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NINDS CDE Notice of Copyright
Please visit this website for more information about the instrument: NIH ToolBox Website.
Information regarding iPad administration: NIH Toolbox and PROMIS iPad App
Information regarding cost: Pricing for Tools
NeuroRehab Supplemental - Highly Recommended:
Recommendations for Use: Indicated for studies requiring a measure of cognitive performance limitations.
Supplemental: Cerebral Palsy (CP), Myalgic encephalomyelitis/ Chronic fatigue syndrome (ME/CFS) and Traumatic Brain Injury (TBI)
Exploratory: Sport-Related Concussion (SRC)
Short Description of Instrument
The battery contains 7 new, validated measures designed to assess unique domains of cognitive functioning (Episodic Memory, Reading, Vocabulary, Processing Speed, Working Memory, Executive Function, and Attention).
The battery is administered on an iPad with the assistance of an examiner (e.g., research assistant, technician). The examiner will read instructions and administer measures. The iPad will record responses and compute normative scores based on age and other demographic categories. Administration time for the cognitive domain is = 30 minutes.
The National Institutes of Health Toolbox is part of the NIH Blueprint initiative. It seeks to assemble brief, comprehensive assessment tools that will be useful in a variety of settings with an emphasis on measuring outcomes in epidemiologic studies and clinical trials over time and across the lifespan.
NIH Toolbox Overview:
The goal is to help improve communication within and between fields of biomedical research and advance knowledge by using common data elements. The battery will examine various cognitive (episodic memory, language, processing speed, working memory, executive functions, attention), emotional (negative affect, factor,  positive affect [psychological well-being factor], stress and coping, social relationships [social satisfaction factor), sensory (vestibular, audition, olfaction, taste, vision) and motor functions (dexterity, strength, locomotion, endurance, balance).
ME/CFS Recommended Modules:
    • Attention: Flanker Test based on Eriksen's paradigm - administration time about 4-5 min.
    • Working Memory: List Sorting Task - administration time about 7 min.
    • Processing Speed: Pattern Comparison Processing Speed Task - administration time about 90 secs.

Sport-Related Concussion Specific: Validation version contains 8 new tests designed to measure unique domains of cognitive functioning (Episodic Memory, Reading, Vocabulary, Processing Speed, Working Memory, Executive Function, and Attention). The battery is administered on a touchscreen computer with the assistance of a technician. Technician will read instructions and administer items. Touch screen computer will record responses and computer scored. Administration time for the cognitive domain = 30 minutes).
Other Important Notes:
The battery is designed to measure these domains in ages 3 through 85. All measures are available and normed in both English and Spanish.
A recent article (Holdnack et al. 2017) provided a model for utilizing the NIH Toolbox Reading test as an indicator of premorbid cognitive functioning. The reading adjusted cognitive scores index current performance to an estimate of pre-injury ability.  
Comments/Special Instructions
NeuroRehab Specific: The computerized modular batteries are comprised of tests of multiple cognitive abilities. These batteries are in modular form so that the researcher can build the battery that is needed. It is important to note even though the test is computerized, it still must be administered by an examiner.
It takes approximately 30 minutes to administer the full battery. It does not have alternate forms.
Scoring and Psychometric Properties
Automated scoring by the Toolbox platform.
Psychometric Properties:
The battery has gone through extensive work to identify and pre-test the constructs to be measured. All measures were validated and normed on a very large, nationally representative sample.  Information on validation, norming, and measure development, as well as publications on the NIH Toolbox, are available on the NIH Toolbox Website.
Strengths: The NIH Toolbox Cognitive Battery provides an overall summary score along with fluid and crystallized cognition summary scores.
Weaknesses: There are no alternate forms of the NIH Toolbox Cognitive Battery. Participants must be able to use a tablet device.
NIH Toolbox Executive Summary. NIH ToolBox (accessed October 20, 2016). Principal Investigator: Richard Gershon PhD e-mail:
Adamson C, Yuan W, Babcock L, Leach JL, Seal ML, Holland SK, Wade SL. Diffusion tensor imaging detects white matter abnormalities and associated cognitive deficits in chronic adolescent TBI. Brain Inj. 2013;27(4):454-463.
Abeare C, Erdodi L, Messa I, et al. Development of embedded performance validity indicators in the NIH Toolbox Cognitive Battery. Psychol Assess. 2021;33(1):90-96.
Beaumont JL, Havlik R, Cook KF, Hays RD, Wallner-Allen K, Korper SP, Lai J, Nord C, Zill N, Choi S, Yost KJ, Ustsinovich V, Brouwers P, Hoffman HJ, Gershon R. Norming plans for the NIH Toolbox. Neurology. 2013;80(11 Suppl 3):S87-S92.
Carlozzi NE, Goodnight S, Casaletto KB, Goldsmith A, Heaton RK, Wong AWK, Baum CM, Gershon R, Heinemann AW, Tulsky DS. Validation of the NIH Toolbox in Individuals with Neurologic Disorders. Arch Clin Neuropsychol. 2017 Aug 1;32(5):555-573.
Casaletto KB, Umlauf A, Marquine M, Beaumont JL, Mungas D, Gershon R, Slotkin J, Akshoomoff N, Heaton RK. Demographically Corrected Normative Standards for the Spanish Language Version of the NIH Toolbox Cognition Battery. J Int Neuropsychol Soc. 2016 Mar;22(3):364-74.  
Casaletto KB, Umlauf A, Beaumont J, Gershon R, Slotkin J, Akshoomoff N, Heaton RK. Demographically Corrected Normative Standards for the English Version of the NIH Toolbox Cognition Battery. J Int Neuropsychol Soc. 2015 May;21(5):378-91.
Nitsch KP, Casaletto KB, Carlozzi NE, Tulsky DS, Heinemann AW, Heaton RK. Uncorrected versus demographically-corrected scores on the NIH Toolbox Cognition Battery in persons with traumatic brain injury and stroke. Rehabil Psychol. 2017 Nov;62(4):485-495.
Gershon RC, Cella D, Fox NA, Havlik RJ, Hendrie HC, Wagster MV. Assessment of neurological and behavioural function: the NIH Toolbox. Lancet Neurol. 2010;9(2):138-139.
Holdnack JA, Tulsky DS, Slotkin J, Tyner CE, Gershon R, Iverson GL, Heinemann AW. NIH Toolbox premorbid ability adjustments: Application in a traumatic brain injury sample. Rehabil Psychol. 2017;62(4):496-508.
Quatrano LA, Cruz TH. Future of outcomes measurement: impact on research in medical rehabilitation and neurologic populations. Arch Phys Med Rehabil. 2011;92(10 Suppl):S7-S11.
Tulsky DS, Heinemann AW. The clinical utility and construct validity of the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with disabilities. Rehabil Psychol. 2017;62(4):409-412.
Weintraub S, Dikmen SS, Heaton RK, Tulsky DS, Zelazo PD, Slotkin J, Carlozzi NE, Bauer PJ, Wallner-Allen K, Fox N, Havlik R, Beaumont JL, Mungas D, Manly JJ, Moy C, Conway K, Edwards E, Nowinski CJ, Gershon R. The cognition battery of the NIH toolbox for assessment of neurological and behavioral function: validation in an adult sample. J Int Neuropsychol Soc. 2014;20(6):567-578.
Zelazo PD, Anderson JE, Richler J, Wallner-Allen K, Beaumont JL, Weintraub S. II. NIH Toolbox Cognition Battery (CB): measuring executive function and attention. Monogr Soc Res Child Dev. 2013 Aug;78(4):16-33.
Togo F, Lange G, Natelson BH, Quigley KS. Attention network test: assessment of cognitive function in chronic fatigue syndrome. J Neuropsychol. 2015;9(1):1-9.
Document last updated January 2022