Examination Of Executive Functions Research Articles

An examination of executive functioning in adolescents with FASD in a self-regulation intervention

Adolescents with Fetal Alcohol Spectrum Disorder (FASD) often have challenges with executive functioning (EF), which impacts their ability to self-regulate. In this study, 23 adolescents with FASD completed a self-regulation intervention. The intervention was a manualized Teen Adaptation of the Alert Program®. A nonrandomized waitlist control design was used, and participants completed pre- and post-testing using performance-based measures of EF, and rating scales of EF were completed by caregivers. Results were analyzed three ways; 1) intervention and waitlist control group comparison, 2) whole sample pre-and post- test comparison, and 3) using Reliable Change Indexes to examine individual-level clinically relevant changes. No significant intervention effects were found when comparing the intervention and waitlist control groups. A significant difference was found on a measure of verbal inhibition when total sample pre-and post-test scores were compared. Using Reliable Change Index analysis, 30% participants showed reliable change in the direction of improvement on direct measures of EF, and 57% demonstrated reliable change in the direction of improvement on rating scales. This research study underscores the importance of investigating both individual and group level changes when analyzing data, as well as using reliable change to understand clinically meaningful effects that may be otherwise masked. These findings highlight the potential of the SR intervention to positively impact EF in adolescents with FASD. This study contributes to the growing literature that demonstrates the potential of individuals with FASD to benefit from direct intervention.

An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa

ObjectivePeople with anorexia nervosa often exhibit inefficiencies in executive functioning (central coherence and set shifting) that may negatively impact on treatment outcomes. It is unclear from previous research whether these inefficiencies can change over treatment. We aimed to (1) investigate whether executive functioning can improve over treatment, (2) determine whether baseline executive functioning moderates treatment outcome, and (3) examine whether baseline executive functioning predicts early change (i.e., increase in body mass index over the first 13 weeks of treatment) or remission.MethodWe conducted linear mixed model and logistic regression analyses on data from the Strong Without Anorexia Nervosa trial (Byrne et al. in Psychol Med 47:2823–2833, 2017). This study was a randomised controlled trial of three outpatient treatments for people with anorexia nervosa: Enhanced Cognitive Behavioural Therapy, Maudsley Model Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management.ResultsWhile set shifting clearly improved from baseline to end of treatment, the results for central coherence were less clear cut. People with low baseline central coherence had more rapid reductions in eating disorder psychopathology and clinical impairment than those with high baseline central coherence. Baseline executive functioning did not predict early change or remission.DiscussionThe detail-focused thinking style commonly observed among people with anorexia nervosa may aid treatment outcomes. Future research that is more adequately powered should replicate this study and examine whether the same pattern of results is observed among people with non-underweight eating disorders.

A cross-sectional examination of executive function and its associations with grazing in persons with obesity with and without eating disorder features compared to a healthy control group.

The current study aimed to investigate associations between grazing and different facets of executive functioning in persons with obesity with and without significant eating disorder psychopathology, compared to a healthy-weight control group. Eighty-nine participants (of which 20 had obesity and marked eating disorder symptomatology, 25 had obesity but without marked eating disorder symptoms, and 44 were healthy-weight age- and sex-matched participants; N = 89; 66.3% female, age = 28.59 (8.62); 18.18-58.34years) completed a battery of neuropsychological tests and demographic and eating disorder-related questionnaires. Poisson, Negative Binomial, and Ordinary Least Squares regressions were performed to examine group differences and the associations of grazing with executive functioning within the three groups. Significantly lower inhibitory control and phonemic fluency were observed for the obesity group without ED features compared to healthy-weight controls. Increasing grazing severity was associated with improved performance in inhibitory control in both groups with obesity, and with phonemic fluency in the obesity group with marked eating disorder features. Although there is mounting evidence that specific cognitive domains, especially inhibition, are affected in obesity, evidence of further detrimental effects of eating disorder psychopathology remains mixed; additionally, for persons with obesity, there may be a weak but positive link between executive functioning and grazing behaviour. III, comparative cross-sectional observational study with a concurrent control group.

A-045 Sluggish Cognitive Tempo in Youth: An Examination of Executive Functioning and Self-Reported Internalizing Symptoms

Abstract Objective Sluggish cognitive tempo (SCT) is a group of attention-related symptoms that are characterized by slowed behavior and thinking, excessive daydreaming, mental confusion or fogginess, and drowsiness.4 Studies have shown that SCT is related to higher rates of anxiety, depression, and social isolation.4 Additionally, recent publications have indicated that aspects of executive functioning (EF) may be impacted in children with SCT.2,5 Meta-analysis confirmed that most SCT research has focused on parent and teacher report.1,3,4 There is an increased need for studies examining SCT with self-report.5 This study will examine how SCT is related to EF and self-reported internalizing symptoms in youth with Attention-Deficit/Hyperactivity Disorder (ADHD). Method Participants were youth aged 8 to 18-years with ADHD (N = 130) referred for neuropsychological testing. Participant demographics: males (N = 82, 63.1%). Measures included the Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale (WISC-V/WAIS-IV) Processing Speed Index (PSI), Conners Continuous Performance Test (CPT) Hit Reaction Time (HRT), Delis-Kaplan Executive Function System Color Word Identification (CWI) and Tower subtests, Behavior Assessment Systems for Children (BASC) self-report scales, and Personality Assessment Inventory-Adolescent (PAI-A) scales. Results Bivariate correlations showed that the PSI was significantly correlated with CWI Inhibition (r = 0.52, p < .01), CWI Inhibition/Switching (r = 0.53, p < .01), Tower (r = −0.20, p < .05), and Social Isolation (r = −0.19, p < .05), with Depression approaching significance (p = .06). The CPT HRT was also significantly correlated with CWI Inhibition (r = −0.19, p < .05) and CWI Inhibition/Switching (r = −0.22, p < .05), with Depression approaching significance (p = .05). Conclusions SCT is associated with EF and self-reported internalizing symptoms and should be included when considering interventions.

Evaluation of fMRI counting task efficiency for normal brain functional connectivity analisys during executive function examination

Aim: to explore functional connectivity of the normal brain during Stroop test modification and new suggested counting test performance.Materials and methods. Data were acquired from 18 healthy volunteers who underwent fMRI examination on 3T scanner with Stroop test modification and new suggested counting test used as block paradigms.Results. Functional connectivity analysis showed involvement of similar regions but with different distribution of positive correlations between them: interhemispheric significant positive correlations during Stroop test modification performance were found between anterior insular cortex, interhemispheric significant positive correlations during counting test performance were found between dorsolateral prefrontal cortices bilaterally and inferior parietal cortices bilaterally. Different distribution of significant correlations could be due to specificity of tasks. Comparative analysis showed significantly higher positive correlations with occipital cortex during Stroop test performance.Conclusions. Received data allow alternative use of the abovementioned paradigms for executive functions investigation, with preference for counting test paradigm in patients with vision disturbances.

Increased Proinflammatory Cytokines, Executive Dysfunction, and Reduced Gray Matter Volumes In First-Episode Bipolar Disorder and Major Depressive Disorder

BackgroundsThe association between systemic inflammation, executive dysfunction, and gray matter (GM) volume difference in first-episode affective disorders, including bipolar and major depressive disorders, is unclear. MethodsTwenty-two patients with first-episode bipolar disorder, 22 age- and sex-matched patients with first-episode major depressive disorder, and 22 matched controls were enrolled in our study; all patients underwent comprehensive assessments, including clinical assessment, executive function examination (Wisconsin card sorting test [WCST]), proinflammatory cytokine receptors (soluble interleukin-6 receptor and tumor necrosis factor-α receptor 1 [TNFR1]), and brain magnetic resonance imaging. Voxel-based morphometry was performed to analyze the GM volume difference between bipolar and major depressive disorders. ResultsPatients with bipolar disorder were more likely to exhibit higher levels of TNFR1 (P = .038), more number of deficits in WCST (P < .05), and smaller GM volume in the middle frontal cortex (uncorrected voxel level P < .001) compared with those with major depressive disorder and healthy controls. Positive associations were observed between the middle frontal cortex volume, executive function, and the TNFR1 level. DiscussionGM volume reduction in the middle frontal cortex, a greater level of systemic inflammation, and executive dysfunction were observed in first-episode affective disorders, especially bipolar disorder. A positive correlation between middle frontal cortex volume, executive function, and the TNFR1 level may indicate a divergent effect of brain and systemic inflammation functioning in the early phase (first episode) of affective disorder.

Frontal lobe dysfunction as a predictor of depression and anxiety following temporal lobe epilepsy surgery

ObjectivePredictors of psychiatric outcome following TLE surgery have proved elusive and represent a current challenge in the practice of TLE surgery. This prospective study investigated whether frontal lobe dysfunction is predictive of poorer psychiatric outcomes. MethodsForty-nine unilateral TLE surgical patients were assessed using the Beck Depression Inventory–Fast Screen (BDI-FS) and Beck Anxiety Inventory (BAI) preoperatively and 6 and 12 months postoperatively. Measures of intellectual function, semantic knowledge, memory and executive function were completed preoperatively, at 6 and 12 months following surgery. ResultsPreoperatively, 33 (67%) patients had minimal depressive symptoms, 8 (16%) were mildly depressed, 2 (4%) were moderately depressed, and 6 (12%) reported severe depressive morbidity. Twenty-three (47%) patients reported minimal anxiety, 18 (37%) were mildly anxious, 6 (12%) were moderately anxious and 2 (4%) patients reported severe anxiety symptoms. A mixed-model repeated-measures analysis was performed on the BDI-FS and BAI scores, adjusting for pertinent covariates identified in univariable analyses. At a year following TLE surgery, anxiety symptoms significantly improved but depressive morbidity did not. Indicators of frontal lobe dysfunction moderated the magnitude and direction of mood change. Specifically, pre-surgical cognitive measures of frontal lobe dysfunction predicted increased depression and anxiety symptoms following surgery. There was no relationship between preoperative BDI-FS or BAI scores and seizure outcome at 12 months or change in affective morbidity and seizure outcome. SignificanceThis is the first longitudinal study to provide evidence that specific pre-surgical cognitive and behavioural indices of frontal dysfunction are predictive of poorer psychiatric outcome following TLE surgery. In addition, our findings highlight the potential utility of a dysexecutive behavioural rating scale (DEX) as an assessment tool in epilepsy. Examination of executive functioning in pre-surgical evaluations may lead to an increase in the power of prognostic models used to predict the psychiatric outcome of TLE surgery.

Examination of Executive Function and Social Phobia Among Female College-Aged Students With Celiac Disease.

Celiac disease (CD) is a T-cell mediated genetically inherited autoimmune disease affecting approximately 1% of the population. Research suggests that CD impacts executive functioning (EF) and social phobia (SP). However, most of the literature in this area focuses on age groups outside of the traditional college age range and has never measured EF and SP together. This descriptive study compared traditional age female college students with CD to age- and sex-matched college students without CD on measures of EF and SP. Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), the Social Anxiety Questionnaire for Adults-Short Form (SAQ-A30), and a demographic questionnaire. Results indicated that participants with CD reported lower grade point averages; scored lower on BRIEF-A measures of working memory, planning/organization, and organization of materials; and scored higher on SAQ-A30 measures involving interactions with the opposite sex and strangers. Implications for nursing practice are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 25-34.].

A-71Cognition and Affect Among Individuals with Chiari Malformation Type I: An Examination of Executive Function and Psychological Distress

A-71Cognition and Affect Among Individuals with Chiari Malformation Type I: An Examination of Executive Function and Psychological Distress

The Influence of Executive Functioning on Facial and Subjective Pain Responses in Older Adults.

Cognitive decline is known to reduce reliability of subjective pain reports. Although facial expressions of pain are generally considered to be less affected by this decline, empirical support for this assumption is sparse. The present study therefore examined how cognitive functioning relates to facial expressions of pain and whether cognition acts as a moderator between nociceptive intensity and facial reactivity. Facial and subjective responses of 51 elderly participants to mechanical stimulation at three intensities levels (50 kPa, 200 kPa, and 400 kPa) were assessed. Moreover, participants completed a neuropsychological examination of executive functioning (planning, cognitive inhibition, and working memory), episodic memory, and psychomotor speed. The results showed that executive functioning has a unique relationship with facial reactivity at low pain intensity levels (200 kPa). Moreover, cognitive inhibition (but not other executive functions) moderated the effect of pressure intensity on facial pain expressions, suggesting that the relationship between pressure intensity and facial reactivity was less pronounced in participants with high levels of cognitive inhibition. A similar interaction effect was found for cognitive inhibition and subjective pain report. Consequently, caution is needed when interpreting facial (as well as subjective) pain responses in individuals with a high level of cognitive inhibition.

IMPAIRED EXECUTIVE FUNCTIONING IN PEDIATRIC TRICHOTILLOMANIA (HAIR PULLING DISORDER).

No neurocognitive examinations of pediatric trichotillomania (hair pulling disorder; HPD) have taken place. As a result, science's understanding of the underlying pathophysiology associated with HPD in youths is greatly lacking. The present study seeks to begin to address this gap in the literature via examination of executive functioning in a stimulant-free sample of children with HPD. Sixteen and 23 children between 9 and 17 years of age meeting DSM-5 diagnostic criteria for HPD or classified as a healthy control, respectively, were recruited (N = 39) to complete structured interviews, self-reports, and a subset of tests from the Cambridge Automatic Neurocognitive Test Assessment Battery (CANTAB) assessing cognitive flexibility/reversal learning (intradimensional/extradimensional; IED), working memory (spatial span; SSP), and planning and organization (Stocking of Cambridge; SOC). Hierarchical regression analyses indicated that, after controlling for appropriate covariates, diagnostic status predicted impaired performance on both the IED (reversal learning only) and SOC (planning and organization) but failed to predict cognitive flexibility or working memory capacity. Correlational analyses revealed that pulling severity was strongly related to working memory capacity, while disparate relationships between pulling styles (automatic, focused pulling) were evident with respect to working memory and planning and organization. Children with HPD performed more poorly on tasks of executive functioning as compared to controls. Correlational analyses suggest potentially distinct pathophysiology underlying automatic and focused pulling warranting further research. Limitations and future areas of inquiry are discussed.

PREDICTING PSYCHIATRIC OUTCOME FOLLOWING TEMPORAL LOBE EPILEPSY SURGERY: A LONGITUDINAL STUDY

ObjectiveNeurosurgery is an effective therapy for selected individuals with medically refractory temporal lobe epilepsy (TLE). Following TLE surgery, however, affective symptoms (depression/anxiety) can worsen or develop for the first time...

An Examination of Executive Functioning in Young Adults Exhibiting Body-Focused Repetitive Behaviors.

Body-focused repetitive behaviors (BFRBs), including hair pulling, nail biting, and skin picking are repetitive, habitual, and compulsive in nature. Although characteristic of disorders such as trichotillomania and skin picking disorder, BFRBs are associated with other psychiatric conditions as well. To date, research has failed to examine neurocognitive risk factors, particularly executive functioning, implicated in BFRBs utilizing a transdiagnostic approach. The present study recruited 53 participants (n = 27 demonstrating BFRBs and n = 26 randomly selected controls) from a larger sample of young adults. Participants completed an automated neurocognitive test battery including tasks of cognitive flexibility, working memory, and planning and organization. Results revealed that participants in the BFRB group demonstrated significantly poorer cognitive flexibility (d = 0.63) than controls. No differences were noted in other neurocognitive domains. However, planning and organization demonstrated a significant relationship with various BFRB severity measures. Implications, limitations, and avenues for further research are discussed.

Implementation Intentions for Physical Activity Behavior in Older Adult Women: An Examination of Executive Function as a Moderator of Treatment Effects

Implementation intentions are effective for enhancing physical activity, but it is unknown how well these effects extend to older adults and/or are modified by cognitive variables. Our objective is to examine (1) the efficacy of an implementation intentions intervention for physical activity in older adult women and (2) to examine the moderating effects of executive function. Participants (N = 75, M age = 73.72) completed measures of executive function and were randomly assigned to weekly implementation intentions for physical activity (experimental condition), implementation intentions for an unrelated behavior (control condition), or no treatment. Baseline activity was measured by accelerometer and self-report; follow-up activity was measured by weekly self-report. Findings indicated a significant treatment effect for the experimental condition and a treatment by executive function interaction. Specifically, participants with relatively stronger executive function benefited most from the experimental intervention. Implementation intentions are effective for enhancing physical activity among older adult women, and the effects may be especially pronounced for those with relatively stronger executive function.

Neuropsychological functioning in youth with obsessive compulsive disorder: An examination of executive function and memory impairment

Preliminary research suggests neuropsychological deficits in youth with obsessive-compulsive disorder (OCD) similar to those in adults; however, small samples and methodological confounds limit interpretation. We aimed to examine the rates and clinical correlates of cognitive sequelae in youth with OCD, focusing on executive functioning and memory abilities. Youth ages 7–17 years with OCD (N=96) completed a hypothesis-driven neuropsychological battery (including the Rey–Osterreith Complex Figure, California Verbal Learning Test, and subtests of the Delis–Kaplan Executive Function System and Wide Range Assessment of Memory and Learning) that primarily assessed executive functioning, memory and processing speed. Cognitive sequelae were identified in 65% of youth (37% using a more stringent definition of impairment). Magnitude of cognitive sequelae was not associated with OCD severity or age; however, greater neuropsychological impairments were found amongst youth prescribed atypical neuroleptics and those diagnosed with comorbid tic disorders. Comorbidity burden was associated with presence of neuropsychological impairment, but was not specific to any single test. Findings suggest that the presence of cognitive sequelae is prevalent amongst treatment-seeking youth with OCD. Deficits were found in executive functioning and non-verbal memory performance but these impairments were not associated with OCD severity.

Eine internationale neuropsychologische Testbatterie für Kinder, Jugendliche und Erwachsene mit Anorexia nervosa – die deutsche Adaptation des Ravello Profils

Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions. The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN. The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.

Contributions of Studies on Alcohol Use Disorders to Understanding Cerebellar Function

Neuropathological, neuropsychological, and neuroimaging studies of human alcoholism provide evidence for degradation of frontal, pontine, thalamic, and cerebellar brain sites and disturbed associated functions. Current studies using neuroimaging combined with examination of executive functions, traditionally considered the sole purview of the frontal lobes, have identified a role for the cerebellum serving as a compensatory processing adjunct to enable normal performance on challenging tasks tapping executive functions. This overview proposes that disruption of an executive frontocerebellar network is a major contributor to characteristic behaviors of alcoholism that, on the one hand, enable alcohol use disorders, and on the other hand, lead to compensation for dysfunctions in alcoholism traditionally considered frontally-based.

The Frontal Assessment Battery Does Not Differentiate Frontotemporal Dementia from Alzheimer’s Disease

Background: An early differentiation of Alzheimer’s disease (AD) from frontotemporal dementia (FTD) is important, since these conditions are essentially different regarding prognosis and therapeutical approach. Until now, no single test is available which allows a reliable differentiation. The Frontal Assessment Battery (FAB) has been found to have good reliability in identifying an executive deficit in frontal syndromes and in extrapyramidal disorders. The ability of the FAB to distinguish AD from FTD in mildly demented patients is less clearly assessed. Methods: We compared FAB scores in a consecutive series of 33 FTD (frontal variant) and 85 AD patients. Results: FAB global scores in the two groups were very similar, also when considering only mildly demented subgroups [Mini Mental State Examination (MMSE) score ≧20; 20 FTD and 38 AD patients]. Considering FAB subscores, only the ‘go-no go’ subtest showed a significant difference, reflecting a poorer inhibitory motor control in AD patients. FAB scores in the two groups of patients correlated with global cognitive decline (MMSE), and with executive and visuospatial test scores, showing good concurrent validity. Conclusion: The FAB does not differentiate patients with AD from those with FTD, like all other executive tests. However, it may be useful in the examination of executive function in AD, FTD and several other pathological conditions.

Neuropsychological Test Performances of Young Depressed Outpatient Women: An Examination of Executive Functions

Thirty young, unmedicated, outpatient, depressed women were compared to an equal number of matching controls on a series of neuropsychological tests purported to be sensitive to the executive functions. Specifically, the measures included the Design Fluency Test, Hand Dynamometer tasks of grip strength, perseveration, and fatigue, the FAS Verbal Fluency Test, the Stroop Color and Word Test, and the Trail Making Test (Parts A and B). Despite past research which has indicated anterior hemispheric asymmetries and impaired neurocognitive performances in depressives, this research failed to identify any reliable differences between depressed and nondepressed women on any of the neuropsychological measures. These results argue against the frequently held stereotype that depressed individuals typically display impaired performances on neurocognitive tasks. Furthermore, since the profile of the depressed sample appeared to differ significantly from past studies, a discussion is provided as to how the characteristics of this group may have impacted the results. Implications of these findings for clinical practice and future research are also provided.

Neuropsychological test performances of young depressed outpatient women. An examination of executive functions.

Thirty young, unmedicated, outpatient, depressed women were compared to an equal number of matching controls on a series of neuropsychological tests purported to be sensitive to the executive functions. Specifically, the measures included the Design Fluency Test, Hand Dynamometer tasks of grip strength, perseveration, and fatigue, the FAS Verbal Fluency Test, the Stroop Color and Word Test, and the Trail Making Test (Parts A and B). Despite past research which has indicated anterior hemispheric asymmetries and impaired neurocognitive performances in depressives, this research failed to identify any reliable differences between depressed and nondepressed women on any of the neuropsychological measures. These results argue against the frequently held stereotype that depressed individuals typically display impaired performances on neurocognitive tasks. Furthermore, since the profile of the depressed sample appeared to differ significantly from past studies, a discussion is provided as to how the characteristics of this group may have impacted the results. Implications of these findings for clinical practice and future research are also provided.