S WITH THE GOAL TO
INCREASE THE QUALITY OF PATIENT
EVALUATION FOR DETECTING
IMPAIRMENT AND DEMENTIA IN
EVERYDAY CLINICAL SETTINGS THINK
ABOUT AMBULATORY TOOLS AND
BETTER IDENTIFY PATIENTS AT AN
EARLIER STAGE OF DISEASE IS
IMPORTANT AND ADDRESSING
BARRIERS TO DETECTING IMPAIRMENT
AND FIDELITY IS HIGHLIGHTED.
I'LL HIGHLIGHT SOME OF THE
ISSUES RIGHT NOW IN TERMS OF THE
THREE SITES.
I WANT TO ACKNOWLEDGE EINSTEIN
AND UCSF AND AT NORTHWESTERN WE
HAVE TWO SPECIFIC ASSESSMENTS
SEQUENCE OF MEMORY AND
DEMENTIONAL CARD SCORE AND
SELF-ADMINISTRATION.
THE INTERESTING THINGS ABOUT
THAT IS EXCITING IS THERE'S DATA
HARMONIZATION OF OUTCOME
MEASURES.
WE CAN LOOK ACROSS THE DIFFERENT
PLATFORMS OF OUR TOOLS NOT JUST
MY COG BUT WHAT OTHER
CIRCUMSTANCES AND A PARADIGM OF
BEING MORE EFFICIENT THAN
ANOTHER.
THESE ARE THE MEASURE OF
FUNCTION AND EPISODIC MEMORY AND
BEST TO HAVE DETECTION OF
DEMENTIA AND FACTORING IN A
TARGET AROUND MCI.
THEN THINKING ABOUT THE FEATURES
AND IF WE HAVE AN OPPORTUNITY TO
THINK ABOUT NEW TESTS, THERE'S
ALREADY MANY SHORT ABBREVIATED
SCREENERS OUT THERE SO WHY
ANOTHER TEST.
A LOT OF THE WORK EARLY ON WAS
SPENDING TIME ON ITERATIVE
DESIGN THINK WHAT COULD BE
BETTER, HOW COULD THINGS WORK
EFFICIENTLY FOR INCORPORATING
TESTS THAT MAY TAKE SOMETHING AS
BRIEF AS A MINI COG ASSESSMENT.
THIS WAS A USER CENTER ITERATIVE
DESIGN APPROACHED INVOLVED
CLINICIANS AND ADMINISTRATORS
AND PATIENTS FAMILIAR IN WORKING
IN PRIMARY CARE CENTERS WORKING
WITH FEDERALLY QUALIFIED HEALTH
CENTER NETWORKS IN THE GREATER
CHICAGO AREA AND ELSEWHERE.
AS IT'S iPAD BASED AND MANY
PRACTICES WE'RE WORKING IN
ESPECIALLY FEDERALLY QUALIFIED
DON'T HAVE iPADS SO THINKING HOW
NEW TECHNOLOGY CAN FIT IN THE
MIX AND HOW IT COULD STREAMLINE
THEIR PRACTICES AND BE A BENEFIT
IS IMPORTANT.
A LOT OF OUR CLINICIANS WE'VE
BEEN TALKING WITH IN THE PAST
DECADE ABOUT HOW DO YOU -- THE
OPPORTUNITIES THERE FOR AN iPAD
NOT JUST FOR MAYBE A COGNITIVE
ASSESSMENT BUT THINKING OF
MEDICATION RECONCILIATION AND
OTHER TOOLS.
THERE WAS INTEREST IN FINDING
WAYS TO EMBED THE TECHNOLOGY
INTO THEIR PRACTICE.
AGAIN WITH CERTAIN CAVEATS.
AND WE HEARD A LOT OVER AND OVER
AGAIN ABOUT HOW THIS COULD BE
INCLUDING MY COG IN THE iPAD
COULD BE OF GREAT VALUE AND
UTILITY IF IT COULD BE
SELF-ADMINISTERED.
I THINK I'D DEFINITELY GIVE A
LOT OF SHOUT OUT TO RICHARD FOR
PUSHING US TO THINK ABOUT THIS
AS SOMETHING THAT IF IT'S NOT
GOING TO WORK AS AN INTERVIEWER
OR COGNITIVE ASSESSMENT IT NEEDS
TO BE SELF-ADMINISTERED WE NEED
TO TAKE THE TIME TO PIVOT WHICH
WHICH WE DID.
IT WAS MEANT TO BE DEFINED TO
AVOID MANUAL DATA COLLECTION
FROM AN ASSESSMENT AND EVEN IF
IT'S A FEW MINUTES LONGER THAN
CURRENTLY IN PRACTICE WITH THE
CURRENT STANDARD OF CARE.
THE IDEA WE COULD SAVE TIME BY
TETHERING IT TO THE ELECTRONIC
HEALTH RECORD AND COMMUNICATE
WITH THE ELECTRONIC HEALTH
RECORD AND HOW TO DO THAT.
WE SPENT A GREAT AMOUNT OF TIME
IN THE NORTHWESTERN TEAMS WHO
ARE HERE AND I'M HOPING WE'LL BE
ABLE TO MEET WITH THEM LATER AS
THEY GIVE A DEEPER DIVE INTO MY
COG AND SHARE THE INCREDIBLY
DIFFICULT AND CHALLENGING WORK
TO MAKE THAT HAPPEN AND
SUCCESSFULLY AS IT HAS BEEN.
THE WAY IT WORKS RIGHT NOW WITH
MY COG IT COMMUNICATES TO THE
E.H.R. THROUGH A BAR OF QR CODE
AND THAT ALLOWS THE iPAD AND
ASSESSMENT WHICH CANNOT MAINTAIN
PRIVATE INFORMATION IN DATA
AFTER THE ASSESSMENT IS
PERFORMED CAN SHARE AND IDENTIFY
AND DROP OFF THE INFORMATION
EXACTLY WHERE IT NEEDS TO FOR
THE PATIENT.
IT AUTO POPULATED RESULTS WITH A
RED LIGHT/GREEN LIGHT WITH
COGNITIVE IMPAIRMENT AND AN EASY
APPROACH TO DETERMINE
EFFICIENTLY.
AND AGAIN WE ALSO DON'T WANT TO
PROVIDE THE TEST RESULT WITHOUT
ALSO OFFERING CLINIC TAILORED
TURN KEY RECOMMENDATIONS IN A
BEST PRACTICE ALERT THAT CAN
LINK TO A LIST OF ALL OF THE
GUIDANCE IN TERMS OF WHAT'S
NEXT.
YOU HAVE TO IDENTIFY THE
COGNITIVE IMPAIRMENT AND THINK
ABOUT EVERYTHING ABOUT
REVERSIBLE CAUSES OR LABS OR
IMAGING AS A RESULT AND WHAT
OTHER TYPES OF REFERRALS WOULD
YOU MAKE BEYOND NEURO PSYCH OR
NEUROLOGY.
WE'VE BEEN DOING WORK WITH CARE
COORDINATION AT OUR HEALTH CARE
SYSTEM.
AND ANOTHER THING RICHARD
HIGHLIGHTED WHEN WE SAW THE
OPPORTUNITY TO WORK WITH MY COG
IN THIS SPACE WAS THINK OF THE
VALUE OVER CURRENT COGNITIVE
SCREENERS AND LOOKING AT NOT
JUST NORMS OF DECLINE BUT
RELATIVE DECLINE BY GETTING A
PATIENT'S BASELINE DROPPED IN
AND THERE ARE FEATURES ALREADY
BASICALLY ENDEMIC TO ELECTRONIC
ELECTRONIC HEALTH RECORDS THAT
ARE LIKE FLOW SHEET AND YOU CAN
TRACK PERFORMANCE LIKE WELLNESS
VISITS AND MAYBE A PATIENT IS
STARTING AT A HIGHER PLACE LIKE
HIGHER EDUCATED AND REPORTING
AND YOU'LL SEE A DROP BECAUSE IT
FALLS WITHIN THE NORMATIVE RANGE
OF THE TEST.
HERE'S SNAP SHOTS OF OUR OWN
ELECTRONIC HEALTH RECORD OF WHAT
THE TESTS WOULD LOOK LIKE AND
TALKING WITH CLINICIANS.
WE WANTED TO MAKE SURE TO SHARE
AND IT WASN'T JUST GIVING THEM A
RED LIGHT GREEN LIGHT BUT
PROVIDE TEST SCORES FOR THE OVER
ALL SCORE AND FOR EACH
INDIVIDUAL SCORE AND WE'D GIVE A
THRESHOLD AS WELL.
CLINICIANS WILL SAY I WOULD WANT
TO KNOW IF THEY'RE ON THE
THRESHOLD AND MAYBE THEY'RE
HAVING A BAD DAY AND MAYBE I'LL
THINK TWICE BEFORE SENDING THEM
DOWN TO A NEURO PSYCH EVALUATION
AND MAYBE RECHECK TO HAVE THEM
COME BACK WITHIN A PERIOD OF
TIME TO RE-EVALUATE AND HAVE DID
CONFIDENCE IT'S INDICATIVE OF
IMPAIRMENT AND NEED TO TRIAGE
DIFFERENTLY.
THOSE VALUES ARE THERE.
AND WE HAVE CLINICAL TRIAL PRAG
MAT IG TRIAL UNDERWAY EVALUATING
PRACTICE TO SEE HOW IT WORKS.
THERE'S TWO WAYS TO TO IMAGINE
HOW YOU DEPLOY MY COG.
ONE IS THROUGH THE ANNUAL
WELLNESS VISIT AND THERE'S VALUE
ADD IN TERMS OF HAVING AN
ASSESSMENT IN PRIMARY CARE
HIGHLY SPECIFIC AND BEING
ATTENTIVE TO THE FACT OF A
GUIDANCE THAT'S COUNTER
INTUITIVE TO THE REQUIREMENT
SINCE 2011 TO DO COGNITIVE
ASSESSMENTS AND THERE'S CONCERN
FOR PSYCHOLOGICAL HARM IF YOU DO
SCREENING AND WE KNOW PATIENTS
WILL BE POTENTIALLY GETTING A
COGNITIVE ASSESSMENT SO WE DO
SUGGEST WE WOULD PUT MY COG IN
THAT MIX.
AND THEN FOR A RAW TEEN VISIT
ALSO AND AGAIN AS HIGHLIGHTED BY
THE ADRD SUMMIT RECOMMENDATIONS
THE PATIENT OR CARE PARTNER
REPORTS IS A WAY TO DEPLOY MY
COG.
IT DOES MEAN FROM AN ELECTRONIC
HEALTH RECORD STANDPOINT WE
LEARN THE NATURE OF THE VISIT IF
IT'S CODEDSS -- CODED AS AN
ANNUAL WELLNESS AND THE TOOL CAN
BE DEPLOYED AT ANY TIME A
CLINICIAN WOULD LIKE TO NOT JUST
WITH THE ANNUAL WELLNESS VISIT.
SO AGAIN IN THINKING ABOUT OUR
ONGOING STUDIES WITH MY COG WE
HAVE TWO PRAGMATIC TRIALS GOING
ON ONE FROM NIA AND ONE FROM
NINDS.
THE FIRST TRIAL WAS FOCUSSED ON
ACADEMIC PRACTICES WITH
REPLICATION SITES AND HAS 40
PRACTICES IN PLACE RIGHT NOW AND
THE MY COG TRIAL WHAT WE CALL
VERSION 2 IS FOCUSSING PRIMARILY
ON FEDERALLY QUALIFIED HEALTH
CENTERS SERVING LATINO AND BLACK
COMMUNITIES EXPERIENCING HEALTH
DISPARITIES IN ADRD.
SO THAT IS AGAIN FOCUSSING ON
WHERE WHAT WE HAVE BEEN ABLE TO
DO IS REBUILD THE PLATFORM FIRST
IN THE ELECTRONIC HEALTH RECORD
WHICH IS AN EXPENSIVE PRODUCT
FOR HEALTH CARE SYSTEM AND ALSO
ONE OF THE MORE WIDELY USED
PLATFORMS AND WE ACTUALLY WANTED
SPECIFICALLY WITH NINDS TRIAL DE
SHOW THE T LIGHTNING SCAN STRIKE
TWO AND'S NOT AGNOSTIC TO ONE
ELECTRONIC HEALTH RECORD FORM
AND WE WANTED TO MAKE SURE IT
WORKED EFFECTIVELY AND TAILORED
TO THE PLATFORM BY SHOWING IT
CAN GO TO GREEN WAY AND ANOTHER
GROUP CALL CANOPY AN ELECTRONIC
HEALTH RECORD AND USED IN THE
COMMUNITY HEALTH CENTER SETTING.
AND THERE'S RATES OF DETECTIVE
COGNITIVE IMPAIRMENT.
THE PROPORTION OF DETECTED CASE
ARE EARLY DETECTED CASES, MCI
AND FOR THE SPECIFIC FOR THE
PRAGMATIC TRIAL WE'RE LOOK
TOWING SEE -- LOOKING TO REDUCE
DISPARITIES WITHIN SITES.
AND SECONDARILY ARE RATES OF
REFERRALS AND DIAGNOSES AND
DETECT AND MACHINE LEARNING
LOOKING TO SEE THROUGH NATURAL
LANGUAGE PROCESSING IF CAREGIVER
INVOLVEMENT HAS BEEN INCREASED.
ALL THE OUTCOMES ARE EQUALLY
IMPORTANT IN THE CASE OF
PRAGMATIC TRIAL AND LOOKING AT
COST, WORK FLOW IMPACT AND
REFERRAL ACCEPTANCE.
I WANT TO GIVE A SHOUT OUT
SPECIFICALLY TO A LOT OF GREAT
WORK HERE AND AGAIN YOU'LL BE
ABLE TO HEAR MORE TODAY AND
TOMORROW ABOUT HOW AGAIN TRYING
TO MEET THE NEEDS OF THE DIVERSE
HEALTH CARE PRACTICES WE'RE
WORKING WITH.
AN EXTENSION OF MY COG HAS BEEN
MADE TO MY COG MOBILE.
TO HAVE A SMART PHONE VERSION
UNTHAT CAN GO UNPROCTORED AS
ANOTHER WAY TO ADDRESS GETTING
COGNITIVE ASSESSMENTS BEFORE A
VISIT.
RIGHT NOW WE SEE ABOUT IN OUR
OWN HEALTH CARE SYSTEM STARTED
OUT WITH ANNUAL WELLNESS VISITS
WHERE WE KNOW INCREASINGLY WANT
TO PUSH OUT ANYTHING THAT COULD
BE COMPLETE THE PATIENT BEFORE A
VISIT BECAUSE THE ANNUAL
WELLNESS VISITS ARE PACKED IN.
SO IF WE CAN DO ANYTHING TO
REDUCE THAT BURDEN THE BETTER
BUT ONLY ABOUT 20% OF ADULTS
OVER 65 WILL GO ON TO THE
PATIENT PORTAL AND COMPLETE AN
ASSESSMENT BEFORE HAND.
THE IDEA WE COULD DO THINGS ON A
SMART PHONE THAT WOULD BE
HELPFUL.
AND AGAIN A LOT OF WHAT WE'RE
TRYING TO CREATE IS REALLY A
COORDINATED SYSTEMS OF PRODUCTS
AROUND MY COG.
IF YOU CAN GET AS MANY PEOPLE
WILLING TO COMPLETE AN iPAD
BECAUSE THAT NUMBER OF LESS THAN
20% JUMPED UP FROM 42% WITH
INITIATIVES GOING ON.
SO THE MORE PEOPLE WE CAN BE
DOING ASSESSMENTS AHEAD OF TIME,
THE BETTER.
IF THOSE RESULTS ARE POPULATED
AND HAVE AN OPPORTUNITY FOR A
CLINICIAN TO EVEN LOOK AT AND
KNOW THAT THIS MIGHT BE
SOMETHING THAT HAS TO BE
DISCUSSED DURING THE VISIT AND
TARGETED IS ALL THE BETTER.
ALSO, HAVING THAT iPAD VERSION
STILL IN PLAY SO WHEN PATIENTS
DO COME IN AND HAVEN'T COMPLETED
IT BY PHONE OR FOR ANYTHING FOR
THAT MATTER, ANY
PATIENT-REPORTED OUT ASSESSMENT
HAVING THE iPADS IN THE PRACTICE
CAN BE A WAY TO GET AT THE
PATIENT'S IN THE OTHER MANNER IN
A MORE EFFECTIVE MEANS.
SO WHETHER IT BE PRE-VISIT OR
DOING MORE WORK TO ADDRESS
MULTIPLE LANGUAGES AND ANOTHER
ISSUE WE'VE SEEN MORE AND MORE
THERE OUR HEALTH CARE SYSTEM
PARTNERS TO MAKE SURE MY COG CAN
BE AVAILABLE IN ALL THE LANGUAGE
THEY NEED AND CONSIDERATIONS OF
OTHER TESTS THAT MIGHT WORK
BETTER ALSO ESPECIALLY ON THE MY
COG MOBILE VERSION TO INCREASE
THE ACCURACY OF THE TESTS ARE
ALL THINGS WE'RE WORKING ON
RIGHT NOW.
AND THANK YOU.
>> HELLO AGAIN.
THIS MORNING NAYS PLEASURE TO
INTRODUCE THE NEXT TALK AND NEXT
SPEAKER.
UNFORTUNATELY DR. MELISSA
TREVINO WHO WAS SUPPOSED TO
INTRODUCE THE NEXT TALK WASN'T
ABLE TO BE WITH US THIS MORNING
SO I HAVE THE HONORS.
IT'S MY PLEASURE TO INTRODUCE
THE MOBILE TOOLBOX IN OUR
SPEAKER, DR. DOREEN RENTZ.
THE NATIONAL INSTITUTE ON AGING
RECOGNIZED THE NEED FOR
INFRASTRUCTURE TO BE ABLE TO
MONITOR COGNITIVE ABILITIES VIA
MOBILE DEVICES.
MOBILE DEVICE ADMINISTRATION HAS
MANY ADVANTAGES IN TERMS OF
ACCESSIBILITY, EFFICIENCY AND
AFFORDABILITY AND MORE PEOPLE
CAN BE TESTED MORE QUICKLY.
FURTHERMORE, USE OF MOBILE PHONE
TECHNOLOGY TO ASSESS COGNITION
COULD ALLOW EXAMINATION OF THE
INFLUENCE OF PSYCHOLOGICAL,
SOMATIC OR CONTEXTUAL STATES
SUCH AS A SOCIAL ENVIRONMENT
WITH FRIENDS ON COGNITIVE
PERFORMANCE IN A REAL-WORLD
ENVIRONMENT.
IN 2017 THE NATIONAL INSTITUTE
ON AGES ISSUED AN RFA AND BEGAN
FUNDING THE DEVELOPMENT OF THE
MOBILE TOOLBOX TO CREATE A
LIBRARY OF COGNITIVE TESTS AND
SUPPLEMENTAL SCALES THAT ARE
OPEN SOURCE, VALIDATED AND
NORMED AND CAN BE ADMINISTERED
ON MOBILE DEVICES.
IT DIDN'T TAKE US VERY LONG TO
APPRECIATE THE URGENT NEED FOR
DEVELOP ADMINISTERED MEASURES
DURING THE COVID-19 PANDEMIC WE
WERE ALL ABLE TO WITNESS FIRST
HAND HOW IMPORTANT IT IS TO HAVE
MEASURES ON HAND THAT PSYCH
METRICALLY SOUND, CAN BE
ADMINISTERED REMOTELY AND FOR
WHICH THE INTEGRITY OF THE
MEASURES CAN BE MAINTAINED.
DR. DORENE RENTZ HAS
APPOINTMENTS AT MASS GENERAL
HOSPITAL AND BRIGHAM AND WOMEN'S
AND HAS BEEN AN ESSENTIAL FIGURE
IN THE DEVELOP NEXT TOOLBOX AND
JOINING US TO SPEAK ABOUT THE
DEVELOPMENT AND FEATURES OF THE
MEASUREMENT SYSTEM.
DR. RENTZ.
>> THANK YOU, MOLLY.
GOOD MORNING, EVERYBODY.
THIS REALLY HAS BEEN A DREAM OF
MINE TO HAVE REMOTE ASSESSMENTS
FOR PROBABLY THE LAST 10 YEARS
SO I'M THRILLED TO TALK ABOUT
THE DEVELOPMENT AND FEATURES OF
THE MOBILE TOOLBOX.
AS YOU KNOW, THIS IS A
MULTI-SITE EFFORT ACROSS THE
MTB1 AND 2 AND MANY DIFFERENT
ACADEMIC INSTITUTIONS ARE
PARTICIPATING INCLUDING OUR OWN.
THE MOBILE TOOLBOX IS A SUITE OF
MOBILE COGNITIVE TESTS DEVELOPED
AND VALIDATED AGAINST GOLD
STANDARD IN CLINIC TESTS.
YOU'LL HEAR MORE ABOUT THAT IN
SESSION 2.
THE MOBILE TOOLBOX IS
ADMINISTERED VIA SMARTPHONE ON
AN INDIVIDUAL'S OWN DEVICE.
IT'S IN IOS AND ANDROID.
AND THE DATA IS ENCRYPTED AND
UPLOADED TO A SECURE ELECTRONIC
DATA CAPTURE SYSTEM AND
INITIALLY IN SAGE AND NOW IN RED
CAP WHICH IS MORE FAMILIAR TO A
LOT OF ACADEMIC INSTITUTIONS AND
INSTANTLY AVAILABLE TO THE
RESEARCHER WHEN THEY WANT TO
EXAMINE THE RESULTS.
THAT'S GOING TO BE TALKED MORE
EXTENSIVELY IN SESSION 2 AND A
SPANISH VERSION WILL BE
AVAILABLE LATER THIS YEAR.
HOW'S IT WORK?
AND AN LINK TOION -- TO
DOWNLOAD TO MY CAP AND CHOOSE TO
DOWNLOAD IT FROM THE APP STORE
AT THE IOS AND ANDROID PHONE AND
THE UNIQUE I.D.
AND ONCE DOWNLOADED THEY CLICK
THE BUTTON TO JOIN THE MOBILE
TOOL BOX STUDY AND ONCE THEY
COMPLETE THE TEST THEY CAN'T GO
BACK AND CAN'T DO IT AGAIN.
THEY CAN'T PRACTICE FOR THE NEXT
TIME.
SO IT'S A ONE-TIME CAPTURE OF
THE COGNITIVE PERFORMANCE.
AND WHAT DOES IT CONFIDENT OF
AND THERE'S EIGHT MOBILE TOOLBOX
CORE MEASURES.
IT TAKES THE NORM FROM AGES 18
TO 85 AND TAKES APPROXIMATELY 30
MINUTES TO ADMINISTER ALL THE
TESTS.
THERE'S SIX MEASURES OF FLUID
COGNITION.
THEY MEASURE EPISODIC AND
ASSOCIATE MEMORY.
I'LL SHOW THE TESTS IN DETAIL IN
A LITTLE BIT AND MEASURE
EXECUTIVE FUNCTIONS OF
INHIBITORY CONTROL, ATTENTION
AND COGNITIVE FLEXIBILITY AND
MEASURE WORKING MEMORY AND
PROCESSING SPEED.
THEN THERE'S TWO MEASURES OF
CRYSTALLIZED COGNITION.
THINGS WELL LEARNED BY THE
INDIVIDUAL AND WE'LL TALK A
LITTLE BIT ABOUT THAT AS WELL.
THE SLIDE ALSO SHOWS YOU HOW IT
APPEARS ON AN iPHONE AND I HAVE
TO SAY HAVING DONE COGNITIVE
ASSESSMENTS FOR A LONG TIME THE
IMAGES AND EVEN OLDER
INDIVIDUALS WILL BE ABLE TO SEE
THEM QUITE CLEARLY.
HERE'S THE FIRST MEASURE
ARRANGING PICTURES.
I THINK RICHARD HAD ALREADY
TALKED ABOUT THIS AND WHAT
HAPPENS ON THE iPHONE IS YOU
HEAR A STORY AND THE PICTURES
ARE SCATTERED LIKE YOU CAN SEE
ACROSS A BLACK BOX.
YOUR JOB IS TO PUT THE PICTURES
IN ORDER OF STORY AND THERE'S
PRACTICE SESSION TO EVERY TASK
AND AN INDICATION THAT YOU'VE
DONE IT CORRECTLY.
THEN THERE'S A TEST I HELPED
DEVELOP WHICH IS ALSO A MEASURE
OF EPISODIC MEMORY.
IT'S CALLED FACES AND NAMES IN
THE MOBILE TOOLBOX AND HERE YOU
INITIALLY HAVE AN ENCODING TRIAL
WHERE YOU EXAMINE A PICTURE AND
IN ORDER TO KNOW WHETHER YOU
ENCODED IT OR NOT YOU TAP IF
IT'S EASY IF YOU THINK IT'S
GOING TO BE EASY TO REMEMBER
THAT FACE OR HARDER TO REMEMBER
THAT FACE NAME PAIR.
AND AFTER THIS TEST, YOU'LL GET
A WHOLE SERIES OF OTHER MOBILE
TOOLBOX TESTS AND LATER ON
YOU'LL HAVE A DELAYED RECALL OF
FACES AND NAMES.
SO SIMILAR TO THE NIH TOOLBOX
YOU HAVE A FLANKER TEST WHICH IS
ARROW MATCHING AND THEN YOU HAVE
THE SHAPE COLOR SORTING TEST
WHERE AGAIN YOU'RE TOLD LOOK FOR
THE SHAPE.
YOU HAVE TO MATCH THE NAME OF
THE DOG TO THE DOING IRRESPECT
ARE -- IRRESPECTIVE OF THE
COLOR IT'S IN AND HAVE A DIGITAL
SEQUENCE SPAN TEST SHOWING
NUMBERS AND LETTERS AND YOUR JOB
IS TO REMEMBER THE NUMBERS AND
LETTERS BUT THEN IN THE NEXT
SLIDE YOU FIRST HAVE THE LETTERS
YOU JUST SAW IN ALPHABETICAL
ORDER AND THE NUMBERS FROM
SMALLEST TO LARGEST.
NOT AN EASY TASK AS IT GETS
LONGER AND LONGER.
THE OTHER IS THE NUMBER MATCH
AND HERE AGAIN YOU LOOK AT THE
SYMBOLS AND THE CORRESPONDING
NUMBER AND YOU'LL BE SHOWN A
SYMBOL AND PUT IN THIS CASE THE
ONE UNDER IT.
THE OTHER GETS A TWO, THE OTHER
GETS AN EIGHT.
AGAIN IT'S LIKE A DIGIT SYMBOL
TEST MEASURING PROCESSING SPEED.
AND THEN YOU GET THE DELAYED
RECALL OF FACES AND NAMES.
THERE'S PROBABLY ABOUT AN EIGHT
TO 10-MINUTE DELAY ONCE YOU GET
THE OTHER MEASURES DONE AND
THERE'S THREE PHASES OF MEMORY
IT MEASURES.
THERE'S FACIAL RECOGNITION,
SORRY, EMILY DOESN'T APPEAR ON
THE FACIAL RECOGNITION BUT SHE
IS THERE AND THEN GET A DELAYED
RECALL TASK AN IMMEDIATE DELAYED
RECALL YOU HAVE TO REMEMBER THE
NAME OF THE FACE AND PUT THE E
UNDER THAT NAME.
AND THEN THERE'S ALSO A NAME
RECOGNITION PHASE.
ALL THESE TESTS SO FAR GIVE YOU
AN ACCURACY AND TIME SCORE.
A PAPER THAT IS ALMOST GETTING
READY TO GO OUT FOR PUBLICATION
IS TEST-RETEST RELIABILITY OF
FACES AND NAMES AND 103
INDIVIDUALS PARTICIPATED OVER A
TWO-WEEK INTERVAL AND THERE'S
PRACTICE EFFECTS.
IF YOU DO IT FOR A SECOND TIME
IN NORMALS OVER THE TWO-WEEK
PERIOD.
BUT THE ADVANTAGE IS THE FACT
THAT IF IT'S NOT -- IF YOU DON'T
NOTICE THAT PRACTICE EFFECT,
THEN THAT'S A RED FLAG SOMEBODY
MAY BE HEADED TOWARDS
IMPAIRMENT.
THEN HAVE YOU THE SPELLING TEST.
YOU'LL HEAR A WORD AND THEN YOU
HAVE TO WRITE THE WORD NEXT TO
IT AND MEASURES CRYSTALLIZED
INTELLIGENCE OR SPELLING AND
FINALLY THERE'S A WORD MEANING
TEST WHERE YOU ARE PRESENTED
WITH THE WORD TALK AND YOU FIND
IN THE MULTIPLE CHOICE THE WORD
THAT IS CLOSEST TO THE WORD YOUR
BEING DOED DOUGH FINE FINE --
THERE'S PRACTICE SESSIONS AND
THE TEST ITSELF AND THE
VOCABULARY AND SPELLING TEST
GETS HARDER AND HARDER AND IT
DOESN'T PRODUCE TORTURE.
IT DOES STOP AT THE RIGHT TIME
SO YOU DON'T GET DISCOURAGED.
AND ONE OF THE THINGS WE'VE BEEN
DOING IS LOOKING AT THE TOOLBOX
IN RELATIONSHIP TO OTHER PAPER
AND PENCIL TESTS.
ONE THING I'M INTERESTED IN IS
SEEING WHETHER THE MOBILE
TOOLBOX COULD BE USED IN
PREVENTIVE TRIALS FOR
ALZHEIMER'S DISEASE.
I WANTED TO DEVELOP WHAT WE USED
IN CLINICAL TRIALS AS A MOBILE
TOOLBOX EQUIVALENT POT PACC5 A
COMPOSITE OF THE MEMORY DELAY
AND SYMBOL AND REMINDING TEST
AND CATEGORY INFLUENCY TEST.
THIS SHOWS A HIGH CORRELATION
EVEN AT BASELINE FOR AMYLOID OR
TAU DEPOSITION AND WE'RE
INTERESTED WHETHER THE MOBILE
TOOLBOX PACC5 COULD SUBSTITUTE
FOR THE PACC5 IN REMOTE
ENVIRONMENTS.
THE ADVANTAGE WOULD BE MORE
CONSISTENT AND CHANGE OVER TIME
RATHER THAN AT SIX MONTHS OR
YEARLY EVALUATIONS.
AND THE STUDY IS STILL ONGOING.
ALL PARTICIPANTS HAD AN
IN-CLINIC PACC5 WITHIN A MAXIMUM
OF SIX MONTHS AS WELL AS THE
REMOTE ADMINISTRATION OF THE
TOOLBOX IN THEIR HOME.
YOU CAN SEE THERE WERE THE AGE
OF THE INDIVIDUALS WAS AROUND
71.
THERE WERE A MAJORITY OF
FEMALES.
THEY WERE HIGHLY EDUCATED.
WE DID A NICE DISTRIBUTION FOR
THE BOSTON AREA OF RACE AND
ETHNICITY AND THEY ALL SCORED IN
THE NORMAL RANGE ON THE PACC.
SO WHAT DID WE DO?
WE DO A CORRELATIONAL ANALYSIS
TO CONFIRM HYPOTHESIZED
ASSOCIATIONS WIN THE IN CLINIC
PACC5 CONTROLLED FOR AGE, SEX
AND YEARS OF EDUCATION.
WE DID A LINEAR REGRESSION
ANALYSES AND THE COMPOSITE
SCORES PREDICTING STANDARDIZED
IN CLINIC ASSESSMENTS.
IN SESSION 2 YOU'LL HEAR ABOUT
THE ASSOCIATION WITH AMYLOID AND
TAU DEPOSITION.
SO WHAT DID WE FIND?
WE FOUND THERE WERE GOOD
SIGNIFICANT CORRELATIONS WITH
THE PACC5.
THERE WAS CORRELATION WITH THE
ARRANGE OF PICTURES AND FACES
AND NAMES TEST.
THE SEQUENCING TEST AND THE
NUMBER SYMBOL, DIGIT SYMBOL TEST
ALL WERE SIGNIFICANT.
AND EVEN WITH EXECUTIVE
FUNCTIONS.
THE ARROW MATCHING TEST AND
CRYSTALLIZED INTELLIGENCE WITH
SPELLING AND WORD MEANING.
WHAT WASN'T CORALED BUT TRENDING
WAS THE SHAPE COLOR SORTING
TEST.
MAYBE IT'S AN EASIER TEST TO DO
BUT OTHERWISE THERE ARE MANY
LOVELY CORRELATIONS WITH PAPER
AND PENCIL PACC5.
WE WANTED TO DETERMINE WHAT
WOULD BE THE OF THE MOBILE
TOOLBOX THAT MATCHES WHAT WE DO
IN THE PACC5.
WE PICKED TWO EPISODIC MEMORY
TESTS WITH THE LOGICAL AND
SKEWED AND SELECTIVE REMINDING
AND HAD PICTURES OF FACES AND
NAMES AND DIGIT SYMBOL TEST AND
PICKED SYMBOL MATCH AND DIDN'T
HAVE AN MMSC SO WE USED THE
VOCABULARY.
WHAT YOU CAN SEE HERE IS THERE
WAS A FAIRLY GOOD CORRELATION
WITH THE PACC5 ALONG WITH THE
MTB, PACC5 COMPOSITE AND EVEN
WITH LINEAR REGRESSIONS
CORRECTING FOR AGE, SEX AND
YEARS OF EDUCATION.
SO WE THINK THAT THE REMOTE MTB
PACC5 MAY BE A GOOD SUBSTITUTE
FOR CLINICAL TRIALS AND I'M
EXCITE ABOUT THAT BUT CAN WE GET
IT DOWN TO FEWER TESTS THE
INDIVIDUAL HAS TO GIVE?
LYING THE MY COG WHICH GOT CUT
DOWN TO TWO TESTS, WE DID A
STUDY LOOKING AT WHAT IF YOU
HAVE A THREE-TEST COMPOSITE FOR
FOUR-TEST COMPOSITE, FIVE, OR
SIX TEST-COMPOSITE.
YOU CAN SEE IF YOU DO THREE IT'S
12 MINUTES, IF YOU DO FOUR IT'S
15 MINUTES AND IF YOU DO FIVE
IT'S 18 MINUTES AND IF DO YOU
SIX IT'S 20 MINUTES.
SO THE RESEARCHER OR THE
CLINICAL TRIALIST HAS
OPPORTUNITIES TO DECIDE WHICH
TEST THEY THINK WOULD BE LESS
BURDENED IN THEIR CLINICAL
TRIALS.
WITH MORE TESTS HAVE YOU MORE
CORRELATION AND EVEN THE 12
MINUTES TEST WAS DECENT FOR YOUR
CLINICAL TRIAL.
SO WHAT ARE THE DRAWBACKS NEEDED
IN DOING THIS REMOTELY?
WE HAD 88 PARTICIPANTS OF ALL
AGES.
SOME GOING UP TO THEIR 80s AND
PARTICIPANTS THERE WERE 17 OR
19% OF PARTICIPANTS THAT NEEDED
ASSISTANCE.
TROUBLE SHOOTING OVER THE PHONE
BY A RESEARCH ASSISTANT COMPLETE
THEIR MTBS ASSESSMENT AND WHAT
IS THE HELP THEY NEEDED?
THEY NEEDED HELP IN DOWNLOADING
THE MTBT APP AND OUT SOME
LOGGING IN AND NEEDED A LIVE
PERSON AVAILABLE SHOULD IT BE
NEEDED.
THE MAJORITY WERE ABLE TO DO IT
ON THEIR OWN.
THOSE WHO NEEDED ASSISTANCE WERE
OFTEN SIGNIFICANTLY OLDER.
THEY WERE THE ONES 77 TO 84
YEARS OF AGE.
THE YOUNGER PARTICIPANTS NEEDED
NO ASSISTANCE.
WE'LL SEE THE MOBILE TOOLBOX AS
US BABY BOOMERS GET OLDER AND
OLDER WILL NOT NEED MUCH
ASSISTANCE AT ALL AND THAT BODE
WELL FOR THE PRIMARY CARE
SETTING THAT PEOPLE WILL BE ABLE
TO DO IT IN THE WAITING ROOM OR
EVEN AT HOME WITH EASE.
AND 59% OF OUR PARTICIPANTS
COMPLETED THEIR ASSESSMENTS
WITHIN THE TWO-WEEK TIME FRAME.
YOU HAVE TO TELL PEOPLE AND I
HAVE TO TELL YOU, ELDERS ARE
BUSY PEOPLE.
WE HAD TO REMIND THEM YOU HAVE
TWO WEEKS TO DO THIS AND MOST OF
THEM DID IT WITHOUT ANY
REMINDERS.
HOWEVER, 41% BECAUSE THEY WERE
TRAVELLING OR OFF IN FLORIDA OR
NEEDED CALLS TO COMPLETE THEIR
ASSESSMENT BEFORE THEIR
ASSESSMENT EXPIRED AND I HAVE TO
TELL YOU, ONLY MAYBE 1% OF
INDIVIDUALS ONCE THEY GOT THE
REMINDER CALL DIDN'T COMPLETE
IT.
HOWEVER, NEEDING ASSISTANCE OR
REMINDERS WAS NOT ASSOCIATED
WITH YEARS OF EDUCATION SO IT
DOESN'T MATTER HOW LONG YOU'VE
BEEN IN SCHOOL OR HOW SMART YOU
ARE AND NOT ASSOCIATED WITH
BASELINE COGNITION.
I THINK IN CONCLUSION THAT THE
MOBILE TOOLBOX IS THE NEXT
GENERATION OF COGNITIVE
ASSESSMENTS ALONG WITH THE OTHER
ASSESSMENTS YOU'RE GOING TO SEE.
I'M GRATEFUL TO THE NIH FOR THIS
EFFORT AND ALSO FOR MOLLY
WAGSTER AND RICHARD GERSHON FOR
LEADING THE EFFORT IN BRINGING
REMOTE ASSESSMENT TO THE WORLD.
THANK YOU VERY MUCH.
>> WE'RE GOING TO GIVE A FEW
SECONDS TO GET THE SYSTEM SET UP
BUT I'LL BE INTRODUCING HER
MOMENTARILY.
PATIENCE.
YOU'VE HEARD ABOUT THE BABY
TOOLBOX THE NIH BABY TOOLBOX BUT
DR. ADOLPH WILL BE GIVING US A
PRESENTATION BRIEFLY.
AND I JUST WANTED TO POINT OUT
THAT THE BABY TOOLBOX THE NIH
BABY TOOLBOX HAS SOME UNIQUE
INNOVATION.
IN PARTICULAR, OBVIOUSLY YOU
CAN'T ASK A ONE--MONTH-OLD
QUESTIONS WHERE YOU EXPECT A
VERBAL ANSWER.
YOU NEED TO BE ABLE TO FIND SOME
INNOVATIVE WAYS TO ASSESS
INFANTS IN PARTICULAR BUT
INFANTS IN TODDLER ESPECIALLY
VERY YOUNG TODDLERS.
SO THE BABY TOOLBOX WAS THE
NORTHWESTERN TEAM WERE
INNOVATIVE IN DEVELOPING THIS
ESSENTIALLY USING THE iPAD
SIMILAR TO A SYSTEM FOR
ASSESSING WITH VIDEO AND THE
ABILITY TO IDENTIFY EYE TRACKING
OR GAZE DETECTION.
IS THIS IS A HIGHLY INNOVATIVE
ADAPTATION THAT THE CONTRACTOR,
NORTHWESTERN AND DR. GERSHON AND
TEAM HAD TO OVERCOME VERY
QUICKLY ONCE THEY DECIDED --
ONCE THEY WERE SELECTED AS THE
CONTRACTOR FOR THE TOOL.
SO WE WERE EXCITED WITH OUT OF
THE BOX STARTING OFF THE TOP
HIGHLY INNOVATIVE APPROACH TO
ASSESSING CHILDREN, PARTICULARLY
INFANTS.
I WILL SAY DR. ADOLPH HAS BEEN A
KEY PLAYER IN DEVELOPING MOTOR
ASSESSMENT IN THE NIH TOOLBOX
AND THE NIH BABY TOOLBOX.
SHE'S THE PROFESSOR OF
PSYCHOLOGY AND NEUROSCIENCE AND
PROFESSOR OF CHILD AND
ADOLESCENT PSYCHIATRY IN NEW
YORK UNIVERSITY AND DIRECT THE
DATA LIBRARY AND PLAY PROJECT
WHICH HAS BEEN EXCITING TOE
WATCH THE PROGRESS OF THOSE TWO
GRANT AWARDS.
AND SHE MAINTAINS THE DATA
VIEWED VIDEO CODING TOOL.
DR. ADOLPH USES OBSERVABLE MOTOR
BEHAVIORS IN A VARIETY OF
TECHNOLOGIES INCLUDING VIDEO,
MOTION TRACKING, FLOOR,
INSTRUMENTATION, FLOOR HEAD
MOUNTING EYE TRACKING, EEG,
ETCETERA.
SHE'S BEEN INNOVATIVE IN USING
EVERYTHING YOU CAN THINK TO TRY
AND ASSESS PARTICULARLY VERY
YOUNG CHILDREN AND THEIR MOTOR
ASSESSMENT.
SHE'S BEEN A WONDERFUL
COLLABORATOR.
SHE'S BEEN ENGAGED IN MANY MANY
DIFFERENT PROJECTS AND WE'RE
DELIGHTED TO HAVE HER TODAY
PRESENTING -- INTRODUCING YOU TO
THE THE BABY TOOLBOX.
THANK YOU, KAREN.
I'LL GO AHEAD AND SIT OFF STAGE.
>> YEAH.
NORTHWESTERN, GOT AWARDED THE
CONTRACT UNDER THE LEADERSHIP OF
RICHARD GERSHON AND RICHARD
ASSEMBLED A TEAM OF DOMAIN LEADS
ACROSS SIX INSTITUTION TO
DEVELOP THE NEW BATTERY FOR
YOUNG CHILDREN.
THE RESULTING DEVELOPMENTAL
BATTERY IS CALLED THE NIH INFANT
AND TODDLER TOOLBOX FOR THE BABY
TOOLBOX FOR SHORT.
AND CUTTING EDGE ASSESSMENT
TOOLS FROM 16 DAYS TO 42 MONTHS
AND WILL BE PUBLICLY AVAILABLE
IN LATE 2024.
THE BABY TOOLBOX IS A NEURAL
PSYCHOLOGICAL BATTERY WITH
COGNITIVE, PSYCHO AND SOCIAL
TOOLBOX FOR USE IN CLINICAL
SETTINGS.
IT WILL BE AVAILABLE IN ENGLISH
AND SPANISH AND DIRECT
ASSESSMENTS AND BEHAVIORAL
OBSERVATIONS WITH SOME
SUPPLEMENTATION FROM PARENT
REPORT MEASURES AND EVERYTHING
ADMINISTERED ON A DIGITAL TABLET
LIKE THE NIH TOOLBOX.
THE BABY TOOLBOX STANDS OUT
AGAINST COMPETITORS BECAUSE OF
ITS INNOVATIVE ASSESSMENT
TECHNOLOGY.
WE USE REAL-TIME AUTOMATED
SCORING YOU PUSH A BUTTON AND
GET THE SCORE AND USE GAZE
TRACKING TO ENABLE TESTING OF
YOUNG INFANTS AND VIDEO CAPTURE
OF BEHAVIOR FOR IMMEDIATE REVIEW
AND ADAPTATION OF BEHAVIORS TOO
FAST OR TINY TO BE SEEN WITH THE
NAKED EYE AND FOR EXPORTS FOR
LONG TERM STORAGE OF THE
BEHAVIORS.
IN CONTRAST ALL THE
MANIPULATIVES IN THE BABY
TOOLBOX ARE AVAILABLE THROUGH
GENERAL PURPOSE.
USERS DON'T HAVE TO BUY
EXPENSIVE OR HARD TO FIND ITEMS.
THIS IS THE BABY TOOLBOX AT A
GLANCE.
IT COVERS ALL THE MAJOR NEURO
PSYCHOLOGICAL DOMAINS IN ENGLISH
AND SPANISH AND USES A VARIETY
OF APPROACHES AND VARIETY OF
TRULY INNOVATIVE TECHNOLOGIES OR
ASSESSMENT USING ONLY
MANIPULATIVES YOU CAN FIND
ANYWHERE.
THE ORIGINAL CONTRACT IDENTIFIED
SIX DOMAIN ARE CRITICAL FOR
EARLY DEVELOPMENT.
EACH DOMAIN IS LED BY A
SCIENTIFIC DOMAIN EXPERT AND
THEN SUPPORTED BY A TEAM OF
EXPERT CONSULTANTS.
THE SIX DOMAINS ARE GROUPED INTO
THE SAME DOMAIN STRUCTURE THAT'S
USED BY THE NIH TOOLBOX,
COGNITIVE, SOCIAL EMOTIONAL AND
MOTOR FUNCTIONS.
EACH DOMAIN TEAM COLLECTED
MEASURES THAT WERE APPROPRIATE
FOR INFANTS FROM 16 DAYS TO 42
MONTHS.
THE MEASURE SELECTION WAS
INFORMED BY AN EXPERT SURVEY
THAT PROVIDED INFORMATION ABOUT
WHAT MEASURES WE SHOULD USE AND
WHAT DOMAINS SHOULD BE IN AND
WHAT THE COST SHOULD BE AND
LENGTH OF ADMINISTRATION SHOULD
BE AND CONDUCTED A SCOPING
REVIEW BEGINNING WITH 37,000
TE
TECHS TO USE THE COMMON MEASURES
IN THE LITERATURE TO NATURE OUR
MEASURE SELECTION.
I WANTED TO SHOW YOU EXAMPLES OF
SOME OF OUR MEASURES.
IN THE COGNITIVE DOMAIN WE HAVE
16 MEASURES PRIMARILY DIRECT AND
OBSERVATIONAL.
MANY TESTS INCLUDING TWO
VERSIONS SO GAZE MEASURES FOR
BABIES UNDER TWO YEARS OF AGE
AND THEN TOUCH BASE MEASURES FOR
CHILDREN OLDER THAN TWO YEARS.
BEHAVIORAL OBSERVATIONS ARE
RECORDED BY THE ADMINISTRATOR
AND THE COGNITION DOMAIN
INCLUDES A WIDELY USED
PARENT-REPORT MEASURE FOR TWO OF
THE SIX LANGUAGE ASSESSMENTS.
GAZE DETECTION ALLOWS FOR THE
YOUNGEST BABIES WHO CAN'T TALK
OR POINT.
GAZE DETECTION USES THE FRONT
FACING CAMERA AND THE TECHNOLOGY
IS CHEAP AND EASY TO USE.
THE SOFTWARE CAN DETECT FACES
AND IDENTIFY EYES AND ESTIMATE
WHERE BABIES ARE LOOKING.
AND THEN THE RESULTING DATA ARE
USED TO DISTINGUISH IF THE
BABY'S LOOKING ON OR OFF THE
SCREEN AND QUANTIFY THE
PERCENTAGE OF LOOK TO ONE OF TWO
IMAGES AND CAN IDENTIFY A LOOK
THAT CAN TRIGGER GAZE CONTINGENT
RESPONSES.
ALL THE GAZE MEASURES FOLLOW THE
SAME PROCEDURE SO FIRST THE
ADMINISTRATOR PLACES THE iPAD TO
TRACK THE CHILD'S FACE THEN WE
CALIBRATE THE SOFTWARE BY
LOOKING AT THE FOUR CORNERS OF
THE SCREEN AND THEN FINALLY WE
PRESENT THE TEST TIMES FOR THAT
PARTICULAR TEST.
I WANT TO SHOW AN EXAMPLE OF AN
ADMINISTRATOR SETTING UP A GAZE
MEASURE CALLED LOOKING WHILE
LISTENING.
THIS TESTS RECEPTIVE LANGUAGE.
SO THE BABY SEE TWO ITEMS ON THE
SCENE AND ONE OF THOSE ITEMS IS
LABELLED.
>> WHERE IS THE NOSE?
SEE THE NOSE?
DO YOU SEE THE CUP?
LOOK AT THE CUP.
WHERE IS THE SHOE?
SEE THE SHOE?
>> HERE'S AN EXAMPLE OF A
TOUCH-BASED TASK CALLED VISUAL
DELAYED RESPONSE.
IT TESTS ATTENTION, EXECUTIVE
FUNCTION AND WORKING MEMORY.
[VIDEO]
>> LOOK AT THAT.
[♪]
WHERE IS IT HIDIHIDING?
TOUCHED WHERE IT'S HIDING.
>> WE HAVE A GAZE MEASURE OF THE
SAME MEASURE WHERE IF THE BABY
LOOKS AT THE PLACE ON THE SCENE
THE CREATURE POPS OUT.
THIS IS AN EXAMPLE OF A
BEHAVIORAL OBSERVATION CALLED
OBJECT COUNTING AND ASSESSES
COUNTING AND CARDINALITY.
THE CHILD COUNTS A SET NUMBER OF
OBJECTS AND THE ADMINISTRATOR
RECORDS THEIR VERBAL RESPONSE.
[VIDEO
[
>> HOW MANY ARE THERE?
>> ONE, TWO, THREE, FOUR,
ELEVEN.
[SPEAKER]
>> IN THE SOCIAL EMOTIONAL DE
MAIN WE GET PARENT REPORTS OF
THEIR NEGATIVE ASSETS AND
SELF-REGULATION AND A HIGHLY
ENGAGING TEST OF PLAY AND PRO
SOCIAL BEHAVIORS.
AN EXAMINER'S SCREEN GUIDES THEM
AND ON THE LEFT ARE THE STEPS
FOR THE ADMINISTRATOR AND ON THE
RIGHT ARE THE SCORABLE
BEHAVIORS.
SHOWING AN EXAMPLE OF ONE PART
OF THE INTERACTIVE SOCIAL
OBSERVATION TEST.
YOU'LL SEE THE EXAMINER OFFER
PROMPTS AND SCORE THE BEHAVIORS
THE CHILD DEMONSTRATED.
[VIDEO]
>> LOOK.
LOOK.
YOU FOUND THE CAR.
READY?
VROOM.
VROOM, BEEP, BEEP.
READY?
HERE IT COMES TO YOU, VROOM.
GIVING IT TO MAMA.
[SPEAKER]
THEY
>> THEY NOTE THE CHILD RESPOND
AND SMILED WITHOUT LOOK AND
SHOWED THE OBJECT TO ITS OTHER.
IN THE MOTOR DOMAIN, WE HAVE
THREE MEASURES.
THEY'RE ALL VIDEO-BASED MEASURES
AND EACH MEASURE HAS VARIANTS OF
THE TASK SO IT CAN SPAN THE
ENTIRE AGE RANGE.
GET UP AND GO TESTS LOCOMOTION
AND POSTURAL TRANSMISSIONS AND
LIFTING THE HEAD WHILE PRONE FOR
THE YOUNGEST BABIES.
REACH TO EAT TESTS REACHING AND
TOOL USE AND PLANNING IN OLDER
CHILDREN.
SIT AND STAND TESTS STATIONARY
POSTURAL CONTROL AND SIMILAR TO
THE STANDING BALANCE TESTS IN
THE NIH TOOLBOX.
I'LL SHOW AN EXAMPLE OF AN
ORDERLY CHILD DOING GET UP AND
GO.
[VIDEO]
>> READY?
ONE, TWO, THREE, GO.
15.
YAY.
MAMA'S GOING TO GO HERE.
OKAY.
READY?
GO TO MAMA.
[SPEAKER]
>> AS SOON AS THE CHILD FINISHES
THE ADMINISTRATOR RECORDS
BEHAVIORS BASED ON IMMEDIATE
REVIEW OF THE VIDEO.
FOR EXAMPLE, THE ADMINISTRATOR
RECORDS HOW THE CHILD GOT OFF
THEIR BACK.
EACH OPTION IS ACCOMPANIED BY A
LINE DRAWING.
SO THE ADMINISTRATOR CAN MATCH
THE BEHAVIOR TO THE OPTIONS
ILLUSTRATED IN THE LINE
DRAWINGS.
HERE THE CHILD GOT UP WITHOUT
ROLLING.
WE SCORED THE MEASURES.
WE USED THREE DIFFERENT SCORING
APPROACHES BASED ON THE MEASURES
AND ON THE DATA.
THERE'S TRADITIONAL IRT JUST
LIKE THE SCORES YOU GET FROM THE
REGULAR NIH TOOLBOX.
EACH TEST GENERATES ONE SCORE
AND THE SCORING ACCOUNTS FOR HOW
STRONGLY IT RELATES TO HOW
DIFFICULT THE ITEM IS RELATIVE
TO OTHER ITEMS.
WE ALSO USE A MAP CALCULATOR.
LIKE TRADITIONAL IRT IT CAN
GENERATE MULTI-DIMENSIONAL
SCORES AND WE USED TRADITIONAL
SCORING METHODS SUCH AS THE
NUMBER CORRECT OR RANK BASED
SCORES USED FOR MEASURES FOR
WHICH AN IRT MODEL DIDN'T FIT OR
WAS INAPPROPRIATE.
THE FINAL DATA ARE NORM SCORES
AND DOMAIN SCORES AND ITEM LEVEL
DATA IF THE RESEARCHER WANTS IT.
LIKE THE NIH TOOLBOX, THE BABY
TOOLBOX WILL BE AVAILABLE IN
BOTH ENGLISH AND SPANISH.
AND ANYTHING THE CHILD OR
CAREGIVERS SEE AND ALL THE AUDIO
CONTENT LIKE HOW MANY ARE THERE
AND WHERE'S THE NOSE?
WE TRANSLATED ALL THAT INTO
SPANISH USING A THIRD-PARTY
VENDOR.
FORWARD AND BACKWARD
TRANSLATIONS WERE CONDUCTED BY
FOUR INDEPENDENT TRANSLATORS TO
COME UP WITH A FINAL VERSION.
THE GOAL WAS TO USE A GENERAL
VERSION OF SPANISH RATHER THAN
VOCABULARY THAT'S SPECIFIC TO
CERTAIN COUNTRIES OR TO CERTAIN
REGIONS.
NE -- THE TRANSLATIONS WERE
REVIEWED BY SPANISH SPEAKING
TOOLBOX STAFF AND CONTENT
EXPERTS.
THE SPANISH VERSIONS WERE
DEVELOPED IN PARALLEL FOR
LANGUAGE APPROPRIATE RULES AND
WAS CULTURALLY SENSITIVE.
FOR EXAMPLE, IN THE LOOKING
WHILE LISTENING TASK, BOTH
ENGLISH AND SPANISH VERSIONS
MATCH ITEMS BASED ON CRITERIA
LIKE WHEN THE EMERGE IN %
DEVELOPMENT AND THE STARTING
CONSONANT SOUND AND WE MATCHED
ITEMS BASED ON THEIR GENDER
THOUGH THEY WERE GOOD FOR
ENGLISH AND SPANISH IT DIDN'T
WORK BECAUSE NOSE IS FEMME --
FEMININE AND BOOK IS MASCULINE.
>> WHERE IS THE NOSE?
SEE THE NOSE?
[SPANISH]
>> WE'RE IN THE FINAL STAGES FOR
VALIDATING STUDIES.
THE INSTRUMENTED WERE NORMED
WITH A NATIONAL SAMPLE OF 2500
STUDENTS AND 500 OF WHOM DID THE
SPANISH VERSION AND WE HAD
ENROLLMENT TARGETS FOR AGE AND
GENDER NESTED WITHIN GEOGRAPHIC
CENSUS REGION AND OTHER RELEVANT
DEMOGRAPHICS.
THESE ARE OUR 16 TESTING SITES.
WE READMINISTER THE TOOLBOX TO A
SUBSET OF CHILDREN WITHIN SEVEN
TO 10 DAYS OF THEIR ORIGINAL
TEST.
TO EVALUATE CONVERGENT VALIDITY
WE ADMINISTERED TWO EXTERNAL
INSTRUMENTS THE AGES AND STAGES
PARENT REPORT QUESTIONNAIRE AND
THE BAYLEY SCALES.
TO EXPLORE CLINICAL FEASIBILITY
WE COLLABORATED WITH THREE SITES
WORKING WITH CLINICAL
POPULATIONS AND EACH SITES IS
PILOTING A SMALL SET OF
CHILDREN.
WE'RE IN THE FINAL STAGES OF
DATA ANALYSIS.
OUR FOURTH COMING RESULTS WILL
INCLUDE THE PSYCHO METRIC
PROPERTIES OF THE BABY TOOLBOX
SUCH AS THE CORRELATIONS WITH
AGE, WITH EXTERNAL MEASURES AND
THE INTERNAL AND TEST, RETEST
RELIABILITY.
A LOT OF THAT DATA IS ALREADY
ANALYZED AND WILL BE PRESENTED
IN DETAIL AT OVER PRESENTATIONS
AT THE CONFERENCE.
TO LEARN MORE ABOUT THE BABY
TOOLBOX, PLEASE COME TO SESSION
1 FROM 1:00 TO 2:00 TODAY.
THE SESSION DESCRIBES THREE OF
THE SIX DOMAINS IN MORE DETAIL
AND INCLUDES IMPLEMENTATION OF
THE BABY TOOLBOX IN THE HBCD
STUDY.
WE HAVE TWO POSTERS AT THE
POSTER SESSION PRESENTING
ADDITIONAL DATA FROM THE NORMING
STUDY.
AND IN ADDITION TO THE
SCIENTIFIC TEAMS WHO CONTRIBUTED
TO EACH DOMAIN, THERE'S A
FABULOUS AWESOME, MAGNIFICENT
TEAM AT NORTHWESTERN WHO MADE
THIS POSSIBLE.
AND HERE'S THE CONTACT
INFORMATION FOR RICHARD GERSHON
THE P.I. OF THE BABY TOOLBOX.
>> IT'S PROBABLY NOT BEEN LOST
TO MOST IN THE ROOM WE'RE A FULL
30 MINUTES AHEAD.
BUT WE'RE GOING TO TAKE A BREAK
NOW AND WE'RE GOING TO EXTEND
THE BREAK AND I WILL ASK THAT
PEOPLE RETURN AT 11:00 FOR
ANOTHER TALK BEFORE LUNCH AND
SOME ANNOUNCEMENTS.
I JUST WANTED TO REMIND THOSE OF
YOU IN THE AUDIENCE THAT IF YOU
DID NOT -- IF YOU WEREN'T ABLE
TO PICK UP YOUR BADGE ON THE WAY
IN TO PLEASE DO SO AT BREAK TO
GET AN ACCOUNTING OF INDIVIDUALS
WHO ARE HERE.
ALSO, I THINK MANY OF YOU MAY
KNOW BY NOW BUT THE NATUR
CAFETERIA OPEN FOR THE
CONFERENCE SO IF YOU NEED A CUP
OF COFFEE OR SOMETHING GO UP TO
THE CAFETERIA ON THE FIRST
FLOOR.
LUNCH WILL BE SERVED THERE AS
WELL AND WE'LL TAKE A BREAK NOW
AND THANKS FOR YOUR ATTENTION
AND WE'LL SEE YOU AT 11:00.
>> HELLO AGAIN.
FOR THOSE WHO MAY BE JOINING US
US VIRTUALLY OR HERE IN THE ROOM
WHO MAY HAVE JUST JOINED.
I'M MOLLY WAGSTER WHERE I SERVE
CHIEF OF THE SYSTEMS NEURAL
SCIENCE BRANCH IN THE DIVISION
OF NEURAL SCIENCE.
I WAS THE LEAD PROJECT OFFICER
FOR THE NIH TOOLBOX CONTRACT AND
CONTINUE TO WORK WITH
NORTHWESTERN UNIVERSITY
INVESTIGATORS FOR CONTINUED
OVERSIGHT OF DEVELOPMENT OF THE
NIH TOOLBOX AND I ALSO SERVE AS
ONE OF THE PROJECT SCIENTISTS
FOR THE MOBILE TOOLBOX
COOPERATIVE AGREEMENT.
MY PRESENTATION THIS MORNING IS
AIMED AT HIGHLIGHTING SOME OF
THE LARGE INITIATIVES THAT HAVE
OR ARE CURRENTLY COLLECTING
PHENOTYPIC DATA USING ONE OR
MORE OF THE MEASUREMENT SYSTEMS
FEATURED AT THE CONFERENCE.
THE UPTAKE OF THE MEASURES BY
THE STUDIES I THINK INDICATES
THE WIDESPREAD AND GROWING
ADAPTATION OF THE MEASURES AND
ILLUSTRATES THE POSITIVE IMPACT
OF HAVING COMMON MEASURES ACROSS
STUDY.
AND RESOURCES FOR SECONDARY DATA
ANALYTIC STUDIES HAVE BEEN
GENERATED AND I'LL EXPAND ON
THESE AS WELL.
THE TITLE IS USE OF NIH TOOLBOX
AND RELATED ASSESSMENTS AND
LARGE INITIATIVES RESOURCES FOR
RESEARCH.
AND ASSESSMENT OF NEUROLOGICAL
AND BEHAVIORAL FUNCTION THE FULL
NAME WAS DESIGN FOR A STANDARD
SEFT INSTRUMENTS TO MEASURE
BEHAVIORAL HEALTH ACROSS THE
LIFE SPAN WHEN ADOPTED AND USED
BROADLY WOULD ALLOW FOR
COMPARISON ACROSS STUDIES AND
MAXIMIZE UTILITY OF THE DATA.
THE NIH TOOLBOX, WHICH WAS
DEVELOPED THROUGH A CONTRACT
SUPPORTED BY THE NIH BLUEPRINT
FOR NEUROSCIENCE RESEARCH WAS
NORMED IN ALMOST 4900
PARTICIPANTS AT SITES THROUGHOUT
THE COUNTRY AND REPRESENTATIVE
OF THE U.S. POPULATION BASED ON
GENDER, RACE, ETHNICITY AND
SOCIO ECONOMIC STATUS.
AS YOU HEARD EARLIER THIS
MORNING, THE NIH TOOLBOX
INCLUDES BRIEF PSYCH METRICALLY
SOUND MEASURES VALIDATE AND
NORMED IN INDIVIDUALS 3 TO 85
YEARS OF AGE IN THE DOMAINS OF
EMOTIONAL, MOTOR, SENSORY AND
COGNITIVE PERFORMANCE.
BOTH AND ENGLISH AND SPANISH
VERSION WAS CREATED AS PART OF
THE ORIGINAL CONTRACT
REQUIREMENTS.
IN PARTICULAR, TO NOTE I THINK,
ALL 8,459 INDIVIDUALS IN THE
NORMING STUDY CONTRIBUTED DATA
FOR ALL MEASURES IN ALL DOMAINS.
THESE EXTENSIVE AND RICH DATA
FROM NORMING ARE AVAILABLE FOR
SECONDARY ANALYSES AND MAY BE
ACCESSED THROUGH THE HARVARD
DATA VERSE REPOSITORY.
THROUGH A SEPARATE AWARD,
FUNDING WAS SECURED TO COLLECT
SALIVA SAMPLES FROM OVER HALF
THE NORMING SAMPLE ALMOST 2700
INDIVIDUALS ACROSS THE AGE SPAN
ENROLLED.
DNA WAS EXTRACTED AND THE
SAMPLES HAVE BEEN STORED AT THE
INDIANA UNIVERSITY SCHOOL OF
MEDICINE AND MAY BE ACCESSED FOR
RESEARCH.
SUFFICIENT AMOUNTS OF DNA ARE
AVAILABLE FOR MULTIPLE TYPES OF
GENETIC ANALYSES IN CONJUNCTION
WITH THE PHENOTYPIC DATA
GATHERED.
IN THE BOX IN THE BOTTOM OF THE
SLIDE YOU SEE SLIGHTLY OVER HALF
THE SAMPLES FROM FEMALES AND 15%
FROM BLACK.
THE NUMBERS IN PARENTHESES
PRESENT THE NUMBER IN THE ACTUAL
CATEGORIES.
AGAIN, TO NOTE FOR THE
INDIVIDUALS WHO CONTRIBUTED DNA
SAMPLES, THAT WE ASSESSED ON
EVERY MEASURE IN EVERY DOMAIN OF
THE NIH TOOLBOX.
AGAIN, A VERY RICH RESOURCE I
THINK FOR INVESTIGATORS TO
EXPLORE.
IN 2017, THE NATIONAL INSTITUTE
ON AGING ISSUED A REQUEST FOR
APPLICATIONS DESIGN TO ESTABLISH
THE MEASUREMENT PROPERTIES OF
THE NIH TOOLBOX IN INDIVIDUALS
WITH COGNITIVE IMPAIRMENT AND
EARLY STAGE ALZHEIMER'S DISEASE
AND IN INDIVIDUALS OVER AGE 85.
SO RECALL THE ORIGINAL CONTRACT
WAS TO DEVELOP MEASURES FOR THE
AGE SPAN OF 3 TO 85 YEARS AND IT
WAS TO DEVELOP MEASURES TO
ASSESS HEALTH AND NOT TO DEVELOP
SCREENERS FOR DISEASE.
IS THE STUDY ADVANCING
MEASUREMENT IN COGNITIVE DISEASE
AND GOES BY AN ACRONYM WHICH IS
SHORTER TO SAY, THE GOAL IS TO
ESTABLISH A RESEARCH RESOURCE
THAT FACILITATES DETECTION OF
DISEASE AT THE EARLIEST STAGES.
IT CAN DETECT CHANGE IN FUNCTION
OVER TIME AND COULD BE USED TO
TRACK SUCCESS OF PREVENTION AND
THERAPEUTIC INTERVENTIONS.
CLINICAL TRIALS FOR ALZHEIMER'S
DISEASE NOW FOCUS ON MUCH
EARLIER STAGES OF THE DISEASE.
INCLUDING THE PRE CLINICAL OR
PRE COGNITIVE IMPAIRMENT STAGE.
HOWEVER, NOT ALL MEASURES OF
COGNITION CURRENTLY USED IN
ALZHEIMER'S DISEASE CLINICAL
TRIAL SENSITIVE AT THE EARLY
STAGES.
IN FACT, PERFORMANCE ON SOME OF
THE NON-COGNITIVE DOMAINS SUCH
AS MOTOR PERFORMANCE OR
EMOTIONAL FUNCTION MAY HAVE TO
DIFFERENTIATE NORMAL AGE-RELATED
CHANGE IN COGNITIVE PERFORMANCE
FROM MILD COGNITIVE IMPAIRMENT
OR FROM EARLY STAGE ALZHEIMER'S
DISEASE.
SO WHILE THIS IS NOT THE ONLY
EXAMPLE TO DATE OF VALIDATING
SOME OR ALL THE TOOLBOX MEASURES
AND DISORDERS IN DISEASE IT'S
ONE OF THE FIRST.
BY DESIGN ARMADA WAS CONDUCTED
IN INDIVIDUALS ENROLLED AT
ALZHEIMER'S DISEASE CENTERS THE
U.S.
THE DATA AMASSED FROM THE
VALIDATION STUDY AVAILABLE
THROUGH THE HARVARD DATA VERSE
REPOSITORY I MENTIONED.
THIS IS WHAT I UNDERSTAND.
IT WILL BE LINKED WITH THE
ACCOMPANYING NEURAL IMAGING,
GENETIC AND OTHER DATA COLLECTED
ON THE INDIVIDUALS THROUGH THE
ALZHEIMER'S DISEASE CENTERS.
SO ANOTHER I THINK EXCELLENT
OPPORTUNITY FOR FURTHER
EXPLORATION GIVEN THE DATA THAT
IS AVAILABLE.
THE HUMAN CONNECTOME PROJECT A
GROUNDBREAKING INITIATIVE, WAS
UNDERTAKEN TO ELUCIDATE BRAIN
CONNECTIST IN RELATIONSHIP TO
BEHAVIORAL AND CONTRIBUTIONS OF
ENVIRONMENTAL FACTORS TO
INDIVIDUAL DIFFERENCES IN BRAIN
CIRCUITRY.
THE ORIGINAL STUDY FOR THE -- I
THINK JUMPED AHEAD I'LL COME
BACK.
THE ORIGINAL STUDY WAS CONDUCTED
IN 1200 ADULTS 22 TO 35 YEARS
FOR THE PHENOTYPIC DATA
COLLECTION MEASURES FROM ALL
DOMAIN BATTERIES IN THE NIH
TOOLBOX MOTOR, SENSORY, EMOTION,
COGNITION WERE EMPLOYED NOT
EVERY MEASURE WAS USED IN THE
ORIGINAL HUMAN CONNECTOME
PROJECT BUT CERTAINLY MEASURES
FROM AT LEAST SOME MEASURES FROM
EACH OF THE BATTERIES WERE USED
TO COLLECT THE PHENOTYPIC DATA.
AND FOR THE HUMAN CONNECTOME
PROJECT WAS LAUNCHED IN 2009
WITH AWARDS FOLLOWING IN 2010
FOR THE YOUNG ADULT CONNECTOME
PROJECT THE ONE I JUST
MENTIONED.
THERE'S BEEN 18 ADDITIONAL
CONNECTOME STUDIES THAT HAVE
BEEN SUPPORTED.
FOUR UNDER THE UMBRELLA OF LIFE
SPAN CONNECTOME PROJECTS AND 14
UNDER THE UMBRELLA OF CONNECT
OMS RELATED TO HUMAN DISEASE.
A FEW ARE REPRESENTED BUT NOT
ALL 18.
THEY RANGE IN SIZE FROM 100 TO
1500 PARTICIPANTS.
THEY COVER A WIDE RANGE OF AZ
AZIZ -- DISEASES AND HAVE BEEN
USED FOR DATA COLLECTION FOR
MANY IF NOT ALL THE SUBSEQUENT
CONNECTOME STUDIES.
DETAILS ABOUT THE STUDIES AND
HOW TO ACCESS THE DATA FOR
SECONDARY ANALYSES MAY BE FOUND
ON THE CONNECTOME COORDINATING
FACILITY WEB PAGE, THE NIMHD
DATA ARCHIVE OR KNOWN AS THE
NDA, HOUSES THE DATA.
I MUST HAVE TOUCHED A LIVE --
THANK YOU.
ANYWAY, TO REPEAT, THE DATA FROM
THE ORIGINAL HUMAN CONNECTOME
PROJECT STUDY IN YOUNG ADULTS AS
WELL AS THE 18 OTHER CONNECTOME
PROJECTS THAT HAVE SPUN OFF FROM
THAT ARE AVAILABLE THROUGH THE
NIMHD DATA ARCHIVE AND MANY, IF
NOT ALL THE STUDIES HAVE
EMPLOYED MEASURES THAT WERE
PULLED FROM THE NIH TOOLBOX.
THE GOAL OF THE ADOLESCENT BRAIN
COGNITIVE DEVELOPMENT STUDY OR
ABCD, IS TO INCREASE THE
INFORMATION OF FACTORS THAT CAN
ENHANCE OR DISRUPT A YOUNG
PERSON'S LIFE TRAJECTORY.
THIS LONG-TERM STUDY OF BRAIN
DEVELOPMENT AND CHILD AND
ADOLESCENT HEALTH HAS RECRUITED
OVER 10,000 CHILDREN AGES 9 TO
10 AND FOLLOWING THEM INTO EARLY
ADULTHOOD.
JUST A LONGITUDINAL STUDY.
ABCD INTEGRATES STRUCTURAL AND
FUNCTIONAL BRAIN IMAGING,
NEUROPSYCHOLOGICAL, BEHAVIORAL
AND OTHER HEALTH ASSESSMENTS
INCLUDING MEASURES FROM THE NIH
TOOLBOX.
DATA COLLECTED THROUGH ABCD
CURRENTLY IS SHARED THROUGH THE
NIMHD DATA ARCHIVE AND A LINK IS
PROVIDED ON THE SLIDE.
AGAIN, ANOTHER OPPORTUNITY,
ANOTHER RESOURCE FOR SECONDARY
DATA ANALYTIC STUDIES.
THE ENVIRONMENTAL INFLUENCES ON
CHILD HEALTH OUTCOMES OR ECHO
STUDY SAY LARGE NIH SUPPORTED
INITIATIVE THAT INVOLVES 84
EXISTING LONGITUDINAL COHORT
STUDIES REPRESENTING 40 STATES
AND PUERTO RICO AND FOR WHICH
OVER 64,000 CHILDREN ARE BEING
FOLLOWED.
THE GOAL IS TO ADVANCE OUR
INFORMATION OF THE EFFECTS OF A
BROAD RANGE OF EARLY
ENVIRONMENTAL FACTORS AND
EXPOSURES INCLUDING PHYSICAL AND
CHEMICAL, PSYCHOSOCIAL,
BEHAVIORAL, BIOLOGICAL ON HEALTH
OUTCOMES FOR CHILDREN.
THE STUDY INCORPORATES NIH
TOOLBOX MEASURES FOR ASSESSING
BEHAVIORAL OUTCOMES.
STARTING IN 2025, THE MOBILE
TOOLBOX ADDITIONALLY WILL BE
USED TO CAPTURE DATA REMOTELY
FROM 40,000 CAREGIVERS INVOLVED
IN THIS STUDY.
AS WELL AS ECHO PARTICIPANTS
TRANSITION FROM ADOLESCENCE TO
ADULTHOOD ALSO, AN ESTIMATED
10,000 CHILDREN WILL BE ASSESSED
USING MEASURES FROM THE NIH BABY
TOOLBOX AND I WILL BE DISCUSSING
THAT IN THE NEXT SLIDE.
SO THE GOAL OF THE NIH INFANT
AND TODDLER TOOLBOX ALSO
REFERRED TO AS THE NIH BABY
TOOLBOX IS TO DEVELOP BRIEF
STANDARDIZED MEASURES TO ASSESS
NEURO, PSYCHOLOGICAL AND SOCIAL
FUNCTION IN INFANTS AND TODDLERS
AGES 1 TO 42 MONTHS.
I KNOW MANY THINGS I'M SAYING
YOU HEARD THIS MORNING BUT BEARS
REPEATING INGING TO PUT IN THET
OF THE DATA WE HAVE AVAILABLE.
SIMILAR TO THE NIH TOOLBOX THE,
BABY TOOLBOX IS THROUGH CONTRACT
THROUGH SUPPORTED BY THE NIH
BLUEPRINT AND BEING LED BIG
KATHY MANN KEOPKE AS THE LEAD
PROGRAM OFFICER.
THE DEVELOPMENT OF THE MEASURES
WAS CONDUCTED IN OVER 2500
INFANTS AND TODDLERS PLUS PARENT
PARTNERS FROM ENGLISH AND
SPANISH SPEAKING HOUSEHOLDS.
ALL NORMING DATA WILL BE DEPOSIT
AND AVAILABLE FOR SECONDARY
ANALYSES.
THE LOCATION STILL TO BE
DETERMINED FOR ANNOUNCEMENT OF
AVAILABILITY OF THE DATA
RESOURCE ARE PLEASE CHECK THE
NIH BLUEPRINT WEBSITE OR THE NIH
BABY TOOLBOX SITE IN THE COMING
MONTHS.
SO ANOTHER GREAT OPPORTUNITY FOR
SECONDARY DATA ANALYTIC STUDIES.
FOR A FINAL SPOTLIGHT, THE
LARGEST LONG TERM STUDY OF EARLY
BRAIN AND CHILD DEVELOPMENT IN
THE U.S. THE HEALTHY BRAIN AND
CHILE DEVELOPMENT OR HBCD STUDY,
PLANS TO ENROLL APPROXIMATELY
7500 PARTICIPATING FAMILIES AND
FOLLOW THEM FROM PREGNANCY
THROUGH EARLY CHILDHOOD.
THE GOAL OF HBCD IS TO
UNDERSTAND HOW THE BRAIN
DEVELOPS AND IS AFFECTED BY
EXPOSURES TO OPIOIDS AND OTHER
SUBSTANCES SUCH AS ALCOHOL,
TOBACCO AND CANNABIS AND HOW THE
BRAIN IS AFFECTED BY EXPOSURES
TO THESE THINGS AND STRESSORS
AND TRAUMA AND OTHER SIGNIFICANT
ENVIRONMENTAL INFLUENCES
INCLUDING THOSE THAT MAY PROMOTE
RESILIENCE.
THE STUDY STEMS FROM THE HEAL
INITIATIVE WHICH STANDS FOR
HELPING TO END ADDICTION LONG
TERM.
COMPOSES THE HEH -- H-E-L PART
OF THE NAME.
THROUGH THE PRESENTATION I HOPE
I'VE BEEN ABLE TO BRING YOUR
ATTENTION TO THE WIDESPREAD AND
INCREASING USE OF THE
MEASUREMENT SYSTEMS FEATURED
HERE AT THE CONFERENCE IN THESE
LARGE NIH-SUPPORTED STUDIES AS
WELL AS THE RICH AND ACCESSIBLE
RESOURCE ARE BEING CREATED I
THINK WILL BE VERY INSTRUMENTAL
FOR US FOR FUTURE EXPLORATION
AND FOR DISCOVERY.
SO THANK YOU FOR YOUR ATTENTION.
I'LL DEAL WITH SOME HOUSEKEEPING
THINGS FIRST AND THEN GO ON TO
THE ANNOUNCEMENT.
SO WE'RE ABOUT TO GO ON LUNCH
BREAK.
THAT WILL BE UNTIL 1:00 P.M.
AT 1:00 P.M. WE'LL START OUR
CONCURRENT SESSIONS AND I'LL
ANNOUNCE WHERE THEY'LL BE HELD
IN A MOMENT.
FOR THOSE ATTENDING VIRTUALLY,
YOU'LL BE ABLE TO ACCESS THESE
CONCURRENT SESSIONS AND LISTEN
TO THE TALKS AND YOU'LL ALSO BE
ABLE TO MOVE FROM ROOM TO ROOM
AS YOU WISH IN ORDER TO HEAR THE
TALKS.
FOR THOSE HERE IN PERSON WE CAN
EASILY MOVE AROUND AND
PARTICIPATE IN THE
PRESENTATIONS.
AS I SAID LUNCH BREAK IS UNTIL
1:00.
THE CAFETERIA ON THE FIRST FLOOR
IS OPEN FOR LUNCH.
I ALSO WANTED TO BRING TO YOUR
ATTENTION SNAG IS IN THE PROGRAM
BUT WE HAVEN'T REALLY DISCUSSED
YET AT THE CONFERENCE.
AGAIN, THE CONFERENCE INTENTION
IS FOR EDUCATION AND
DISSEMINATION PRIMARILY TO BE
ABLE TO GET OUT TO THE
COMMUNITY, THE RESEARCH
COMMUNITY EXTRAMURAL STAFF SUCH
AS MYSELF, NIH INTRAMURAL STAFF
AND THE WIDESPREAD EXTRAMURAL
COMMUNITY AND CLINICAL COMMUNITY
AND INDUSTRY AND EVEN
EDUCATIONAL OUTLETS FOR TRYING
TO BRING TO YOUR KNOWLEDGE AN
UNDERSTANDING OF THESE
MEASUREMENT SYSTEMS, WHAT'S IN
THEM AND HOW THEY WORK AND HOW
TO ACCESS THEM AND GET THAT
INFORMATION OUT.
SO THIS AFTERNOON DURING THE
POSTER SESSION AND TOMORROW
MORNING DURING THE LIVE
DEMONSTRATIONS THAT WILL BE
HELD, WE HAVE GROUPS OF
INDIVIDUALS WHO WILL BE MANNING
TABLES FOR ASK THE EXPERTS
SESSION.
SO THIS WILL BE THIS AFTERNOON
DURING THE POSTER SESSION AS
WELL AS TOMORROW MORNING DURING
THE LIVE DEMONSTRATIONS.
SO WE ENCOURAGE ANY OF YOU HERE
IN PERSON TO AVAIL YOURSELVES OF
THESE INDIVIDUALS.
THEY'LL BE SET UP BY MEASUREMENT
SYSTEM AND WE'LL BE HAPPY TO
ANSWER YOUR QUESTIONS OR IF THEY
DON'T HAVE THE ANSWER READY,
THEY WILL BE TAKING DOWN THE
QUESTION AND WE'LL GET BACK TO
YOU AFTER THE MEETING.
ALSO, AND I DON'T BELIEVE IT HAS
BEEN DISPLAYED AND I KNOW IT'S
NOT ON THE NEXT SLIDE SO I WON'T
PUT THAT UP HERE BUT ALSO WE
HAVE AN E-MAIL ADDRESS FOR WHICH
ONE IS ABLE TO SUBMIT ANY
QUESTIONS FOR SPECIFIC SPEAKERS
OR JUST IN GENERAL.
FROM THE VIRTUAL ATTENDEES AS
WELL AS FOR THOSE WHO ARE HERE
IN THE AUDIENCE.
THAT E-MAIL ADDRESS IS
NIHMEASURESCONF@MAIL.NIH.gov.
LATER TODAY AND THIS AFTERNOON
WE'LL BE DISPLAYING THAT E-MAIL
ADDRESS ON THE SLIDES.
I WANTED TO BRING THAT TO YOUR
ATTENTION SO THERE ARE AGAIN YOU
KNOW THERE ARE AMPLE
OPPORTUNITIES FOR YOU TO
INTERACT, ASK QUESTIONS AND GET
YOUR QUESTIONS ANSWERED.
QUESTIONS WILL PROBABLY NOT BE
ADDRESSED DURING THE MEETING
UNLESS YOU'RE TALKING BIG THE
ASK THE EXPERTS BUT THOSE
QUESTIONS GOING TO THE E-MAIL
ADDRESS WILL BE ANSWERED AND
TAKEN CARE OF AFTER THE MEETING
IS OVER IN THE DAYS AND MAYBE A
COUPLE WEEKS TO COME AFTER THE
MEETING IS OVER BUT WE DO INTENT
TO ANSWER EACH OF THESE
INDIVIDUALLY.
THIS IS SOMETHING I KNOW HAS
BEEN WEIGHING ON EVERYONE'S
MIND.
I WANT TO MAKE SURE YOU
UNDERSTAND WE HAVE TIMED THIS
CONFERENCE SO THAT YOU WILL HAVE
AMPLE OPPORTUNITY TO PARTICIPATE
IN THE SOLAR ECLIPSE.
[APPLAUSE]
>> THANK YOU.
THIS IS THE ONLY WAY I CAN GET
APPLAUSE.
TODAY MARKS SOLAR ECLIPSE WHICH
IN BETHESDA IS 39% OF TOTALITY.
I'VE BEEN SPENDING TIME GOOGLING
THIS SO I THINK I HAVE ALL THE
FACTS.
IT WILL BEGIN HERE IN BETHESDA
AT 2:04 P.M.
WHILE WE'RE IN THE CONCURRENT
SESSION.
THE MAXIMUM WILL BE AT 3:20 P.M.
WHILE WE'LL BE ON BREAK BEFORE
WE GO TO THE POSTER SESSIONS SO
FEEL FREE TO GO TO THE ATRIUM
LEVEL WHERE THE POSTERS AND ASK
THE EXPERTS WILL BE AND EVEN
OUTSIDE IF YOU WISH.
THE ECLIPSE ENDS AT 4:32 P.M.
THIS WILL BE WHILE WE'RE IN THE
POSTER SESSION BUT IF YOU
HAVEN'T BEEN ON THE ATRIUM LEVEL
IT'S FLOOR TO CEILING WINDOWS.
YOU CAN EASILY ACCESS THE
OUTSIDE.
IT WILL BE PERFECT VIEWING AT
LEAST IF YOU DON'T LOOK DIRECTLY
AT THE SUN FOR THE ECLIPSE.
>> WILL YOU HAVE GLASSES?
>> THAT WASN'T ANYTHING IN THE
NIH BUDGET FOR THAT BUT YOU'LL
HAVE TO CREATE YOUR OWN PIN HOLE
I GUESS, BRUNO, AND LOOK AT IT
THAT WAY.
ALL RIGHT.
SO I DID WANT TO MAKE AN
IMPORTANT ANNOUNCEMENT.
SO AS WE WERE PUTTING TOGETHER
THIS CONFERENCE WE WANTED TO
ACKNOWLEDGE THE OPPORTUNITY TO
BRING IN MORE JUNIOR
INVESTIGATORS, PEOPLE WHO MAY BE
USING SOME OF THESE MEASUREMENT
SYSTEMS IN THEIR WORK BUT SORT
OF STARTING OUT IN THEIR CAREER.
WE HAD THE OPPORTUNITY TO MAKE
TRAVEL GRANTS AWARDS WHO
SUBMITTED AN ABSTRACT FOR A
POSTER SESSION OR PLATFORM
MEANING ONE OF THE CONCURRENT
SESSIONS TO DATE.
I WANTED TO TAKE A MOMENT TO
RECOGNIZE THESE INDIVIDUALS WHO
HAVE COME FROM FAR AND WIDE AND
WE REALLY APPRECIATE THEM BEING
HERE AND PARTICIPATING AND BRING
THEIR INFORMATION AND KNOWLEDGE
TO THIS MEETING.
WE HAVE DR. AOKO.
CALLIE TYNER FROM UNIVERSITY OF
DELAWARE.
KELLY WATSON FROM VANDERBILT
UNIVERSITY MEDICAL CENTER.
CAN CALLIE STAND UP?
THERE SHE IS.
AMANDA COOK MAHER FROM
UNIVERSITY OF MICHIGAN.
GAIL HARMATA FROM UNIVERSITY OF
IOWA.
THANKS.
JO
JODI CHARVIS.
LINDSEY BECKER FROM OHIO STATE
UNIVERSITY.
I'M MISSING HER.
THERE'S BRIGHT LIGHTS IN MY
EYES.
AMANDA FLAGG FROM UNIVERSITY OF
ALBANY STATE UNIVERSITY OF NEW
YORK.
SHREYA ARUN FROM VIRGINIA
COMMONWEALTH UNIVERSITY.
AND LIJUAN YIN FROM UNIVERSITY OF CHICAGO.
THANK YOU SO MUCH.
ALL RIGHT. SO BEFORE WE BREAK FOR LUNCH I
JUST WANTED TO ANNOUNCE OR
REMIND YOU IT SHOULD BE IN YOUR
PROGRAM BUT THE CONCURRENT
SESSIONS WHICH WILL START AT
1:00 SESSION 1 ON THE NIH BABY
TOOLBOX WILL BE HELD HERE IN THE
MAIN AUDITORIUM WHERE WE ARE
RIGHT NOW.
SESSION 2 WHICH IS ON THE MOBILE
TOOLBOX WILL BE HELD IN BALCONY
A YOU CAN ACCESS THROUGH THE
ATRIUM LEVEL AND SESSION 3 WHICH
IS FOCUSSED ON MY COG WHICH IS
ALSO ONE FLOOR UP AT THE ATRIUM
LEVEL IN BALCONY B.
SO I HOPE EVERYONE ENJOYS THEIR
LUNCH.
LOOK FORWARD TO SEEING YOU BACK
IN THE CONCURRENT SESSIONS AT
1:00 AND IF WE MISS EACH OTHER
FOR SOME REASON SEE YOU TOMORROW
FOR THE DEMONSTRATIONS AND THE
REST OF THE PROGRAMMING.
THANK YOU.
I'M KATHY MANN KEOPKE A PROGRAM
DIRECTOR AT NICHD.
AND I ALSO AM THE CONTRACT
OFFICER
I WILL INTRODUCE YOU.
DR. HAN COMPLETED HER Ph.D. AT
NORTHWESTERN UNIVERSITY IN
COGNITIVE PSYCHOLOGY IN 2023.
SO SHE IS A NEW POSTDOC.
SHE'S NOW A POSTDOCTORAL SCHOLAR
AT NORTHWESTERN UNIVERSITY.
SHE HAS BEEN AN ACTIVE MEMBER OF
THE NORTHWESTERN UNIVERSITY NIH
BABY TOOLBOX TEAM.
AND SPECIFICALLY WORKING ON
EXECUTIVE FUNCTION AND COGNITIVE
MEASURES.
WELCOME.
THREW -- THANK YOU FOR BEING
HERE.
>> THANKS, KATHY.
HAPPY TO BE HERE.
HI, I'M CAT HAN A POSTDOC AT
NORTHWESTERN AND HAVE BEEN
PRIVILEGED TO WORK ON THE BABY
TOOLBOX.
WE'LL FOCUS ON PROGRESS AND
UPDATES SPECIFIC TO THE
EXECUTIVE FUNCTION AND COGNITION
DOMAIN.
SO EXECUTIVE FUNCTION AND
COGNITION COVERS TOP DOWN GOAL
DIRECTED COGNITION.
THIS IS A SUPER IMPORTANT IN
DELAYS IN DEVELOPMENT HAVE BEEN
LINKED TO ADHD AND CONDUCT
DISORDER AND OTHER PSYCHIATRIC
CONDITIONS.
FOR OUR PURPOSES EF COG MEASURES
IN THE BABY TOOLBOX TO ASSESS
THE DOMAIN AND MEASURE SELECTION
AND SOME POLITICAL RESULTS IS
WHAT I'LL COVER FROM A NORMING
STUDY FROM RECRUITED INFANTS
ACROSS THE U.S.
IN TERMS OF MEASURE SELECTION
AND ADMINISTRATION, A LOT OF
WORK WAS PUT INTO TASK SELECTION
WITH A SCOPING REVIEW AND LANDED
ON A FEW TASKS.
WE SPLIT THIS INTO GAZE-BASED
MEASURES FOR 6 TO 21-MONTH-OLD
AND TOUCH BASED MEASURES FOR THE
OLDER 22 TO 42 MONTH CHILDREN.
THESE PARADIGMS FOR GAZE BASE IS
FOLLOWS A PARADIGM AND VISUAL IT
DELAYED RESPONSE AND FOR THE
TOUCH BASED TASK MEMORY RESPONSE
IN THE GOAL OF ASSESSING
CONSTRUCTS OF EXECUTIVE
FUNCTION, LEARNING AND MEMORY AS
WELL AS TRYING TO DO THIS IN
CHILDREN IN ABOUT 10 MINUTES.
THE CHILDREN SEE EIGHT SECOND
TRIALS LIKE THIS ANIMAL IMAGE
AND NOVELTY IS ASSESSED FROM
PRESENTING THE OLD ITEM THE DOG
AND CAT.
AND EXPECT CHILDREN SHOULD PAY
ATTENTION TO THE NEW ITEM, THE
CAT.
WE HAVE THE VDR TASK AND HERE AN
ANIMATED CREATURE POPS UP AND
HIDES BEHIND TWO BOXES ON THE
SCREEN.
AND THEY HIDE THE CURTAIN CLOSES
FOR A CERTAIN AMOUNT OF TIME AND
THAT DELAY IS AGE BASED.
SHORTER TIMES FOR THE YOUNGER
CHILDREN AND LONGER TIMES FOR
THE OLDER CHILDREN TO SCALE THE
TASK IN TERMS OF DIFFICULTY.
FOR THE GAZE-BASED VERSION THE
GOAL IS TO LOOK AT THE BOX AND
REVIEW THE CREATURE THAT'S
HIDDEN AND IN THE TOUCH BASED
VERSION TO TOUCH THE BOX TO
REVEAL THE CREATURE.
FINALLY WE HAVE THE MEMORY TASK
FOR THE TOUCH BASED VERSION.
IT FOLLOWS THE NARRATIVE THE
CHILDREN SHOULD FEED THE HUNGRY
ANIMAL TO HELP WITH ENCODING THE
ANIMALS ON THE SCREEN.
TWO ANIMALS ARE PRESENTED ON THE
LEFT AND RIGHT SIDES OF THE
SCREEN AT A TIME.
ONCE THE ANIMAL IS TOUCHED, THE
NEW ANIMAL OF THE TWO IS NO
LONGER HUNGRY.
CHILDREN DO 11 TRAILS AND THE
ENCODING PORTION HAS THE RULE TO
TOUCH THE NOVEL ANIMAL.
AFTER THE EIGHT TO TEN-MINUTE
DELAY THERE'S A PORTION
INCLUDING 22 TRIALS INCLUDING
IMAGES ALREADY PRESENT WITHIN
ENCODING.
AND THIS ALSO CONTAINS WHAT WE
CALL DIAD ITEMS THAT WERE
PRESENT IN THE FIRST HALF OF THE
TEST MAKE AN APPEARANCE IN THE
SECOND HALF AND THIS IS DONE TO
ENSURE THE CHILD ISN'T
FORGETTING OR GUESSING ON THESE
ITEMS.
SO FOR MEASURING WE DEVELOPED
SCORING MODELS AND BEFORE THAT
I'LL GO INTO OUR APPROACH INTO
MEASUREMENT.
THIS SPANS MOST MEASURES THAT
UTILIZE IRT NOT JUST COG.
WE ASPIRE TO A MEASUREMENT
SYSTEM THAT SHOULD BE
COMPREHENSIVE AND METHODOL
METHODOLOGICALLY SOUND AND ALLOW
FOR MEANINGFUL COMPARISONS AND
SENSITIVE ACROSS STAGES.
WITH THE GOAL IN MIND WE ASSESS
AT DIFFERENT AGES UNDER THE IDEA
THEY CAN BE ALL MEASURED UNDER A
SINGLE LATENT VARIABLE.
AND WE USE IRT OR ITEM RESPONSE
THEORY SCORE THE MODELS.
HERE IN THE NEXT FEW SLIDES I'LL
PRESENT THE RESULTS FROM SCORING
MODELS FOR SPECIFICALLY THE
TOUCH BASED MEASURES AND USE A
PARTIAL DATA SET FROM THE
NORMING SAMPLE OF ABOUT 2500
INFANTS RECRUITED.
SO FOR THE EF COG SCORES WE FIND
FOR BOTH MEMORY TASK AND TOUCH
PORTION AS WELL AS THE VDR TASK
THE TOUCH PORTION THESE SCORES
WE GENERATED USING IRT CORRELATE
WELL WITH AGE AND AS EXPECTED
WITH AGE.
AND THE MEMORY TASKS
SPECIFICALLY WE USE THE TASK
PORTION.
ITEMS ARE CAT CATEGORIZED AS
SELECT IF THE SCORE THE ITEM FOR
BOTH ITEMS IN THE DIAD.
THE FIRST HALF AND SECOND HALF
AND FOR VDR TOUCH, ITEMS ARE
CATEGORIZED AS CORRECT OR
INCORRECT IF THEY SELECT THE
SIDE FOR WHICH THE CREATURE HID.
I HAVE PRELIMINARY RESULTS ON
EXTERNAL VALIDITY WE HAD DONE
WITH OUR SCORES.
SO A SUBSET OF INFANTS CAME BACK
TO COMPLETE THE BAYLEY FOURTH
EDITION KNOWN TO BE A GOLD
STANDARD PAPER AND PENCIL
ASSESSMENT OF INFANT
DEVELOPMENT.
120 INFANTS WERE RECRUITED AND A
PARTIAL DATA SET ARE USED
COMPARE THE GROWTH VALUE SCORES.
ON THE Y AXIS YOU CAN SEE OUR
LATENT TRAIT SCORES FROM IRT FOR
EACH OF THE EF COG TOUCH
MEASURES.
YOU CAN SEE FOR VDR TOUCH AND
MEMORY TASK TOUCH VERSION THESE
SCORES CORRELATE WITH THE BAYLEY
AS EXPECTED SHOWING CONVERGENT
VALIDITY WITH THIS EXTERNAL
MEASURE.
THIS CONCLUDES OUR PRELIMINARY
RESULT AND PROGRESS FOR THE EF
COG DOMAIN FOR THE COOL BOX.
AND THE NEXT STEPS INCLUDE
CONFIRMING THE SCORING MODEL
WITH THE FULL SAMPLE INCLUDING
BOTH ENGLISH AND SPANISH
SPEAKING PARTICIPANTS AND PLAN
TO DO FURTHER VALIDITY ANALYSES
WITH THE AGES AND STAGES
QUESTIONNAIRE WHICH IS A VERY
SHORT VALIDATED CAREGIVER
SCREENING REPORT.
WE ALSO PLAN TO CONDUCT
TEST/RETEST RELIABILITY WITH 228
CHILDREN TO COMPLETE THE BABY
TOOLBOX MEASURES ABOUT 7 TO 10
DAYS AFTER THE FIRST SESSION.
AND WE PLAN TO CONDUCT VALIDITY
ANALYSIS WITH THE FULL SAMPLE
AND REWEIGHT THE SAMPLE TO MATCH
THE 2022 AMERICAN COMMUNITY
SURVEY TO CREATE NORM ADJUSTED
SCORES.
I'D LIKE TO THANK OUR AMAZING EF
COG TEAM.
THIS WAS TRULY A TEAM EFFORT TO
MAKE ALL THIS HAPPEN NOT JUST
FOR EF COG BUT ACROSS THE
DOMAINS AND MEASURES.
I'D LIKE TO ALSO THANK THE
TOOLBOX TEAM AND OUR SAGO
PARTNERS WHO HELPED COLLECT DATA
AND OUR FUNDING SOURCE, NIH.
>> OKAY.
SO, I'M GOING TO SIT OVER HERE
TO BE OUT OF THE WAY.
I FOR GET TO MENTION WHEN I WAS
INTRODUCING DR. HAN OUR FIRST
TWO SPEAKERS ARE FROM
NORTHWESTERN UNIVERSITY AND HAVE
BEEN SIGNIFICANT CONTRIBUTORS TO
THE MEASURES THEY'LL BE
DISCUSSING.
I WOULD LIKE TO INTRODUCE OUR
NEXT SPEAKER DR. SARA
PILA-LEIDERMAN AND HOLDS A
MASTER'S OF ARTS IN CHILD
STUDIES AND HUMAN DEVELOPMENT
FROM THE ELLIOTT PEARSON CLICK
IN AND STUDIES IN EARLY
CHILDHOOD EDUCATION.
THANK YOU.
>> THANK YOU.
I'M VERY EXCITED TO TALK TO YOU
TODAY ABOUT WORK THAT I'M DOING
AT NORTHWESTERN WITH NUMERACY
AND EARLY MATH DOMAIN.
WHEN I TALK ABOUT EARLY MATH AND
NUMERACY WE'RE TALKING ABOUT SUB
DOMAINS OF SHAPE AND SPATIAL
RELATIONS, APPROXIMATE NUMBER
SYSTEM AND NUMBER RECOGNITION.
WE ALSO TALK ABOUT ADDICTION AND
SUB DISTRACTION OR ARITHMETIC.
WE KNOW THEY'RE IMPORTANT
BECAUSE THEY'RE PREDICTIVE OF
LATER ACADEMIC ACHIEVEMENT AND
ALSO SPECIFICALLY MATHEMATICAL
ACADEMIC PERFORMANCE.
SO AGAIN, TODAY I'LL DESCRIBE
THE DEVELOPMENT CORRELATIONS
WITH AGE AND EXTERNAL VALIDITY
OF THE MEASURES WE DEVELOPED
THAT ASSESS THE MATH DOMAIN.
SO WE SELECTED TASKS FROM OUR
DOMAIN EXPERTS, DOUGLAS CLEMENS
AND JULIE SAROMA AND SCOPING
REVIEW.
WE LANDED ON THAT WOULD FIT
WITHIN OUR TIME FRAME THAT WERE
DEVELOPMENTALLY APPROPRIATE AND
COULD FEASIBLY CREATE.
THESE TURNED INTO FOUR TOUCH OR
VERBAL RESPONSE-BASED MEASURES
COUNTING, ARITHMETIC AND WHO HAS
MORE.
THESE ARE FOR CHILDREN OVER 24
MONTHS AND THE GAZE-BASED
MEASURES TRYING TO GET AT THE
SAME THING, NUMERICAL CHANGE
DETECTION AND SPATIAL CHANGE
DETECTION FOR THOSE UNDER 24
MONTHS AND I'LL TALK ABOUT THESE
IN TURN.
FIRST OUR COUNTING MEASURE IS
MADE UP OF TWO DIFFERENT PARTS.
IN THE FIRST PART, PART 1,
VERBAL COUNTING, CHILDREN ARE
ASKED BY THE ADMINISTRATOR TO
COUNT AS HIGH AS THEY CAN
SEQUENTIALLY.
THE ADMINISTRATOR WILL SAY HOW
HIGH CAN YOU COUNT, PLEASE START
AT ONE AND SHOW ME AND WHAT THEY
COUNT TO AND THE ADMINISTRATOR
WILL STOP THEM WHEN THEY FINISH
SOMETHING, HERE ARE THE HIGHER
COUNTS RECEIVE HIGHER SCORES AS
EXPECTED.
AND THEN IN VERBAL COUNTING
WHICH YOU MAY HAVE SEEN EARLIER
THIS MORNING, IS A SET OF ONE TO
EIGHT ITEMS ACROSS SIX DIFFERENT
TRIALS WHERE THE iPAD WILL SAY
HOW MANY ARE THERE, WHEN THE
CAMERA APPEARS THE CHILD WILL
RESPOND IN TURN, THE
ADMINISTRATOR WILL RECORD THEIR
RESPONSE AND THE NEXT ITEM WILL
APPEAR.
HOW MANY ARE THERE WITH TWO
TREES FOR EXAMPLE AND THEN
MOVING FORWARD TO THREE APPLES
SO ON AND SO FORTH.
EACH TRIAL HERE IS SCORED AS
CORRECT OR INCORRECT AND THE TWO
TOGETHER USE A SPECIAL MAP
GENERATOR TO GET AT SCORES FOR
VERBAL COUNTING AND OBJECT
COUNTING INTO ONE MEASURE.
SUBATIZING IS TOO SHORT FOR A
NUMBER TO COUNT BUT GET AT THE
NUMBER RECOGNITION AND THE IED.
ASKED HOW MANY DID YOU SEE AND
CHILDREN RESPOND ARE HOW MUCH
THEY SAW AND THE ADMINISTRATOR
INPUTS THAT RESPONSE AND THEN WE
MOVE ON.
THERE ARE FOUR ITEMS OF
DIFFERENT SMALL QUANTITIES ONE
TO FOUR.
EACH SCORED AT CORRECT AND
INCORRECT AS WELL.
AND ADDITION AND SUBTRACTION
QUESTIONS AND THE ADMINISTRATE
IR WILL SAY IF I HAVE TWO BLOCKS
AND FIND ANOTHER HOW MANY DO I
HAVE NOW.
THE CHILD CAN RESPOND AND HAVE
THE OPPORTUNITY TO USE BLOCKS AS
MANIPULATIVES TO HELP BUT THE
ADMINISTRATOR DOES NOT DO THEM
THAT FOR THEM.
AGAIN, EACH TRIAL IS SCORED AS
CORRECT OR INCORRECT TO THESE
SIMPLE ADDITION AND SUBTRACTION
QUESTIONS.
IN WHO HAS MORE CHILDREN ARE
ASKED TO TOUCH THE BIRD WITH
MORE OBJECTS.
A BIRD APPEARS AND CHILDREN ARE
ASKED TO TOUCH AFTER THE iPAD
SAYS WHO HAS MORE.
THERE'S A DEMONSTRATION ITEM
WHERE THE ADMINISTRATOR SHOWS
THEM WHAT'S EXPECTED AND A
PRACTICE ITEM FOR CHILDREN TO
PRACTICE THE TOUCHING COMPONENT
OF WHO HAS MORE.
THEN THERE ARE 22 LIVE ITEMS IN
WHICH EACH ONE IS SCORED AS
CORRECT OR INCORRECT WITH A
FIXED TRIAL ORDER ON HOW MANY OR
WHAT RATIO SHOULD APPEAR AT ANY
GIVEN TIME.
OUR GAZE MEASURES FOR NUMERICAL
CHANGE DETECTION, CHILDREN ARE
SHOWN TWO STREAMS OF IMAGES ON
THE LEFT AND RIGHT AND THESE
BASICALLY DIFFER IN TERMS OF
SAME, DIFFERENT, SAME,
DIFFERENT, PATTERNS OF DOTS YOU
SEE.
FOR EXAMPLE IF, THE RATIO IS ONE
TO THREE YOU'LL HAVE FOUR AND
TWELVE BUT WILL ALWAYS HAVE AT
LEAST ONE STREAM THAT HAS FOUR.
AND THEN SAME, DIFFERENT, SAME.
THIS IS USING OUR EYE TRACKING
AND GAZE-BASED SOFTWARE TO
UNDERSTAND WHERE CHILDREN ARE
LOOK ON THE SCREEN AS YOU CAN
SEE IN OUR AR KIT THESE CAPTURE
HERE.
THIS IS OUR SPATIAL CHANGE
DETECTION WHERE THERE ARE TWO
STREAMS OF GEOMETRIC SHAMES --
SHAPES IN TWO OF THE STREAMS AND
A THIRD HAS ONE TARGET ON THE Y
AXIS.
I'LL BRIEFLY SHOW WHAT YOU THAT
LOOKS LIKE IN PRACTICE AND HAS A
LAST CLIP OF CALIBRATION YOU'VE
SEEN.
THERE'S MUSIC THAT HAPPENS IN
THE BACKGROUND AS WELL.
IN TERMS OF OUR NORMING STUDY
AND MEASURE SCORING, WE FOUND IN
GENERAL FOR THE FOUR TOUCH AND
VERBAL-BASED RESPONSE OPTIONS,
THAT CHILDREN DO PERFORM BETTER
AS THEY AGE WHICH IS AS
EXPECTED.
THESE RESULTS ARE FROM A SUBSET
OF OUR PARTICIPANTS WHO
COMPLETED THE NORMING STUDY TO
START WITH BUT I'LL TELL YOU
NEXT STEPS WE'RE LOOKING FOR TO
GO TO THE ENTIRE SAMPLE SOON.
AND THEN WE USE THE PARTIAL DATA
SET FOR OUR SCORING MODEL
GENERATION AND AS YOU CAN SEE,
GOOD CORRELATION WITH AGE FOR
THESE ITEMS.
AND IN TERMS OF EXTERNAL
VALIDITY, SIMILARLY WE THAT'D
SAME SUBSET AND HAD PEOPLE
COMPLETE THE BAYLEY 4 AND WHILE
THERE'S NO EXACT COMPARABLE
MEASURE FOR NUMERACY OR MATH WE
USED THE COGNITIVE GLOBAL SCALE
COMPOSITE TO THE GSV AS WELL TO
MAP AND IT DOES APPEARS TO HAVE
GOOD CORRELATIONS WITH OUR
MEASURES VERBAL AND OBJECT
COUNTING AND SUBITZING AND
COUNTING AND ARITHMETIC EVEN IF
IT'S NOT ONE FOR ONE
CORRESPONDENCE.
IN TERMS OF NEXT STEPS WE'RE
LOOKING TO CONFIRM THE SCORING
MODEL WITH THE FULL SAMPLE
INCLUDING ENGLISH AND SPANISH
SPEAKING PARTICIPANTS AS DESIGN
IN BOTH LANGUAGE.
WE'LL PERFORM FURTHER VALIDITY
ANALYSES WITH THE SAMPLE AND
THOSE WHO COMPLETED OUR AGES AND
STAGES QUESTIONNAIRE AND PLAN TO
REWEIGHT THE SAMPLE TO MATCH THE
2022 AMERICAN COMMUNITY SURVEY
AND CREATE THE AGE-ADJUSTED NORM
SCORES AND FINALLY CONDUCT
TEST-RETEST RELIABILITY ON THOSE
WHO TOOK THE BABY TOOLBOX AND
RETURN ARED SEVEN TO 10 DAYS
LATER TO COMPLETE.
ANOTHER BIG THANK YOU TO THOSE
WHO WORKED ON THIS AND I'LL BE
AT THE DEMO SESSIONS FOR BABY
TOOLBOX TOMORROW SO HAPPY TO
ANSWER QUESTIONS LATER AND LET
YOU GET TO PLAY AROUND WITH
THESE MEASURES.
THANK YOU.
>> THANK YOU.
THANK YOU, SARAH, WHY DON'T YOU
STAY AT THE TABLE AND CATHERINE.
THANK YOU.
SO OUR NEXT PRESENTER IS
DR. JULIE KABLE.
SHE IS AN ASSOCIATION PROFESSOR
OF BOTH THE DEPARTMENT OF
PSYCHIATRY AND BEHAVIORAL
SCIENCES AND THE DEPARTMENT OF
PEDIATRICS DIVISION OF AUTISM
AND RELATED DEVELOPMENTAL AND
THE ASSOCIATE DIRECTOR OF THE
EXPOSURE CLINIC AT THE SCHOOL OF
MEDICINE AND MARKUS AUTISM
CENTER CHILDREN'S HEALTH ATLANTA
AT EMORY UNIVERSITY.
HER RESEARCH THAT INCLUDES
INTERVENTION RESEARCH AS WELL AS
BASIC CLINICAL SCIENCE HAS
FOCUSSED ON THE IMPACT OF
PRENATAL TERATTOGENS SUCH AS
ALCOHOL, CIGARETTES AND COCAINE
ON FUNCTIONING THROUGHOUT THE
LIFE SPAN.
DR. KABLE DID NOT SIGNIFICANTLY
CONTRIBUTE TO THE NIH BABY
TOOLBOX BUT SHE AND OTHER HBCD
SITES CHOSE TO USE PARTS OF THE
BABY TOOLBOX AND WERE HAPPY TO
HAVE THEM AS EARLY ADOPTERS WHO
PROVIDED INFORMATION AND
FEEDBACK.
>> I'M JUST A REPRESENTATIVE ARE
OF THE INFANT ASSESSMENT CORE
AND IT'S NOT ALL MY WORK AND MY
COLLEAGUES ARE IN THE AUDIENCE
HERE WHO HELPED WITH ALL THIS.
SO HBCD HEALTHY BRAIN CHILD
DEVELOPMENT STUDY TO UNDERSTAND
THE NORMATIVE DEVELOPMENT OF
INDIVIDUALS FROM BIRTH TO 9 TO
10 YEARS OF AGE.
WE'RE RECRUITING IN PREGNANCY
AND FOLLOWING THE PROSPECTIVELY
OVER TIME.
THERE'S TWO MAIN GOALS OF OUR
STUDY TO ADDRESS OUR GAP IN
KNOWLEDGE ABOUT ENVIRONMENTAL
EXPOSURES PARTICULARLY OPIATE
AND OTHER DRUG USE AND HOW THAT
IMPACTS INFANT AND CHILD
DEVELOPMENT.
AND ALSO TO IMPROVE OUR
INFORMATION OF NORMAL COGNITIVE
SOCIAL FUNCTION FROM THE
PRENATAL PERIOD THROUGH EARLY
CHILDHOOD WITH THE FOCUS ON
NEUROIMAGING PIECES.
WE'RE FUNDING BY A VARIETY OF
AGENCIES AND THERE WAS MANY AND
THE HEAL FUNDING HELPS SUPPORT
THE PROJECT.
WE WANT TO ACKNOWLEDGE THEIR
SUPPORT AND TELL THEM WE'RE VERY
GRATEFUL.
THE HBCD STUDY SPANS OUR
CONTINENT.
SO IN GREEN YOU CAN SEE THE
DIFFERENT SITES INVOLVED IN DATA
COLLECTION FOR THE STUDY.
AND THE PURPLISH FUCHSIA COLOR
IS OUR ADMIN CENTER AT
CALIFORNIA UNIVERSITY SAN DIEGO
AND IN YELLOW IS OUR DATA
COORDINATING CENTER.
EACH SITE IS RESPONSIBLE FOR
ENROLLING 300 PARTICIPANTS.
WE ARE CHALLENGED WITH
RECRUITING SAMPLE THAT'S
CONSISTENT WITH OUR U.S. CENSUS
DATA.
THERE ARE METRICS A DASHBOARD
WE'RE TRYING TO MEET.
50% OF OUR SAMPLE IS ENROLLED
FROM GENERAL POPULATION AND
SHOULD MATCH THESE METRICS THAT
ARE ESTABLISHED FOR US AND THEN
25% HAVE A SUBSTANCE USE
DISORDER AND THEN ANOTHER 25 ARE
DESIGN TO MATCH THE SOCIO
ECONOMIC CHARACTERISTICS OF THE
SUBSTANCE ABUSING SAMPLE.
WE'RE INTERESTED IN A VARIETY OF
FACTORS IN HOW THEY AFFECT
NEURAL DEVELOPMENTAL TRAJECTORY
AND LOOKING AT THINGS RELATED TO
THE MATERNAL CAREGIVER AND
COGNITIVE FACTORS AND GENETIC
FACTORS AND PSYCHOSOCIAL FACTOR.
WE HAVE VARIOUS WORK GROUPS WHO
TACKLE THESE DOMAINS AND DEVELOP
BATTERIES THAT GO THROUGH THE
NEURAL DEVELOPMENTAL STAGES.
THIS IS A GRAPHIC WE USE TO
COMMUNICATE OUR TIME LINE OF
EVENTS IN HBCD.
YOU'LL SEE VISIT ONE IS WHEN WE
ARE SEEING PEOPLE PRENATALLY IN
ENROLLING THEM AND AT THAT POINT
WE DO QUESTIONNAIRES AND COLLECT
BIO SPECIMENS AND WHEN THE
BABY'S BORN 0 TO 1 MONTH AT
VISIT TWO WE CONTINUE TO COLLECT
QUESTIONNAIRES AND BIO SPES
MAN'S AND START -- SPECIMENS AND
BEGIN INFORMATION ON THE MOTHER
AND BABY.
WE THEN ARE ABLE TO FOLLOW AND
CONTINUE THOSE AT VISITS THREE
AND NINE MONTHS, VISITS FOUR 9
TO 15 MONTHS AND THIS
DEVELOPMENT WINDOW OF 15 TO 48
MONTHS AND BELIEVE IT WILL BE
CUT INTO BUT WE CAN'T SAY UNTIL
WE MOVE TO THE NEXT FUNDING
PERIOD.
IT'S AROUND THIS PERIOD AROUND
VISIT THREE WHEN WE START DOING
INFANT ASSESSMENT PIECE.
IN ADDITION TO THESE WINDOWS OF
ASSESSMENT WE'RE ALSO DOING
VISITS AT FIVE, 10 TO 17 MONTHS,
VISIT SEVEN, AND EIGHT, 36 TO 60
MONTHS AND THOSE ARE REMOTE
VISITS.
OUR SAMPLING PROCEDURE'S DESIGN
TO COVER THE ENTIRE
DEVELOPMENTAL SPAN.
WE'RE DOING JITTERED VISIT
WINDOWS WHERE THEY'RE ASSIGNED
TO ONE POCKET AND YOU'LL SEE IF
A BABY'S ASSIGNED TO THE TOP
LEVEL SO THERE'LL BE SEEN IN THE
3 TO 8 MONTH WINDOW IN THE TIME
PERIOD AND THESE ARE ASSIGNED AT
BIRTH AND THEN BE SEEN AT AN
EARLY WINDOW FOR THE 9 TO 14
MONTH VISIT AND RANDOMLY TO THE
OTHER COMPONENTS FOR THE 15 TO
47 AND SIMILARLY ALONG THE LINES
FOR THAT ONE OPPOSED TO THIS
PERSON WHO IS AT THE LATER PART
OF THE THREE-DAY MONTH WINDOW
THEN THE 9 TO 14 MONTH AND THEN
RANDOMLY ASSIGNED TO ONE OF
THESE SLOTS ALONG THE PATH.
SO THE NICE PART ABOUT THAT IS
IT ALLOWS US TO SAMPLE A BROAD
RANGE OF DEVELOPMENT.
WE HAVE TO HAVE DEVELOPMENT
BATTERIES THAT BECAUSE OF THE
DEVELOPMENT CHANGES ARE NOT
GOING TO BE EXACTLY THE SAME AT
DIFFERENT LEVELS.
AND THE WORK GROUP THE COGNITIVE
AND LANGUAGE WORK GROUP HAD
REPRESENTATION OF THE DOMAINS
PROCESSING, MEMORY AND EXECUTIVE
FUNCTION AND NEURAL MOTOR
FUNCTION AND LANGUAGE NUMERACY
AND ADAPTIVE FUNCTION.
WE OPTED TO USE THE BABY TOOLBOX
OF THE NIH INFANT AND TODDLER
TOOLBOX BECAUSE WE WANTED TO
TAKE ADVANTAGE OF THE
DEVELOPMENTAL NEUROSCIENCE
THAT'S GONE INTO THE DEVELOPMENT
OF THE INSTRUMENT.
AND WE THOUGHT IT WOULD MAP WELL
OR DOVETAIL WELL INTO THE ABCD
EFFORT TO MAP NEURAL COGNITIVE
FUNCTION TO BRING AS WE PROGRESS
FORWARD IN THE STUDY THAT'S
GOING TO MOVE TO 9 TO 12 YEARS
OF AGE.
IN ADDITION, WE'RE COLLECTING
OTHER MEASURES AND SO WHEN YOU
THINK ABOUT POTENTIAL VALIDITY
STUDIES FOR THE BABY TOOLBOX I
THINK YOU CAN TAP ON TO OUR
MEASURES WE'RE COLLECTING.
WE'RE DOING THE BAYLEY SCALES OF
INFANT AND TODDLER DEVELOPMENT
AT THE FOURTH EDITION AT VISIT
FOUR BETWEEN 9 TO 14 MONTHS.
WE'RE DOING SENSORY PROCESSING
MEASURES AT VISIT THREE AND
FIVE.
THE McCARTHER-BATES INVENTORY
AND DEFERRED VISITATION AT SIX
AND DIVIDE IT INTO SOMETHING
REASONABLE AT SOME POINT AND THE
BEHAVIOR SCALES WE'RE DOING AT
VISIT FIVE AND SEVEN.
THIS IS A MAP SHOWING EACH OF
THE DEVELOPMENT POCKETS WE'RE
DOING EACH OF THESE.
WE'RE DOING THE MULLEN
EXPRESSIVE AND RECEMENTIVE
MEASURES AT VISIT THREE AND THEN
AT VISIT SIX AND THEN VISIT SIX
OR EIGHT AGAIN.
THE VISUAL RECEPTION AT VISIT
SIX AND EIGHT AND THE GAZE TASKS
LOOKING WHILE LISTENING WHICH
WILL TRANSITION TO PICTURE
VOCABULARY AND NUMERICAL CHANGE
DETECTION STARTING AT VISIT
THREE THROUGHOUT VISIT FOUR AND
VISIT SIX AND MOVE INTO THE
TOUCH TASKS.
I HERE'S A TIME LINE OF OUR.
WE STARTED IN JULY OF LAST YEAR
AND MARION NOVAK TRAINED OUR
MEASURE EXPERTS AND THEY WENT
BACK AND TRAINED THEIR STAFF.
WE THEN DID AN OVER ALL HBCD
STAFF TRAINING VEIA ZOOM AND THY
HELPED WITH CERTIFICATION FOR
THE ENTIRE STAFF.
SO ALL HBCD STAFF WERE ABLE TO
SUBMIT CERTIFICATION VIA VIDEO
IN SEPTEMBER 2023 AND THEN IN
NOVEMBER, 2023 WE HAD OUR FIRST
V3 PILOT WHEN WE INITIATED
INFANT ASSESSMENTS AND AS OF
MARCH 14 WHEN I HAD TO SUBMIT
THE SLIDES OR NEAR THE DATA I
HAD TO SUBMIT THE SLIDES WE HAD
27 PEOPLE CERTIFIED ACROSS 23
SITES.
TWO SITES PASSED THE ADULT
PROTOCOL BUT STILL HAD TO WORK
ON THE CHILD ASSESSMENT
PROTOCOL.
I'LL SHARE WITH YOU SOME OF OUR
TRAINING COMPONENTS.
PART OF THE TRAINING IS TO FIRST
GET CHECKED DOING THE MULLEN
ITEMS WITH AN ADULT TO SHOW YOU
KNOW HOW TO ADMINISTER THE
ITEMS.
SECOND IS THE MULLEN AND GAZE
MEASURES WITH AN ACTUAL CHILD.
YOU CAN SEE THE PASS RATES ARE
RELATIVELY HIGH, 69.8% FOR THE
ADULT TECHNIQUE.
AND IT GOES DOWN TO 52.8 FOR THE
CHILD AND WE THINK THERE IS A
HEAVY BURDEN POSTBACCALAUREATE
INDIVIDUALS MAKING UP OUR
RESEARCH ASSISTANTS AND
STRUGGLING IN DEALING WITH
INFANT ASSESSMENT AND MANAGING
BEHAVIOR THROUGH THE PROTOCOL.
BUT WE DO WANT TO POINT OUT THE
BAYLEY 4 WENT THROUGH A SIMILAR
PROCEDURE AND THEIR SUCCESS RATE
IS 36.5%.
WE HAVE A SLIGHT ADVANTAGE OVER
THE BAYLEY AND TRAINING PROCESS.
WHEN WE LOOK AT AVERAGE NUMBER
OF VIDEOS IT TAKES TO GET
CERTIFIED, FOR ADULT IT'S 1.24,
FOR A CHILD 1.64.
SO YOU CAN SEE DOING THAT
THERE'S STILL THE ADDITIONAL
ELEMENT OF MANAGING THE BABY
THROUGH THE PROCEDURE.
ADDITION TO THE TRAININGS WE'RE
DOING UPDATES ON CALL AND WHERE
WE SEE A PROBLEM, WE GO TO THE
WHOLE RA GROUP ON A WEEKLY BASIS
AND SAY HERE'S THE PROBLEMS.
WATCH OUT FOR THIS SO YOU DON'T
FAIL YOUR ASSESSMENT.
WE DO NEURAL COGNITIVE OFFICE
HOURS EVERY THURSDAY SO THE
THREE OF US STAFF THAT
PERIODICALLY.
YOU MAY NOT HAVE EVERYBODY,
EVERY DAY BUT ONE OF US IS THERE
EVERY THURSDAY AND WE ANSWER THE
QUESTIONS FROM THE RAS FROM THE
SITES.
WE GENERATE TIPS FOR FUSSY
BABIES.
THAT'S AN ONGOING AREA OF
DEVELOPMENT FOR THOSE WHO DON'T
HAVE INFANT ASSESSMENT
EXPERIENCE NEED SUPPORT IN AND
GO ONE-ON-ONE TRAINING WITH
STAFF AS NEEDED AND LOOK AT
FIDELITY AND RELIABILITY OVER
THE COURT -- COURSE OF THIS
STUDY AND CHECKING THE 10th
VIDEO AND MONITOR FOR SITE
PROBLEMS AND ASSESSOR PROBLEMS
AND ITEM LEVEL PROBLEMS WHERE
THE WHOLE STAFF NEED TO BE
RETRAINED BECAUSE OF FREQUENT
ERRORS AND YOU JUST NEED TO
UNDERSTAND THE PUBLIC ACCESS AT
THE END IN THE PINKISH COLOR
AREA.
THIS IS OPEN SCIENCE.
ALL OUR RESEARCH WILL BE
AVAILABLE FOR PEOPLE TO
DOWNLOAD.
OUR FIRST ANTICIPATED AVAILABLE
DATA IS EARLY NEXT YEAR.
I DON'T ANTICIPATE A LOT OF
INFANT ASSESSMENT MATERIAL IN
THAT BECAUSE WE'RE LOCK THE DATA
AS OF JULY AND THERE'S NOT A LOT
OF V 3 STUFF YET.
THAT'S IT.
>> THANK YOU VERY MUCH.
WE REALLY APPRECIATED HAVING
SOMEONE WHO WAS NOT ONE OF THE
TOOL BUILDERS BUT BEING AN EARLY
ADOPTER IS AN IMPORTANT COHORT
IN TOOL MEASUREMENT DEVELOPMENT.
DR. KAREN ADOLPH IS THE
PROFESSOR OF APPLIED PSYCHOLOGY
AND THE CHILD AND ADOLESCENT
PSYCHIATRY AND PROFESSOR OF
CHILD AND ADOLESCENT PSYCHIATRY
AT NEW YORK CENTER AND DIRECTS
THE VIDEO LIBRARY AND PLAY
PROJECT AND MAINTAINS THE DAY TO
VIEW VIDEO CODING TOOL AND USES
OBSERVABLE MOTOR BEHAVIORS AND A
VARIETY OF TECHNOLOGIES
INCLUDING VIDEO, MOTION TRACKING
AND INSTRUMENT OF FLOORS, HEAD
MOUNTED EYE TRACKING AND EEG
AMONG OTHER MEASURES.
AS A DEVELOPMENTAL TO STUDY THE
DEVELOPMENT PROCESSES.
AS I MENTIONED EARLIER TODAY AND
AS YOU'LL HEAR AGAIN NOW,
DR. ADOLPH HAS BEEN A KEY PLAYER
IN DEVELOPING ALL THE MOTOR
ASSESSMENTS IN BOTH NIH BABY
TOOLBOX AS WELL AS THE NIH
TOOLBOX.
DR. ADOLPH HAS BEEN A VALUABLE
ASSET TO THE BABY TOOLBOX AND
WE'RE BLOOD GLOOD HAD TO HAVE H
PRESENT.
>> THANK YOU, KATHY.
I'LL TALK ABOUT ASSESSMENT FOR
THE MOTOR DEVELOPMENT FOR THE
BABY TOOLBOX.
EXISTING METHODS OF MEASURING
MOTOR DEVELOPMENT IN CHILDREN
RELY ON SUBJECTIVE ASSESSMENTS
FROM EXPERTS WHO HAVE EXTENSIVE
TRAINING OR THEY REQUIRE
EXTENSIVE AND CUMBERSOME
RECORDING TECHNOLOGIES TO TRACK
CHILDREN'S MOVEMENT.
WE CAME UP FOR A WAY WITH TO
ASSESS MOTOR DEVELOPMENT USING
JUST AN iPAD AND COMMON ITEMS
LIKE A MEASURING CUP.
WE LEVERAGED THE VIDEO
CAPABILITIES OF THE iPAD TO
RECORD AND CODE CHILDREN'S
BEHAVIORS IN REAL TIME.
THE USE OF THE VIDEO IS SUPER
COOL BECAUSE ADMINISTRATORS CAN
CAPTURE BEHAVIORS THAT ARE
HAPPENING TOO FAST FOR THEM TO
SEE WITH THEIR NAKED EYE AND CAN
QUANTIFY THE TIMING AND SPEED OF
THE MOVEMENTS AND THEY CAN
EXPORT THE VIDEOS FOR FURTHER
ANALYSES.
FIRST I'LL SHOW UP THE GET UP
AND GO TASK OF LOCOMOTION AND
THE GET OUT PART LOOKS AT
TRANSITIONS AND THE GO PART
TESTS LOCOMOTION.
THIS IS AN EXAMPLE OF GET UP AND
GO BEING RECORDED ON THE iPAD IN
A HOME AND FOR BABIES WHO CAN
CRAWL OR WALK THE ADMINISTRATOR
PUTS THEM ON THEIR BACKS AND
ENCOURAGES THEM TO GET UP AND GO
TO THEIR CAREGIVER.
AND THEN THEY'LL GO UP AND THEN
GET DOWN FROM A STAIR HEIGHT
PLATFORM.
THEN THE APP PROMPTS THE
ADMINISTRATOR THROUGH A SERIES
OF QUESTIONS ABOUT EACH BEHAVIOR
IN SEQUENCE LIKE HOW DID THIS
CHILD GET OFF THEIR BACK?
THE ADMINISTRATOR CAN SCROLL
THROUGH THE VIDEO TO SEE WHAT
THE CHILD DID TO KNOW HOW THEY
SHOULD ANSWER.
EVERY ANSWER HAS A LINE DRAWING
THAT REMINDS THE ADMINISTRATOR
WHAT THE BEHAVIORS ARE.
SO IT ALLOWS YOU TO MATCH THE
VIDEO THAT YOU'RE LOOKING AT
DIRECTLY TO THE PICTURE THAT
YOU'RE SEEING.
IF THE CHILD TRAVELED THREE
METERS WITHOUT STOPPING, THEN
THE APP CAPITALIZES ON THE iPAD
FUNCTIONALITY TO FIND THE SPEED
OF THEIR WALK OR CRAWL BASED ON
THE START AND END TIMES TO GO
THREE METERS.
THE CAN SCROLL BACK AND FORTH
UNTIL THEY FIND THE EXACT START
AND END TIMES.
WE HAVE VERSIONS OF THE TASK FOR
CHILDREN WITH DIFFERENT SKILL
LEVELS INCLUDING BABIES WHO
CANNOT YET CRAWL OR WALK OR
ROLL.
THE APP GUIDES THE ADMINISTRATOR
BASED ON QUESTIONS TO THE PARENT
AND GUIDES THEM THROUGH
IDENTIFYING AND TIMING THE
SKILLS THAT THE CHILD DISPLAYED.
REACH TO EAT ASSESSES MANUAL
SKILLS AND TOOL USE.
THIS IS AN OLDER CHILD DOING THE
REACH TO EAT TASK.
OLDER CHILDREN REACH FOR SMALL
CHEERIOS AS AN UPSIDE-DOWN
AMERICA CUP AND DO THE TOOL USE
TASK WITH A SPOON.
FIRST YOU'LL SEE THE EASY
VERSION WHERE THE CHILD PICK UP
THE SPOON AND THE MORE
CHALLENGING VERSION WHERE THE
SPOON HANDLE IS POINTING THE
WRONG WAY FOR THAT HAND.
AUTO HERE'S WHERE THE VIDEO PLAY
PLAYBACK REALLY SHINES.
WHICH DID THE CHILD USE TO GRASP
THE CHEERIOS.
THEY CAN USE THE VIDEO PLAY BACK
TO SCORE IMPORTANT AND PRECISE
BEHAVIORS LIKE GRIPS.
USING THE VIDEO PLAY BACK THE
ADMINISTRATOR CAN SLOW DOWN,
BACK UP AND FREEZE THE FRAME ON
THE EXACT MOMENT OF THE GRASP.
REACH TO EAT IS ADAPTIVE.
ALL THE TASKS ARE ADAPTIVE.
THIS BABY CAN'T GRAB IT FROM THE
SMALL BASE AND KNOCKED IT TO THE
SMALL TABLE AND INSTEAD OF
MOVING TO THE MORE ADVANCED TASK
THE APP PROMPT THE ADMINISTRATOR
TO TEST GRASPING WITH THE LARGE
BASE AND NOW THAT CHILD CAN
GRASP JUST FINE.
FOR THE YOUNGEST CHILDREN WHO
ARE NOT YET EATING SOLID FOODS
LIKE CHEERIOS THEY DO A SIMILAR
TASK WITH A BLOCK.
SIT AND STAND MEASURES
STATIONARY POSTURAL CONTROL.
AS ALWAYS, THERE'S A DIFFICULT
COMPONENT FOR EACH TASK FOR EACH
AGE GROUP SO THEY'RE NEVER AT
CEILING.
THIS OLDER CHILD IS TRAINED TO
DO A TANDEM STAND WITH ONE FOOT
IN FRONT OF THE OTHER.
IT'S REALLY DIFFICULT.
EVEN FOR THE OLDER CHILD IT'S
STILL A CHALLENGE.
USING THE APP WE CAN GO BACK AND
FORTH TO FRAME THE EXACT START
AND STOP TIME THAT WILL REVEAL
HOW LONG THE CHILD HELD POSTURE
AND FIND THE MOMENT THE CHILD
STEPPED OUT OF THE STAND.
FOR YOUNGER CHILDREN WE ASSESS
BASIC SITTING AND STANDING.
HERE'S AN INFANT ATTEMPTING TO
DO A FEET A PART STAND.
CAN'T QUITE HOLD IT VERY LONG
AND THE BABY DOING THE
INDEPENDENT SITTING TASK.
WHICH POSTURES YOU TEST ARE
DICTATED BY QUESTIONS TO THE
PARENTS AND THE APP GUIDES YOU
THROUGH WHAT TO ADMINISTER AND
HOW TO CODE IT.
FINALLY FOR THE YOUNGEST BABIES
WHO CAN'T SIT WE TEST HEAD
CONTROL CALLED PULLED TO SHUT.
WE'RE STILL IN THE PROCESS OF
DEVELOPING THE FINAL SCORES SO
FAR WE'VE ANALYZED ABOUT
TWO-THIRDS OF THE DATA.
WE'LL HAVE GROSS AND FINE MOTOR
COMPOSITE SCORES AND SCORES FOR
SUB DOMAINS THAT INCLUDE
POSTURAL CONDITIONS, LOCOMOTION
AND MANUAL DEXTERITY AND
PLANNING.
WE'LL HAVE FULL SCORES FOR GET
UP AND GO AND REACH TO EAT BUT
FOR SIT AND STAND THERE WERE
ISSUES IN ADMINISTRATION AND
CHILDREN'S COMPLIANCE SO WE'RE
RECOMMEND ARE -- RECOMMENDING
IT'S USED AS A SUPPLEMENTAL AND
WE'RE SEEING VARIABILITY WITHIN
EACH AGE GROUP AND LEERS THE
CORRELATION BETWEEN THE GROSS
MOTOR COMPOSITE SCORE AND
CHILDREN'S AGE.
THOUGH ONLY A SMALL SUBSET
RETURN TO COMPLETE THE BAYLEY
SCALES WE ALSO FIND STRONG
CORRELATIONS BETWEEN THE GROSS
MOTOR COMPOSITE SCORE AND THE
GROSS ON THE BAYLEY.
SIMILARLY, THE BABY TOOLBOX FINE
MOTOR COMPOSITE SCORE IS WELL
WITH CHILDREN'S AGE AND THE FINE
MOTOR COMPOSITE SCORE IS
CORRELATED WITH FINE MOTOR ON
THE BAILEY.
-- BAYLEY AND FOR THE BABY
TOOLBOX WE DEVELOPED A WAY FOR
NON-EXPERTS TO OBTAIN DETAILED
QUANTITATIVE ASSESSMENTS BASED
ON DIRECTLY OBSERVED BEHAVIORS
IN A SHORT AMOUNT OF TIME.
AND EVERY 10 MINUTES YOU CAN
MEASURE A SUITE OF LOCO MOTOR
SCORES AND IMPLICATIONS FOR
DAILY LIFE.
EACH TASK IS ADAPTIVE SO THAT
MEANS FROM THE VERY FIRST CLUMSY
MOVEMENT IN A ONE-MONTH-OLD TO
SKILLED EFFICIENT MOVEMENT IN
4-MONTH-OLDS AND THEY CAN BE
ADMINISTERED OUTSIDE THE LAB
SETTING BECAUSE THE ONLY TOOLS
YOU NEED ARE THE iPAD AND A FEW
COMMON OBJECTS LIKE MEASURING
CUPS AND A SPOON.
THE BIG INNOVATION IS OUR USE OF
THE iPAD'S VIDEO CAPABILITIES TO
FACILITATE CODING DURING THE
SESSION.
PRECISE VIDEO PLAY BACK AND SIDE
BY SIDE COMPARISONS TO DRAWINGS
OF THE TARGET BEHAVIORS ALLOW
FOR QUICK AND ACCURATE CODING OF
EVEN FINE DETAILS OF MOTOR
BEHAVIOR.
AND THE VIDEOS CAN BE EXPORTED
TO BE ANALYZED FURTHER.
THEY CAN BE SHARED ON DATA AND
REUSED AND SHOWN TO CLINICIANS
IF PARENTS ARE CONCERNED.
AND I WANT TO ACKNOWLEDGE ALL
THE RESEARCHERS AND WONDERFUL
STAFF AT NORTHWESTERN AND AT NYU
WHO HELPED US PUT THIS TOGETHER
AND BABIES WHO LET US TRY OUT
OUR IDEAS DURING COVID WHEN WE
WERE TRYING TO DO IT ALL ON
ZOOM.
>> SO, THANK YOU VERY MUCH ALL
OUR SPEAKERS FOR THIS SESSION.
A WONDERFUL SESSION.
I'LL SAY THAT IT WAS A NICE
BLEND IN MY OPINION OF THE TEST
DEVELOPERS AND THEIR ANALYSIS OF
THE TEST TO THIS POINT AS WELL
AS EARLY ADOPTERS AND
SCIENTISTS.
WE WERE DOING A LOT OF THE
INITIAL DEVELOPMENT OF THE TEST
DURING COVID-19 AND NOT WANTING
TO EXPOSE YOUNG CHILDREN AND
INFANTS WE HAD SCIENTISTS AND
THANK GOD A LOT OF POSTDOCS HAD
KIDS.
SO WE HAVE SAMPLE FOR ALL THE
MEASURES TO DEVELOP THE
MEASURES.
THAT'S NOT AN INCONSEQUENTIAL
THING.
MEASUREMENT IS A DETAILED AND
LENGTHY EFFORT.
I THINK IT'S IMPORTANT TO
RECOGNIZE ALL THE WORK THAT
EVERYONE THAT'S SITTING UP HERE
TODAY HAS PUT INTO MAKING THIS A
REALITY, A USABLE TOOL FOR
SCIENTISTS EVERYWHERE.
I ALSO WANT TO ACKNOWLEDGE THAT
ALL THE PRESENTATIONS WE'RE
WORKING WITH DATA BEFORE WE HAVE
FINALIZED THE NORMING SCORES FOR
THE MEASURES.
SO SPEAKING ABOUT THE NORMATIVE
VALUES IS DIFFICULT BECAUSE THE
PROCESS ALSO IS A LENGTHY AND
VERY INVOLVED PROCESS OF
DEVELOPING THOSE NORM SCORES.
SO WE ARE MOVING QUICKLY FORWARD
BUT THERE'S STILL WORK TO BE
DONE BEFORE WE'RE READY TO
RELEASE THE TOOL TO THE PUBLIC.
THE OTHER THING I WANT TO
MENTION ASIDE FROM ALL THE WORK
DURING COVID WHICH IS INCREDIBLE
WORK DESPITE THE CHALLENGES OF
COVID IS THAT WE ESSENTIALLY
HAVE EYE LARGE SAMPLE AND
VALIDATED IT AND HAVE
RELIABILITY TESTING AND YOU'LL
HEAR ALL THAT ONCE ALL THE
SCORING AND WASN'T REPORTED IN
PART BECAUSE IT'S STILL BEING
ANALYZED RIGHT NOW.
IMPORTANT PART OF MAKING A
USEFUL TOOL.
FINALLY, I WOULD SAY SO ONE OF
THE TOOLS OF DEVELOPING THE NIH
BABY TOOLBOX WAS TO MAKE IT EASY
TO ADMINISTER, HIGHLY MOBILE AND
NOT RIVER MENTION THE NUMBER
PERIPHERAL MEASURES AND ONE
THING CHALLENGE IS TO KEEP THE
ITEMS LIMITED AND THE TIME
REQUIRED TO ADMINISTER THE TEST
LIMITED AND THE EXPERTISE TO
ADMINISTER THE TESTS.
SO ALL OF THOSE THINGS WERE
UNIQUE CONTRIBUTIONS THAT THE
BABY TOOLBOX OFFERS.
IN THAT PROCESS THOUGH A LOT OF
PEOPLE SAY CAN ANYBODY OFF THE
STREET START ADMINISTERING THE
TESTS AND THE ANSWER IS NO FOR
SEVERAL REASONS.
ONE IS IT'S A CLASS B MEASURE
WHICH MEANS THAT YOU HAVE TO
DEMONSTRATE THE REASON YOU WANT
TO ADMINISTER THE TEST BECAUSE
WHEN YOU MAKE A TEST WIDELY
AVAILABLE TO THE GENERAL PUBLIC
YOU HAVE A LOT OF PEOPLE
PRACTICING SO THEY SCORE WELL.
HARD TO DO WITH AN INFANT BUT
EVEN WITH AN INFANT YOU CAN BIAS
THE VALUES.
THE OTHER REASON THAT WE DON'T
DO ANYBODY ON THE STREET CAN
ADMINISTER THE TEST BUT WE DON'T
REQUIRE AN ADVANCED DEGREE IS
ESSENTIALLY IT'S USEFUL AS WE
SAW FOR SOME OF THE VIDEO, THANK
YOU, KAREN THAT HAVING SOME
EXPERIENCE WITH YOUNG CHILDREN
AND BEING ABLE TO MANAGE THEIR
BEHAVIOR IN A TEST ENVIRONMENT
IS VERY HELPFUL.
THE OTHER ITEM I WANT TO MEASURE
IN REGARD TO THE MEASUREMENT
TOOLS IS ESSENTIAL LY WE NEED
PEOPLE WHO CAN DEMONSTRATE THAT
THEY ADMINISTERED THE TEST
CORRECTLY AND IN DOING THAT THE
NORTHWESTERN TEAM HAS USED THE
TRAIN THE TRAINER MODEL.
THAT MEANS THE EFFORT FOR THE
NORTHWESTERN TEAM IS LOWER BUT
THEY WILL FACILITATE MAKING SURE
THAT THOSE FOLKS THAT YOU TRAIN
TO ADMINISTER THE TEST ARE IN
FACT PREPARED TO ADMINISTER THE
TEST CORRECTLY.
ALL OF THOSE PIECES ARE CRITICAL
TO MEASUREMENT DEVELOPMENT AND
MAKING AN EFFECTIVE USEFUL AND
RELIABLE MEASURE.
SO I WOULD DELIGHTED WE SAW ON
ALL OF THE SLIDES THAT PROVIDED
DATA THAT WE HAVE A HIGH DEGREE
OF VALIDITY AT LEAST.
WE ALSO HAVE DATA THAT THERE'S A
HIGH DEGREE OF RELIABILITY.
SO WITH THAT, I WOULD LIKE TO
OPEN UP THE TIME TO QUESTIONS
BUT BEFORE I DO THAT, I JUST
WANT TO MENTION THAT IF YOU
AREN'T ABLE TO GET YOUR QUESTION
ANSWERED RIGHT NOW YOU'LL HAVE
SEVERAL OTHER OPPORTUNITIES.
THERE'S AN ASK THE EXPERT
SESSION THIS AFTERNOON AS WELL
AS TOMORROW MORNING SO YOU CAN
ASK QUESTIONS AND FOR THOSE
ONLINE YOU CAN SEND YOUR
QUESTIONS TO THE
NIHMEASURESCONFERENCE@MAIL.NIH.
gov.
WITH THAT I WILL IT UP FOR
QUESTIONS.
>> HI, THANKS ALL OF YOU.
IT'S GREAT TO SEE WHAT'S
HAPPENING WITH BABY TOOLBOX.
I WONDERED IF ANYONE CAN SPEAK
TO THE MULLEN COMPONENTS OF THE
BABY TOOLBOX AND HOW THAT'S
GOING.
>> WE'RE DEVELOPING MODELS FOR
EXPRESSIVE AND WE RECEIVE THE
COMPLETE DATA SET AND SCORING IS
STILL IN PROGRESS FOR ALL THREE
MEASURES.
RESULTS SOON TO COME.
>> HI.
I'M A PEDIATRICIAN, PHYSICIAN
SCIENTIST FROM COLUMBIA AND I'M
REALLY HERE TO SEE IF I CAN
UTILIZE THIS RESOURCE FOR MY
RESEARCH.
SO ONE OF THE -- LISTENING TO
HBCD STUDY, THAT WAS VERY
INSIGHTFUL TO THINK OF HOW TO
PLAN FOR IT AND THE QUESTION
THAT COMES TO MY MIND IS WHAT IS
THE LONG-TERM PLAN OF
MAINTAINING THE TRAINABILITY FOR
THESE MEASURES AS YOU MENTIONED,
IT'S NOT SOMETHING WE CAN GIVE
TO RESEARCH ASSISTANTS OR
RESEARCH COORDINATORS WHO ARE
GOING TO BE COLLEGE GRADUATES OR
FRESH OUT OF COLLEGE AND NEED TO
BE ABLE TO USE THE DATA
CORRECTLY WE NEED TO HAVE
VALIDITY AND STANDARDIZED
ETCETERA.
IS THERE A PLAN -- LONG-TERM
PLAN WHEN THE DEVELOPMENT PART
IS DONE.
IS THERE A PLAN BY NIH, ANYBODY
ELSE?
>> SO I DON'T KNOW IF ANY OF YOU
WANT TO ANSWER THAT QUESTION.
I HAVE SOME ANSWER BUT GO AHEAD.
>> I'LL ONLY JUST MENTION AS
SOMEONE ON THE TRAINING TEAM
THAT WE ARE THINKING ABOUT THESE
THINGS THROUGHOUT THE COURSE OF
CREATING TRAINING MATERIALS AND
THEN DISSEMINATING THEM AS WELL.
>> SO THERE'S A LOT OF EFFORT
THAT'S GOING INTO DEVELOPING
TRAINING MATERIALS INCLUDING
VIDEO, PAPER, THE LIKE.
NORTHWESTERN SHOULDN'T BEING THE
PERMANENT CERTIFIER BUT THEY
WILL PROBABLY DEVELOP SOME
SYSTEM FOR CERTIFYING IF YOU
WANT.
THAT WOULD NOT BE OFFERING
EVERYBODY ON YOUR TEAM
THROUGHOUT TIME.
TRAINING.
AGAIN, WE WOULD EXPECT THE TRAIN
THE TRAINER KIND OF MODEL.
THE GOAL IS IS THE INPUT FROM
NORTHWESTERN ONCE THE TOOL IS
RELEASED TO THE PUBLIC IS THAT
THERE WILL BE DIMINISHING OVER
TIME BUT NOT NOTHING AND
DEVELOPING TOOLS TO PROVIDE
TRAINING PEOPLE CAN DO IN
ADVANCE ON THEIR OWN.
SITES OF DATA COLLECTION AND 45
SITES OF DATA ANNOTATION FOR THE
NIH PLAY PROJECT AND I THINK
IT'S IMPORTANT TO ENSURE YOU
HAVE FIDELITY TO THE PROTOCOL
ALL THE WAY THROUGH.
IF IT WERE MY STUDY, I WOULD
WANT THAT.
THE MOTOR MEASURES, EVERYTHING'S
ON VIDEO.
IT'S REALLY EASY TO DETERMINE
YOUR OWN QUALITY ACRITERIA AND
CHECK WHETHER PEOPLE ARE MEETING
IT OR NOT AND FOR THE OTHER
MEASURES IT'S ALSO PRETTY EASY
PUT A VIDEO CAMERA ON WHAT'S
HAPPENING AND HAVE FIDELITY OF
THE PROTOCOL BECAUSE YOU LOOK AT
THE RAW DATA BEFORE IT TURNED
INTO A SCORE AND THEN CAN
DECIPHER BASED ON YOUR QUALITY
ASSURANCE CRITERIA.
>> I'LL ADD FOR HBCD WE'RE
TRAINING INDIVIDUALS WHO ARE
MOSTLY POST-BACS AND HAVE NO
EXPERIENCE WITH INFANT
ASSESSMENT.
I WOULD SAY THERE'S VARIABILITY.
YOU'LL ALWAYS FIND YOU NEED THE
RIGHT PERSON WITH THE RIGHT
PERSONAL WILL DO A BETTER JOB
THAN MAYBE SOMEONE NOT AT VERSED
AND COMFORTABLE WITH DEALING
WITH BABIES.
THERE'S SOME ELEMENT OF THAT.
AND WE HAVE BEEN ABLE TO PUT
PEOPLE THROUGH THOSE TRAINING
EXPERIENCES AND IT'S A
RELATIVELY SHORT FOUR HOURS
TOTAL OR THE INITIAL TRAINING
AND ACCESS TO MATERIALS AND
THEY'VE BEEN ABLE TO SUBMIT A
VIDEO AND BEEN ABLE TO BE
COMPLIANT AND REACH THE CRITERIA
THAT WERE ESTABLISHED BY
NORTHWESTERN WE WERE TAUGHT TO
BE ABLE TO GET RELIABILITY AND
THEN WE'RE ADDING IN THAT PEER
MENTORING MODEL AND WANT THAT TO
BE PART OF THE ACTIVE LEARNING
PROCESS SO THEY'RE LOOKING AT
SOMEONE ELSE'S VIDEO WHILE
THEY'RE VIDEO'S BEING LOOKED AT
AND MONITORING THAT TO MAKE SURE
WE'RE ADHERING TO GOOD FIDELITY
TO WHAT WE'RE DOING IN THE FIELD
BECAUSE IT DEPENDS ON WHAT YOU
WANT OR HOW YOU WANT TO
ORCHESTRATE IT BUT IT'S A GREAT
MODEL TO MAKE SURE YOU HAVE GOOD
ASSESSMENTS FROM THE BEGINNING
TO THEN OF THE STUDY.
>> NEW.
-- THANK YOU.
>> WE'RE ACTUALLY PAST 2:00 AND
SO WE NEED TO STOP.
WE HOPE THOSE WHO HAD QUESTIONS
THAT WERE QUEUEING UP WILL COME
TO THE ASK THE EXPERTS.
THANK YOU VERY MUCH EVERYONE.
VERY GLAD TO HAVE YOU HERE
TODAY. GREAT JOB, LADIES.
HI, FOLKS.
WE'RE GOING TO GET STARTED.
I NAME IS MATT SUTTERER WITH THE
NATIONAL INSTITUTE ON AGE AND
I'LL BE MODERATING THE NIH
TOOLBOX ACROSS THE LIFE SPAN AND
IN CLINICAL POPULATIONS.
AND FIRST SPEAKER IS CALLIE
TYNER FROM THE UNIVERSITY OF
DELAWARE WITH THE NEW TB VISUAL
REASONING TESTS.
>> HELLO.
HOPEFULLY YOU GUYS CAN HEAR ME?
SPEAK LOUDER?
I'LL WORK ON THAT.
ADVANCING.
THERE WE GO.
OKAY.
SO I'M KALLIE TYNER FROM THE
UNIVERSITY OF DELAWARE AND
EXCITED TO BE SHARING
INFORMATION FROM NEW TESTS ON
THE TOOLBOX I DEVELOP AS PART OF
A TEAM CALLED THE REASONABLE
REASONING TASK OR VR.
I'LL DESCRIBE THE IMPETUS AND
THE APPROACH FOR DEVELOPING IT
AND SOME INFORMATION ON THE
PSYCHO METRIC PROPERTIES.
SO WHY DID WE DEVELOP THE NEW
TASK FOR THE NIH TOOLBOX?
AREN'T THERE ENOUGH TESTS
ALREADY?
NO.
THERE'S THE LARGE ECHO STUDY
THAT USES THE TOOLBOX AND THE
STAKEHOLDERS WERE ASKED FOR
FEEDBACK AND WE LOOKED AT THE
FEEDBACK AND REALIZED THE TEST
OF ABSTRACT REASONABLE ARE
REASONING WAS MISSING FOR THE
CURRENT TESTS AVAILABLE FOR
CHILDREN.
SO YOU MAY BE AWARE VISUAL
REASON ARING -- REASON ARING
MEASURES ARE GOOD OR ABSTRACT
AND RELATED TO COGNITIVE ABILITY
AND COULD BE A NICE TEST IN THE
TOOLBOX THAT ARE OTHER VERBAL
TESTS LIKE LIST SORTING, WORKING
MEMORY AND OVER THINGS LIKE
PICTURE VOCABULARY THAT ARE
VERBAL.
IT ALSO COULD BE HELPFUL FOR
CHILDREN ESPECIALLY YOUNGER KIDS
WHO DON'T HAVE THE SKILLS OF
READING OR WRITING ABILITY TO BE
ABLE TO EVALUATE THEM IN A
NON-VERBAL WAY.
AND WE WANTED TO SEE IF WE CAN
DEVELOP A TEST THAT WOULD WORK
FOR CHILDREN AS YOUNG AS 3.
SO WHAT WAS OUR DEVELOPMENT
APPROACH?
A MAJOR FACTOR WAS TIMING AND
DOESN'T WANT TO INCREASE THE
TIME BURDEN OR LENGTHY TEST TOO
MUCH.
OUR GOAL WAS A TEST THAT WOULD
TAKE MIGHT TO SEVEN MINUTES TO
COMPLETE.
GENERALLY WE TRIED TO FOLLOW THE
DESIGN PRINCIPLES OF THE NIH
TOOLBOX FREE OF INTELLECTUAL
PROPERTY CONCERNS AND ABLE TO BE
ADMINISTERED ON THE iPAD WITH
MULTIPLE CHOICE RESPOND ARING
AND REQUIRE LIMITED EXAMINER
INVOLVEMENT.
WE ALSO HAD A GOAL FOR LIFE SPAN
ASSESSMENT.
WE WANTED IT TO BE APPROACHABLE
FOR KIDS OF PRESCHOOL AGE AND
OLDER.
WE ALSO WANTED IT TO BE
SENSITIVE TO COGNITIVE DEFICITS
AND WANTED IT TO BE FREE OF
POTENTIAL COMPOUNDS THAT MIGHT
INTERFERE.
LET ME REVIEW A FEW OF THE
CHALLENGES WE FACED WHEN
DEVELOPING THIS.
ONE THING WE THOUGHT ABOUT OFTEN
WAS TIMING.
WE WANTED TO KEEP IT BRIEF TO
AVOID INCREASING THE BURDEN AND
IF YOU HAVE GIVEN A TEST OF
VISUAL REASONING BEFORE YOU MAY
BE AWARE THEY COULD BE TIME
INTENSIVE AND OFTEN TAKE 10
MINUTES OR SOMETIMES MORE LIKE
20 OR 30 MINUTES DEFENDING ON
THE DEVELOINDIVIDUAL AND YOU MAK
IMPOSING A TIME LIMIT WOULD KEEP
IT BRIEF BUT DOESN'T WANT TO
IMPOSE MEMORY OR PROCESSING
SPEED TO COMPLETE THE TEST.
WE WORKED TO DEVELOP THE TEST AS
A COMPUTERIZED ADAPTIVE TEST AS
A WAY OF BALANCING BREVITY WITH
THE GOALS OF HIGHER RELIABILITY.
ANOTHER MAJOR CHALLENGE WE
CONSIDERED WAS THE FACT THAT
THIS WITH US GOING TO BE A
VISUAL TEST AND IDEALLY MORE OF
A NON-VERBAL TEST.
SO WE WANTED THE TEST TO BE FREE
OR INDEPENDENT FROM VERBAL
SKILLS LIKE READING, SPEECH,
LISTENING, SOMANTIC NONL AND
LOOK AT HOW WE TAUGHT THE TEST
AND HOW PEOPLE WOULD RESPOND TO
THE TEST.
FOR TEACHING THE TEST WE
DEVELOPED ANIMATIONS SHOWN IN
THE APP WHEN SOMEONE IS LEARNING
THE TEST.
ANIMATIONS ARE PLAYED WHILE THEY
HEAR THE INSTRUCTIONS
PRERECORDED AND THE INSTRUCTIONS
ARE ALSO WRITTEN ON TE SCREEN.
AND I'M HESITANT TO CALL IT A
PURELY NON-VERBAL TEST BECAUSE
THERE'S STILL INSTRUCTION ARE
VERBAL AND ADDING THE ANIMATIONS
LOWERS THE DEMANDS OF THE TEST
AND MAKES IT MORE NON VERBAL.
ALSO FOR RESPONDING PARTICIPANTS
JUST TAP AN IMAGE ON THE SCREEN
SO THERE'S NO NEED TO NAME THE
ITEM THEY SEE OR GIVE ANY KIND
OF SPOKEN RESPONSE.
THE THIRD CHALLENGE THAT WE FACE
THAT WAS IMPORTANT FOR THIS TEST
WAS THE FACT THERE ARE A LOT OF
COMMON SENSORY VISUAL PROBLEMS
THAT COULD INTERFERE WITH
PERFORMANCE ON THE VISUAL TEST
WE DIDN'T WANT TO INTERFERE.
SO THINGS LIKE COLOR PERCEPTION
OR COLOR-BLINDNESS, VISUAL ACUTE
TI VARY AND APPEAR FREQUENTLY IN
THE POPULATION.
WE WORK TO AVOID THEM BY --
AVOIDING FINE DETAILS BEING
CRITICAL FOR RESPONDING.
DIFFICULT TO PERCEIVED
DIFFERENCES IN SHADING THAT MAY
REQUIRE HIGHER LEVEL OF CONTRAST
SENSITIVITY AND AVOID COLOR
COMBINATIONS LIKE RED/GREEN OR
BL
BLUE/PURPLE AND LOOKED AT
DISCRIMINATION, REASONING,
SERIAL REASONING AND SPATIAL
VISUALIZATION AND MENTAL
ROTATION WERE THE DIFFERENT
COGNITIVE SKILLS INVOLVED.
THESE ARE NOT REAL ITEMS AND
THEY SEEM VERY EASY BECAUSE
THESE ARE EXAMPLES OF SOME OF
THE EASIEST TYPES OF ITEMS
DEVELOPED FOR YOUNG CHILDREN.
THE TWO ON THE TOP ARE THE
PATTERN COMPLETION ITEMS AND
BOTTOM LEFT SERIAL AND RIGHT IS
ANALOG REASONING TYPE OF ITEM.
WE NEXT MOVED THESE ITEMS INTO
SEVERAL PHASES OF TESTING.
WE FIRST CONDUCTED AN ITEM TRIAL
AND IN TWO PILOTS.
OUR GOALS WERE FIRST TO IDENTIFY
CONCERNS WITH ANY OF THE ITEMS
THINGS LIKE ITEMS THAT WERE
CONFUSING OR TOOK TOO LONG FOR
PEOPLE TO RESPOND OR A PLAUSIBLE
ANSWER OTHER THAN OUR DIRECT
RESPONSE AND GAUGED THE
FEASIBILITY, PARTICULARLY THE
FEASIBILITY FOR YOUNGER KIDS
RESPONDING TO THE TEST AND ALSO
THE TIME REQUIRED FOR ADULTS TO
TAKE IT.
THOSE WERE THE THINGS THAT WERE
ON OUR MIND.
SO FIRST WE DID AN ITEM TRIAL
WITH 95 PEOPLE IN PERSON AND 23
PEOPLE AFTER THAT TOOK A
POST-TEST COGNITIVE DE BRIEFING
INTERVIEW TO DETECT
UNINTENTIONAL CHALLENGES OR
PROBLEMS WITH TE ITEMS AND NEXT
COMPLETED TWO CALIBRATION
PILOTS.
ONE IN PERSON AND ONE WITH
ANOTHER RESEARCH PANEL.
BASED ON THE ITEM TRYOUTS IN THE
PILOTS WE DID REMOVE, MODIFY AND
DEVELOPED AN IF YOU NEW ITEMS TO
FILL MEASUREMENT GAPS.
WE LEARNED FROM THE RESULT ARE
CHILDREN WERE ABLE TO COMPLETE
THE TASKS SUCCESSFULLY AND DID
FIND THOUGH CHILDREN YOUNGER
THAN 5 STRUGGLED WITH THE MORE
COMPLEX ITEM TIMES EXCEPT FOR
THE SIMPLE COMPARISON TYPE OF
ITEM AN EXAMPLE OF WHICH IS ON
THE SCREEN.
SO WE'RE ADDING TIMING.
CHILDREN RESPONDED FASTER THAN
ADULTS AND FOR ADULTS SLOWER
RESPONDING WAS ASSOCIATED WITH
BETTER PERFORMANCE WHICH
REINFORCED WHAT WE KNEW ABOUT
VISUAL REASONING TESTS WHERE
THEY CAN BE QUITE LENGTHY.
NEXT WE PREPARED FOR CALIBRATION
AND VISUAL REASONING WAS
INCLUDED IN THE V3 STUDY AND THE
DATA FROM THAT WERE USED TO
CALIBRATE THE ITEMS AND DEVELOP
NORMS.
THE STUDY INCLUDED TEST
ARE-RETEST RELIABILITY AND
ASSESSMENT AND USING THE MATRIX
TEXT FROM THE WEXLER SKILLS AS
THE GOLD STANDARD OF THE
CONSTRUCT.
CALIBRATION ANA
CALIBRATION ANALYSES RESULT ARED
IN A BANK OF 180 ITEMS FROM THE
CALIBRATION DATA SET IT WAS
DECIDED TO NORM THE TEST FOR
AGES 4 AND UP.
AND WE WERE ABLE TO CALIBRATE
THE TEST AS A CAT.
BASED ON SIMULATIONS FROM THE
STUDY IT WILL TAKE TWO TO FIVE
MINUTES FOR CHILDREN TO COMPLETE
THE CAT AND FOUR TO NINE MINUTES
FOR ADULTS WITH MOST ADULTS
COMPLETING IN LESS THAN SEVEN
MINUTES AND TEST-RETEST
RELIABILITY WAS CONSISTENT WITH
OTHER TOOLBOX FLUID COGNITION
TEST.
THIS IS A GRAPH OF A PLOT OF THE
SCORES ON VR BY AGE.
AND WE FOUND THAT FOR 3 TO
11-YEAR-OLDS, AGE WAS MODERATELY
STRONGLY CORRELATED WIN SCORES
IN THE POSITIVE DIRECTION.
THE ASSOCIATION WITH AGE WAS
SMALLER FOR AGES 12 TO 17
SUGGESTING THAT'S THE AGE RANGE
FOR THE CONSTRUCT STARTS TO
STABILIZE AND FOR ADULTS, VR
SCORES WERE NEGATIVELY
CORRELATED WITH AGE CONSISTENT
WITH OTHER FLUID COGNITIVE TEST
PEAK AROUND 85 AND DELINE WITH
AGE.
LOOKING AT THE ASSOCIATIONS WITH
A VALIDATION MEASURES THE WEXLER
REASONING TEST IT WAS SUPPORTED
FOR VR.
WE HYPOTHESIZED A CORRELATION OF
.5 OR GREATER USED WHEN
DEVELOPING OTHER TOOLBOX
COGNITIVE TESTS AND THAT WAS
FOUND FOR ADULTS ON THE WAYS
THOUGH SLIGHTLY WEAKER FOR
CHILDREN 3 TO 5 WHO TOOK THE
WHIPSY.
WE CONSIDERED VR WITH MORE
GENERAL MEASURES OF COGNITIVE
FUNCTIONING AND THE WEXLER FULL
SCALE I.Q. OFFER FS I.Q. AND THE
TOOLBOX COMPOSITES.
VR APPEARS TO BE A STRONG PROXY
FOR GENERAL INTELLIGENCE AND
COGNITION WHICH HAS BEEN
OBSERVED WITH OTHER SIMILAR
TESTS AND THIS WAS ESPECIALLY
TRUE FOR SCHOOL-AGED CHILDREN
WHERE THE CORRELATION OF VR WITH
FULL SCALE I.Q. WAS NEARLY
IDENTICAL TO THE TOTAL COGNITION
COMPOSITE.
THESE RESULTS ALSO SUPPORTED
CONSIDERING VR AS A FLUID
COGNITIVE TEST FOR ADULTS AND
THE DISTINCTION WASN'T PRESENT
FOR CHILDREN WHICH IS CONSISTENT
WITH WHAT WE KNOW ABOUT THE
TRAJECTORIES OF FLUID AND
COGNITION SIMILAR FOR CHILDREN.
LATER TEEN YEARS.
IN SUMMARY, VISUAL REASON ARING
WAS DEVELOPED DE NOVO AND GIVEN
AS A CAT AND RELEASED NOW IN V3
VIA THE iPAD APP FOR THE NIH
TOOLBOX AND EXPANDS THE
COGNITION DOMAIN TO BE MORE
INCLUSIVE OF VISUAL AND SPATIAL
REASONING SKILLS AND WE'VE SEEN
MODERATE TO STRONG CORRELATIONS
WITH MATRIX REASONING, FULL
SCALE I.Q. AND TOOLBOX XOT
COMPOSITE.
WE THINK WE'D LIKE TO STUDY WITH
MORE RESEARCH VR COULD PERHAPS
BE COMBINED WITH A PICTURE
VOCABULARY TO FORM A TRUE SUB
TEST I.Q. ESTIMATE AND SOMETHING
WE'LL LOOK AT FURTHER.
PLEASE CHECK OUT THE TOOLBOX
WEBSITE OR REACH OUT BY EMAIL IF
YOU WOULD LIKE TO ASK ANY
QUESTIONS.
THANKS.
>> THANK YOU.
NEXT SPEAKER IS GOING TO BE GAIL
HARMATA FROM THE UNIVERSITY OF
IOWA LOOKING AT ASSOCIATIONS
BETWEEN NIH TOOLBOX AND
EMOTIONAL BATTERY MEASURES AND
PREVIOUS SUICIDE AT THE SAME
TIME IN BIPOLAR TYPE 1.
>> ALL RIGHT.
LET'S GET STARTED.
SO UNFORTUNATELY, BIPOLAR
DISORDER IS A SEVERE PSYCHIATRIC
ILLNESS CHARACTERIZED BY MOOD
SWINGS WHICH INCLUDE DEPRESSION
AND MANIA.
THERE ARE TWO SUBTYPE HAVE
DIFFERENT PROFILES OF HOW THOSE
MOOD SWINGS LOOK LIKE.
WE HAVE TYPE 1 CHARACTERIZED BY
ONE FULL MANIC EPISODE AND TYPE
2 MORE FOCUSSED ON DEPRESSIVE
AND HYPOMANIA AS NOT SEVERE
MANIA SYSTEMS.
FOR THE PURPOSE OF TODAY'S TALK
OUR SAMPLE INCLUDED PEOPLE WITH
TYPE 1.
INDIVIDUALS WITH BIPOLAR
DISORDER ARE 30 TO 60 TIMES MORE
LIKELY TO ATTEMPT SUICIDE AND
OVER THEIR LIFE TIME UP TO 50%
OF AFFECTED INDIVIDUALS WILL
ATTEMPT SUICIDE AND UP SOME WILL
DIE AND BETTER UNDERSTANDING OF
RISK FACTORS WILL HELP PREDICT
AND PREVENT SUICIDE ATTEMPTS IN
THE POPULATION.
THERE'S MANY RISK FACTORS
IDENTIFIED FOR SUICIDAL BEHAVIOR
AND BIPOLAR DISORDER.
ONE IS PAST SUICIDE ATTEMPT
PREDICTIVE FUTURE SUICIDE AT THE
SAME TIME HISTORY OF ATTEMPT OR
MOOD DISORDERS IS PREDICTIVE
FUTURE ATTEMPTS AND ASSOCIATED
WITH SUICIDAL BEHAVIOR.
HAVING AN ALCOHOL OR SUBSTANCE
USE DISORDER AND GENDER WHICH IS
INTEREST IN THAT FEMALES ARE
MORE LIKELY TO OR WOMEN ARE MORE
LIKELY TO AT THE SAME TIME
SUICIDE BUT MEN ARE MORE LIKELY
TO DIE BY SUICIDE.
POSSIBLY IN PART EXPLAINED BY
THE LETHAL METHOD USED FOR
LETHALITY OF THE METHOD BUT NOT
COMPLETELY WHICH IS AN
INTERESTING QUESTION.
CONTINUING ON, OTHER SOCIO
DEMOGRAPHIC FACTORS MAY INCLUDE
FAMILY STRUCTURE, SOCIO ECONOMIC
STATUS PAST HISTORY OF ABUSE.
WE HAVE A VARIETY OF DIFFERENT
CONSTRUCTS AND EXPERIENCES THAT
ARE CONTRIBUTING TO RISK FOR
SUICIDAL BEHAVIOR.
THERE'S PSYCHO, SOCIAL AND
EMOTIONAL FACTORS.
SO THINGS LIKE SADNESS,
PERCEIVED QUALITY OF LIFE,
HOPELESSNESS, THESE DIMENSIONS
OF EMOTIONAL EXPERIENCE AND THEN
ALSO THE CHARACTERISTIC OF AN
INDIVIDUAL'S PSYCHIATRIC SYMPTOM
PROFILE WHERE A PERSON WITH
SEVERE DES PRESSIVE OR CURRENT
DEPRESSIVE EPISODE AND PEOPLE
WITH MORE RAPID CYCLING AND
EARLIER AGE OF ONSET AND DELAY
OF INITIAL TREATMENT ARE ALL
FACTORS THAT CONTRIBUTE TO
GREATER RISK FOR SUICIDAL
BEHAVIOR.
SO A BIG QUESTION HERE IS CAN WE
BETTER UNDERSTAND HOW SOME OF
THESE SOCIAL AND EMOTIONAL
FUNCTIONING CONSTRUCTS RELATE
ARE TO SUICIDE ATTEMPTS IN
BIPOLAR DISORDER.
WE CHOSE THE NIH TOOLBOX AS A
WAY OF LOOKING AT THIS THAT HAD
SEVERAL ADVANTAGES.
WE ALREADY DISCUSSED THIS
THROUGHOUT THE DAY HOW IT'S A
SINGLE AND BRIEF ASSESSMENT AND
WE ZOOMED IN ON THE EMOTION
TOOLBOX AND BATTERY.
THIS BATTERY COVERS A VARIETY OF
CONSTRUCTS WHICH WE'LL GO OVER
IN A BIT AND WELL VALIDATED AND
SELF-ADMINISTERED AND DOES NOT
REQUIRE CLINICAL INTERVIEW.
SOME ASSAYS COLLECTED WERE
CLINICIAN OR EXPERIMENTAL
DELIVERED AND THIS WAS
SELF-ADMINISTERED.
IN TERMS OF HOW IT'S BEEN USED
PREVIOUSLY IN SUICIDE RESEARCH,
THE NIH TOOLBOX HAS BEEN
EMPLOYED IN AT LEAST TWO STUDIES
RELATED TO SUICIDAL IDEATION BUT
NOT IN TERMS OF ATTEMPT.
IT'S IMPORTANT TO DISTINGUISH
THESE AS CONCEPTS BECAUSE THE
VAST MAJORITY OF PEOPLE WITH
SUICIDAL IDEATION DO NOT GO ON
TO HAVE AN ATTEMPT.
THAT'S ANOTHER QUESTION WE MIGHT
END UP LOOKING INTO BUT FOR
PURPOSES OF TODAY WE'RE LOOKING
AT HISTORY OF ACTUAL ATTEMPT.
SO WE USED VERSION 2 OF THE
TOOLBOX.
SO IT WILL BE A LITTLE BIT
DIFFERENT FROM WHAT WAS
DESCRIBED IN THE EARLIER TALK IN
TERMS OF THE EMOTION SUB
DOMAINS.
SO IN DOMAIN 1 WE HAVE
PSYCHOLOGICAL WELL BEING AND
SATISFACTION AND MEANING AND
PURPOSE IN LIFE AND FOR THE
SOCIAL RELATIONSHIPS DOMAIN WE
HAVE EMOTIONAL SUPPORT,
INSTRUMENTAL SUPPORT,
FRIENDSHIP, LONELINESS,
PERCEIVED REJECTION AND
HOSTILITY IN DOMAIN 3 STRESS AND
SELF-EFFICACY AND IN DOMAIN 4 WE
HAVE NEGATIVE AFFECT.
FEAR, AFFECT AND SADNESS AND
ANGER INCLUDING AFFECT,
HOSTILITY AND PHYSICAL GRESSION.
THE PEOPLERY PURPOSE WAS TO
COLLECT MRI OF THE BRAINS OF
INDIVIDUALS WITH BIPOLAR TYPE 1
AND INCLUDED MEASURES.
SO WE RECRUITED PEOPLE AND WITH
AND WITHOUT BIPOLAR TYPE 1 AND
DIAGNOSIS WAS CONFIRMED WITH THE
DIAGNOSTIC INTERVIEW AND AT THE
SAME TIMES INCLUDED THE
MONTGOMERY ASPERG SCALE AND
COLUMBIA SUICIDE SEVERITY RATING
SCALE.
OF THE STUDY WE STARTED AND
DECIDED TO ADD THE NIH TOOLBOX
IN AND 148 COMPLETED THE EMOTION
COMPONENT OF THE TOOLBOX.
HERE'S A TRUNCATED VERSION YOU
CAN SEE CONTROLS AND BIPOLAR
DISORDER TYPE 1 WITHOUT AN
ATTEMPT HISTORY AND WITHOUT.
WE HAVE NO DIFFERENT IN THE
DISTRIBUTION ABOUT THE THE
SELF-REPORT SOCIO ECONOMIC
STATUS AND THE ANXIETY WERE
DIFFERENCES AND WE SAW SOCIO
ECONOMIC DIFFERENCES BUT THOUGHT
IT WAS INTERESTING TO NOTE.
DOES THE NO. EMOTIONAL BATTERY
CORRELATE WITH THE SYSTEM SCALES
COLLECTED?
WE SAW BELIEVABLE RESULT ARE.
WE SAW AND CORRELATION
COEFFICIENT AND WE HAVE THE
CLINICAL ASSESSMENT SCALES AND
THEN WE HAVE EACH OF THE
DIFFERENT SUB DOMAINS OF THE
EMOTION BATTERIES IN THE COLUMNS
AND THE THINGS YOU EXPECT TO BE
MORE ADAPTIVE ARE USUALLY
NEGATIVELY CORRELATED WITH THE
SYMPTOM RATING SCALES AND THINGS
THAT ARE THINGS YOU WOULD WANT
TO BE ADAPTIVE ARE NEGATIVELY
AND LESS ADAPTIVE ARE POSITIVELY
CORRELATED.
FOR EXAMPLE, ONE WOULD EXPECT
SADNESS FROM THE TOOLBOX TO BE
HIGHLY CORRELATED WITH THE
DEPRESSION SCORE AND WE SEE THAT
AND IT IMPORTANT TO CAPTURE
CLINICALLY RELEVANT INFORMATION
WITH THE TOOLBOX.
AND WE ALSO HAVE A MORE DETAILED
BREAKDOWN BY QUESTIONS OF THE
ASSESSMENTS BUT FOR PURPOSES OF
TIME WE WON'T GO INTO THAT.
OUR PRIMARY QUESTION IS DOES
SUICIDE HISTORY RELATE TO
RESPONSES ON BATTERY?
AND IN ORDER TO AVOID YOU HAVING
TO LOOK AT 17 DIFFERENT GRAPHS,
I SUMMARIZED FROM THE SLIDE THAT
INDEED WE SEE NUMEROUS DOMAINS
ARE DIFFERENT BETWEEN THE TWO
GROUPS OF BIPOLAR DISORDER
PARTICIPANTS.
WE SEE HERE IN BLUE THAT WE HAVE
THE INDIVIDUALS THAT DO HAVE A
PRIOR SUICIDE ATTEMPT OF LOWER
REPORTED RANKINGS ON THESE
ITEMS.
WE HAVE LIFE SATISFACTION AND
EMOTIONAL SUPPORT AND
SELF-EFFICACY ALOWER AND
LONELINESS AND PERCEIVED SADNESS
AND ANGER AND HOSTILITY ARE
HIGHER IN THIS GROUP.
WE NOTED DIFFERENCES BETWEEN
CONTROL GROUPS AND OUR PRIMARY
TARGET OF INTEREST.
ALL THIS MAKE SENSE AND THEN
WERE INTERESTED IN CAN WE
COMBINE ALL THE INFORMATION
TOGETHER TO IDENTIFY WHICH GROUP
AN INDIVIDUAL BELONGED INTO
BASED ON THE MEASURES ALONE.
SO IF WE CAN, WHICH ARE THE MOST
IMPORTANT IN THE CLASSIFICATION.
WE DEVELOPED A MACHINE LEARNING
MODEL AND SELECTED A RANDOM
FOREST TO ALLOW FOR INHERENT
VARIABLE AND WE USED FIVE-FOLD
ACROSS VALIDATION AND THIS IS
IMPORTANT BECAUSE OUR RELATIVELY
SMALL DATA SET WE WANTED TO
IMPROVE RIGOR AND REDUCIBILITY.
THE 19 FEATURES INCLUDED IN THE
MODEL WERE THE 17 SUBDOMAIN
RATINGS AS SEEN IN THE GRAPHIC
BEFORE AND AGE AND SELF-REPORTED
SEX.
THE OUTCOME WAS BINARY AND
REMOVED THE CONTROL GROUP FROM
THIS AND LOOKED WITHIN BIPOLAR
DISORDER PARTICIPANTS AND
COMPUTED WHEN THE VARIABLE WAS
PER MUTED AND YOU CAN SEE THE
RESULT ARE HERE THAT OVER ALL
THE MODEL WAS ABLE TO PREDICT
GROUP MEMBERSHIP WITH AROUND 70%
ACCURACY AND IN BACK WE HAVE
MEAN DECREASE IN ACCURACY WITH
PERMUTATION.
SO WHEN HAVE YOU A BIGGER NUMBER
THAT MEANS THE ACCURACY OF THE
MODEL'S HURT THE MOST WHEN IT
WAS PERMUTED AND WE HAVE ANGER,
PERCEIVED STRESS AND
SELF-EFFICACY AND PERCEIVED
REJECTION AND CAN INDICATE THE
DIRECTIONALITY OF THE EFFECT
CORRESPONDING WITH THE PREVIOUS
SLIDE AND THIS ALL MAKES SENSE
IN THE WAYS YOU WOULD EXPECT
SUCH AS LONELINESS BEING HIGHER
AND ALL THAT.
THE EMOTIONAL SUPPORT WAS THE
ONE IN THE LEAD.
SO JUST TO WRAP THIS UP, WE
DEFINITELY OBSERVED THAT MOOD
AND EMOTIONAL CONSTRUCTS ARE
BEING CAPTURED IN WAYS WE WOULD
EXPECT BY THE TOOLBOX.
AND THIS WAS RELATED TO SUICIDE
ATTEMPT HISTORY WITHIN BIPOLAR
DISORDER PARTICIPANTS.
THE MACHINE LEARNING MODEL WE
USED HAD ACCURACY AND
DISTINGUISHED THE TOP
DISTINGUISHING FEATURES AND BY
IDENTIFYING THE TOP FEATURES WE
CAN POTENTIALLY GUIDE FUTURE
TREATMENT OR INTERVENTION
OPTIONS.
SO FOR EXAMPLE, IF THERE WERE
MORE POLICIES TO INCREASE THE
AVAILABILITY OF EMOTIONAL
SUPPORT SO MAYBE THERAPIES OR
PROMOTE ANOTHER TYPE OF
INTERVENTION PROVIDING PEOPLE
AND SOMEONE TO TALK TO, ALSO
STRESS REDUCTION IN MANAGEMENT
METHODS.
ALL THESE THINGS COULD LEAD TO
CHANGES IN TREATMENT AND WARRANT
FURTHER STUDY.
IT'S POSSIBLE THE BATTERY COULD
HAVE CLINICAL SCREEN TOOL FOR
FUTURE SUICIDE RISK BUT AGAIN
IT'S A CROSS-SECTIONAL STUDY SO
WE'D NEED FURTHER STUDIES TO
ASSESS THIS.
AND WE ARE HOPING TO COMBINE OUR
CURRENT WORK IN THE MRI IMAGING
WITH THIS WORK TO END REPORT ON
THE RESULTS IN THE FUTURE.
THANK YOU VERY MUCH.
>> SO NEXT UP WE HAVE LEILA
GACHECHILADZE FROM THE
UNIVERSITY OF MARYLAND IN HIRN
TOOL BOOCHL ASSESSMENT IN
PATIENTS WITH DRUG RESISTANT
TEMPORAL LOBE EPILEPSY
UNIVERSITIES CONTROLS.
>> I'M HAPPY TO TALK ABOUT THE
NIH TOOLBOX ASSESSMENT IN
PATIENTS WITH DRUG RESISTANT
TEMPORAL LOBE EPILEPSY VERSUS
CONTROLS.
BEFORE WE DIVE INTO THE DETAILS,
LET ME SET THE STAGE BY SHOWING
THE BACKGROUND STORY OF THE
PROJECT.
THE PRIMARY WAY TO MEASURE
COGNITIVE FUNCTIONING IN
PATIENTS WITH DRUG RESISTANT
TEMPORAL LOBE EPILEPSY IS
THROUGH THE NEURAL PSYCHOLOGICAL
ASSESSMENT CONSIDERED TO BE GOLD
STANDARD TEST.
THE ASSESSMENT HAS MANY
ADVANTAGES.
IT PROVIDES DETAILED INFORMATION
REGARDING PERFORMANCE AN VARIETY
OF COGNITIVE DOMAINS AND ASSISTS
IN SURGICAL PREDICTION OF THE
POSTSURGICAL OUTCOMES IN THE
PATIENT POPULATION.
WHILE THE NEURO PSYCHOLOGICAL
TESTING YIELDS RICH INFORMATION
FOR CLINICAL AS WELL AS RESEARCH
PURPOSES, THERE ARE SEVERAL
CHALLENGES WHEN USING THIS
MEASURES.
IT NEEDS TO BE INTERPRETED BY A
NEUROPSYCHOLOGIST AND EXTENSIVE
TEST THAT LIMITS AND SAYS AND
REQUIRES TIME TO ADMINISTER AS
WELL AS SCORE.
WITH THAT IN MIND LET'S TALK
ABOUT THE NIH TOOLBOX.
AND EXECUTING AND TREND OVER
TIME AND NO STUDIES HAVE BEEN
PUBLISHED WITH DRUG RESISTANT
EPILEPSY AND WE KNOW THEY'LL
SCORE WORSE THAN CONTROLS AND
BUILDING ON THAT IDEA IN THE
STUDY WE AIM TO DEMONSTRATE THE
NIH TOOLBOX COGNITIVE BATTERY IS
SENSITIVE ENOUGH TO IDENTIFY
COGNITIVE DIFFERENCES AGAIN
PATIENTS WITH DRUG RESISTANT
TEMPORAL LOBE EPILEPSY VERSES
CONTROLS.
THE PATIENTS WITH TEMPORAL LOBE
EPILEPSY AT THE CENTER WERE
SCREENED AND THIS IS THE
INCLUSION CRITERIA THAT WE USED
PATIENTS WITH AGE MORE THAN 18
CONFIRMED TEMPORAL LOBE EPILEPSY
WITH WORK UP WERE INCLUDED.
DRUG RESISTANT MEANS ALL
PATIENTS CONTINUE TO HAVE SE --
SEIZURES WITH THERAPEUTIC DOSES
AND THOSE WITHOUT CONSENT WERE
EXCLUDE.
WE MATCHED A HEALTHY CONTROL
SUBJECT BASED ON AGE AND GENDER
AND THEN COLLECTED AND
DEIDENTIFIED PATIENT INFORMATION
INCLUDING AGE, RACE, GENDER AND
EPILEPSY AND THEY ALL UNDERWENT
COGNITION BATTERY TESTING.
ONCE THEY UNDERWENT THE TESTING
WE USED THE FULLY CORRECTED T
SCORE FROM EACH TEST FOR
COMPARISON AND WE ANALYZED THE
DATA BY USING A TEST.
WHY WE USED THE FULLY CORRECTED
T SCORE WE'LL COVER THAT IN MORE
DETAIL LATER ON.
LET'S DELVE IN THE
CHARACTERISTICS OF THE PATIENTS
AT BASELINE.
WE HAD TOTAL 33 SUBJECTS
RECRUITED AND FROM THE 33, 15
WERE TEMPORAL LOBE EPILEPSY
PATIENTS AND MEAN AGE OF 38 FROM
TEMPORAL LOBE EPILEPSY GROUP WE
HAD SEVEN WITH DOMINANT LOBE
EPILEPSY MEANING LANGUAGE
DOMINANCE AND TWO WITH
BITEMPORAL EPILEPSY.
THE MAIN NOTABLE DIFFERENCE
BETWEEN THE TLE AND CONTROL
GROUP WAS IN RACE AND EDUCATION.
SO IN TEMPORAL LOBE EPILEPSY
PATIENT WE HAD ALMOST EQUAL
NUMBER OF WHITE AND BLACK
POPULATION WHILE IN CONTROLS THE
MAJORITY WERE WHITE.
EDUCATION WISE IN TEMPORAL LOBE
EPILEPSY PATIENTS MOST HAD HIGH
SCHOOL OR COLLEGE DEGREE WHILE
IN CONTROLS MAJORITY OF PATIENTS
HAD MASTERS AND BEYOND.
CONSIDERING THIS DIFFERENCE IN
RACE AND EDUCATION THIS PROMPTED
US TO USEFULLY CORRECTED T SCORE
INSTEAD OF AGE CORRECTED T SCORE
AS ADJUSTED BASED ON AGE,
GENDER, EDUCATION AS WELL AS
RACE.
NOW THAT WE HAVE COVERED THE
BASELINE CHARACTERISTICS LET'S
DISCUSS THE RESULTS.
SO THESE ARE THE DOMAINS
ASSESSED BY THE NIH TOOLBOX
BATTERY AND THE MEASURES USED TO
ASSESS THOSE DOMAINS.
WE HAVE TWO MEASURES FROM NIH
TOOLBOX FOR EXECUTIVE TWO
MEASURES FOR LANGUAGE AND ONE
FROM THE NIH TOOLBOX.
IN MOST COGNITIVE DOMINANCE
THESE ARE THE T SCORES IN
TEMPORAL LOBE EPILEPSY GROUP AND
IN CONTROLS AND THIS IS THE P
VALUES.
SO IN MOST COGNITIVE DOMAINS
ASSESSED BY THE COGNITION
BATTERY BEING ATTENTION AND
EXECUTIVE FUNCTION AND WORKING
MEMORY AND PROCESSING SPEED.
CONTROL GROUP SCORED
SIGNIFICANTLY HIGHER THANK THE
TEMPORAL LOBE EPILEPSY GROUP
WITH A P VALUE LESS THAN 50 AS
EXP
-- 05 AND WE DIDN'T SEE A
DIFFERENCE IN EPISODIC MEMORY.
AND NOW LET'S SHIFT OUR FOCUS TO
THE LIMITATIONS OF THE STUDY.
SO THE FIRST THE SAMPLE SIZE IS
PRETTY SMALL AND THIS MIGHT BE
THE REASON WHY WE DIDN'T SEE
STATISTICAL SIGNIFICANCE
DIFFERENCE IN EPISODIC MEMORY
AND LANGUAGE AS WE HAD TO
COMBINE ALL EPILEPSY PATIENTS
TOGETHER WITH DOMINANT AND
NON-DOMINANT TEMPORAL LOBE
EPILEPSY PATIENTS AND TO
OVERCOME THE CONTROLS WE USED
FULLY CORRECTED T SCORE.
WE IDENTIFIED THE CONTROL
PARTICIPANTS PERFORMED
SIGNIFICANTLY BETTER THAN THE
TEMPORAL LOBE EPILEPSY PATIENTS
ACROSS DOMAINS INCLUDING
ATTENTION, WORKING MEMORY,
PROCESSING SPEED AND EXECUTIVE
FUNCTION AND OUR RESULT ARE
SUGGEST THE NIH TOOLBOX BATTERY
CAN BE USED AS AN ADJUNCT TEST
IN PATIENTS WITH DRUG RESISTANT
TEMPORAL LOBE EPILEPSY.
WE FEEL IT WILL BE PARTICULARLY
USEFUL ASSESSMENT TOOL TO ASSESS
COGNITIVE TRENDS OVER TIME IN
THE POPULATION.
ESPECIALLY IF THE PATIENT IS
UNDERGOING SURGERY OR NEURO
STIMULATION DOWN THE ROAD.
MOVING FORWARD WE'RE WORKING ON
HAVING A BIGGER SAMPLE TO BE
ABLE TO CLASSIFY PATIENTS BASED
ON THEIR EPILEPSY DIAGNOSIS AND
WE'LL ALSO LOOK TO COMPARE THE
NIH TOOLBOX WITH NEURO PSYCH
ASSESSMENT AND SEE IF THE SCORES
CORRELATE.
THANK YOU.
>> THANK YOU.
SO OUR LAST SPEAKER ACTUALLY IS
FIRUZE OGUZE AND LOOKING AT
INDIVIDUAL PSYCHOLOGICAL TRAITS
PREDICT THE ACTIVITY OF LIMBIC
AND PREFRONTAL AREAS.
CAN YOU HEAR US?
>> HELLO.
FIRST THANK YOU FOR HAVING ME
TODAY.
I'M HAPPY TO BE PART OF THIS
ORGANIZATION.
FIR FIRUZE A MASTER STUDENT IN
THE NEUROSCIENCE FIELD AAND TALK
OF MY DRIED OF INDIVIDUAL
PSYCHOLOGICAL TRAITS PREDICT THE
ACTIVITY OF LIMBIC AND
PREFRONTAL AREAS.
I'D LIKE TO START WITH EMOTIONAL
COGNITION THE MOST APPEAL AND
WELL KNOWN TOPIC IN THE
PSYCHOLOGY WHEN WHEN IT COMES TO
DIVERSION OF THE EMOTION
PROCESSING.
RESEARCHERS WHEN THEY
INVESTIGATE THESE TOPIC
RESEARCHERS MOSTLY USE FACIAL
EXPRESSIONS OR BASIC EMOTIONS
WHICH WE ALL KNOW AS HAPPY,
SURPRISED, ANGRY, FEAR, DISGUST.
AND THEY USE FACIAL EXPRESSIONS
BECAUSE IT'S PROVEN MODERATION
IN RELEVANCE TO RESPOND EVEN
THOUGH THERE IS NO EXISTING
EMOTIONAL CONTACT.
AS NEGATIVE EMOTIONS, ANGER AND
FEAR IS WELL KNOWN WITH A LIMBIC
AREA ACTIVATION IN THE
NEUROSCIENCE FIELD.
HOWEVER, LIMBIC SYSTEM IS ALSO
KNOWN AS IN COGNITIVE TRAITS
SUCH AS INTELLIGENCE AND
FUNCTION AND ORIENTATION AND TAN
BE LOOKED AT FOR EMOTIONS IS A
TOPIC IN THE NEURO PSYCH FIELD
NOWADAYS.
TO INVESTIGATE, WE WOULD LIKE TO
POINT THE RELATIONS FOR
COGNITIVE AND EMOTIONAL TRAITS
DURING THE EMOTIONAL PROCESSING
AND WORKING FROM MEMORY TASK.
LOOKED AT ACTIVATION LOOKING TO
EMOTIONAL AND COGNITIVE FACTORS.
THE QUESTION IS HOW DID WE
INVESTIGATE.
TO MAKE THE STUDY POSSIBLE WE
USED THE HUMAN CONNECTOME
PROJECT BY WASHINGTON UNIVERSITY
AND RECRUITED 894 PARTICIPANTS
FOR BOTH FMRI DATA A TASK FOR
DIFFERENT SHAPES.
FOR WORKING MEMORY TASKS WE
EMBED TASKS WITH PROCESSORS AND
NOR MEASURES NIH TOOLBOX TOOK A
BIG ROLE IN OUR PROCESSING TASK
AND A DOMAIN FOR FEAR AND
SOMATIC AROUSAL.
WE USED PENNSYLVANIA UNIVERSITY
PSYCHOLOGICAL TEST MODULE WHICH
IS TASK AND LINE ORIENTATION
TASK AND RECOGNITION.
FOR ALL TASKS WE USED AN
ADJUSTED SCALE.
FOR THE STATISTICAL ANALYSES WE
WOULD LIKE TO SIMPLIFY THE DATA
REFERRED TO ANALYSIS.
WE DID DID ANALYSIS BY AIM OF
MEASURES AND AT THE END WE
OBTAINED SPATIAL ORIENTATION,
EXECUTIVE FUNCTION FOR COGNITION
AND FOR EMOTION WE HAD NEGATIVE
EFFECTS.
FOR FMRI ANALYSIS WE DEFINED
CONTRAST AND THEN WE HAD OUR ONE
SAMPLE T TEST TO OBSERVE OUR
SIGNIFICANT AREAS.
YOU CAN SEE ON THE RIGHT IMAGE
WE HAVE OUR SIGNIFICANT AREAS
FOR THE WORKING MEMORY TASK AND
ON THE LEFT IMAGE WE HAVE OUR
SIGNIFICANT AREAS FOR EMOTIONAL
PROCESSING TASKS.
IN THE LAB YOU CAN SEE EMOTION
AND ON THE RIGHT ZERO BACK
CONTRAST.
TO DO OUR PHOTO ANALYSIS WE
EXTRACT OUR REGIONAL DATA WITH
ANALYSIS AND HAVE OUR REGIONS OF
INTEREST.
OUR REGIONS OF INTEREST WERE
LIMBIC AREA, DORSE LATERAL CORE
TEXT FOR COGNITIVE AREAS AND
TOOK WHAT HAS THE PEAK
ACTIVATION SINCE WE HAD FACE
MASK TASK.
-- MATCHING TASK.
AT THEN TO OBSERVE THE
INTERACTION TO OBSERVE OUR
HYPOTHESIS RESULTS WE LOOKED AT
OUR ACTION BETWEEN REGION OF
INTEREST AND BEHAVIORAL FACTORS.
TO SUM UP, OUR MULTIPLE ANALYSIS
WERE CONDUCTED TO OBSERVE THE
INTERACTION BETWEEN REGION OF
INTEREST HYPOTHALAMUS AMYGDALA
HIPPOCAMPUS AND THE VENTRAL
LATERAL AND PREFRONTAL CORTEX
AND FACTORS LIKE INTELLIGENCE,
EXECUTIVE FUNCTION AND NEGATIVE
EFFECTS.
THERE WERE RESULTS WE OBSERVED
HIGHER INTELLIGENCE SCORES
ASSOCIATED WITH DORSAL LATERAL
AND PREFRONTAL CORTEXES DURING
WORKING MEMORY TASK.
AND AS A SUPPORTIVE EVIDENCE WE
HAVE OUR LIMBIC AREA ACTIVATION
DURING THE WORKING MEMORY
ASSOCIATED WITH SPECIAL
ORIENTATION FACTOR.
AND AGAIN AS A SUPPORTIVE
EVIDENCE WE HAVE OUR DORSAL
LATERAL AND PREFRONTAL CORTEX
ACTIVATION DURING WORKING MEMORY
WHICH IS ASSOCIATED WITH
EXECUTIVE FUNCTION.
WE HAVE OUR DORSAL LATERAL
CORTEX ACTIVATION WITH NO
SIGNIFICANT RELATION ARE FOUND
DURING THE EMOTION TASK.
TO SUM UP WE CAN SEE THE RESULTS
AS A MULTI-DIRECTIONAL
INTERPRETATION FOR CLINICAL
STUDIES FOR EXAMPLE INDIVIDUAL
DIFFERENCES OR NEUROSCIENCE
LIMBIC AND PREFRONTAL AREA IN
IMPORTANCE DURING OVERRIDING FOR
BEHAVIORAL FACTORS AND ALSO IT'S
AN INNOVATIVE TOOL TO BRING
MODELS TO ELEVATE OUR
STATISTICAL ANALYSIS AND I CAN
SAY WE CAN CALL MOST THE
ACQUIRED DATA LIMITATION FOR THE
STUDY AS FUTURE DIRECTIONS WE
CAN USE MORE SENSITIVE PSYCHO
PHYSIOLOGICAL MEASURES SUCH AS
MEASURE
MEASURIE IING NEGATIVE EMOTIONS
THE COLLABORATION OF PREFRON CAL
CORTEX ACTIVATION AND LIMBIC
AREA ACTIVATION REMIND ARE ME TO
FUNCTIONAL CONNECTIVE STUDIES
AND HOW TO ELEVATE THE PROJECT.
THANK YOU FOR LISTENING.
I'LL BE AWAITING YOUR QUESTIONS.
>> THANK YOU.
WE ARE NOW AT Q&A IF I CAN GET
THE OTHER SPEAKERS TO COME UP ON
STAGE AND BRUCE, IF YOU CAN STAY
ON THE LINE.
-- FIRUZE STAY ON THE LINE.
>> OKAY.
>> AND FOR THOSE LISTENING
ONLINE, IF YOU HAVE QUESTIONS
SEND THEM TO THE MAILBOX AT THE
E-MAIL AND WE CAN RESPOND.
>> HI, EVERYONE.
VERY NICE TALKS.
THANK YOU VERY MUCH.
I WAS INTERESTED IN THE ONE WITH
INTEROPERABLE EPILEPSY AND
WONDERING, YOU ARE USING THE NIH
TOOLBOX FOR PRESURGERY.
HAVE YOU USED IT POST SURGICALLY
AND WHAT RESULTS ARE YOU SEEING?
>> SO, THIS IS LIKE THE FIRST
PART OF THE STUDY AND THIS IS
THE DATA THAT WE ANALYZED AS OF
NOW.
BUT WE ALSO COLLECTED THE DATA
IN PATIENTS AFTER RNS PLACEMENT
AND AFTER SURGERY.
SO OUR PLAN STO IS TO COMPARE
DATA AND RNS AND WE'RE WORKING
ON THAT BUT WE DON'T HAVE
RESULTS AS OF NOW.
>> PERFECT.
I'D BE INTERESTING TO SEE IF
YOUR SCORES HAVE IMPROVED
BECAUSE THEY NO LONGER HAVE
EPILEPSY ANYMORE.
THANK YOU VERY MUCH.
>> WE HAVE A GOOD AMOUNT OF
PATIENTS WHO ARE UNDERGOING THE
RNS THERAPY AND UNDERGOING NEURO
STIMULATION AND MEANING IT
PROVIDES AND STIMULATES YOUR
BRAIN AND IT HELPS TO PREVENTHE
S
SEE -- SEIZURES AND MAY AFFECT
THE PATIENT GROUP.
THERE'S DECENT AMOUNT OF
PATIENTS WHO HAVE THE RNS IN
PLACE AND ARE UNDERGOING NIH
TOOLBOX TESTING EVERY LIKE SIX
MONTHS AND WE'RE WORKING ON THAT
DATA TOO.
>> FABULOUS, THANK YOU.
>> I'LL TAKE A MODERATOR
PREROGATIVE HERE.
I'M WONDERING IF YOU CAN SPEAK
MORE ABOUT YOUR EXPERIENCE USING
THE EMOTION BATTERY FOR THE
TOOLBOX.
WE HAVEN'T HAD -- WE HEARD ABOUT
COGNITION BATTERY AND YOUR
EXPERIENCES USING THE EMOTION
BATTERY AND VIS A VIS THE
CLINICAL ASSESSMENTS.
>> THAT'S A GREAT QUESTION.
I WILL SAY I'M NOT THE PERSON
WHO IS ADMINISTERING IT SO I
DON'T WANT TO OVERLY INTERPRET
THIS BUT MY UNDERSTANDING IS
IT'S BEEN SIMPLE TO IMPLEMENT.
I THINK IT WILL HAVE PEOPLE WHO
ASK QUESTIONS HOW SHOULD I
ANSWER THIS AND THEY WAFFLE
AROUND ABOUT THINGS AND THAT MAY
BE RELATED IF THEY'RE IN A MANIC
STATE TO BE A LITTLE MORE CHATTY
ABOUT THINGS BUT OVER ALL IT'S
BEEN A GOOD EXPERIENCE.
I THINK IN TERMS OF LENGTH THE
REST OF THE TOOLBOX TAKES LONGER
THAN THIS PART BUT WE PRIORITIZE
THE EMOTION BATTERY BECAUSE OF
OUR COHORT.
BUT, YEAH, WE'RE INTERESTED IN
IMPLEMENTING THE REST OF THE
TOOLBOX AS WELL.
>> THIS ONE IS FROM THE
AUDIENCE.
>> THIS QUESTION IS FOR CALLIE.
I WAS WONDERING IN GENERAL, I
KNOW THAT YOUR VISUAL TASK AND
REASON ARING TASK HAD MULTIPLE
KINDS OF QUESTIONS LIKE THE
ANALOG AND SERIAL, WAS THERE
MOTIVATION FOR MAKING THAT
DIFFERENCE FROM WHAT THE WAYS
DOES, FOR EXAMPLE, LIKE THERE
WORE TWO ENTIRELY QUESTION TYPES
WITH I THINK THE COMPLETION
VERSION OF IT.
>> I THINK YOUR TALKING ABOUT
THE WAYS THAT EXPLAIN THAT
YOU'RE LOOKING AT A GRID OF FOUR
OR NINE AND YOU'RE LOOKING FOR
SOMETHING THAT'S MISSING.
OR THERE'S LIKE A SERIES OF
PICTURES AND YOU HAVE TO DETECT
THE PATTERN.
SO WE DID USE BOTH OF THOSE KIND
OF TYPES SO EITHER A GRID OF
EITHER FOUR OR SIX OR NINE
THINGS WITH SOMETHING THAT'S
SAYING SOMETIMES WE HAVE MORE
THAN ONE THING IS MISSING.
AND THEN WE USE THE SERIES AND
WE EXPANDED IT BEYOND THAT --
BEYOND THOSE TWO ITEM TIMES TO
INCLUDE I THINK I HAD AN EXAMPLE
OF A SIMPLE COMPARISON.
SO REALLY FOR THE YOUNGEST KIDS
THAT WAS THE ITEM TYPE THAT WAS
THE MOST CONSISTENT THEY COULD
ANSWER IS LOOKING FOR THE
STIMULUS IN ONE OF THE RESPONSE
CHOICES AS A BASIC LEVEL.
YOUR QUESTION, I WANT TO MAKE
SURE TO ANSWER YOUR QUESTION IS
WHY WE ELABORATED.
>> WHY DID YOU MIX THEM TOGETHER
LIKE IN TERMS OF THE THIRD TYPE
YOU JUST SPOKE ABOUT.
>> WELL, A LOT OF IT HAS TO DO
WITH OUR INTEREST IN EXPANDING
THE AGE RANGE.
SO WE WERE TRYING TO DEVELOP
ITEMS THAT WOULD WORK FOR KIDS
AS YOUNG AS 3 WHICH IS A HARD
AGE TO DEVELOP COMPLEX ITEMS FOR
BECAUSE WE'RE TALKING ABOUT KIDS
WHERE EVEN THE QUESTION
ANSWERING PROCESS IS CHALLENGING
FOR THEM.
SITTING IN FRONT OF THE iPAD,
UNDERSTANDING THEY NEED TO PICK
A RESPONSE.
THAT'S REALLY CHALLENGING SO
THAT WAS A BIG PART OF WHY WE
TRIED THOSE OUT AND THEY WORKED
AND YOU KNOW, WE THERE'S BEEN A
LOT OF DIFFERENT VISUAL
REASONING TEST AND THE REASONING
FOR THE WEXLER IS PARTICULARLY
POPULAR RIGHT NOW BUT THERE'S
OTHER TESTS LIKE THE RAVEN'S
MATRICES USED SINCE THE 30 AND
THE NON-VERBAL INTELLIGENCE.
THERE'S DIFFERENT TESTS THAT GET
TO THE VISUAL ABSTRACT REASONING
AND WE USED THE WEXLER VERSION
AS OUR GOLD STANDARD BECAUSE
IT'S WELL ESTABLISHED AND
POPULAR RIGHT NOW.
I THINK WHAT WE CONCEPTUALIZE
THE CONSTRUCT AND ABSTRACT
REASONING WE WANTED TO TRY TO BE
INCLUSIVE PARTICULARLY BECAUSE
IT IS GIVEN AS A CAT.
WE NEEDED A GOOD RANGE OF
DIFFICULTIES TO MEASURE PEOPLE
AND ON THE WEXLER IT'S NOT A CAT
SO THEY GET A RAW SCORE BASED ON
HOW MANY ITEMS THEY COMPLETE.
WITH OUR TEST WE NEEDED THEM TO
BE ABLE TO JUMP IN WITH
DIFFICULT ITEMS.
>> IF YOU HAVE TIME FOR A
FOLLOW-UP QUESTIONS I WAS
WONDERING AT THE BEGINNING OF
YOUR TALK YOU WERE TALKING ABOUT
HOW YOU WANTED TO CREATE A
VISUAL ANALOG TO SOME THINGS
THAT EXIST IN THE TOOLBOX.
AND I WAS WONDERING, YOU EVEN
CITED I THINK THE LIST WORKING
MEMORY TASK.
WAS THERE ANY INTEREST IN DOING
A VISUAL WORKING MEMORY TASK AND
HOW DID YOU END UP ON VISUAL
REASONING OPPOSED TO ANY OTHER
ANALOG DOMAIN?
>> THERE'S A NUMBER OF VISUAL --
I WOULD THINK LIKE SPEEDED
MATCHING FOR KIDS IS KIND OF A
PROCESSING SPEED, WORKING MEMORY
FOR KIDS.
I FEEL LIKE THE NIH TOOLBOX
ALREADY HAS A LOT OF WORKING
MEMORY FOCUSSED THINGS LIKE
FLANKER.
I ALWAYS BLANK WHEN I'M TRYING
TO THINK OF OTHER EXAMPLE TESTS.
JUST BY NATURAL WITH COGNITIVE
ASSESSMENT I THINK IT'S EASY TO
DEFAULT TO MORE VERBAL TESTS
BECAUSE IT'S A REALLY HELPFUL
WAY TO EVALUATE SOMEONE IS TO
TALK TO THEM AND GIVE THEM
INSTRUCTIONS, HAVE THEM PROVIDE
A RESPONSE.
BUT I THINK THAT'S WHAT WAS
MISSING TO FILL IN A GAP WAS
SOMETHING MORE VERBAL AND I HAVE
AN INTEREST IN EVALUATING THE
PERFORMANCE ON THE TEST FOR
PEOPLE WHO ARE MAYBE HAVE A
CLINICAL CONDITION THAT'S
LEADING THEM TO BE IN A MORE
NON-VERBAL CATEGORY LIKE AN
AUTISM SPECTRUM DISORDER BUT WE
HAVEN'T DONE THOSE ANALYSES YET.
>> THANK YOU.
>> THIS ONE IS ALSO FOR
DR. TYNER.
I'M A RECENT ADOPTER OF THE
TOOLBOX CLINICALLY IN THE
COMMUNITY AND HAD OCCASION TO
WORK WITH A 68-YEAR-OLD WOMAN
RECENTLY WHO WAS EXPERIENCING
POTENTIAL EARLY DEMENTIA SIGNS
DECLINE AND WITH A LOT OF
ANXIETY AND THIS IS MORE OF A
CLINICAL OBSERVATION, I REALLY
LIKE PROGRESS MATRICES SO I LIKE
YOUR TEST BUT THIS ONE WOMAN HER
ANXIETY SPIKED THROUGH THE
CEILING WHEN SHE TOOK THE TEST.
AS SOMEBODY STILL NEW TO
ADMINISTERING BATTERY I
STRUGGLED WITH HOW MUCH TO SAY
TO KEEP TRYING AND KEEPER HER
FROM GETTING FRUSTRATED WITH I'M
JUST GOING GUESS.
THERE'S THE OBSERVATION OF THE
REACTION THIS ONE INDIVIDUAL HAD
FOR WHAT IT'S WORTH.
>> THANK YOU FOR SHARING THAT.
IT'S NICE TO HEAR IT'S BEING
USED IN THE FIELD.
THANK YOU.
>> TRYING TO FORMULATE THAT TO
EXTRAPOLATE IN DEVELOPING THESE
TESTS DID YOU ENCOUNTER IN TERMS
OF USER ACCEPTANCE TRAINING OR
SIMILAR ASPECTS OF EXPERIENCES
SIMILAR OR DISTINCT FROM THAT
YOU MAY FILTER IN?
>> I THINK ONE AREA THAT CAME TO
MIND WAS I ALLUDED TO THIS A FEW
TIMES IN MY PRESENTATION WE DOES
DID HAVE TO BALANCE THE PRESSURE
OF THE TEST NOT ADDING
SIGNIFICANT TIME BURDEN TO THE
TOOLBOX.
DESPITE THE FACT IT CAN TAIN
TAKE A LONG TIME FOR PEOPLE TO
DO VISUAL REASON ARIE IIE IING
REASONING TEST, FROM MY OWN
EXPERIENCE I'VE TAKEN 30 MINUTES
FOR MATRIX REASONING
PARTICULARLY IF THEY'RE HIGH
FUNCTIONING OR HAVE ANXIETY
ABOUT PICKING THE WRONG ANSWER
AND WANTING TO CHECK AND RECHECK
THEIR WORK BEFORE GIVING A
RESPONSE.
THE PRESSURE EXISTS AND ON THE
OTHER HAND WE WANTED TO KEEP THE
TEST BRIEF.
CAT WAS THE SOLUTION WE CAME TO
BUT I HAVE WONDERED IF BECAUSE
THE CAT WILL START WITH
DIFFERENT ITEMS DEPENDING ON THE
PERSON'S AGE AND EDUCATION, I
HAVE WONDERED IF IT'S MISSING
PERHAPS KIND OF THE BUILD UP YOU
GET FROM A NON-CAT TEST WHERE
THE FIRST DOZEN ITEMS ARE VERY
EASY AND HELPS SOMEONE BUILD
CONFIDENCE WITH THE TEST AND
SOMETHING WE SHOULD PROBABLY
CONSIDER AND LOOK AT MORE BUT
IT'S THE NATURE OF NEEDING TO
MANAGE THE TIME CONSTRAINTS BY
REMOVING THAT BUILD UP PERIOD
AND BRINGING SOMEONE INTO THE
CAT ENVIRONMENT WHERE PERHAPS IF
THEY GET THE FIRST ITEM RIGHT
THEY'RE GIVEN MORE AND MORE
DIFFICULT ITEMS VERY QUICK FL
FLIP -- QUICKLY.
THANK YOU FOR THE QUESTION AND
OBSERVATION.
>> DOES IT HAVE AN ADAPTIVE
DESIGN?
ARE YOU TORTURING PEOPLE OVER
SEVEN MINUTES OR DOES IT END?
>> IT DOES END.
IT'S COMPUTER-ADAPTIVE TEST SO I
THINK IT CAPS -- I THINK IT'S 20
TO 35 ITEMS.
IT WOULD END AT 35 ITEMS BEFORE
OR AFTER A CERTAIN STANDARD AREA
IS REACHED AFTER A MINIMUM OF 20
ITEMS.
I WON'T FORCE PEOPLE AND FORCE
THEM TO DO THOSE ITEMS BUT IT
GIVES A NUMBER OF ITEMS AND I
THINK FOR ADULTS MOST PEOPLE
WERE DONE IN SEVEN MINUTES.
BUT A FEW PEOPLE TOOK UP TO NINE
IN THE SIMULATION.
>> ALL RIGHT.
WE'RE ABOUT AT TIME AND DON'T WA
TO KIND THOSE IN THE AUDIENCE
FROM GOING OUT AND SEEING THE
PARTIAL ECLIPSE WE GET HERE IN
BETHESDA.
I JUST WANT TO THANK ALL OF OUR
SPEAKERS AND LET FOLKS KNOW IN
PERSON THAT THE POSTER SESSION
THE EXPERT SESSION WILL BEGIN AT
3:45 IN THE ATRIUM AND BALCONIES
A AND B.
FOR THE VIRTUAL AUDIENCE THIS IS
THEN OF OUR VIRTUAL CONTENT FOR
TODAY AND RESUME THE CONFERENCE
VIDEOCAST TOMORROW APRIL 9 AT
11:15 A.M.
THAT'S A SEPARATE LINK THAN THE
ONE YOU WATCHED TODAY BUT YOU
SHOULD HAVE THOSE DETAILS AT
HOME.
I THANK EVERYONE.