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Cognitive Assessment Throughout Development

Posted on 30 November 2016 in Clinical Trials / Research

Although most people might immediately think of a need for cognitive tests in diseases associated with aging, such as dementia and Alzheimer’s disease, there is actually a breadth of opportunity for measuring cognition across all age ranges. However, tests which might be ideal for healthy young adults, such as university students, might not be so applicable for children. Young children might struggle with verbal responses, culturally-specific stimuli, and tasks that are too long or difficult. Psychologists often use specific tests which have been specially designed to work well with children. In light of this, what factors should be considered when choosing a good cognitive test for assessing young people using CANTAB?

Computerized cognitive assessment

The advent of computerised testing provides tools for researchers to learn about cognitive development in new ways. Aspects of behaviour such as strategic organization and processing ability, which reflect the development of specific neural networks, are not easily captured by traditional paper and pen neuropsychological tests (Luciana et al., 1999). The CANTAB tests were designed from the start for use by study participants who might be physically frail or have difficulties in following complicated instructions. Because they are nonverbal, the tests themselves are also not influenced by increasing language skills. The participants just need to be proficient enough to understand the instructions. Moreover, many CANTAB tasks have different variants appropriate for different ages, for example the Paired Associates Learning (PAL) task is adaptive and will end early if the participant makes a certain amount of errors.

When administering neuropsychological tests it is always important to tease out the factors that are ‘non-cognitive’ such as mood and motivation, as well as controlling for the context of the testing session. The testing room should be quiet, comfortable, have minimal external distractions, and remain consistent across all participant in a study.  These are particularly important for young children who might not understand the study situation as well as an adult

Cognitive testing in young children

Executive function development can be characterised in a series of ‘spurts’, emerging in the early years of development, with the majority of functions coming ‘online’ by the age of eight (De Luca, 2003). CANTAB is currently not recommended for children under the age of 4, as it is unclear how variation in neurobiological and social development at this age could affect the collection of reliable data.

Children’s performance in the Spatial Working Memory (SWM) task has been informative in relation to prefrontal cortex (PFC) maturation. For example, children aged 4-12 are able to complete the easiest problems (2-3 item search) in a manner that is not significantly different to adults.  Although children perform less well on more difficult problems, this research confirms that executive functionality is present as early as 4 years old (Luciana, 2003). Luciana (2003) also measured the performance of children aged 4-12 using three other CANTAB tests: Motor Screening Task (MOT), Spatial Span (SSP), and Pattern Recognition Memory (PRM), reporting that “in general children found the testing format to be interesting and motivating”. These findings can be extended into developmental disorders as well. Clinicians can ascertain the nature of neurocognitive impairments in a reliable manner by comparing individual differences in a child’s performance to their matched age range. Research of disorders such as ADHD has benefited from CANTAB cognitive tasks, as they are sensitive to age-related changes in cognitive function, and performance is known to correlate with specific regions in the brain. Studies have identified age-related discrepant performance of different CANTAB tasks, which implies that the psychological (and neural) substrates underlying task performance develop at different times and rates (Robbins et al., 1998; DeLuca et al. 2003). When designing a study that focuses on a paediatric population, you should consider the length of the testing session, as young children tend to tire easily.  For recommendations on CANTAB for paediatric populations please contact us.

Cognitive assessment in adolescents

While the difficulty of testing older children is not as obvious as those associated with younger age groups, young adult brains are still going through a rapid period of development. Research has shown that young adults with ADHD are more likely to be prone to impulse control disorders, cognitive impulsivity, substance abuse, and emotional dysregulation (Chamberlain et al., 2016). Measuring specific cognition domains in particular disease areas can be informative in understanding the nature of neuropsychological deficits, and help in designing intervention methods. Tseng and Gau (2013) suggest that intervention methods that target executive function (specifically working memory and planning) might be effective in diminishing social dysfunction in youth with ADHD (Tseng & Gau, 2013).

So which test?

Research with CANTAB has demonstrated that comparing cognition across a range of ages can be especially useful in interpreting the impairments accompanying disorders of developmental. Many of the features which make the CANTAB tasks suitable for older adults are also applicable to testing cognition in the young: clear visual stimuli, large target areas to touch, simple task construction, and step-by step instructions. This means that CANTAB tasks are adaptive to a range of cognitive performers across many disease areas, cultures and ages. Studies using CANTAB can also work across age groups with children being tested on the exact same tests using the same stimuli that are employed in adult studies.

Contact us for advice on which CANTAB tests to include for your trial population.

Or read over 30 years of research with CANTAB, we have over 1,800 peer-reviewed research papers, in many different diseases and disorders, across the lifespan.


References:

Chamberlain, S.R., Ioannidis, K., Leppink, E.W., Niaz, F., Redden, S.A. and Grant, J.E. (2016). ADHD symptoms in non-treatment seeking young adults: relationship with other forms of impulsivity’, CNS Spectrums, 1-9.

DeLuca, C.R., Wood, S.J., Anderson,V., Buchanan, J.A., Proffitt, T.M., Mahony, K. & Pantelis, C. (2003).Normative Data from the CANTAB. I: development of executive function over the lifespan, Journal of Clinical Experimental Neuropsychology, 25(2), 242-254.

Luciana, M., Lindeke, L., Georgieff, M., Mills, M. and Nelson, C.A. (1999) ‘Neurobehavioral evidence for working-memory deficits in school-aged children with histories of prematurity’, Developmental Medicine & Child Neurology, 41(8), 521–533.

Luciana, M. (2003). Practioner Review: Computerized assessment of neuropsychological function in children: clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB), Journal of Child Psychology and Psychiatry, 44(5), 649-663.

Luciana, M. and Nelson, C.A. (2000). Neurodevelopmental assessment of cognitive function using CANTAB: validation and future goals, Functional Neuroimaging in Child Psychiatry, 379-397.

Robbins, T.W., James, M., Owen, A.M, Sahakian, B.J., Lawrence, A.D., McInnes, L., & Rabbitt, P.M.A. (1998). A study on performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: Implications for theories of executive functioning and cognitive aging, Journal of International Neuropsychological Society, 4, 474-490.

Tseng, W-L., and Gau, S.S-F. (2013). Executive function as a mediator in the link between attention-deficit/hyperactivity disorder and social problems, Journal of Child Psychology and Psychiatry, doi:10.1111/jcpp.12072.