Behavior Rating Inventory Of Executive Function Research Articles

A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants' average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=-12.203, 95% CI -17.882 to -6.523; P<.001), owing to lower scores on the subscales Inattention (β=-3.966, 95% CI -6.285 to -1.647; P<.001), Hyperactivity/Impulsivity (β=-5.735, 95% CI -8.334 to -3.137; P<.001), and Oppositional Defiant Disorder (β=-2.995, 95% CI -4.857 to -1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=-6.312, 95% CI -10.973 to -1.650; P=.006) and Global Executive Composite (β=-5.952, 95% CI -10.214 to -1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806.

Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder

ABSTRACT Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.

Using the Indonesian Computer-Based Game Prototype as a Computer-Based Game Inventory for Executive Function in Children and Adolescents: A Confirmatory Factor Analysis and Concurrent Validity Study.

Executive function influences children's learning abilities and organizes their cognitive processes, behaviors, and emotions. This cross-sectional study examined whether an Indonesian Computer-Based Game (ICbG) prototype could be used as a Computer-Based Game Inventory for Executive Function (CGIEF) in children and adolescents. The study was conducted with 200 children, adolescents, and their parents. The parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF) questionnaire, and the children and adolescents completed the CGIEF. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were performed using LISREL Version 8.80. The construct of CGIEF was valid/fit with normal theory-weighted least squares = 15.75 (p > .05). SEM analysis showed that the theoretical construct of the CGIEF was a valid predictor of executive function. The critical t value of the pathway was 2.45, and normal theory-weighted least squares was 5.74 (p > .05). The construct reliability (CR) for CGIEF was 0.91. Concurrent validity was assessed using the Bland-Altman plot, and the coefficient of repeatability (bias/mean) was nearly zero between the t scores of total executive functions of the CGIEF and BRIEF. This preliminary study showed that the CGIEF can be useful as a screening tool for executive dysfunction, metacognitive deficits, and behavioral regulation problems among children and adolescents in clinical samples.

Differences between parent- and teacher-reported executive functioning behaviors after traumatic injuries

ABSTRACT Deficits in executive functioning (EF) behaviors are very common following pediatric traumatic brain injury (TBI) and can linger well after acute injury recovery. Raters from multiple settings provide information that may not be appreciated otherwise. We examined differences between parent and teacher ratings of EF using data examining longitudinal outcomes following pediatric TBI in comparison to orthopedic injury (OI). We used linear mixed models to determine the association of rater type and injury type with scores on the Behavior Rating Inventory of Executive Functioning (BRIEF). After controlling for demographic variables, rater type and injury type accounted for a small but significant proportion of the variance in EF. Teachers’ ratings on the BRIEF were significantly higher than parent ratings for global EF and metacognition, but not for behavior regulation, regardless of injury type, indicating greater EF concerns. All BRIEF ratings, whether from teachers or parents, were higher for children with TBI than for those with OI. Results suggest that parents and teachers provide unique information regarding EF following traumatic injuries and that obtaining ratings from persons who observe children at school as well as at home can result in a better understanding of situation-specific variability in outcomes.

Assessment of Executive Function Skills in Children with Isolated Growth Hormone Deficiency: A Cross-sectional Study.

This study aims to evaluate executive functions such as inhibition and working memory in children with isolated growth hormone deficiency (IGHD) using performance-based tests and parent-report scales. A total of seventy children between the ages of 7 and 12 were included in the study. To evaluate the executive functioning (EF) performances of the participants, the Visual Aural Digit Span Test-B Form (VADS-B) and Stroop task were applied. Executive functioning was also evaluated using the Behavior Rating Inventory of Executive Function (BRIEF). Children with IGHD received lower scores on the VADS-B administered to assess short-term memory (p<0.05). And, the completion time for the Stroop-color/word test was significantly longer in children with IGHD (p<0.05). Children with IGHD were determined to receive higher scores on all sub-scales of the BRIEF scale completed by the parents of the participants, with statistically significant differences for all sub-scales except for "organization of materials" (p<0.05). We determined poorer executive function skills in children with IGHD. Executive function skills may influence academic success by affecting children's language skills, mathematical comprehension, cognitive flexibility, and hypothetical thinking. Therefore, we think that psychiatric evaluation of children with IGHD before and during treatment will positively contribute to both their academic performance and social relationships.

Sleep quality and executive function in a diverse sample of healthy young adults

Few studies examine the relationship between sleep and executive function in diverse samples of young adults. Our research aims to fill this gap by analyzing how self-reported sleep quality is related to informant-rated executive function as a whole and its working memory component in a diverse sample of 29 healthy college students. Using the self-report measure, the Pittsburgh Sleep Quality Index (PSQI), we divided our sample into two groups based on cutoff criteria (score ≥5: poor sleep): good sleep quality (n = 11) and poor sleep quality (n = 18). Participants were on average 20.86 years old. Informants rated participants’ executive functioning and working memory using the Frontal Systems Behavior Scale (FrSBe) and Behavior Rating Inventory of Executive Function (BRIEF). Individuals in the poor sleep quality group were reported as having significantly worse executive function and working memory scores. Young adult college students who report less than 7 hours of sleep per night have lower scores on informant measures of working memory and executive function. This study raises awareness about how self-reported sleep experiences are related to other’s observation of cognitive abilities in everyday life in a diverse young adult sample.

Assessment of Executive Functioning in School-Age Children With And Without Stuttering: A case-control study

Background: Stuttering is defined as a neurodevelopmental disorder, with disruptions in the normal fluency and time patterning of speech that are inappropriate for the individual's age and language skills. Executive functions (EF) include various cognitive skills, such as directing the attention required for planning and maintaining thoughts and behaviors, suppressing inappropriate stimuli, keeping the processed information active, and providing the transition between the information. This study was aimed at investigating whether there is a difference between school-age children with and without stuttering about executive functions (EF) skills and attention. Method: Twenty-six children with stuttering (14 boys; mean age=10.1±2.88) and twenty-five children without stuttering (14 boys; mean age=10.2±2.77) aged between 7 and 12 were admitted to the study. The participants were administered the Visual Aural Digit Span Test-B Form (VADS-B), which evaluates working memory and audiovisual attention, and the Cancellation Tests (CT), which evaluates sustained attention. The Parents of the participants were applied the Behavior Rating Inventory of Executive Function (BRIEF), which was developed to evaluate executive functions, problem-solving skills and adaptive behaviors. Differences in mean subscores of VADS-B, CT, and BRIEF were analyzed using univariate analysis of covariance (ANCOVA) with participant group as the factor and VADS-B, CT, and BRIEF subscores as the dependent variable; Chronological age (years) was designated as a covariate. Results: This study was conducted between two groups that were equal in terms of age, gender, developmental steps (walking, talking, toilet training), family structure, and socioeconomic status (p&gt;0.05). All subscales of VADS-B (aural-verbal, aural-written, visual-verbal, visual-written) were found to be significantly lower in children with stuttering (p&lt;0.05). In cancellation test results, there was a significant difference between the groups in terms of hit scores and total number of errors in organized letter and random letter forms (p&lt;0.05). No difference was found between the two groups in the BRIEF scale completed by the parents (p&gt;0.05). Conclusion: This study demonstrated that school-aged children with stuttering had weaker working memory and sustained attention performance in performance-based tests. Thus, we believe that in the evaluation and treatment of stuttering, comprehensive approaches should be adopted to evaluate attention and executive functions and to improve these functions. In this area, studies with larger samples are needed in which stuttering, attention, and executive functions are evaluated more comprehensively with different tasks (computer-based performance tests, parent-teacher scales, etc.) and neuroimaging (magnetic resonance imaging [MRI]). Lastly, the tasks used in our study (VADS-B, CT, and BRIEF) were applied to Turkish-speaking school-age children with stuttering for the first time. In this regard, we think that our study will contribute to the literature.

Executive functioning in children with ADHD Investigating the cross-method correlations between performance tests and rating scales.

Replicated evidence shows a weak or non-significant correlation between different methods of evaluating executive functions (EF). The current study investigates the association between rating scales and cognitive tests of EF in a sample of children with ADHD and executive dysfunction. The sample included 139 children (aged 6-13) diagnosed with ADHD and executive dysfunctions. The children completed subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Children's Organizational Skills Scale (COSS). Pairwise Spearman correlations were calculated between the composite and separate subscales of cognitive tests and rating scales. In secondary analyses, pairwise Spearman correlations were conducted between all composite scales and subscales, stratified by child sex and child ADHD subtype. The correlation analyses between composite scores yielded no significant correlations. The results when comparing CANTAB TO and BRIEF GE are r=-.095, p=.289, and r=.042, p=.643 when comparing CANTAB TO and COSS TO. The analyses between all composite scales and subscales found one significant negative correlation (r=-.25, p<.01). There are significant cross-method differences when stratified by the ADHD-Inattentive subtype, showing significant negative correlations (moderate) between CANTAB and BRIEF composite (r=-.355, p=.014) and subscales. It is possible that the different methods measure different underlying constructs of EF. It may be relevant to consider the effects of responder bias and differences in ecological validity in both measurement methods. The results found no significant correlations. The expectation in research and clinical settings should not be to find the same results when comparing data from cognitive tests and rating scales. Future research might explore novel approaches to EF testing with a higher level of ecological validity, and designing EF rating scales that capture EF behaviors more so than EF cognition.

בדיקת תוקף של מטלה ביצועית בלתי מובנית (UPT), למדידת תפקודים ניהוליים בקרב ילדים

Background: Executive Functions (EFs) are assessed by performance-based measures in clinical settings and rating scales in ecological settings. Research has shown a lack of a correlation between both methods. In order to bridge the gap, the Unstructured Performance-Based Task (UPT) was developed. This assessment includes 42 questions randomly presented on a large piece of paper and is accompanied by a behavioral checklist. Aim: To examine the construct validity of the UPT and the behavioral checklist by examining group differences in UPT scores between children with and without Attention Deficit Hyper Disorder (ADHD) and EF deficits A further aim is to examine associations between the UPT and performance-based measures and rating scales. Method: The UPT was translated and culturally adapted for Hebrew speaking children in Israel. Participants were 42 children (aged 8-11 years), 21 with ADHD and EF deficits and 21 without a diagnosis or EF deficit. Parents completed a sociodemographic questionnaire, the Performance Skills Questionnaire, and the Behavior Rating Inventory of Executive Function (BRIEF) to assess EF deficits in ecological settings. Children completed the UPT and other widely used assessments: Digit Span Forward and Backward, Verbal Working Memory, Trail Making Test, and Tower of Hanoi. Results: Significant differences were found between groups in some of the UPT measures and the behavioral checklist. Associations were found between some UPT measures and the behavioral checklist and performance-based EF measures, as well as the BRIEF rating scale. Conclusions: The measures of Total Correct Items, Total Blank Items, and completion time in UPT may be valid for EFs assessment. The behavioral checklist may be a valid assessment for behavior in ecological settings. The UPT may assist in identifying EF deficits in children and setting goals in Occupational Therapy interventions.

Does early adversity predict executive functioning difficulties among undergraduates? Dissociations among self-report, performance, and EEG measures.

The present research aimed to determine whether self-reports of early adversity predicted individual differences in self-reported and laboratory-measured executive functioning in college-aged samples. Two studies with young adult samples (n = 231 and n = 61) measured endorsement of adverse childhood experiences (ACEs), self-reported executive functioning difficulties on the Behavior Rating Inventory of Executive Function (BRIEF), and self-report measures of depression and emotion regulation. The second sample also completed laboratory performance tasks of working memory, inhibitory control, and selective attention while electroencephalogram (EEG) was recorded. In both samples, greater self-reported ACEs predicted greater reports of executive functioning difficulties on the BRIEF (rs = 0.378 and 0.322), relationships of medium effect size that remained significant when controlling for depression and emotion regulation variables. In the second sample, despite robust EEG/event-related potential (ERP) task findings in the group as a whole, neither lab task performance nor EEG/ERP measures were reliably correlated with individual differences in ACEs. We consider multiple alternative explanations for why early adversity predicted self-reported executive functioning difficulties but not lab task performance or neural measures in the same sample. These findings may reflect a propensity for negative self-evaluation among those with early adverse experiences, leading to inflated estimates of their own executive function problems. Alternatively, the findings may indicate that the lab tasks are insufficient in tapping aspects of executive functions that are relevant outside the lab context. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Identifying the neurostimulation target for treatment of cognitive impairment in aging and early cerebral small vessel disease].

To develop individualized approaches to the use of neuromodulation as a non-pharmacological treatment of cognitive impairment (CI) based on the assessment of compensatory brain reserves in functional MRI (fMRI). Twenty-one adults over 45 years of age, representing a continuum from healthy norm to mild cognitive impairment due to aging and early cerebral small vessel disease, were studied. All participants underwent fMRI while performing two executive tasks - a modified Stroop task and selective counting. To assess the ability to compensate for CI in real life, functional activation and connectivity were analyzed using the BRIEF-MoCA score as a covariate, which is the difference in ratings between the Behavior Rating Inventory of Executive Function (BRIEF) and the Montreal Cognitive Assessment Scale (MoCA). Both fMRI tasks were associated with activation of areas of the frontoparietal control network, as well as supplementary motor area (SMA) and the pre-SMA, the lateral premotor cortex, and the cerebellum. An increase in pre- SMA connectivity was observed during the tasks. The BRIEF-MoCA score correlated firstly with connectivity of the left dorsolateral prefrontal cortex (DLPFC) and secondly with involvement of the occipital cortex during the counting task. The developed technique allows identification of the functionally relevant target within the left DLPFC in patients with CI in aging and early cerebral microangiopathy.

Prevalence and patterns of executive function, adaptive function, and behavioral outcomes in preschool and school age children with congenital diaphragmatic hernia

BackgroundExecutive function, adaptive function, and behavioral outcomes in congenital diaphragmatic hernia (CDH) survivors have not been well studied. AimTo evaluate executive and neurobehavioral dysfunction in preschool and early school-aged children with CDH. Study designRetrospective cohort study. SubjectsAll eligible CDH survivors ages 3 to 7 years enrolled in our follow-up program between February 2020 and February 2021. Outcome measuresThe Behavior Rating Inventory of Executive Function (BRIEF), the Adaptive Behavior Assessment System, 2nd Edition (ABAS-II), and the Child Behavior Checklist (CBCL) were used to assess functional and behavioral outcomes. Summary scores were compared to standard population norms. ResultsA total of 100 patients were enrolled during the study period. Of those, 73 parents completed at least one of the questionnaires, resulting in completion of the BRIEF, ABAS-II, and CBCL for 63, 68, and 63 patients, respectively. Preschool children had normal executive function (BRIEF-P) while global executive composite (P = 0.012) and the emotional regulation index (P = 0.010) for school age patients (BRIEF-2) were worse. CDH survivors had favorable adaptive functioning (ABAS-II). Mean CBCL scores for preschool attention problems (P = 0.018), school age attention problems (P = 0.001), and attention deficits hyperactivity problems (P = 0.027) were significantly worse. Prematurity, surrogate markers of disease severity, non-white race, and public insurance status were associated with worse neurobehavioral dysfunction in bivariable analysis. ConclusionsThe majority of preschool and school age CDH survivors have age-appropriate executive, adaptive and behavioral functioning. CDH survivors, however, have lower executive function and attention scores compared with the general population.

Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children

The utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown. To evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB. Randomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months. Participants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228). The 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes. Of the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: -3.1 for adenotonsillectomy vs -1.9 for watchful waiting; difference, -0.96 [95% CI, -2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, -0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, -9.02 [97% CI, -15.49 to -2.54] and -6.52 [97% CI, -11.59 to -1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, -11.2% [97% CI, -17.5% to -4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy. In children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up. ClinicalTrials.gov Identifier: NCT02562040.

Executive Difficulties and Depressive Symptoms Predict Future Acute Pain Emergency Visits and Hospitalizations in Children with Sickle Cell Disease

Patients with sickle cell disease (SCD) commonly experience episodes of disabling vaso-occlusive pain leading to emergency department (ED) visits or hospitalizations. SCD is also associated with significant neurocognitive risk due to overt stroke, silent cerebral infarcts, and chronic insufficiencies in oxygen and/or glucose delivery to the brain. Neurocognitive deficits are observed early in life and are often characterized by deficits in executive functioning skills (e.g., planning, organizing, attention). The patterns of progressive chronic medical complications and functional limitations associated with SCD place children at higher risk of experiencing depressive symptoms. Research in patients with SCD has suggested that the experience of pain is associated with executive skills and depression in children with SCD. However, studies have yet to explore the bidirectional relationship between these constructs. It is important to understand the directionality and causal nature of this relationship using a longitudinal approach to optimize treatment approaches. The primary objective of this study was to investigate associations between pain-related ED visits or hospitalizations with future parent-reported executive functioning and depression; conversely we examined how executive difficulties and depression predicted subsequent pain-related visits. All patients were enrolled in the St. Jude longitudinal cohort study, the Sickle Cell Clinical Research Intervention Program (SCCRIP; Hankins et al., Pediatric Blood &amp; Cancer 2018). The number of ED visits or hospitalizations due to pain-related reasons in the year pre- and post-assessment were obtained retrospectively from chart review. This data was then cleaned, validated, and merged with other data sets. Parent ratings of executive skills were collected using the Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite scale. Depressive symptoms were measured using the parent version of the Behavior Assessment System for Children 2 nd or 3 rd Edition (Depression scale). Multivariable generalized linear regression was used to examine associations between the number of pain-related hospitalizations with executive difficulties and depressive symptoms after adjusting for age, sex, sickle genotype, current hydroxyurea treatment, and geocoded social vulnerability. P-values &amp;lt;0.05 were considered significant. We included 374 patients with SCD (60% HbSS/HbSβ 0-thalassemia; see Table 1). The mean age of participants at the time of psychological evaluation was 11.84 years (SD=3.39; Range= 8-18). In the year prior to the assessment, patients experienced an average of 0.27 pain events requiring a visit to the ED (SD=0.97, Range=0-11). In the year post evaluation, there were an average of 0.36 events (SD=1.08, Range=0-9). Hospitalizations due to pain occurred an average of 0.09 times (SD=0.37, Range=0-3) in the year before the evaluation and 0.11 times (SD=0.35, Range=0-2) post-evaluation. The number of pain events leading to ED visits or hospitalization in the year prior to the evaluation were not associated with future depressive symptoms or executive difficulties. However, parent-rated executive difficulties and symptoms of depression were positively associated with future ED visits (p=0.033 and p=0.032) and hospitalizations (p=0.005 and p=0.009) in the year following the evaluation (Table 2). Executive functioning difficulties and depressive symptoms predicted greater frequency of future ED visits and hospitalizations among children with SCD. Hospital visits due to acute SCD pain did not predict future executive difficulties or depressive symptoms. Behavioral and pharmacological treatments targeting depressive symptoms and executive difficulties should be tested to decrease the frequency of acute care visits due to pain in SCD.

Abstract 13952: Neurodevelopmental Outcomes in Early Adolescence: The Pediatric Heart Network’s Single Ventricle Reconstruction Trial

Introduction: Neurodevelopmental (ND) and functional impairments for survivors of palliated hypoplastic left heart syndrome (HLHS) are among the most consequential morbidities, resulting in an increased risk of poor school performance and lower reported quality of life. Longitudinal follow-up of those enrolled in the Single Ventricle Reconstruction (SVR) III study provides opportunity to measure important outcomes such as ND, and understand associated risk factors. Goals/Aims: Describe and identify predictors of ND outcomes at 10-12 years of age in participants enrolled in SVR. Methods: Transplant-free survivors from the SVR III trial were invited to complete in-person ND assessments, including the Wechsler Intelligence Scale for Children-V, Wechsler Individual Achievement Test-III, and the Behavior Rating Inventory of Executive Function (BRIEF). Descriptive and regression analyses were performed. Results: Of the 237 enrolled in SVR III, 200 (84%) received a ND assessment. Participants who did vs did not undergo assessment were more likely to be male (63% vs 51%), white (87% vs 76%) and have a higher Child Opportunity Index (61 ±26 vs 46 ±39). Mean Full Scale IQ for the cohort was almost 1 standard deviation (SD) below the normative mean (88 ±18), with 39% &gt;1 and 15% &gt;2 SD below the normative mean. Similar patterns were seen for Reading (38% &gt;1 SD and 16% &gt; 2SD) and Math Composites (38% &gt;1 SD, 19% &gt; 2SD). Executive functions measured with the BRIEF were similarly affected, with 25% to 45% of individuals showing clinically significant (T score &gt;65) Plan/Organization problems on parent and teacher forms, respectively. Measures of socioeconomic status, number of complications, and requirement for a gastrostomy-tube were all independent predictors for multiple ND outcomes. Conclusions: In early adolescence, transplant-free survivors of surgical palliation for HLHS show clinically significant ND concerns across multiple domains of functioning. The distribution of outcomes is broad. Our findings support the American Heart Association recommendations for screening and evaluation in middle school to inform interventions that promote academic success and quality of life.

34 Severity of Traumatic Brain Injury Predicts Neurobehavioral Outcomes and White Matter Microstructure

Objective:Pediatric traumatic brain injury (TBI) is the leading cause of disability in children under the age of 15, often resulting in executive function deficits and poor behavioral outcomes. Damage to white matter tracts may be a driving force behind these difficulties. We examined if whether 1) greater TBI severity was associated with worse neurobehavioral outcome, 2) greater TBI severity was associated with tract-based white matter microstructure, and 3) worse neurobehavioral outcome was associated with white matter microstructure.Participants and Methods:Twelve children with complicated-mild TBI (cmTBI; Mage=12.59, nmale=9), 17 with moderate-to-severe TBI (msTBI; Mage =11.50, nmale=11), and 21 with orthopedic injury (OI; Mage =11.60, nmale=16), 3.94 years post injury on average, were recruited from a large midwestern children’s hospital with a Level 1 Trauma Center. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Child Behavior Checklist (CBCL) while children completed 64-direction diffusion tensor imaging in a Siemens 3T scanner. White matter microstructure was quantified with FMRIB’s Diffusion Toolbox (FSLv6.0.4). Tract-Based Spatial Statistics computed fractional anisotropy (FA) and mean diffusivity (MD) for the cingulum bundle (CB), inferior fronto-occipital fasciculus (IFOF), superior longitudinal fasciculus (SLF), and uncinate fasciculus (UF), bilaterally.Results:Group differences were assessed using one-way ANOVA. Children with msTBI were rated as having worse Sluggish Cognitive Tempo on the CBCL than children with cmTBI and OI (p=.02, eta2=.143); no other parent-rated differences reached significance. Group differences were found in left SLF FA (p=.031; msTBI&lt;cmTBI=OI) and approached significance in left UF FA (p=.062, eta2=.114; msTBI&lt;OI). Group differences were also found in right IFOF MD (p=.048; msTBI&gt;OI) and left SLF MD (p=.013; msTBI&gt;cmTBI=OI). Bivariate correlations assessed cross-domain associations. Higher left IFOF FA was associated with better BRIEF Metacognitive Skills (r=-.301, p=.030) and CBCL School Competence (r=.280; p=.049). Higher left SLF FA was associated with better BRIEF Behavioral Regulation and Metacognitive Skills (r=-.331, p=.017 and r=-.291, p=.036, respectively), and CBCL School Competence and Attention Problems (r=.398, p=.004 and r=-.435, p=.001, respectively). Similarly, higher right UF FA was broadly associated with better neurobehavioral outcomes, including Behavioral Regulation and Metacognitive Skills (r=-.324, p=.019 and r=-.359, p=.009, respectively), and School Competence, Attention Problems, and Sluggish Cognitive Tempo (r=.328, p=.020, r=-.398, p=.003, and r=-.356, p=.010, respectively). Higher right CB MD was associated with worse Behavioral Regulation (r=.327, p=.018) and more Attention Problems (r=.278, p=.046); higher left and right SLF MD was associated with Sluggish Cognitive Tempo (r=.363, p=.008, r=.408, p=.003, respectively).Conclusions:Children with TBI, particularly msTBI, were rated as having cognitive slowing; while other anticipated group differences in neurobehavioral outcomes were not found, this appears driven by milder difficulties in cmTBI and OI groups. In fact, across CBCL and BRIEF subscales, children with msTBI were rated as approaching or exceeding a full standard deviation deficit based on normative data. TBI severity was also associated with white matter microstructure and cross-domain associations linked microstructure with observable neurobehavioral morbidities, suggesting a possible mechanism post-injury. Future longitudinal studies would be useful to examine the temporal evolution of deficits.

51 Cognitive Functioning in Neurofibromatosis Type 1: The Role of Community Socioeconomic Status

Objective:Neurofibromatosis type 1 (NF1) is a neurogenetic disorder associated with increased risk of neuropsychological challenges. While research has evidenced associations between environmental factors and neurocognitive development, few studies have examined the role that socioeconomic status (SES) plays on neuropsychological development in NF1. The aim of this study is to examine the relationship between community SES and cognitive/psychosocial outcomes in a neuropsychology clinic sample of pediatric NF1 patients.Participants and Methods:The sample consisted of 47 youth with NF1 (M age=11.91, SD=3.69). The sample was 51.1% female, 72.3% White, 19.1% Black/African American, and 4.3% Hispanic. All participants had completed neuropsychological assessments for clinical purposes at an outpatient clinic in an urban, midwestern medical center. Data from neuropsychological measures and demographic information were pulled from records and entered into a de-identified dataset. The Wechsler Intelligence Scales, California Verbal Learning Test (CVLT), Woodcock Johnson Test of Achievement, and parent- and teacher-report versions of the Behavior Assessment System for Children (BASC) and the Behavior Rating Inventory of Executive Function (BRIEF) were used to examine broad neuropsychological functioning. The Area Deprivation Index (ADI) measures SES at the community level, as opposed to the individual level. It is composed of 17 factors related to education, poverty, employment, and housing. This information is used to assign index scores by zip code, with scores on a scale of 110 and 10 indicating the highest level of socioeconomic disadvantage. Mean ADI for this sample was 4.02 (SD=1.93).Results:Mean neurocognitive scores were consistently in the low average to average range. Parent and teacher scores on the BASC were in the average range. Mean scores on the BRIEF indicated Global Executive Composite scores in the mildly and moderately elevated range for parents and teachers, respectively. Correlational analyses revealed significant associations between ADI scores and immediate recall performance on the CVLT (Trials 1-5; r=.37; p=.03) and the BRIEF Planning and Organization subscale (r=.35; p=.02). Both remained significant after controlling for FSIQ (CVLT: rFSIQ=.49, p=.003; BRIEF: rFSIQ=.38; p=.02).Conclusions:Mean cognitive scores for the sample are consistent with existing literature demonstrating that individuals with NF1 are at risk of reduced functioning in several domains. Sample mean ADI of 4 indicates a relatively low level of disadvantage in this sample., ADI was significantly associated with two variables, and greater deprivation was associated with better list learning performance. This suggests that the role of community SES is likely nuanced in how it impacts neurocognitive development. Results provide mild evidence of an association between ADI and learning and planning/organization. However, limitations to the current study, including a small sample size, and the retrospective nature, likely limits a more detailed understanding of the true relationship between community resources and cognitive and psychosocial outcomes among children with NF1. Future research comparing larger low and high ADI samples is necessary to fully examine the relationship between these factors. With better understanding of how community SES may limit or support neurocognitive and psychological growth in this population, more effective interventions can be designed for this group whose members are at notable risk for cognitive and psychological challenges.

57 Executive Functioning Correlates with Adaptive Behaviors in Wiedemann-Steiner Syndrome

Objective:Wiedemann-Steiner syndrome (WSS) is a rare Mendelian disorder of epigenetic machinery caused by a mutation in KMT2A, with hallmark features that include intellectual disability and developmental delay. Animal models have helped identify the critical roles KMT2A plays in prefrontal neuron maturation and executive function (i.e. working memory) development. However, the neurobehavioral phenotype of individuals with WSS, including executive functioning, remains poorly characterized. Accordingly, this study aimed to 1.) examine the neurobehavioral profile (adaptive, psychosocial, and executive functioning) associated with WSS and 2.) the correlations between executive functioning and these domains.Participants and Methods:A total of 25 mothers of individuals with WSS (13 females, Mean age=12.78 years, SD=7.88) completed a combination of parent-informant questionnaires. The caregivers completed the Adaptive Behavior Assessment System 3rd Edition (ABAS-3), the Strengths and Difficulties Questionnaire (SDQ), and a version of the Behavior Rating Inventory of Executive Function (BRIEF). Descriptive analyses were conducted to examine proportion of the sample with clinically significant concerns on the BRIEF and SDQ, and low to very low adaptive skills based on ratings on the ABAS-3. Partial correlations were computed to examine the relationships between overall executive functioning (BRIEF General Executive Composite, GEC) with adaptive domains (ABAS-3 Conceptual, Practical, Social), and psychosocial functioning (SDQ Emotional Problems, Conduct Problems, Hyperactivity, Peer Relations, Prosocial Behaviors) while accounting for age. Associations that survived Benjamin Hochberg correction are reported.Results:Of our sample, 64% were rated in the very elevated range for executive functioning problems (BRIEF GEC), with a greater proportion endorsing clinically significant concerns with behavior regulation (68%) relative to cognitive regulation (48%). Majority of participants was rated in the low or very low range for ABAS-3 General Adaptive Composite (72%), with a greater proportion showing problems in Practical (64%) and Conceptual Domains (64%) relative to Social Domain (44%). Among those who completed the SDQ, caregiver ratings implicate elevated Total Problems (90%) with greater concerns observed in Emotional Problems (62%), Hyperactivity (81%) and Peer Relationship difficulties (95%). After controlling for age, executive functioning difficulties were associated with weaker skills in the Conceptual (r=-0.56, p=0.003), Social (r=-0.44, p=0.028) and Practical domains (r=-0.51, p=0.009); as well as more Hyperactivity (r=0.49, p=0.025) and Conduct problems (r=0.58, p=0.007). Specifically, day-to-day challenges with executive functions were related to weaker adaptive skills in Self-Care (r=-0.54, p=0.006), Self-Direction (r=-0.53, p=0.007), and Communication (r=-0.49, p=0.01).Conclusions:Individuals with WSS are at risk for executive functioning deficits, which in turn may impact the development of and/or day-today application of adaptive skills and behavior regulation. Future clinical research should further explore the development and neurophysiology of executive functions among those with WSS with multidisciplinary methods, including behavioral, cognitive and neurobiological metrics. Those working with individuals with WSS may consider executive functioning interventions, which may yield indirect benefits to self-regulation and daily use of life skills.

28 Executive Functioning in Children with Sluggish Cognitive Tempo

Objective:Sluggish cognitive tempo (SCT) is an attentional disorder characterized by excessive daydreaming, reduced alertness, slowed motor behavior, and mental fogginess. The purpose of the present study was to examine potential executive functioning group differences between children with high SCT symptoms versus those with low SCT symptoms. It was hypothesized that children with high SCT symptoms would have greater executive functioning deficits than children with low SCT symptoms, as reported by their teachers.Participants and Methods:There were 32 children in this study, between the ages of 6 to 13 (M = 8.94; SD = 1.97). To measure the level of SCT symptomology, an average rating on four items from the Child Behavior Checklist (CBCL; Items 13, 17, 80, 102) and an average rating from five items from the Teacher's Report Form (TRF; Items 13, 17, 60, 80, 102) were acquired and averaged to produce a combined measure of SCT. The present study had fair to good reliability for CBCL and TRF with Cronbach alpha values of .71 and .82 respectively. Eighteen participants had SCT scores above the Garner et al. (2010) cutoff criteria for the CBCL (SCT over 0.67) or the TRF (SCT over 0.75) which placed them in the high SCT group. The 13 participants who did not meet criteria for high SCT were considered the low SCT group. To measure executive function, Behavior Rating Inventory of Executive Function (BRIEF) teacher ratings were used. A general linear model multivariate analysis was conducted on each measure of the BRIEF teacher reports with ADHD-Inattentive (ADHD-IN) and Verbal Comprehension Index (VCI) scores as covariates.Results:There were significant group differences between the BRIEF Teacher Global Executive Composite scores of the high SCT group (M = 60.81, SD = 7.78) versus the low SCT group (M = 50.31, SD = 6.87), F(1, 30) = 11.73, p &lt; .001, np2 = .59. The high SCT group scored significantly higher than the low SCT group on the Initiate (p &lt; .001), Working Memory (p &lt; .001), Plan/Organize (p &lt; .001), Monitor (p &lt; .01), and Organization of Materials (p &lt; .05) subscales. These findings indicate that the children in the high SCT group had greater executive functioning difficulties overall than the low SCT group.Conclusions:Children with high SCT symptoms demonstrated greater executive functioning deficits than children with low SCT symptoms regarding metacognition but not behavioral regulation. This means that children with SCT likely struggle more with initiating tasks, planning, organization, memory, and monitoring their thinking and behaviors than children without SCT. These skills are important for learning, which may at least partially help explain why children with SCT experience problems in school.

1 Executive Functioning and Anxiety/Depressive Symptoms as Mediators Between ADHD and Quality of Life: A 10-year Longitudinal Study

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.