Demographically Corrected Normative Standards for the English Version of the NIH Toolbox Cognition Battery
Open accessAbstract
Demographic factors impact neuropsychological test performances and accounting for them may help to better elucidate current brain functioning. The NIH Toolbox Cognition Battery (NIHTB-CB) is a novel neuropsychological tool, yet the original norms developed for the battery did not adequately account for important demographic/cultural factors known to impact test performances. We developed norms fully adjusting for all demographic variables within each language group (English and Spanish) separately. The current study describes the standards for individuals tested in English. Neurologically healthy adults (n=1038) and children (n=2917) who completed the NIH Toolbox norming project in English were included. We created uncorrected scores weighted to the 2010 Census demographics, and applied polynomial regression models to develop age-corrected and fully demographically adjusted (age, education, sex, race/ethnicity) scores for each NIHTB-CB test and composite (i.e., Fluid, Crystallized, and Total Composites). On uncorrected NIHTB-CB scores, age and education demonstrated significant, medium-to-large associations, while sex showed smaller, but statistically significant effects. In terms of race/ethnicity, a significant stair-step effect on uncorrected NIHTB-CB scores was observed (African American<Hispanic<White). After applying normative corrections, NIHTB-CB no longer demonstrated any significant associations with demographic factors. The previously developed norms still maintained significant associations with demographic factors, and demonstrated more variable impairment rates in segments of the healthy normative sample. Similar to other neuropsychological tests, demographic factors demonstrated significant associations with unadjusted NIHTB-CB scores. Application of fully corrected scores will help account for unwanted variance that is associated with non-clinical factors to more accurately reflect effects of disease-related changes in brain function. (JINS, 2015,21, 378–391)
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Demographically-corrected norms demonstrate better accuracy with less demographic bias on cognitive measures than age-only adjusted scores in neurological populations.
“Demographically-corrected norms demonstrate better accuracy with less demographic bias (Casaletto et al., 2015; R. K. Heaton, Ryan, L., & Grant, I., 2009; Taylor & Heaton, 2001) on cognitive measures than age-only adjusted scores in neurological populations.”
From Using the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with traumatic brain injury. (2017) · cites this paper as Casaletto et al., 2015
The Discussion (page unavailable) describes fully demographically adjusted scores as the best indicator of possible impairment, and the Abstract reports that these scores removed significant demographic associations. But the study used neurologically healthy participants; it did not demonstrate better accuracy than age-only scores in neurological populations. (LLM, conf=0.87)
Experimental — accuracy not yet measuredDemographically-corrected normative standards for NIHTB-CB were developed in a cohort of neurological healthy adults (N=1038).
“For the NIH Toolbox Cognition Battery (NIHTB-CB), demographically-corrected normative standards were developed in a cohort of neurological healthy adults (N=1038) in order to determine deviations from expected levels of performances.”
From Using the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with traumatic brain injury. (2017) · cites this paper as Casaletto et al., 2015
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Cognition assessment using the NIH Toolbox
Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., Carlozzi, N. E., Slotkin, J., Blitz, D., Wallner-Allen, K., et al. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872ded · Cited by 1,287 · cited 2× · see citing works
“Detailed descriptions of the individual Toolbox Cognition measures are provided in Weintraub et al. (2013), and Heaton et al. (2014) describes the validation of the Composite Scores.”
MethodSelf-citationAkshoomoff, N., Beaumont, J. L., Bauer, P. J., Dikmen, S. S., Gershon, R. C., Mungas, D., Slotkin, J., Tulsky, D., Weintraub, S., Zelazo, P. D., et al. (2013) · Monographs of the Society for Research in Child Development · doi:10.1111/mono.12038 · Cited by 299 · see citing works
Self-citationOrganization of Data on Life-Span Development of Human Abilities
HORN, J. L. (1970) · Life-Span Developmental Psychology · doi:10.1016/b978-0-12-293850-4.50022-4 · Cited by 226 · see citing works
TAYLOR, M. J., & HEATON, R. K. (2001) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617701777107 · Cited by 174 · see citing works
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Flagged first, then by citations
Research works printed but not linked: 18
- Beaumont JL Havlik R Cook KF Hays RD Wallner-Allen K Korper SP Gershon R Norming plans for the NIH Toolbox Neurology 2013 80 11 Suppl. 3 S87 S92 23479550 PMC3662345
- Byrd DA Touradji P Tang MX Manly JJ Cancellation test performance in African American, Hispanic, and White elderly Journal of the International Neuropsychological Society 2004 10 3 401 411 15147598
- Cattell RB Abilities: Their structure, growth, and action 1971 Cambridge Cambridge Unversity Press
- Deming WE Stephan FF On a least squares adjustment of a sampled frequency table when the expected marginal totals are known Annals of Mathematical Statistics 1940 11 4 427 444
- Diehr MC Cherner M Wolfson TJ Miller SW Grant I Heaton RK HIV Neurobehavioral Research Center Group The 50 and 100-item short forms of the Paced Auditory Serial Addition Task (PASAT): Demographically corrected norms and comparisons with the full PASAT in normal and clinical samples. J ournal of Clinical and Experimental Neuropsychology 2003 25 4 571 585 12911108
- Gasquoine PG Race-norming of neuropsychological tests Neuropsychology Review 2009 19 2 250 262 19294515
- Gershon RC Wagster MV Hendrie HC Fox NA Cook KF Nowinski CJ NIH toolbox for assessment of neurological and behavioral function Neurology 2013 80 11 Suppl. 3 S2 S6 23479538 PMC3662335
- Heaton RK Akshoomoff N Tulsky D Mungas D Weintraub S Dikmen S Gershon R Reliability and validity of composite scores from the NIH Toolbox Cognition Battery in adults Journal of the International Neuropsychological Society 2014 20 6 588 598 24960398 PMC4103963
- Heaton RK Marcotte TD Mindt MR Sadek J Moore DJ Bentley H Grant I The impact of HIV-associated neuropsychological impairment on everyday functioning Journal of the International Neuropsychological Society 2004 10 3 317 331 15147590
- Heaton RK Ryan L Grant I Grant I Adams K Demographic influences and use of demographically corrcted norms in neuropsychological assesment Neuropsychological assessment of neuropyschiatric and neuromedical disorders 2009 New York, NY Oxford University Press 127 155
- Horn JL Organization of abilities and the development of intelligence Psychological Review 1968 75 242 259 4875815
- Loewenstein DA Arguelles T Barker WW Duara R A comparative analysis of neuropsychological test performance of Spanish-speaking and English-speaking patients with Alzheimer’s disease Journal of Gerontology 1993 48 3 P142 P149 8482824
- Manly JJ Byrd DA Touradji P Stern Y Acculturation, reading level, and neuropsychological test performance among African American Elders Applied Neuropsychology 2004 11 1 37 46 15471745
- Manly JJ Jacobs DM Touradji P Small SA Stern Y Reading level attenuates differences in neuropsychological test performance between African American and White elders Journal of the International Neuropsychological Society 2002 8 341 348 11939693
- Mungas D Reed BR Haan MN Gonzalez H Spanish and English neuropsychological assessment scales: Relationship to demographics, language, cognition, and independent function Neuropsychology 2005 19 4 466 475 16060821
- Norman MA Evans JD Miller WS Heaton RK Demographically corrected norms for the California Verbal Learning Test Journal of Clinical and Experimental Neuropsychology 2000 22 1 80 94 10649547
- Norman MA Moore DJ Taylor M Franklin D Jr Cysique L Ake C HNRC Group.Demographically corrected norms for African Americans and Caucasians on the Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test-Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version Journal of Clinical and Experimental Neuropsychology 2011 33 7 793 804 21547817 PMC3154384
- Royston P Sauerbrei W Stability of multivariable fractional polynomial models with selection of variables and transformations: a bootstrap investigation Statistics in Medicine 2003 22 639 659 12590419
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Greene, A. S., Shen, X., Noble, S., Horien, C., Hahn, C. A., Arora, J., Tokoglu, F., Spann, M. N., Carrión, C. I., Barron, D. S., et al. (2022) · Nature · doi:10.1038/s41586-022-05118-w · Cited by 167 · see citing works
Scott, E. P., Sorrell, A., & Benitez, A. (2019) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617719000614 · Cited by 69 · see citing works
Using the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with traumatic brain injury.
Tulsky, D. S., Carlozzi, N. E., Holdnack, J., Heaton, R. K., Wong, A., Goldsmith, A., & Heinemann, A. W. (2017) · Rehabilitation Psychology · doi:10.1037/rep0000174 · Cited by 67 · see citing works
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Holdnack, J. A., Iverson, G. L., Silverberg, N. D., Tulsky, D. S., & Heinemann, A. W. (2017) · Rehabilitation Psychology · doi:10.1037/rep0000145 · Cited by 23 · see citing works
Ciriegio, A. E., Watson, K. H., Pfalzer, A. C., Hale, L., Huitz, E., Moroz, S., Roth, M. C., Snow, A. L. B., Jones, M. T., Guthrie, C. S., et al. (2022) · Neuropsychology · doi:10.1037/neu0000793 · Cited by 14 · see citing works
Iverson, G. L., & Karr, J. E. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.724888 · Cited by 13 · see citing works
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Aghamoosa, S., Lopez, J., Rbeiz, K., Fleischmann, H. H., Horn, O., Madden, K., Caulfield, K. A., Antonucci, M. U., Revuelta, G., McTeague, L. M., et al. (2024) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2023-332680 · Cited by 12 · see citing works
Aghamoosa, S., Nolin, S. A., Chen, A. A., Caulfield, K. A., Lopez, J., Rbeiz, K., Fleischmann, H. H., Horn, O., Madden, K., Antonucci, M., et al. (2025) · Brain Stimulation · doi:10.1016/j.brs.2025.04.012 · Cited by 6 · see citing works
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- Authors
- Casaletto, K. B., Umlauf, A., Beaumont, J., Gershon, R., Slotkin, J., Akshoomoff, N., & Heaton, R. K.
- Affiliations
- San Diego State University (US)
- University of California San Diego (US)
- Northwestern University (US)
- Corresponding author
- Heaton, Robert K.
- ORCID
- Venue
- Journal of the International Neuropsychological Society
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-05
- Volume
- 21
- Issue
- 5
- Pages
- 378-391
- ISSN
- 1355-6177 (ISSN-L)
- 1469-7661
- PMC
- PMC4490030
- OpenAlex
- W2114629989
- Cited by
- 271
- References
- 4
- Citations by year
- 2026: 28 · 2025: 27 · 2024: 36 · 2023: 35 · 2022: 30 · 2021: 18 · 2020: 24 · 2019: 21 · 2018: 21 · 2017: 22 · 2016: 6 · 2015: 3
- FWCI
- 23.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the International Neuropsychological Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (HHS-N-260–2006-00007-C)
- Foundation for Rehabilitation Psychology
- National Institute of Mental Health (P30MH062512)
- National Institute on Drug Abuse (F31DA035708)
- National Cancer Institute (U2CCA186878)
- Office of Behavioral and Social Sciences Research
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HHSN267200700027C)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- NIH Toolbox Cognition Battery, normative standards, demographic correction, sex differences, educational attainment, cognitive performance, fluid intelligence, crystallized intelligence, children, adults, English language norms
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Child, Child, Preschool, Cognition, Demography, Female, Humans, Male, Middle Aged, National Institutes of Health (U.S.), Neuropsychological Tests, Reference Values, United States, Young Adult
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