Executive Function In Children Research Articles

A Systematic Review of the Influence of Aquatic Exercises on the Physical and Psychological Health of Children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorder (ASD) show significant motor deficits and behavioral dysfunctions, as part of their clinical manifestations. Also, these children are facing important difficulties in social learning, which negatively impacts their adjustment to society’s requirements. Apart from other modes of exercise, aquatic exercises may be more attractive to children. Aquatic exercises have been shown to have a beneficial effect on gross motor skills and executive functions in children with ASD. Aim: To study the influence of aquatic exercises on the physical and psychological health of children with ASD. Methods: Researchers used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews and meta-analyses. Researchers looked for articles on PubMed, Google Scholar, and by manual search. Searched articles were screened for relevancy. Potential articles were selected using inclusion and exclusion criteria. Results: Out of the 231 articles, four studies were included in the current systematic review. The age of participants ranged from 3−15 years. Overall, included studies found improvements in various aspects of gross motor and executive functions by aquatic exercise in children with ASD. Conclusion: Aquatic exercises can provide health benefits to children with ASD. Aquatic exercises can be useful as a part of therapy in children with ASD. There is wide scope for further studies to evaluate the beneficial effects of aquatic exercises.

Mediators of the association between physical activity and executive functions in primary school children

ABSTRACT There is growing interest in identifying the mechanisms underpinning the effects of physical activity on executive functions (e.g. inhibitory control, cognitive flexibility) in children. Our study examined cardiorespiratory fitness, muscular fitness, and motor competence as potential mediators of this relationship. The study used baseline data from the Learning to Lead (L2L) cluster randomised controlled trial. In total, 675 children (7–11 years, 49.5% girls) completed measures of moderate-to-vigorous physical activity (MVPA), cardiorespiratory fitness, muscular fitness, motor competence, and executive functions. Structural equation modelling was used to examine the potential mediating roles of cardiorespiratory fitness, muscular fitness, and motor competence in the cross-sectional association between MVPA and executive functions. Cardiorespiratory fitness (β = 0.06, SE = 0.021, p = 0.004) partially mediated the association between MVPA and cognitive flexibility. Muscular fitness was a significant mediator of the association between MVPA and both inhibitory control (β = 0.03, SE = 0.014, p = 0.027) and cognitive flexibility (β = 0.06, SE = 0.021, p = 0.005). No significant mediated effects were found for motor competence. Our findings suggest cardiorespiratory and muscular fitness (but not motor competence) mediate the association between physical activity and executive functions in children.

Effects of aerobic exercise on executive function among overweight and obese children: a systematic review and meta-analysis

ObjectiveOverweight and obesity are serious public health issues worldwide and significantly impair children’s executive function (EF). However, there is no consensus regarding the benefits of aerobic exercise, on the EF of overweight and obese children. This study systematically evaluated the intervention effects of aerobic exercise on EF and its subcomponents (inhibitory control, working memory, and cognitive flexibility) in overweight and obese children.MethodsWe searched six databases—PubMed, Web of Science, Cochrane Library, Embase, EBSCOhost, and China National Knowledge Infrastructure—until March 17, 2024 for randomized controlled trials examining the effects of aerobic exercise on the EF of overweight and obese children the Cochrane Risk of Bias Assessment Tool. Following heterogeneity testing, RevMan 5.4 and Stata 17.0 were used for meta-analysis and subgroup analysis of the three indicators. The standardized mean difference (SMD) and 95% confidence intervals (CI) were used as statistical measures for effect analysis with the SMD value as the effect size and a p-value of ≤0.05 indicating statistical significance.ResultsEighteen studies involving 1,260 participants were included. Aerobic exercise significantly improved overall EF (SMD = −0.50, 95% CI [−0.68, −0.32], p < 0.01) with a moderate to high positive effect on inhibitory control (SMD = −0.52, 95% CI [−0.72, −0.31], p < 0.01) and working memory (SMD = −0.63, 95% CI [−1.06, −0.20], p < 0.01) but not on cognitive flexibility (SMD = −0.32, 95% CI [−0.71, 0.07], p = 0.11). These results suggest that EF in overweight and obese children is influenced by factors such as exercise characteristics and body mass index (BMI). Subgroup analysis revealed a significant moderating effect of exercise type, exercise intensity, session time, and individual BMI on EF.ConclusionAerobic exercise selectively improved EF in overweight and obese children. Subgroup analysis indicated that cognitive engagement in ball game interventions of at least moderate intensity and a single session of 25–40 min are more beneficial for improving EF in overweight and obese children. Extremely obese children (BMI > 25 kg/m2) do not benefit from the intervention, highlighting the need for a specific focus on intervention outcomes in future studies.

Empowering Social Growth Through Virtual Reality–Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial

Background Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation. Objective This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training. Methods A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention. Results The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05). Conclusions The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits. Trial Registration ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526 International Registered Report Identifier (IRRID) RR2-10.2196/48208

Prenatal risk factors for child executive function at 3–5 years of age: the roles of maternal mood, substance use, and socioeconomic adversity in a prospective cohort study

BackgroundA growing body of literature links prenatal mood and substance use to children's cognitive and behavioral development. The relative contribution of these risk factors on children's executive function (EF) in the context of socioeconomic adversities needs further evaluation. To address this gap, we investigated the role of prenatal maternal anxiety and depression on childhood EF, specifically inhibitory control and working memory, within the context of socioeconomic adversities and prenatal substance use. We hypothesized that higher maternal mood symptoms, higher persistent prenatal drinking and smoking, and lower socioeconomic status would be associated with lower EF skills during early childhood.MethodsWe used data from 334 mother–child dyads followed prospectively through pregnancy and the offspring’s childhood. Prenatal maternal depression and anxiety were assessed via standardized questionnaires. Prenatal alcohol and tobacco consumption were assessed via a timeline follow-back interview. The EF touch battery assessed child inhibitory control and working memory at 3–5 years of age (4.76 ± 0.58 years, 171 females). Separate linear regression models were used to estimate the association of prenatal tobacco, alcohol, anxiety, and depression exposure with our two components of child EF, inhibitory control and working memory, while adjusting for gestational age, sex, and age at assessment. The following variables were also included as covariates: maternal educational achievement, employment status, parity, and household crowding index.ResultsChildren of mothers with high trait anxiety scores had reduced inhibitory control compared to children of mothers without trait anxiety or depression (β = -0.12, 95% CI:-0.22,-0.01). Children of mothers in the moderate to high continuous smoking group showed lower inhibitory control (β = − 0.19, 95% CI:-0.38,-0.01) compared to children of mothers in the none smoking group. Additionally, lower maternal education and higher household crowding were each associated with reduced inhibitory control. We found no significant association between prenatal maternal depression, anxiety, or socioeconomic factors with working memory.ConclusionsThese results underscore the need for comprehensive context-specific intervention packages, including mental health support for women to promote healthy inhibitory control development in children.

Witnessing their mother’s acute and prolonged stress affects executive functioning in children

Stress can detrimentally affect physical and mental health, especially during childhood. During this critical period, parental bonds can foster resilience or amplify stress. This study explored whether mothers’ everyday stress can act as a source of childhood stress, affecting children’s executive functioning. 76 healthy mother-child dyads participated, with mothers assigned to a stress-inducing or stress-free condition. Children observed their mothers and were subsequently tested for cognitive flexibility and working memory. Subjective stress, heart rate, and cortisol were measured repeatedly in mothers and children, alongside everyday stress perceptions. Linear mixed models showed that children’s acute stress response was associated with impaired cognitive flexibility. Maternal stress, both acute and past-month, was a better predictor of children’s cognitive performance than children’s own stress. Quadratic relationships indicated the highest error rates at very low and high maternal stress. We found no evidence that children’s working memory was impaired by their own or their mothers’ stress. Although expected covariations of acute or prolonged stress between mothers and children were not observed, an interaction between maternal past-month stress and acute stress condition provided insights into adaptive mechanisms in children. These findings underscore the significant impact of maternal stress on children’s executive functioning, illustrating how parental experiences shape children’s everyday outcomes.

Child's Externalizing and Internalizing Problems and Caregiver Strain: Mediation of Child's Executive Functions.

The aim of the study is to explore the role of child's executive functions in the relation between child's externalizing and internalizing problems and caregiver strain in early school age children. The caregiver strain refers to providing nurture and care for a dependent family member. A sample includes 175 caregiver-child dyads and 36 school teachers. Participants completed the Family Strain Index which measures caregiver strain or burden (caregivers), the Strengths and Difficulties Questionnaire which measures child's externalizing and internalizing problems (teachers), and behavioral tasks that measure executive functions (children). Using structural equation modelling, the analysis resulted in a full mediation of the child's externalizing problems on the caregiver strain by child's executive functions. However, the association of child's internalizing problems with caregiver strain has not been confirmed. These results indicate that better child's executive functions buffer the negative effect of child's externalizing problems on caregiver perceived burden. Based on these results, we can suggest that interventions should be focused on programmes to improve the child's executive functions in the family and educational context, along with caregiver training aimed at providing emotional and social support, or individual therapy.

Intergenerational coparenting and child development outcomes: A systematic review

AbstractGrandparents often serve important childrearing roles. The present study is a systematic review of research that examined the association between intergenerational coparenting and children's development. Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, 220 records were identified, and 16 studies were included in the final review. The review provided a detailed analysis of the methodological characteristics of research in this area. Findings indicated that better intergenerational coparenting was associated with higher levels of children's social competence, executive functioning, and attachment security. Evidence also suggests parenting mediates the relation between intergenerational coparenting and child development. Several directions for future research emerged from the review including the need (a) for measurement strategies that reflect the multidimensional nature of intergenerational coparenting, (b) to consider the various parent‐grandparent dyads, and (c) to incorporate other family factors and processes (e.g., quality of parent‐grandparent relationships) into studies that focus on intergenerational coparenting.

Enhancing daily life for children with cognitive developmental delay through insights into brain development.

Cognitive developmental delay, including severe intellectual disability (IQ below 70) and borderline intellectual functioning (IQ 70-85), poses significant challenges, including high costs and emotional burden. Early diagnosis and interventions might improve adaptive behavior and daily life functioning. High-risk groups include children with neonatal complications, congenital anomalies, genetic disorders, or metabolic errors, yet over 50% of cases have unknown causes. To provide timely diagnosis and intervention for children with cognitive developmental delay, it is important to increase our understanding and ability to prognosticate their level of functioning. The pivotal role of brain development in the first few years of life presents a window of opportunity for these goals. By detailed investigation of common patterns in structural brain development and connectivity by MRI in relation to cognitive and executive functioning, this review aims to identify potential factors that might improve understanding and prognostication of children with cognitive developmental delay. Exploring similarities among diverse patient groups with childhood cognitive developmental delay, this review intends to provide a nuanced perspective. IMPACT: This review identified several MRI brain developmental markers, especially in the white matter, that might hold potential to be a prognostic marker for intellectual and executive functioning in children with cognitive developmental delay. Bringing together information on aberrant brain developmental trajectories and connectivity across different patient childhood populations with cognitive developmental delay might improve our understanding and prognostication.

Executive function in children with neurodevelopmental conditions: a systematic review and meta-analysis.

Executive function (EF) delays are well documented in paediatric neurodevelopmental conditions (NDCs). There is no consensus about whether EF delay represents a transdiagnostic feature of NDCs. This systematic review and meta-analysis synthesized 180 studies reporting two or more NDC comparisons on EF, examined differences between NDCs, and the moderating effects of gender, age, publication year, DSM editions and assessment types. Studies using established EF measures across seven domains (attention, fluency, set-shifting, set-switching, response inhibition, planning and working memory) in participants under 18 were included. Summary effects were compared: (1) for all reported NDCs relative to control, (2) for each individual NDC relative to control and (3) between NDC groups. Results confirmed that EF delay was a transdiagnostic feature of neurodevelopmental delay, with a moderate effect size of delay across all NDCs (g = 0.56, 95% confidence interval (CI) 0.49-0.63) compared with control. This effect increased with comorbidities (g = 0.72, 95% CI 0.59-0.86), DSM-5 criteria and informant measures. Comparisons between NDCs revealed few differences: children with tic disorders (TD) showed smaller EF delays, children with attention-deficit/hyperactivity disorder (ADHD) showed larger delays in attention, response inhibition, planning and working memory compared with TD and specific learning disorders, while children with autism spectrum disorders showed greater delays on set-switching compared with ADHD. Findings support transdiagnostic models of neurodevelopment to further a developmentally sensitive science that can reveal how EF delays contribute to brain circuitry, symptom profiles and functioning, and ultimately support early interventions and outcomes for all children with NDCs.

Effects of Playing an Interactive Educational App on Children's Learning and Executive Function

AbstractChildren are increasingly using educational apps, but little research has been conducted to determine their effectiveness. The current study compared the effect of an interactive touchscreen app to the effect of a noninteractive video about the app on young children's Chinese characters learning and executive functions (EFs). In a mixed between‐within design, 50 children aged 5 to 6 years old were randomly assigned to play the app on touchscreen or to watch a noninteractive video about the app. Results showed that children in the app condition made more progress from the pretest to the posttest in Chinese characters learning, and more improvement in working memory scores and inhibitory capacity scores compared to the video condition. Results suggest that interactive literacy apps on touchscreens benefit children's learning and EFs. Future research should continue to focus on the impact of different forms of touchscreen use on children's executive functioning.

Physical Activity and Executive Functioning in Children and Adolescents with Congenital Heart Defects: A Scoping Review.

Children and adolescents (C&As) with congenital heart defects (CHDs) have decreased functional capacity and executive functioning (EF) due to brain abnormalities and decreased cerebral perfusion. Exercise may improve EF via increased cognitive demands and cerebral blood supply. The purpose of this review was to identify evidence describing the impact of physical activity (PA) interventions on EF in C&As with CHDs. The following databases were searched from 2000 to 2024: MEDLINE, EMBASE, CINAHL, Scopus, CENTRAL, and PsycInfo. The inclusion criteria consisted of participants aged from birth to 18 years with CHD, interventions related to PA, and EF as an outcome measure. Articles were excluded if adults were included, translation to English was impossible, and full access was unavailable. Of 613 initial articles, 3 were analyzed, with only 1 meeting all inclusion criteria. The included study found significant improvements in self-reported cognitive functioning and parent-reported social functioning after 12 weeks of aerobic exercise in children aged 10-15 years with CHDs. Common themes among the reviewed articles indicated that EF remains impaired throughout the lifespan, children have unique interventional and developmental needs, and research remains limited despite theoretical benefits. Further investigation of the effect of PA on EF in C&As with CHDs is needed.

The apple does not fall far: stable predictive relationships between parents’ ratings of their own and their children’s self-regulatory abilities

Having control over your own behavior and impulses is a critical skill that influences children’s academic, social, and emotional development. This study investigates the stability and predictive relationships between parents’ ratings of their own and their children’s executive function and delay aversion. Using data from approximately 1700 families collected during the COVID-19 pandemic, we employed hierarchical structural equation models and cross-lagged panel models to analyze the temporal stability and directional influences of executive function and delay aversion assessments.Our analysis revealed a substantial latent correlation (r = 0.48, p < 0.001) between parents’ and children’s executive function problems, indicating a shared variance of approximately 23%. Significant cross-lagged effects were found, with parental executive functions at T1 predicting child executive functions at T2 (β = 0.16, p = 0.005). For delay aversion, we found a latent correlation of r = 0.53 (p < 0.001) and significant within-timepoint and temporal stability, but no cross-lagged effects.These findings suggest that higher levels of executive function problems reported by parents at T1 correspond to an increased perception of similar problems in their children at T2. This highlights the importance of parental self-perception in assessing children’s abilities. Our results highlight the importance of incorporating family dynamics into interventions targeting executive function difficulties and delay aversion in children, and understanding this interplay enables the development of more effective, individualized approaches to support positive developmental outcomes.

You are here! Rethinking children's executive function development in the presence of others

You are here! Rethinking children's executive function development in the presence of others

Effects Of Physical Exercise On Fundamental Movement Skills And Executive Functions In Children With ASD

Effects Of Physical Exercise On Fundamental Movement Skills And Executive Functions In Children With ASD

The Comparison of Psychological Factors and Executive Functions of Children with Attention Deficit Hyperactivity Disorder and Cognitive Disengagement Syndrome to ADHD and ADHD Comorbid with Oppositional Defiant Disorder

Objective: The study aims to examine family functionality, emotion regulation difficulties, preference for loneliness, social exclusion, internalizing and externalizing disorders, and executive functions in children with Attention Deficit Hyperactivity Disorder (ADHD) and Cognitive Disengagement Syndrome (CDS) and compare with ADHD, and ADHD+ Oppositional Defiant Disorder (ODD). Method: This study included 842 children aged 8–12 years. The subjects were categorized according to DSM-V as ADHD (n = 246), ADHD + ODD (n = 212), ADHD + CDS (n = 176), and Control group (n = 207). The solitude and social exclusion, difficulties in emotion dysregulation and Barkley SCT scales, Child Behavior Checklist, family assessment device, and Central Vital Signs (CNSVS) test were used. Results: According to the study, children with ADHD + CDS had higher rates of internalizing disorders. They also preferred being alone and experienced more difficulty communicating with their parents and solving problems within the family. Additionally, these children had difficulty recognizing and understanding the emotional reactions of others. The ADHD + ODD group presented a poorer performance on CNSVS domain tests except for the psychomotor speed test than other groups. Also, ADHD + CDS children had the lowest psychomotor speed scores and lower scores on reaction time and cognitive flexibility than pure ADHD children. Conclusion: This study will contribute to the etiology, treatment, and clinical discrimination of ADHD + CDS.

Early childhood executive function predicts concurrent and later social and behavioral outcomes: A review and meta-analysis.

Executive function (EF), the set of mental processes and skills involved in goal-oriented planning, organizing, and controlling behavior, is believed to support child development across many domains of life. However, although ample evidence suggests a relation between childhood EF and academic skills, it is less clear what its role is in domains beyond academics. We report a meta-analysis of relations between early childhood EF (assessed at 36-60 months of age) and social, health, and behavioral outcomes assessed concurrently and longitudinally (1,459 effect sizes, 158 studies, n = 144,642). No significant relations were found between EF and health outcomes. EF was concurrently associated with emotion understanding and regulation, prosocial skills, peer acceptance, and skill at lying. Both concurrently and longitudinally, EF was positively associated with peer acceptance, adaptive classroom behavior, and social competence, and negatively associated with internalizing and externalizing problems, and inattention and hyperactivity. For adolescent outcomes, only the relation between EF and internalizing could be meta-analyzed, and no significant relation was found between these variables. The magnitude of effect sizes varied, with absolute values ranging from r = .02 to .30. Moderator analyses indicated the relation between EF and behavioral outcomes varied by outcome, but there was no such finding for EF and social or health outcomes. EF was more strongly associated with teacher- versus parent-reported behavioral problems. There was little evidence that quality indicators affected effect sizes. There was also little evidence of publication bias. Overall, our results are consistent with the possibility of broad relevance of EF for child development; yet, future research should provide stronger causal tests of hypothesized relations between EF and outcomes to better understand the nature of EF and whether fostering it can promote healthy development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of Joint Attention Training on Basic Social Communication, Anxiety and Executive Functions of Children with Autism Spectrum

Introduction: The aim of this study was to investigate the effectiveness of joint attention training on basic social communication, anxiety and executive functions of children with autism. Methods: The research design was quasi-experimental and pre-test and post-test with control group. The statistical populations of children with autism spectrum were referred to the psychiatric and psychological centers in Urmia City during the year 2021-2022. 30 individuals (15 ones from the shared attention group and 15 from the control group) were selected as a statistical sample using the available and targeted method. Data via questionnaires of basic social communication (Zabov, 2010), anxiety (Spence, 1999), executive functions of the parents' brief form (Balster Gerard et al., 2000) were collected during the intervention therapy method of joint attention training (Vakilizad and Abedi, 2015) (12 sessions, 3 days a week, each session was an hour and a half, each session was divided into 3 parts of 25 minutes with a 5 minute break for the child). Then the data were analyzed with Software SPSS V. 16 and multivariate analysis of covariance test. Results: The results showed that joint attention training increased basic social communication and executive functions and reduced anxiety in children with autism spectrum. The differences between the investigated groups and the conducted tests were significant (P≤0.01). Conclusion: Interventional treatment methods such as joint attention training should be developed for the treatment of autistic patients, so that with the help of these methods, the individual and collective life of these patients can be improved.

Executive Function and Adherence in Children and Adolescents Living with HIV: Evidence from the HIV-associated Neurocognitive Disorders in Zambia (HANDZ) Study.

Executive function (EF) may be impaired in people with human immunodeficiency virus (HIV) infection, and poor EF may affect medication adherence. However, there is little data on EF in children with HIV in sub-Saharan Africa. 208 children/adolescents with perinatally acquired HIV and 208 HIV-exposed uninfected controls were recruited in Zambia for this prospective cohort study. EF was measured using performance-based, self-report, and parental report measures. Adherence over one year of follow-up was assessed through questionnaires and viral load measurement. Children with HIV performed significantly worse on all three measures of EF. Lower parental rating of EF was associated with poorer antiretroviral therapy adherence (OR: 1.5, 95% CI = 1.02 - 2.2, p = 0.04). Children with HIV have EF impairments which may lead to consequences like poor medication adherence and treatment failure. Interventions to improve EF or compensate for impaired EF may be necessary in this population.

Early High-Dose Erythropoietin and Cognitive Functions of School-Aged Children Born Very Preterm

Children born very preterm are at risk for long-term neurodevelopmental sequelae. Prophylactic high-dose recombinant human erythropoietin (rhEpo) shortly after birth has not been shown to improve cognitive, motor, and behavioral development at 2 and 5 years. To investigate whether early high-dose rhEpo is associated with better executive functions and processing speed-late-maturing cognitive functions-in school-aged children born very preterm. This single-center cohort study was a prospective, observational follow-up study of a multicenter neonatal clinical trial; 365 children born very preterm (mean gestational age, 29.3 weeks [range, 26.0-31.9 weeks]) who had been enrolled in the Swiss EPO Neuroprotection Trial at birth between 2005 and 2012, and who were included in the primary outcome analyses at 2 years, were eligible to be recruited for the EpoKids study between 2017 and 2021 when they were at school age. Term-born children were additionally recruited and included in a control group. Data were analyzed between May and September 2022. Administration of rhEpo (3000 IU/kg) or placebo (saline, 0.9%) intravenously 3 times within the first 2 days of life as part of the Swiss EPO Neuroprotection Trial. A comprehensive neuropsychological test battery assessed executive functions and processing speed, and parents reported on their child's executive functions in everyday life to test the hypothesis that early high-dose rhEpo administration is associated with better cognitive outcomes at school age. In the EpoKids study, 214 children born very preterm (58.6% of 365 children in eligible cohort) were assessed at a mean age of 10.4 years (range, 6.9-13.4 years); 117 (54.7%) were boys. There was no evidence that the 117 children who had received rhEpo differed from the 97 children who had received placebo in any of the 15 executive function and processing speed tests, nor in parent-rated executive functions (estimates ranged from -0.138 to 0.084, all 95% CIs included 0). Irrespective of rhEpo or placebo allocation, children born very preterm scored lower on 11 of 15 executive function and processing speed tests than term-born peers (estimates ranged from 0.112 to 0.255, 95% CIs did not include 0). This study found no evidence for a positive association between prophylactic early high-dose rhEpo administration and long-term neurodevelopmental outcomes after very preterm birth. These results suggest that a comprehensive approach, including pharmacological and nonpharmacological prevention and intervention strategies, is needed to support these children's neurodevelopmental outcome.