Impact of psychiatric comorbidity, resilience and executive function on childhood and adolescent headaches: A narrative review.

Executive functions (EFs) are interrelated cognitive processes that have been studied in relation to behavior, attention, academic achievement, and developmental disorders. Studies of EF skills assessed through parent report and performance-based measures show correlations between them ranging from none to modest. Few studies have examined the relationship between EF skills measured through parent report and performance-based measures in relation to adaptive function. The present study included preschool children born preterm as a population at high risk for EF impairments. Preschool children (N = 149) completed a battery of EF tasks that assess working memory, response inhibition, idea generation, and attention shifting or cognitive flexibility. Parents reported on children’s EF and adaptive skills. Preterm children showed more parent-rated and performance-based EF impairments than did full-term children. The combined use of either parent report or performance-based measures resulted in the identification of a large number of children at risk for EF impairment, especially in the preterm group. Both parent report and performance-based EF measures were associated with children’s adaptive function. EF skills are measurable in young child'ren, and we suggest that EF skills may serve as targets for intervention to improve functional outcomes. We recommend the use of both parent report and performance-based measures to characterize children’s EF profiles and to customize treatment.

Objective: To investigate the current status of insomnia symptoms and executive function (EF) impairments among adolescents from regions with different economic development levels, and to analyze their relationship with depressive symptoms, so as to provide clues for improved depressive symptoms screening practices. Methods: This population-based cross-sectional study employed a multistage, stratified cluster random sampling method. During November 2017 to January 2018 and December 2018 to January 2019, a total of 2 495 adolescents aged 11 to 18 years were selected from Shanghai, representing a highly developed economic region, and 2 704 adolescents aged 11 to 18 years were selected from Shangrao city, Jiangxi province, representing a less developed economic region. The depressive symptoms were assessed using the short version of the 21-item depression, anxiety, and stress scale, based on which participants were categorized into groups with or without depressive symptoms. Insomnia symptoms and EF impairments were measured using a self-designed insomnia scale and the behavior rating inventory of executive function, respectively. Participants were further classified into 4 subgroups: neither insomnia nor EF impairment, EF impairment only, insomnia only, and comorbid insomnia and EF impairment. Chi-square test was used to compare the differences in basic information of adolescents from different regions. Multivariate Logistic regression models were applied to examine the associations between insomnia, EF impairment, and their combination with depressive symptoms as well as the differences in gender and school-stage among each subgroup. Results: A total of 2 305 adolescents were recruited from Shanghai (1 192 boys and 1 113 girls, 1 266 junior high school students and 1 039 senior high school students) and 2 250 adolescents from Shangrao (1 126 boys and 1 124 girls, 1 146 junior high school students and 1 104 senior high school students). The numbers of adolescents with depressive symptoms, insomnia symptoms and EF impairment in Shanghai were 460 adolescents (20.0%), 907 adolescents (39.3%), and 411 adolescents (17.8%), respectively, all of which were fewer than those in Shangrao, which were 616 adolescents (27.4%), 1 251 adolescents (55.6%), and 524 adolescents (23.3%), respectively (all P<0.001). In Shanghai, the numbers of adolescents with EF impairment only, insomnia only, and comorbid insomnia and EF impairment were 219 adolescents (9.5%), 670 adolescents (29.1%), and 237 adolescents (10.3%), respectively. And in Shangrao, the corresponding numbers were 193 adolescents (8.6%), 865 adolescents (38.4%), and 386 adolescents (17.2%), respectively. Compared to adolescents in Shanghai with neither EF impairment nor insomnia, the risk of depressive symptoms was all higher in adolescents with EF impairment only, insomnia only, and comorbid EF impairment-insomnia (OR=2.86, 6.48, 20.10; 95%CI 1.57-5.22, 5.09-8.26, 13.66-29.58; all P<0.01). Similar results were observed in adolescents in Shangrao (OR=3.22, 4.82, 10.91; 95%CI 1.66-6.28, 3.09-7.51, 7.26-16.40; all P<0.01). The analysis of gender and educational stage differences showed that, compared to the group neither EF impairment nor insomnia, the risk of depressive symptoms all higher in the groups with EF impairment only, insomnia only (all P<0.05), and comorbid EF impairment-insomnia, and the risk in comorbid EF impairment-insomnia group was the highest (all P<0.05). Conclusions: Compared with adolescents in regions with underdeveloped economies, those in economically developed regions had lower rates of insomnia, EF impairment, and depression. Both insomnia and EF impairment significantly increase the risk of depressive symptoms. Their coexistence confers the highest risk and therefore warrants particular attention for prevention and intervention efforts.

Background: Children with specific language impairment (SLI) have problems with non-linguistic areas such as executive function (EF) skills, in addition to language skills. EF skills are crucial for language development and processing. Conversely, language acquisition can also enhance EF skills, suggesting a bidirectional relationship. Speech therapists (STs) play a crucial role in providing interventions focused on EF skills for school-age children with SLI. Nevertheless, there is a scarcity of comprehensive evaluations regarding the effects of EF interventions for school-age children with SLI that enhance EF and language skills. Objective: The purpose of this systematic review (SR) was to investigate which EF interventions have affected EF skills for school-age children with SLI and to investigate how improvements in EF skills could improve language skills in these children with SLI. Materials and methods: This SR followed the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines with a descriptive-analytical approach. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024545361). Searched databases included ERIC, PubMed, APA PsycINFO, and ProQuest Dissertations and Theses. The authors used the Single-Case Experimental Design (SCED) and the Joanna Briggs Institute (JBI) critical appraisal tool for quality assessment. Results: A total of 5,737 studies were retrieved, of which 4 studies were included in this review. The evidence supports the notion that EF interventions could improve EF skills (i.e., visuospatial WM, attention, inhibition, and cognitive flexibility) as well as language skills (i.e., language comprehension and production, particularly grammatical skills) in children with SLI aged 6 to 12 years. This study also indicates that while there are promising outcomes, the effects can be inconsistent and vary depending on the type of intervention and the specific skills targeted. EFs offer a cognitive framework that facilitates language acquisition, comprehension, and production throughout development and across different contexts. Conclusion: EF interventions could have the potential to improve both EF skills and language skills. EF skills are essential for language development and processing, and vice versa. Therefore, STs could integrate EF interventions with traditional language interventions.

Behavior problems and executive function impairments in preterm compared to full term preschoolers.

Objective:Executive functioning (EF) is impaired in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), and EF challenges are exacerbated in youth with ASD and ADHD (ASD+ADHD), which may impact diagnostic timing. We hypothesized youth with ASD+ADHD would be more impaired in EF (as opposed to other functional domains) compared to autistic youth without ADHD (ASD-only), with particular deficits in metacognition and inhibition. We also predicted youth with ASD+ADHD would be at significant risk for delayed ASD diagnosis and that greater EF challenges would predict earlier age of ASD diagnosis across groups.Participants and Methods:Data from a clinical database was extracted for 400 youth who received a new diagnosis of ASD after age 5, either with a co-occurring diagnosis of ADHD (ASD+ADHD group: n=297; Mage of ASD diagnosis=10.49; 25.9% female; 48.1% white) or without a co-occurring ADHD diagnosis (ASD-only group: n=100; Mage of ASD diagnosis=12.02; 34.0% female; 44.7% white). EF was measured with the BRIEF-2 parent-report, and ASD symptom strength was measured with the SRS-2 School Age form. Independent samples t-tests investigated whether a) the ASD+ADHD group was uniquely impaired in EF compared to the ASD-only group, b) parents of ASD+ADHD report elevated EF problems, and c) the ASD+ADHD group was at significant risk for delayed ASD diagnosis. Pearson correlations examined the association between age of ASD diagnosis and EF for each diagnostic group. Hierarchical linear regressions further analyzed whether specific EF domains concurrently predicted age of ASD diagnosis, after controlling for the known predictors of assigned sex at birth, FSIQ, and ASD symptom strength.Results:The ASD+ADHD group had greater challenges in overall EF (t=-6.42, p&lt;.001), metacognitive skills (t=-6.47, p &lt;.001), and inhibition skills (t=-7.06, p&lt;.001). There was no significant difference in parent-reported autism symptoms between the ASD and ASD+ADHD groups (t=0.973, p=.331). The ASD+ADHD group received ASD diagnoses earlier than the ASD-only group (t=4.194, p&lt;.001). In the ASD-only group, age of ASD diagnosis was not significantly correlated to overall EF, metacognitive skills, nor inhibition skills (ps&gt;.05). In the ASD+ADHD group, ASD diagnosis was significantly related to overall EF (r(297)=.128, p=.027) and metacognitive skills (r(297)=.329, p&lt;.001) but not inhibition skills (r(297)=.078, p=.180). Hierarchical linear regressions controlling for assigned sex at birth, FSIQ, and SRS-2 T-scores were used to determine whether these EF components significantly predicted age of ASD diagnosis. Overall EF did not predict age of ASD diagnosis in the ASD+ADHD group (ß=.034, t=1.417, p=.157), but metacognitive skills did (ß=.123, t=5.582, p&lt;.001).Conclusions:Our findings suggest youth with ASD+ADHD have greater impairment in overall EF, metacognition, and inhibition compared to ASD-only youth, despite similar levels of ASD traits, consistent with hypotheses. Contrary to our hypothesis, youth with ASD+ADHD in this sample were diagnosed with ASD earlier. However, results also suggest EF problems, specifically metacognitive deficits, predict later age of ASD diagnosis. Future research is needed to replicate findings and better understand how EF and other functional domains predict ASD diagnostic timing.

The authors reviewed 35 open-label sertraline trials for executive impairment in ischemic cerebrovascular disease. Outcomes included clock-drawing, the Executive Interview (EXIT25), the Geriatric Depression Scale, and the Mini-Mental State Examination. Clinically "meaningful" improvement was defined as a >3.0 EXIT25 point decline from baseline. "Remission" was defined as the achievement of an EXIT25 score <15/50. Only EXIT25 scores improved significantly. Twenty patients (57.1%) experienced a clinically meaningful improvement in executive control function. Twelve (34.3%) achieved remission. Our findings suggest that sertraline may have both statistical and clinically meaningful effects on executive control function in ischemic cerebrovascular disease. The authors discuss the implications for future clinical trials.

Executive function and mathematics in preschool children: Training and transfer effects

Association of executive function impairment, history of falls and physical performance in older adults: a cross-sectional population-based study in eastern France.

Objective:Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with impaired executive functioning and anxiety/depressive symptoms, which may contribute to reduced quality of life. We tested the hypotheses that (1) a childhood diagnosis of ADHD is related to reduced quality of life in emerging adulthood and that (2) this relationship is mediated by impaired executive functioning and anxiety/depressive symptoms.Participants and Methods:We assessed 85 children and adolescents with ADHD and 50 typically developing peers at baseline (Mean age = 11.6 years, 58% males), two-year follow-up, and 10-year follow-up with neuropsychological tests of executive functioning, the Behavioral Rating Inventory of Executive Function (BRIEF), the Short Moods and Feelings Questionnaire (SMFQ), and the Revised Children’s Manifest Anxiety Scale, second edition (RCMAS-2), as well as the Perceived Quality of Life scale (PQoL) at the 10-year follow-up. Four neuropsychological tests of executive functioning, the Letter-Number Sequencing test (working memory), the Color-Word Interference test condition 3 (response inhibition), the Color-Word Interference test condition 4 (shifting), and the trail making test condition 4 (cognitive flexibility) were combined into a neuropsychological executive functioning composite score based on high factor loadings (&gt; .73). the parent-reported BRIEF indexes, the behavioral regulation index, and the metacognition index were used as measures of everyday executive functioning. We conducted independent samples t-tests to compare the groups and simple and parallel mediation analyses with full information maximum likelihood estimation to examine whether the different executive functioning measures and anxiety/depressive symptoms at two-year follow-up mediated the relationship between baseline ADHD and self-reported quality of life at 10-year follow-up.Results:Baseline ADHD was associated with more difficulties with executive functioning on a composite measure of neuropsychological tests (p &lt; .001, Hedges g = .79) and parent-reported everyday metacognitive (p &lt; .001, Hedges g = 2.37) and behavioral regulation executive functioning (p &lt; .001, Hedges g = 1.55), as well as self-reported anxiety (p &lt; .001, Hedges g = 1.05) and depressive symptoms (p &lt; .001, Hedges g = 1.00) at two-year follow-up. Baseline ADHD was associated with lower self-reported quality of life (p = .001, Hedges g = -.67) at 10-year follow-up. The mediation analysis showed that everyday metacognitive executive functioning (p = .011, ß = -.497) and an anxiety/depressive symptoms composite (p &lt; .001, ß = -.404) parallelly mediated the relationship between ADHD and quality of life.Conclusions:Impaired everyday executive functioning and anxiety/depressive symptoms may represent two distinct pathways to reduced quality of life in emerging adults with a childhood diagnosis of ADHD. These findings stress the importance of targeting both cognitive and emotional aspects in interventions for children and adolescents with ADHD to improve later quality of life.

Sickle cell disease (SCD) is a genetic hematological disorder with complications including pain crises, chronic anemia, infections, organ damage, and stroke. The frontal lobes are highly susceptible to stroke in youth with SCD, and subsequently, executive functioning skills are often compromised. Additionally, children with SCD often have atypical adaptive demands, particularly medical-self care activities. Impairments in executive functioning may help explain difficulties with independent self-management and transition to adult hood. In an interactional model described by Tarazi and colleagues (2007), the role of increased medical self-care demands and executive dysfunction in the development of self-care independence in children with chronic illness is considered. The current study aimed to investigate the relationship between executive functioning and adaptive functioning in youth with SCD by identifying which variables are most important in self-management and independence. It also aimed to validate the KIS-SCD as a measure of independence in medical-self care activities. Twenty-seven participants, ages 12-18 completed neuropsychological testing (general intelligence, attention, processing speed, memory, and executive functioning) and a measure of disease knowledge. Caregivers completed questionnaires assessing adherence, executive functioning, adaptive functioning, and medical self-care independence. Participants displayed borderline executive functioning skills despite parent reports of executive functioning within normal limits. Parent reports of executive functioning (BRIEF) were significantly correlated with adaptive functioning (ABAS-II; r = -.67, p &lt; .01) and medical self-care independence (KIS-SCD; r = -.65, p &lt; .01. Differences were found between those with low and high demands on response monitoring (t(24) = 2.32, p = .029) and inhibition/flexibility (t(24) = 2.07, p = .049). Results from hierarchical linear regression analyses revealed significantly greater predictive value of parent reports of executive functioning than other cognitive and medical variables for general adaptive functioning. Cognitive skills (i.e., sustained attention, memory) held the strongest predictive values for medical self-care independence. No variables were significantly predictive of adherence to SCD clinic appointments. Findings suggest that performance-based measures of executive functioning may be more sensitive that parent report measures in identifying executive functioning impairments in SCD. Executive functioning may explain variance in general adaptive functioning, particularly as it relates to parent reports, suggesting that parent reports and performance-based measures assess separate constructs of executive functioning. Cognitive functioning may be more related to disease-specific demands than global adaptive functioning. Continued research is recommended to further investigate the interaction between executive functioning and medical demand levels. Implications for these findings in the context of disease management and transition planning are discussed.

As a result of their hearing loss, adults with cochlear implants (CIs) would self-report poorer executive functioning (EF) skills than normal-hearing (NH) peers, and these EF skills would be associated with performance on speech recognition tasks. EF refers to a group of high order neurocognitive skills responsible for behavioral and emotional regulation during goal-directed activity, and EF has been found to be poorer in children with CIs than their NH age-matched peers. Moreover, there is increasing evidence that neurocognitive skills, including some EF skills, contribute to the ability to recognize speech through a CI. Thirty postlingually deafened adults with CIs and 42 age-matched NH adults were enrolled. Participants and their spouses or significant others (informants) completed well-validated self-reports or informant-reports of EF, the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A). CI users' speech recognition skills were assessed in quiet using several measures of sentence recognition. NH peers were tested for recognition of noise-vocoded versions of the same speech stimuli. CI users self-reported difficulty on EF tasks of shifting and task monitoring. In CI users, measures of speech recognition correlated with several self-reported EF skills. The present findings provide further evidence that neurocognitive factors, including specific EF skills, may decline in association with hearing loss, and that some of these EF skills contribute to speech processing under degraded listening conditions.

Background: Increased intake of alcohol causes changes in the cognitive process, affecting many important functions such as execution, recent memory, and visuospatial abilities. Sometimes changes imparted by alcohol use are irreversible. Aims and Objectives: The impairments caused by alcohol abuse are usually underdiagnosed even though they are moderate to severe. To this purpose, we studied the cognitive improvement on abstinence of alcohol use. Materials and Methods: The present study was done in 100 patients, whose diagnosis was made as per the International Classification of Disorders-10 as alcohol dependence syndrome. Patients were administered with the scales, the Severity of Alcohol Dependence Questionnaire (SAD-Q), Montreal Cognitive Assessment, Postgraduate Inventory Battery of Brain Dysfunction (PGIBBD), Trail Making Test-B, Digit Span Test, and Digit Vigilance Test. The evaluation of patients was done after 2 weeks of the last alcohol intake and reassessed at the end of the 3rd and 6th months, scores were compared. Analysis of data was done by using mean and standard deviation for continuous variables. The categorical variables were presented as frequency and percentages, and the comparisons between the quantitative data were done by analysis of variance test. Results: The cognitive assessment revealed impairments in executive function, short-term verbal memory, recent memory, visuospatial abilities, visual recognition, and processing speed on initial evaluation, and all the values improved in 6 months of abstinence. Conclusions: In this study, we found, there was significant impairment in memory, executive function, processing speed, visuospatial and recognition skills, initially, and improvement in cognitive function in alcohol.

To evaluate the effects of bilingual exposure on executive function (EF) skills, measured by parent-rating and performance-based instruments, in preterm and full-term preschoolers. Children age 3 to 5 years (mean 4.4) born preterm (PT; n = 82) and full term (FT; n = 79) had monolingual (PT-M, n = 51; FT-M, n = 53) or bilingual (PT-B, n = 31; FT-B, n = 26) language exposure. Groups were similar in age, gender and race, but PT children had lower socioeconomic status (SES) than FT children. Parents completed a language questionnaire and diary and a standardized parent rating of EF skills. Children completed EF tasks that tap response inhibition, working memory, and cognitive flexibility. ANCOVA and logistic regression examined effects on EF of birth group (PT/FT), language status (M/B), and birth group by language status interaction, controlling for age and SES. Compared to children born FT, children born PT had significantly higher parent-rated EF scores and poorer performance on all but one EF task, both indicating more EF problems. No main effects of language status and no birth group by language status interactions were significant. PT status was clearly associated with poorer EF skills, similar to many other studies. In this sample, bilingual exposure conferred neither an advantage nor disadvantage in the FT and PT group. This information may prove useful in counseling families of both PT and FT children about the impact of bilingual exposure on their children's cognitive skills.

Purpose Auditory deprivation has downstream effects on the development of language and executive functioning (EF) in prelingually deaf children with cochlear implants (CIs), but little is known about the very early development of EF during preschool ages in children with CIs. This study investigated the longitudinal development of EF and spoken language skills in samples of children with normal hearing (NH; N = 40) or CIs (N = 41) during preschool ages. Method Participants were enrolled in the study between ages 3 and 6 years and evaluated annually up to the age of 7 years. Mixed-effects models were used to evaluate and predict growth of spoken language and EF skills over time. Results Children with CIs scored lower than NH peers on language measures but improved significantly over time. On performance-based neurocognitive measures of controlled attention, inhibition, and working memory, children with CIs scored more poorly than the sample of NH peers but comparable to norms, whereas on a parent report behavior checklist, children with CIs scored more poorly than both NH peers and norms on inhibition and working memory. Children with CIs had poorer EF than the sample of NH peers in most domains even after accounting for language effects, and language predicted only the verbal working memory domain of EF. In contrast, EF skills consistently predicted language skills at subsequent visits. Conclusions Findings demonstrate that, despite significant improvement over time, some domains of EF (particularly parent-reported EF) and language skills in children with CIs lag behind those of children with NH during preschool ages. Language delays do not fully explain differences in EF development between children with CIs and NH peers during preschool ages, but EF skills predict subsequent language development in children with CIs.

Despite consensus in the developmental literature regarding the role of executive function (EF) skills in supporting the development of language skills during the preschool years, we know relatively little about the associations between EF skills, including all EF components, and vocabulary skills among preschool‐aged children. In this paper, we address this gap by fitting structural equation models to examine the associations between beginning‐of‐preschool EF and end‐of‐preschool receptive vocabulary, as well as the association between beginning‐of‐preschool receptive vocabulary and end‐of‐preschool EF skills, to data from 400 preschool‐aged children. We find that EF skills at the beginning of preschool are a significant predictor of receptive vocabulary skills at the end of preschool, controlling for receptive vocabulary at the beginning of preschool. However, receptive vocabulary skills at the beginning of preschool do not predict EF skills at the end of preschool, controlling for EF at the beginning of preschool. Our findings are suggestive of the important role EF plays in supporting growth in receptive vocabulary skills, above and beyond earlier vocabulary levels, and of the direction of the developmental pathway between EF and receptive vocabulary in the preschool years. The discussion highlights the need for further research in the optimal approach for supporting children's EF skill development in preschool. Copyright © 2013 John Wiley &amp; Sons, Ltd.