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

Transcription

1 Normal toddler, school age and adolescent neurocognitive development and measurements in these age groups Gahan J. Pandina, PhD Janssen Research & Development April 17, 2015 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 1

2 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 2

3 Agenda Introduction to cognitive assessment of children Assessment instruments IQ, Achievement, Neuropsych, etc. Assessment issues Change over time Scores, norms Testing in special populations 3

4 Childhood is a dynamic period of physical, psychosocial, and cognitive growth COGNITIVE Piaget PSYCHOSOCIAL Erikson MORAL Kohlberg COGNITIVE Modern theories Birth 2 yrs 4 yrs 6 yrs 8 yrs 10 yrs 12 yrs 14 yrs 16 yrs 18 yrs Sensorimotor Engage, explore environment 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 Pre-conventional Stage 1. Obedience / Punishment Orientation Stage 2. Individualism / Exchange Conventional Stage 3. Good Interpersonal 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) 4

5 Brain Growth Over Time Cortical Gray Matter (Ages 5-20 years N=13) Total & Regional Brain Volume Norms (Ages 4-18 years, N=325) Boys Girls Gogtay, Giedd, et al., (2004). PNAS, 101 (21), Brain Dev Cooperative Group (2012). Cereb Cortex, 22,

6 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 6

7 Factors affecting cognitive development Developmental problems Medical problems Learning disabilities Language Impairment Psychiatric Conditions Education Genetics Culture Stress Nutrition Environment 7

8 IQ Tests 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 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) 8

9 Achievement Tests 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 Examples of Achievement Tests Wechsler Individual Achievement Test II Kaufman Test of Educational Achievement II Wide Range Achievement Test IV WIAT II K-TEA II WRAT IV 9

10 Neuropsychological Tests Initially developed to assess brain trauma or cognitive dysfunction Tests based on theories of brain function (i.e., Luria) Measure specific domains of function Neuropsych Tests Developmental NEuroPSYchological Assessment II Halstead Reitan & Reitain Indiana Test Batteries for children Luria-Nebraska Neuropsychological Battery for Children NIH Toolbox - Cognition Battery NEPSY HRBC/RIBC LNNB-C 10

11 Assessment Instruments Age Ranges IQ WPPSI-III WISC-V WAIS IV SB 5 WJ III NU DAS II K-ABC II Achievement Neuropsych WIAT II KTEA II WRAT IV LNNB - C NEPSY II WRAT IV NIH Cog 11

12 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 12

13 13

14 Scoring and Profiling Categorical Descriptions of WISC, WAIS Domain Scores Adapted from WISC V manual Score Description %ile 146+ Very superior > Superior Above average Average Below average Low 1-2 <54 Very low <1 14

15 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 intertesting intervals Other issues Test adequacy (language, cultural norms) Accurate estimation at tails Demand characteristics of testing environment 15

16 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 16

17 THANK YOU 17