Longitudinal profiles of executive functioning from infancy to 5 years of age-A FinnBrain Birth Cohort Study.

Background: Driving under the influence of cannabis (DUIC) almost doubles car crash risk (odds ratios range: 1.28-2.49). Known DUIC correlates include male gender, low perceived danger of DUIC, and greater frequency of cannabis and other drug use. Less is known about the role of executive cognitive functioning (e.g., skills in planning, organization) as a correlate of DUIC. Deficits in executive cognitive functioning could precede, and be exacerbated by heavy cannabis use, potentially contributing to DUIC risk. Objectives: This cross-sectional survey study used a person-centered analysis (latent profile analysis) to (1) identify prototypical profiles representing aspects of executive functioning and substance use in young adults, and (2) determine which profiles were associated with self-report of DUIC. We hypothesized that at least two profiles would be identified: mainly or only cannabis use vs polysubstance use. We also predicted that the polysubstance use profile would be associated with worse executive functioning and self-report of DUIC. Method: Young adults (N=69; ages 18-25; mean age=20.0 [SD=1.9]; 62.3% female; 75.4% White, 13.0% Black, 11.6% Other race/ethnicity) who reported weekly cannabis use were recruited from the community in Pittsburgh, PA to participate in a study of cannabis effects on cognition. Baseline collected demographics, self-reported age of cannabis use onset (age <16 vs age >16), NIDA modified ASSIST, Marijuana Withdrawal Checklist, Alcohol Use Disorders Identification Test (AUDIT), Behavior Rating Inventory of Executive Functioning (BRIEF) (working memory, organization/planning scales), and Marijuana Consequences Questionnaire (item on “driven a car when high” in past 6 months). Latent profile analysis (LatentGold 5.1) was used to identify distinct classes, testing the fit of 1-5 classes. Each model included 10 indicators: age of cannabis use onset, frequency of cannabis and tobacco use, cannabis withdrawal severity, ASSIST scores for cannabis, cocaine and hallucinogens (the substances most often reported), AUDIT score, and BRIEF working memory, and organization/planning scores. For the best fitting model, covariates (i.e., self-report of DUIC, age, gender) were examined as profile correlates in a separate, final step. Results: A model with 3 latent profiles was selected (see Figure). The profiles represented “Polysubstance Use” (40.8%), “Primary Cannabis” (22.3%), and “Later Onset Cannabis” (36.9%). Polysubstance use profile reported more cannabis-related problems and other drug use, and more problems with executive functioning than the other profiles (p<.05). Later Onset (vs Polysubstance Use) profile had older onset age (p<.05), and had the lowest level of cannabis involvement. Primary Cannabis and Later Onset profiles did not differ in report of problems with executive functioning. DUIC in the past 6 months (reported by 50.7% of the total sample) was more likely to be reported by Polysubstance use than Later Onset profile (p<.01). Polysubstance use profile was younger than Primary Cannabis profile (p<.05). The profiles did not differ by gender. Conclusions: As hypothesized, Polysubstance Use profile (which reported early cannabis use onset; and worse executive functioning, including problems with memory, planning/ organization) was associated with self-report of DUIC. Results highlight the role of self-reported executive functioning difficulties in DUIC risk, and the importance of targeting polysubstance use in preventing DUIC.

Using Latent Profile Analysis and Related Approaches in Adolescent Health Research

ABSTRACTBACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults.OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults.DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012).METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively.RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function.CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

The aim of the present study was to investigate associations between internalizing and externalizing symptoms and deficits in executive functions (EF) as well as to examine the overall heterogeneity of EFs in a sample of preschool children attending a psychiatric clinic (n = 171). First, based on cut-off points signifying clinical levels of impairment on the parent-completed Child Behavior Checklist (CBCL), children were assigned into groups of internalizing, externalizing, combined or mild symptoms and compared to a reference group (n = 667) with regard to day care teacher ratings of EFs on the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P). Second, latent profile analysis (LPA) was employed to identify distinct subgroups of children representing different EF profiles with unique strengths and weaknesses in EFs. The first set of analyses indicated that all symptom groups had more difficulties in EFs than the reference group did, and the internalizing group had less inhibition-related problems than the other symptom groups did. Using LPA, five EF profiles were identified: average, weak average, attentional problems, inhibitory problems, and overall problems. The EF profiles were significantly associated with gender, maternal education level, and psychiatric symptom type. Overall, the findings suggest that the comparison of means of internalizing and externalizing groups mainly captures the fairly obvious differences in inhibition-related domains among young psychiatric outpatient children, whereas the person-oriented approach, based on individual differences, identifies heterogeneity related to attentional functions, planning, and initiating one’s action. The variability in EF difficulties suggests that a comprehensive evaluation of a child’s EF profile is important regardless of the type of psychiatric symptoms the child presents with.

ObjectiveChildren in Flint, Michigan, have experienced myriad sociodemographic adversities exacerbated by the Flint water crisis. To help inform child-focused prevention and intervention efforts, we aimed to describe patterns of neurodevelopmental outcomes among preschoolers who experienced the Flint water crisis before age 2 years.MethodParticipants were 170 preschoolers who completed a comprehensive neurodevelopmental assessment battery, including directly administered measures of cognitive and executive functioning and maternal-report of adaptive skills and behavioral problems. We used latent profile analysis to derive subgroups. Multivariate multinomial logistic regression was conducted to examine the predictors of profile memberships, including child sex and maternal/family-level factors selected from an array of measured exposures using least absolute shrinkage and selection operator regression.ResultsThree latent profiles were identified: Profile 1—relative weakness in all domains (50%); Profile 2—normative functioning in all domains (34.1%); and Profile 3—relative strengths in executive function and behavior (15.9%). Profile 1 showed lower scores across cognitive and behavioral domains. Profile 2 demonstrated abilities within the normal range across domains. Profile 3 showed relative strength in executive functioning with few behavior problems, despite lower cognitive performance. Children across all profiles showed adaptive behavior in the adequate range. Child sex and maternal IQ were significant predictors of profile membership.ConclusionsChildren in Flint demonstrated diverse patterns of development in the face of sociodemographic and environmental adversities. Comprehensive screening and neurodevelopmental profiling of children in this at-risk population are needed to identify areas of needs and inform appropriate service delivery.

Executive functioning profiles in adolescence: Using person-centered approaches to understand heterogeneity

Executive functioning (EF) is one of the building blocks in parental caregiving behavior, and contextual variables have been reported to moderate the link between EF and caregiving behavior. Although psychological distress due to various factors is prevalent during early parenthood and is negatively associated with adult EF, it is not known whether psychological distress influences the maternal EF/caregiving link. This study explored the association between maternal EF and caregiving behavior (more specifically, Emotional Availability/EA), and whether single and cumulative maternal psychological distress domains moderated the EF/EA association in a general population sample of 137 Finnish birth cohort mothers with 2.5-year-old children. EF was measured with a composite of five computerized Cogstate tasks, EA with the Emotional Availability Scales, and three psychological distress domains with self-report questionnaires (depression: EPDS, anxiety: SCL-90, insomnia: AIS). Better EF was significantly associated with more positive, sensitive caregiving, but this association was no longer significant when controlling for education level. Neither individual nor cumulative distress domains moderated the EF/EA association significantly, although the observed moderation effects were in the expected direction. These findings suggest that EF should be recognized alongside socioemotional factors as variables that are associated with parental caregiving behavior during toddlerhood. Furthermore, if the non-significant moderation results are replicated, they indicate that mothers in community samples are not at great risk for psychological distress that would compromise their capacity to utilize their EF while caring for their child. Further studies are needed to confirm these findings, as well as to examine these associations among fathers and in samples that have higher levels of chronic stressors. Studies with more diverse samples in terms of distress levels and EF performance would provide further insight into early childhood parenting and its risk factors.

Parental executive functioning (EF) and parenting behaviors can be affected by the multiple stressors that are often present during early parenthood. However, little is known about how commonly experienced psychological distress during early parenthood is associated with parental EF capacity. We explored the links between psychological distress and EFs in a general population sample of 150 Finnish birth cohort mothers with 2.5-year-old children. The symptoms of depression, anxiety, insomnia, and poor couple relationship adjustment were measured with the self-report questionnaires EPDS, SCL-90, AIS, and RDAS. EFs were assessed with five computerized Cogstate tasks. When the psychological distress measures were added to a hierarchical regression analysis as continuous variables, no significant single or additive associations with EFs were found. When the distress measures were dichotomized to compare symptoms below/above cutoffs indicating clinically elevated levels, single distress domains remained as non-significant predictors, but a cumulative risk index of the number of concurrent clinically elevated distress domains was significantly associated with EFs. Thus, mothers with a higher number of concurrent clinically elevated psychological distress domains (i.e., depression, anxiety, insomnia, and poor couple relationship adjustment) tended to have lower EFs. This association is possibly bi-directional – clinically elevated distress within several domains could have a cumulative, depleting effect on maternal EF capacity, but a lower EF capacity could also increase the vulnerability for experienced distress within several concurrent domains. Longitudinal studies are needed to clarify potential causal links between stressors and EF.

Parental mentalization refers to a parents’ capacity and interest to consider the individual experience and mental state underlying the behaviors of the child. Higher mentalization is considered a key aspect for parental sensitivity in interaction, fostering child’s socioemotional and self-regulatory development. Yet, previous studies have not examined the dynamic pathways through which the maternal mentalization may develop, nor their effects on child development. Thus, in the current person-oriented study, first, we identify distinct profiles and longitudinal trajectories of maternal mentalization from pregnancy to child’s 2 years of age. Second, we test how the profiles and trajectories associate with children’s internalizing and externalizing problems, social–emotional competence and effortful control at the age of 2 years. Third, we examine how the profiles and trajectories associate with contextual demographic and child related. The substudy was part of the FinnBrain Birth Cohort and included families from general population (n = 2,687). Mothers reported their parental reflective functioning (PRF) at late pregnancy, 6 months and 2 years of child’s age. Both mothers (n = 1,437) and fathers (n = 715) reported the developmental child outcomes at the child’s age of 2 years. Latent Profile Analysis and Latent Transition Analysis were used to identify PRF profiles and trajectories. The results showed decreasing heterogeneity in PRF from pregnancy to child’s age of 6 months and 2 years (i.e., four, three and two latent classes, respectively). Most mothers progressed towards high PRF over time. Second, the profiles and trajectories depicting high PRF associated with child high social–emotional competence at the age of 2 years, yet no clear positive effects were found on child’s problems and effortful control. The group of mixed PRF trajectories showed strongest association with child’s internalizing and externalizing problems. Finally, there were theoretically meaningful associations between the PRF trajectories and both the contextual (e.g., parity) and child related (e.g., infant temperament) factors. This was the first study to explore the early unfolding of maternal mentalization. The results are discussed in relation with the potential mechanisms accounting for child development and with the nature and limitations of self-reported parental mentalization.

Executive function (EF) impairments are prevalent in survivors of neonatal critical illness such as children born very preterm (VPT) or with complex congenital heart disease (cCHD). This paper aimed to describe EF profiles in school-aged children born VPT or with cCHD and in typically developing peers, to identify child-specific and family-environmental factors associated with these profiles and to explore links to everyday-life outcomes. Data from eight EF tests assessing working memory, inhibition, cognitive flexibility, switching, and planning in n = 529 children aged between 7 and 16 years was subjected into a latent profile analysis. Three EF profiles were identified: The “favorable” profile was defined by mean scores in the normal range (z-scores ≤ −0.5 below the norm; n = 263, 49.7%). The “at-risk” profile’s mean scores were 0.5 to 1 SD below the norm (n = 236, 44.6%). The “impaired” profile’s mean scores were >1 SD below the norm (n = 30, 5.8%). Children of the two clinical groups were more likely to fall into the at-risk or impaired profile. Irrespective of clinical group, lower socioeconomic status, slower processing speed and poorer fine motor skills were associated with a more impaired profile. In turn, falling into the at-risk or impaired profile was associated with a higher need for educational support, poorer everyday-life EFs and more behavioral problems. Children in the impaired profile reported lower psychosocial quality of life. This study provides evidence for an increased risk of survivors of neonatal critical illness to present with an impaired EF profile that translates into everyday-life difficulties. Long-term monitoring is needed to promote optimal outcome.

Introduction: Cigarette smoking is associated with increased cerebrovascular disease risk and reduced cognitive performance, particularly in domains sensitive to vascular insults, such as executive function and processing speed. Short-term blood pressure variability (BPV) is associated with cognitive decline among older adults with and without hypertension (HTN) and BPV is significantly greater among smokers than non-smokers. However, it is unknown if greater short-term BPV contributes to lower cognitive performance in smokers. We hypothesized that greater beat-to-beat BPV would be associated with lower cognitive performance in smokers and that this relation would be independent of mean blood pressure (BP). Methods: Twenty-three smokers (3 current/20 former; age 69 ± 9; pack-years 33 ± 17; systolic BP (SBP) 133 ± 18; diastolic BP (DBP) 71 ± 8; anti-HTN medication use 16Y/7N)), without chronic obstructive pulmonary disease, completed measurements of beat-to beat BPV by 10 minutes of finger plethysmography and electrocardiography, and neuropsychological testing. Age-adjusted neuropsychological test t-scores were grouped into four cognitive domains (executive function, processing speed, language and memory recall). Results: Greater systolic BPV was associated with lower cognitive performance in the executive function (r=-0.59, p<0.01), processing speed (r=-0.60, p<0.01) and language (r=-0.49, p<0.01) domains. The associations between systolic BPV with executive function and processing speed remained significant after adjusting for age, sex, pack-years, years of education, mean SBP and anti-HTN medication use (all p<0.05). Similarly, greater mean BPV was associated with lower executive function (r=-0.50 p=0.01), processing speed (r=-0.60, p<0.01) and language (r=-0.59, p<0.01). However, only the association between mean BPV and executive function remained significant after adjusting for age, sex, pack-years, years of education, mean SBP and anti-HTN medication use (p<0.05). There was no association between systolic or mean BPV and memory recall. Conclusion: These data suggest that greater beat-to-beat BP variability may contribute to lower cognitive performance in smokers and that this relation is independent of mean SBP.

Although the important role of children's executive function (EF) in their reading development has been well-established, less is known about the extent to which multilingual children's EF components vary and whether the variability in different EF abilities explains multilingual children's English reading achievement. The present study explored the US first-grade multilingual children's (N = 3,819) profiles of EF abilities and how the profile membership was associated with their English reading achievement, using a nationally representative sample of multilingual children from the Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K: 2011) study. We fit latent profile analysis with various EF components, including working memory, cognitive flexibility, inhibitory control, approaches to learning, and attentional focus, and found three distinct EF profiles in multilingual children: (a) Below-Average EFs with Above-Average Cognitive Flexibility (10.13%), (b) Above-Average EFs (84.09%), and (c) Very Low Cognitive Flexibility (5.78%). Controlling for kindergarten English reading achievement scores and demographic variables, children in the Above-Average EFs profile attained a significantly higher English reading achievement score than their peers, while children in the Very Low Cognitive Flexibility group had the lowest English reading achievement score. Our findings highlight the importance of understanding multilingual children's heterogeneity in EF and have implications for the early identification of and tailored intervention for multilingual children at risk for reading difficulties.

BackgroundObesity, a major risk factor for cardiometabolic disease, is associated with lower cognitive performance from childhood to senescence, especially on tasks of executive function. In the cardiovascular domain, fat stored viscerally rather than elsewhere in the body carries particularly high risk. It is unknown whether this is also true in case of obesity-cognition relationships. The aim of this study is to assess the cross-sectional relationship between visceral fat (VF) and cognitive performance in a community sample of healthy adolescents.MethodsIn a community-based sample of 983 adolescents (12–18 years old, 480 males), VF was quantified using magnetic resonance imaging, total body fat was measured using a multifrequency bioimpedance and cognitive performance was assessed using a battery of cognitive tests measuring executive function and memory.ResultsWe found that larger volumes of VF were associated with lower performance on six measures of executive function (p=0.0001 to 0.02). We also found that the association of VF with executive function was moderated by sex for a subset of measures, such that relationship was present mainly in females and not in males (sex-by-VF interaction: p=0.001 to 0.04). These relationships were independent of the quantity of total body fat and a number of potential confounders, including age, puberty stage and household income.ConclusionsOur results suggest that the adverse association between obesity and executive function may be attributed to fat stored viscerally and not to fat stored elsewhere in the body. They also suggest that females compared with males may be more sensitive to the potentially detrimental effects of VF on cognition.

Cognitive reserve modulates between neurodegenerative processes and the clinical manifestations of cognitive impairment and dementia. This construct is associated with the capacity to optimise the execution of tasks by recruiting neuronal networks and with the use of alternative cognitive strategies that would be mediated by formal educational processes.To analyse the level of reading skills as a measure of cognitive reserve and as a reliable predictor of performance in tests for evaluating different cognitive domains.The sample consisted of 87 healthy subjects who were asked to complete the Word Naming test as an indicator of the level of reading skills; this allowed us to divide the sample into subjects with a low and a high level of reading ability. A broad neuropsychological battery was then applied.The subjects with a low level of reading skills displayed lower general cognitive performance, reduced processing speed and cognitive deficits. Furthermore, the level of reading skills is a better predictor of performance in executive functions and general cognitive performance than the variables age, years of schooling and education.The level of reading skills has shown itself to be a good measure of cognitive reserve and a reliable predictor of executive and cognitive functioning in ageing.

Attention-deficit/hyperactivity disorder (ADHD) is proposed to be a neuropsychologically heterogeneous disorder that encompasses two distinct sub-groups, one with executive function (EF) deficits and one with delay aversion (DA). However, such claims have often been based on studies that have operationalized neuropsychological deficits using a categorical approach - using intuitive but rather arbitrary, clinical cut-offs. The current study applied an alternative empirical approach to sub-grouping in ADHD, latent profile analysis (LPA), and attempted to validate emerging subgroups through clinically relevant correlates. One-hundred medication-naïve children with ADHD and 96 typically developing children (6-14 years) completed nine EF and three DA tasks as well as an odor identification test. Parents and teachers provided reports of the children's behavior (ADHD and EF). Models of the latent structure of scores on EF and DA tests were contrasted using confirmatory factor analysis (CFA). LPA was carried out based on factor scores from the CFA and sub-groups were compared in terms of odor identification and behavior. A model with one DA and two EF factors best fit the data. LPA resulted in four sub-groups that differed in terms of general level of neuropsychological performance (ranging from high to very low), odor identification, and behavior. The sub-groups did not differ in terms of the relative EF and DA performance. Results in the ADHD group were replicated in the control group. While EF and DA appear to be dissociable constructs; they do not yield distinct sub-groups when sub-grouping is based on a statistical approach such as LPA.