Normal toddler, school age and adolescent neurocognitive development and measurements in these age groups

Gahan J. Pandina, PhD Janssen Research & Development April 17, 2015

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Presented at FDA, Center for Drug Evaluation and Research (CDER) Advancing the Development of Pediatric Therapeutics (ADEPT) Workshop: Evaluation of long-term Neurocognitive Development in Pediatrics

I have the following financial interests to disclose

• Full time employee of Janssen Research & Development

• Johnson & Johnson stockholder

• This presentation represents opinions of Dr. Pandina, and does not reflect the opinions of Janssen or Johnson & Johnson

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Agenda

• Introduction to cognitive assessment of children

• Assessment instruments

– IQ, Achievement, Neuropsych, etc.

• Assessment issues

– Change over time

– Scores, norms

• Testing in special populations

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Childhood is a dynamic period of physical, psychosocial, and cognitive growth

Sensorimotor Engage, explore

environment

Birth 2 yrs 4 yrs 6 yrs 8 yrs 10 yrs 12 yrs 14 yrs 16 yrs 18 yrs

Pre-operational Representational/ symbolic

thought

Concrete operational Mental operations replace action: meta

cognition

Formal operations Abstract thought, logical principles

Trust vs. Mistrust

Autonomy vs. Shame

Initiative vs. Guilt Industry vs. Inferiority

Identity vs. Alienation Identity (self) vs.

Identity Confusion

COGNITIVE Piaget

MORAL Kohlberg

PSYCHOSOCIAL Erikson

Pre-conventional Stage 1. Obedience / Punishment Orientation Stage 2. Individualism / Exchange

Conventional Stage 3. Good Inter-personal relationships Stage 4. Maintaining social order

Cattell-Horn-Carroll (CHC) Model, Extended Gf Gc Theory, PASS Theory, Triarchic Theory (Sternberg), Multiple Intelligences (Gardner), Social Constructivism (Vygotsky)

COGNITIVE ‘Modern’ theories

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Brain Growth Over Time

Gogtay, Giedd, et al., (2004). PNAS, 101 (21), 8174–8179

Cortical Gray Matter (Ages 5-20 years N=13)

Brain Dev Cooperative Group (2012). Cereb Cortex, 22, 1-12.

Total & Regional Brain Volume Norms (Ages 4-18 years, N=325) Boys

Girls

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Common Uses of Cognitive Assessment

• School-based evaluations for academic problems – Education planning (placement) – Tracking school progress

• Clinical use in psychiatric, other medical settings – Diagnosis and referral for specific conditions – Tracking of treatment outcome

• Research – Cognitive development – Disease biology, outcome, biomarkers

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Factors affecting cognitive development

Developmental problems

Medical problems

Learning disabilities

Language Impairment

Psychiatric Conditions Stress

Nutrition

Genetics Environment

Culture

Education

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IQ Tests

Examples of Intelligence Tests Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) Wechsler Intelligence Scale for Children (WISC-V) Wechsler Adult Intelligence Scale (WAIS IV) Stanford Binet (SB 5) Woodcock Johnson 3rd ed. Normative Update (WJ III NU) Differential Abilities Scale (DAS II) Kaufman Assessment Battery for Children (KABC-II)

• Assess a range of cognitive abilities

• Strong basis in cognitive theory • CHC (2, 3, > factor theory), Luria, PASS Theory, etc.

• Large normative database, many languages • Age, grade, sex-based norms

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Achievement Tests

Examples of Achievement Tests Wechsler Individual Achievement Test II WIAT II Kaufman Test of Educational Achievement II K-TEA II Wide Range Achievement Test IV WRAT IV

• Measure academic performance and learning • Age, sex, grade norms available

• Yield scores in select domains, cognitive profile

• Combine w/ IQ testing, identify learning disabilities • IQ vs. achievement (LD), skill areas

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Neuropsychological Tests

Neuropsych Tests Developmental NEuroPSYchological Assessment II NEPSY Halstead Reitan & Reitain Indiana Test Batteries for children HRBC/RIBC Luria-Nebraska Neuropsychological Battery for Children LNNB-C NIH Toolbox - Cognition Battery

• Initially developed to assess brain trauma or cognitive dysfunction

• Tests based on theories of brain function (i.e., Luria)

• Measure specific domains of function

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Assessment Instruments – Age Ranges 2 4 6 8 10 12 14 16 18 +

WPPSI-III

WISC-V

WAIS IV

SB 5

WJ III NU

DAS II

K-ABC II

IQ

WIAT II

KTEA II

WRAT IV

Achi

evem

ent

LNNB - C

NEPSY II

WRAT IV

NIH Cog

Neu

rops

ych

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Other Types of Tests

• Different domain / cognitive functions • Learning & memory, attention, perceptual organization &

memory, problem solving… • CVLT-C, CPT, RCFT, Bender-Gestalt…

• Computer batteries • CANTAB, CogState, CNB…

• Experimental tests for emerging cognitive skills • Social cognition, emotional intelligence…

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Scoring and Profiling Categorical Descriptions of WISC,

WAIS Domain Scores Adapted from WISC V manual

Score Description %ile 146+ Very superior >99 131-145 Superior 98-99 126-130 Above average 85-97 85-115 Average 16-84 70-84 Below average 2-14 55-69 Low 1-2 <54 Very low <1

http://www.mindsparke.com/iq.php?id=2

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Issues in cognitive testing

• Test selection and interpretation • Average vs. “best” performance • Assessment of change

– Tests commonly used over longer periods – Many tests not appropriate for brief inter-

testing intervals

• Other issues – Test adequacy (language, cultural norms) – Accurate estimation at tails – Demand characteristics of testing

environment

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Testing in Special populations

• Very young children – Specialized equipment, experience – Behavioral issues more prevalent,

familiarity and technique important – Select appropriate tests, stimuli

• Clinically referred populations – Experience – Setting, referral source – Behavioral observations during testing – Challenging behavior

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THANK YOU

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