Research

ECHO (Environmental Influences on Child Health Outcomes)

Multi-PI: David Cella, PhD

Contact PI: Richard Gershon, PhD

Project Manager: Magdalena Kupczyk, MPH

Sponsored by the National Institutes of Health (NIH), the ECHO Program represents a network of medical specialists, scientists, and scholars dedicated to enhancing the health of children for generations to come. The goal of the nationwide consortium is to understand the effects of a broad range of early environmental influences on child health and development. ECHO is committed to both learning what factors affect child health and to finding ways to enhance it, with aims to:

1. Enhance the health of children and adolescents through research that may help inform healthcare practices, programs, and policies.
2. Create a culture that helps teams of child health researchers work together to achieve the best results.

ECHO PRO Core

The Person Reported Outcome (PRO) Core (Multi-PIs Cella & Gershon) is a key operational component of the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Research Program. Comprised of 69 existing pediatric longitudinal cohort studies across 200 sites in 40 states and Puerto Rico, ECHO is a 7-year initiative (2016-2023) examining the effects of a broad range of early environmental exposures on children’s health and development. With the mission to enhance the health of children and adolescents for generations to come, ECHO focuses on five primary outcomes with high public health impact: 1) pre-, peri-, and postnatal outcomes; (2) neurodevelopment; (3) upper and lower airways (e.g., asthma); (4) obesity; and (5) positive health (e.g., life satisfaction). Based at Northwestern University’s Feinberg School of Medicine in the Department of Medical Social Sciences, with collaborators across the country, the PRO Core contributes to ECHO through the following key activities: survey and performance measurement development and validation; data harmonization and statistical analyses; ECHO-wide Cohort Data Collection Protocol development, implementation, and evaluation; cohort training and support for the NIH Toolbox®, PROMIS®, and other PRO measures; and Positive Health research leadership.

Infant and Toddler (Baby) Toolbox

PI: Richard Gershon, PhD

Scientific Director: Aaron Kaat, PhD

Project Manager: Vitali Ustsinovich, MA

Funded by the National Institutes of Health (NIH), the Infant and Toddler (Baby) Toolbox (NBT) is a five-year contract to create an iPad-based measurement tool for administering, scoring, and interpreting infant and toddler assessments of cognition, social functioning, language (receptive and expressive), early mathematics/numeracy, self-regulation, and executive function in children between 1- and 42-months of age. As a natural extension to the NIH Toolbox®, assessments will include direct child assessment and observations supplemented as needed by reporting from parents or legal guardians.

Baby Toolbox Timeline

• NIH Baby Toolbox App development: 2020/2021 – Identification and selection of measures, development, and design of iPad-based app for the assessment of cognitive function in infants and toddlers.
• Validation: Fall 2021 - Recruit diverse subgroups for usability testing and validation of selected measures of numeracy, expressive and receptive language, self-regulation, social functioning, cognition and executive function and motor skills in infants and toddlers aged 0-42 months.
• Norming: Spring 2023 – Extensive data collection to develop baseline population norms for NIH Baby Toolbox measures.
• Public release: 2024 –Dissemination of NIH Baby Toolbox app for research use.

National Institutes of Health (NIH) Toolbox ® for the Assessment of Behavioral and Neurological Function

PI: Richard Gershon, PhD

Product Manager: Julie Hook, PhD, MBA, ABPP

Developed with support from the National Institutes of Health, the NIH Toolbox (NIHTB) is an interactive suite of over 100 validated tests designed to assess cognitive, sensory, motor, and emotional function from the convenience of an iPad. The goal of the NIHTB was to create a large battery of instruments for researchers and clinical professionals to quickly access key aspects of cognitive, emotional, sensory, and motor health, for longitudinal, clinical, and comparative effectiveness research at a minimal cost. Using state-of-the art test development techniques including item response theory (IRT) and computer adaptive testing (CAT), each test can be easily administered in 5 minutes or less. Nationally normed across the lifespan for ages 3-85, users can choose from standard or customizable batteries and examine automated test scores on the spot through a user-friendly report or CSV data file. As the principal investigator, Richard Gershon, PhD, led a worldwide team of more than 300 scientists across 80 institutions to create the NIHTB. Today, all of the NIHTB measures are normed in English and Spanish. Many of the cognitive measures are translated for use worldwide.

NIH Toolbox ® Scientific Review Board

To ensure its continued innovation and relevancy for years to come, a team of scientific experts across the fields of Cognition, Motor, Sensation, and Emotion were selected to help shape the direction of the NIH Toolbox. Learn more about the Scientific Review Board and its members in the link above. 

NIH Toolbox Publications

Over 350 peer reviewed articles reference use of the NIH Toolbox in 25+ disease areas in both research and clinical applications. A list of NIH Toolbox publications is maintained in the link above.

Special Journal Issues

• Rehabilitation Psychology - 2017
• Journal of the International Neuropsychological Society - 2014
• Neurology - 2013
• Monographs of the Society for Research in Child Development - 2013

NIH Toolbox Training

Administration of the NIH Toolbox requires training, practice and the proper equipment and materials. There are two primary avenues for learning how to administer NIH Toolbox test:

• eLearning – An online training curriculum (including didactics, video demonstrations, and quizzes) that can be utilized at the trainee’s convenience.
• Workshops – These 1.5 day in-person sessions provide participants with basic information about each test, opportunities to practice, and feedback from experienced NIH Toolbox administrators.

International NIH Toolbox – Translations

Project Coordinator: Amy Giella, BA

• NIH Toolbox en Español

Fox, R., Manly, J., Slotkin, J., Peipert, J., & Gershon, R. (2020). Translation and Cultural Reliability and Validity of the Spanish-Language Version of the NIH Toolbox. Assessment: SAGE Journals.  https://pubmed.ncbi.nlm.nih.gov/32264689/

Gershon, R., Fox, R., Manly, J., Mungas, D., Nowinski, C. Roney, E. & Slotkin, J. (2020). The NIH Toolbox: Overview of Development for Use with Hispanic Populations. Journal of the International Neuropsychological Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319898/.

• NIH Toolbox Cognition Tests in African (Swahili and Dholuo)

Duffey, M., Ayuka, D., Ayodo, G., Abuonji, E., Nyalumbe, M., Giella, A., Hook, J., Tran, T. & McHenry, M. (2021). Translation and Cultural Adaptation of NIH Toolbox Cognitive Tests into Swahili and Dholuo Languages for Use in Children in Western Kenya. Journal of the International Neuropsychological Society.

https://pubmed.ncbi.nlm.nih.gov/34027848/

Mobile Toolbox

Contact PI: Richard Gershon, PhD

Multi-PIs: Lara Mangravite, PhD, Aaron Kaat, PhD, Michael Weiner, PhD, Dorene Rentz, PhD

Scientific Director: Cindy Nowinski, MD, PhD

Project Manager: Zahra Hosseinian, MA

Funded by the National Institute on Aging (NIA), the Mobile Toolbox project is a nationwide consortium designed to build a common platform on Android and iOS for cognitive assessment management and dynamic data analysis. Intended for administration in adults aged 20 to 85, this comprehensive smartphone app-based research platform aims to enable remote cognitive assessment to allow users to embed self-administered cognitive tests into research studies. These app-based cognitive assessment tools will help differentiate normal from abnormal cognitive change, furthering the understanding of pathological cognitive decline and facilitating the development of effective prevention and treatment strategies.

Mobile Toolbox Timeline

• Mobile App Development: 2020 – Development, design, and beta testing of iOS and Android smartphone-based tests to measure cognitive function.
  • Validation Testing: 2021 – Recruit diverse subgroups for usability testing, examining memory, executive function, and processing speed, in both healthy and cognitively-impaired individuals.
  • Generation of Population Norms: 2022 – Further data collection for baseline testing; develop new pilot studies and make baseline data and documentation publicly available.
  • Public Dissemination: 2023 – Complete analyses and disseminate findings, materials, software, and data.

ARMADA (Advancing Reliable Measurement in Alzheimer's Disease and cognitive Aging)

PI: Richard Gershon, PhD

Multi-PI: Sandra Weintraub, PhD, ABPP

Project Manager: Vitali Ustsinovich, MA

Aging-associated cognitive decline, whether mild or severe, can profoundly affect the independence, well-being, and quality of life of those aged 65 and older. Development of effective interventions and treatments for this requires standard, psychometrically sound, easy-to-use measures that are sensitive to early indicators of cognitive decline and capture non-cognitive factors associated with or predictive of cognitive changes. Funded by the National Institute on Aging (NIA), the ARMADA project is designed to meet this need by validating and expanding measures from the four NIH Toolbox® (NIHTB) domains – Cognition, Emotion, Sensory, and Motor – in individuals with mild cognitive impairment, early Alzheimer’s disease, and in healthy individuals over age 85. To ensure that the NIHTB will be a valuable resource for cognitive aging research, ARMADA aims to:

1. Validate English and Spanish versions of an expanded NIHTB version in existing, well-characterized, ethnically, and racially diverse samples of adults ages 65-85 representing the trajectory of cognitive aging and in cognitively normal individuals 86+ years of age.
2. Expand the NIHTB by adding innovative instruments to assess neurological functions associated with cognitive aging.
3. Facilitate use of the NIHTB in aging research by ensuring it is a readily available resource with robust user support.

MyCog (Rapid Detection of Cognitive Impairment in Everyday Clinical Settings)

Contact PI: Richard Gershon, PhD

Multi-PI; Michael Wolf, PhD

Scientific Director: Cindy Nowinski, PhD, MD

Project Manager: Zahra Hosseinian, MA

Cognitive impairment (CI) is increasing in the US as the elderly population increases, and therefore early detection of CI is critical for ensuring its appropriate management. Funded by the National Institute of Neurological Disorders and Stroke (NINDS), MyCog is a research project designed to create a brief screening battery (the MyCog iPad App) to identify patients with increased risk for CI and/or dementia for further evaluation. This brief, new technology can be easily implemented in everyday clinical settings with diverse populations. MyCog aims to:

1. Create a standalone MyCog App that will report screening results as either “No CI detected”, or `CI detected” and provide follow-up recommendations and guidelines for each outcome.
2. Validate MyCog in primary care settings and determine its sensitivity in detecting early indicators of CI.
3. Evaluate the success of MyCog clinical implementation in primary care settings.
4. Optimize MyCog for use in clinical settings by adjusting scoring algorithms to maximize efficiency and incorporating features that facilitate clinical integration.

Toolbox Detect

Contact PI: Richard Gershon, PhD

Multi-PI: Michael Wolf, PhD, MPH

Scientific Director: Cindy Nowinski, MD, PhD

Project Manager: Zahra Hosseinian, MA

Designed to test the effectiveness of the MyCog iPad app as a new standard of care, the Toolbox Detect project was created as clinical trial intended to refine and embed the MyCog paradigm into routine clinical care at 40 clinics spread across Northwestern Medicine - and Access – a federally-qualified health center (FQHC) organization ​ with 35 health centers, located throughout Chicago, Cook and DuPage counties.