Richard Gershon, PhD, has a shiny new toolbox of measures of neurological and behavioral function that will revolutionize large-scale clinical research by making data collection faster, cheaper and more accurate. It also will help researchers recruit children and adults for studies because participation will be much less time consuming.
On Sept. 10 and 11, Gershon will introduce the new NIH Toolbox for Assessment of Behavioral and Neurological Function to hundreds of researchers at a special National Institutes of Health (NIH) conference in Bethesda, Maryland. At the end of September, the resource will be made fully available to the research community and clinicians.
Gershon, an associate professor of medical social sciences at Northwestern University Feinberg School of Medicine, has led an ambitious six-year NIH-funded study reflecting the efforts of 235 scientists around the world that provides the first common measurements for neurological and behavioral health. Currently, one researcher’s test to measure depression, for example, isn’t the same as another’s, so their study results aren’t comparable. Research is built on others’ findings so standardization will be of significant benefit.
The new set of tests — available in Spanish and English — slashes the number of questions and time required for study participants by up to 90 percent. The tests also are royalty-free (some other tests often have expensive royalties that hike the cost of research) and can be administered by anyone with a basic college education, a less expensive alternative to the Ph.D. level-person with specialized training now required to administer them.
For example, one intelligence test that normally takes three hours is cut to 30 in minutes with the new NIH Toolbox version. Many traditional “gold standard” tests are trimmed from 30 items to five. Every test in the new set of measures was validated to make sure it yields comparable or better results than the longer ones.
Many of the streamlined tests are accomplished through computer adaptive testing –- Gershon’s expertise. In this approach, the computer is constantly adjusting the questions to meet the level of the person being tested, eliminating lots of extraneous questions.
“With the computer we cut to what we need to measure in each individual person,” Gershon said. “We zero in on that person’s individual level of functioning and don’t waste their time asking questions far above or below their ability.”
This is how it works. If a computerized adaptive version of a vocabulary test is administered to a third grader, the first item to be answered by the student will be at third grade level. If the student gets that correct, the next item will be 3.5 level and so forth until the computer has zeroed in on the student’s precise ability level. A traditional vocabulary test may have 50 items to answer, but the computer version requires less than half that amount to assess performance. The shorter test will be more reliable because half the items on the traditional test would be below the student’s ability and half would be above it.
The new tests will be a valuable resource for use in longitudinal studies measuring behavior. They are the first to measure a continuum of health from dysfunction through superfunction in neurological and behavioral health for persons ages 3 to 85. Most existing tests were developed to measure dysfunction or to diagnose disease. A benefit of the continuum is being able to identify — in longitudinal studies, epidemiological studies and clinical trials — where problems begin to emerge and what the causes may be. To develop norms for the continuum, researchers measured a sample of 5,000 people in English and Spanish of various races and ethnicities of every age in 10 different data collection sites around the country.
Gershon tapped top scientists in the country in each domain to develop the instruments. For the olfaction measure, eight top researchers conferred to examine the worldwide inventory of smell tests and eventually designed their own. The NIH Toolbox version costs $2 a person (to pay for the scratch and sniff cards) compared to the gold standard tests, which are available for $15 to $30.
In addition to smell, some of the measures include multiple areas of cognition, emotional health and motor and sensory functioning such as vision and hearing.
More than 30 Northwestern scientists and staff members were involved in the NIH Toolbox, including David Cella, PhD, chair of medical social sciences, and senior researchers Sandra Weintraub, PhD, William Rymer, MD, PhD, Nina Kraus, PhD, and Steve Zecker.
This project is supported by federal funds from the NIH Blueprint for Neuroscience Research and the Office of Behavioral and Social Sciences Research, National Institutes of Health, under Contract No. HHS-N-260-2006-00007-C.