Assessment Of Executive Functions Research Articles

The latent structure of the Delis-Kaplan system for autism.

A core feature of autism is deficits in executive functioning (EF), including difficulty with planning, cognitive flexibility, and working memory. Despite a growing need for evidence-based assessments of EF for autism populations, statistical models of many commonly used measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), have not been investigated for a sample of autistic participants. The purpose of this study was to address a gap in the literature regarding the latent structure of the D-KEFS in a sample of autistic individuals. The D-KEFS is one of the most widely used clinical assessments of executive function, but its factor structure has not been examined in a sample of autistic participants. Reliability analyses were performed for sample subgroups based on participants' clinical and demographic characteristics, including IQ, autism severity, age, and race/ethnicity. Verbal Fluency (VF) was found to consistently decrease or not affect the overall reliability score. Additionally, one- and two-factor structure models were tested for the D-KEFS with a sample of autistic participants. The one-factor model was not found to be a good fit for the data. However, the two-factor model, with Cognitive Flexibility and Abstraction latent factors, was found to fit the data relatively well. This two-factor model was reexamined excluding the VF observed variable, resulting in a better overall model fit. Communication deficits are a common feature of autism, which explains why the VF task, that requires participants to produce novel words, may not be an adequate measure of executive function for autism populations.

Developmental and behavioral phenotypes of pediatric patients with PTEN hamartoma tumor syndrome.

Our study characterized the neurodevelopmental spectrum of individuals with PTEN Hamartoma Tumor Syndrome (PHTS), a syndrome that predisposes to both neurodevelopmental phenotypes and cancer risk. We aim to better understand life-impacting neurodevelopmental features of PHTS. Our study recruited 20 children/adolescents with PHTS, who were then administered assessments for autism spectrum disorder (ASD) and other neurocognitive measures, including assessment of IQ, executive and adaptive functioning, and health-related quality of life. Thirteen individuals (65%) were identified as having ASD, of which five were newly diagnosed during the study. Of those, ASD symptom severity was in the mild-moderate range for 77%. Overall, IQ was in the average range, with a mean of 92.61 (SD 24.45, p = 0.5), though there was a non-statistically significant trend toward individuals without ASD having a higher mean IQ (102.7 vs 82.3; p = 0.1). Subjects had significant impairment in processing speed (mean 75.38, SD 24.75, p < 0.05), decreased adaptive functioning skills across all domains, and a trend toward having more executive functioning problems. Individuals with PHTS are at increased risk of neurodevelopmental disorders, including ASD and impaired executive and adaptive functioning. Although clear guidelines exist for cancer surveillance for individuals with PHTS, additional guidelines and screening for neurodevelopmental disorders are warranted.

Principles for Adapting Assessments of Executive Function across Cultural Contexts.

Direct assessments of executive functions (EFs) are increasingly used in research and clinical settings, with a central assumption that they assess "universal" underlying skills. Their use is spreading globally, raising questions about the cultural appropriateness of assessments devised in Western industrialized countries. We selectively reviewed multidisciplinary evidence and theory to identify sets of cultural preferences that may be at odds with the implicit assumptions of EF assessments. These preferences relate to motivation and compliance; cultural expectations for interpersonal engagement; contextualized vs. academic thinking; cultural notions of speed and time; the willingness to be silly, be incorrect, or do the opposite; and subject-matter familiarity. In each case, we discuss how the cultural preference may be incompatible with the assumptions of assessments, and how future research and practice can address the issue. Many of the cultural preferences discussed differ between interdependent and independent cultures and between schooled and unschooled populations. Adapting testing protocols to these cultural preferences in different contexts will be important for expanding our scientific understanding of EF from the narrow slice of the human population that has participated in the research to date.

Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review.

Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while the assessment of executive functions (EF) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicate removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60Hz, pulse durations ranging 1-2ms, and intensity ranging 2-6mA. Cognitive function was monitored with the Stroop task, spatial-2-back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

Abstract P170: Cognitive Function at Midlife by Sexual Orientation and Gender Identity in the CARDIA Cohort

Introduction: Sexual and gender minority (SGM) individuals have higher prevalence of dementia risk factors compared to non-SGM individuals. However, it is not known if differences in cognitive function appear during midlife, as prior studies lack comprehensive measures for sex, sexual orientation, and gender identity (SSOGI) or standardized cognitive assessments. We utilized Coronary Artery Risk Development in Young Adults (CARDIA) study data to assess midlife cognition by SSOGI. Hypothesis: We hypothesize that middle-aged sexual minority (SM) and transgender and non-binary (TGNB) participants demonstrate worse cognitive test scores compared to non-SM and non-TGNB participants, respectively. Methods: A total of 1,978 CARDIA participants completed cognitive assessments at Y25 and self-reported SSOGI measures at Y35. Participants with a history of brain cancer, kidney failure, or stroke prior to Y25 were excluded. Y25 examination included administration of standardized cognitive assessments of verbal memory (Rey Auditory Verbal Learning Test; RAVLT), processing speed (Digit Symbol Substitution Test; DSST), and executive function (Stroop Test). SSOGI variables are listed in Table 1 . Wilcoxon t-tests were used to compare cognitive test scores between analytic subgroups. Results: Mean age of the overall cohort at Y25 was 45 (SD = 3.6) years and 43% identified as Black. TGNB individuals performed significantly worse on a memory recall portion of the RAVLT ( p &lt;0.001) and DSST ( p &lt;0.05) compared to non-TGNB individuals. There was no significant difference in cognitive test scores between SM and non-SM and gay/lesbian and bisexual individuals. See Table 1 for statistical results. Conclusions: Preliminary findings suggest TGNB individuals may demonstrate lower midlife cognitive performance related to verbal memory and processing speed compared to non-TGNB individuals. Future studies will analyze associations of depression and chronic conditions with cognitive scores and expand to later CARDIA time points.

Subjective and objective assessments of executive functions are independently predictive of aggressive tendencies in patients with substance use disorder

Background and aimsImpairments in executive functions have been found to influence violent behavior. Executive functions are crucial in the treatment of patients with substance use disorders because substance use generally impairs cognitive processes and is therefore detrimental for executive functions thereby reducing control of behavior and thus of consumption impulses. We studied correlations between subjective, i.e. self-report, and objective, i.e. behavior-based, assessment of executive functions and the predictive validity of these measures for aggression in patients with substance use disorder. MethodsThe study included 64 patients with a diagnosed substance use disorder who were convicted according to the German Criminal Code for crimes they committed in the context of their disorder and were therefore in treatment in forensic psychiatric departments in Germany. Multiple self-report and behavior-based instruments were used to assess executive functions, appetitive and facilitative aggression as well as clinical and sociodemographic variables. ResultsParticipants showed impaired executive functions, and measures of executive functions predicted aggressive tendencies and violent offenses. Despite ecological validity of the findings, the subjective and objective assessments of executive functions did not correlate with each other, which corroborates studies in other clinical settings. ConclusionsWe discuss that this finding may be due to the conceptual differences between subjective and objective measures. Therefore, self-report and behavior-based measures should not be used as proxies of each other but as complementary measures that are useful for comprehensive diagnostics of cognitive impairments and assessment of risks for violent behavior.

The relationship between objective and subjective executive function in Parkinson’s disease

ABSTRACT Introduction Difficulties in executive functioning (EF) are common in PD; however, the relationship between subjective and objective EF is unclear. Understanding this relationship could help guide clinical EF assessment. This study examined the relationship between subjective self-reported EF (SEF) and objective EF (OEF) and predictors of SEF-OEF discrepancies in PD. Method One-hundred and sixteen non-demented PD participants completed measures of OEF (i.e. problem-solving, cognitive flexibility, inhibition, and working memory) and SEF (Frontal Systems Behavior Scale-Self Executive Dysfunction Subscale). Pearson bivariate correlations and linear regressions were performed to examine the relationship between SEF and OEF and the non-motor symptoms (e.g. mood, fatigue), demographic, and PD characteristic (e.g. MCI status) predictors of discrepancies between OEF and SEF (|OEF minus SEF scores|). Correlates of under-, over-, and accurate-reporting were also explored. Results Greater SEF complaints and worse OEF were significantly associated (β =.200, p = .009) and 64% of participants accurately identified their level of OEF abilities. Fewer years of education and greater symptoms of depression, anxiety, and fatigue significantly correlated with greater discrepancies between OEF and SEF. Fatigue was the best predictor of EF discrepancy in the overall sample (β = .281, p = .022). Exploratory analyses revealed apathy and fatigue associated with greater under-reporting, while anxiety associated with greater over-reporting. Conclusions SEF and OEF are significantly related in PD. Approximately 64% of non-demented persons with PD accurately reported their EF skill level, while 28% under-reported and 8% over-reported. SEF-OEF discrepancies were predicted by fatigue in the overall sample. Preliminary evidence suggests reduced apathy and fatigue symptoms relate to more under-reporting, while anxiety relates to greater over-reporting. Given the prevalence of these non-motor symptoms in PD, it is important to carefully consider them when assessing EF in PD.

Assessing the Contribution of Measures of Attention and Executive Function to Diagnosis of ADHD or Autism.

Attention and executive function (EF) dysregulation are common in a number of disorders including autism and attention-deficit/hyperactivity disorder (ADHD). Better understanding of the relationship between indirect and direct measures of attention and EF and common neurodevelopmental diagnoses may contribute to more efficient and effective diagnostic assessment in childhood. We obtained cognitive (NIH Toolbox, Little Man Task, Matrix Reasoning Task, and Rey Delayed Recall) and symptom (CBCL, and BPMT) assessment data from the Adolescent Brain and Cognitive Development (ABCD) database for three groups, autistic (N = 110), ADHD (N = 878), and control without autism or ADHD diagnoses (N = 9130) and used ridge regression to determine which attention and EF assessments were most strongly associated with autism or ADHD. More variance was accounted for in the model for the ADHD group (31%) compared to the autism group (2.7%). Finally, we ran odds ratios (using clinical cutoffs where available and 2 standard deviations below the mean when not) for each assessment measure, which generally demonstrated a greater significance within the indirect measures when compared to the direct measures. These results add to the growing literature of symptom variably across diagnostic groups allowing for better understanding of presentations in autism and ADHD and how best to assess diagnosis. It also highlights the increased difficulty in differentiating autism and controls when compared to ADHD and controls and the importance of indirect measures of attention and EF in this differentiation.

The Long and Winding Road to Real-Life Experiments: Remote Assessment of Executive Functions with Computerized Games-Results from 8 Years of Naturalistic Interventions.

Mate Marote is an open-access cognitive training software aimed at children between 4 and 8 years old. It consists of a set of computerized games specifically tailored to train and evaluate Executive Functions (EF), a class of processes critical for purposeful, goal-directed behavior, including working memory, planning, flexibility, and inhibitory control. Since 2008, several studies were performed with this software at children's own schools in interventions supervised in-person by cognitive scientists. After 2015, we incorporated naturalistic, yet controlled, interventions with children's own teachers' help. The platform includes a battery of standardized tests, disguised as games, to assess children's EF. The main question that emerges is whether the results, obtained with these traditional tasks but conducted without the presence of researchers, are comparable to those widely reported in the literature, that were obtained in more supervised settings. In this study, we were able to replicate the expected difficulty and age effects in at least one of the analyzed dependent variables of each employed test. We also report important discrepancies between the expected and the observed response time patterns, specifically for time-constrained tasks. We hereby discuss the benefits and setbacks of a new possible strategy for this type of assessment in naturalistic settings. We conclude that this battery of established EF tasks adapted for its remote usage is appropriate to measure the expected mental processes in naturalistic settings, enriching opportunities to upscale cognitive training interventions at schools. These types of tools can constitute a concerted strategy to bring together educational neuroscience research and real-life practice.

In search of better practice in executive functions assessment: Methodological issues and potential solutions.

The multicomponent nature of executive functions (EF) has long been recognized, pushing for a better understanding of both the commonalities and the diversity between EF components. Despite the advances made, the operationalization of performance in EF tasks remains rather heterogeneous, and the structure of EF as modeled by confirmatory factor analyses (CFA) is still a topic of debate (Karr et al., 2018). The present work demonstrates these two issues are related, showing how different operationalizations in task-based performance indicators impact the resulting models of EF structure with CFA. Using bootstrapped data from 294 children (8-12 years old) and nine EF tasks (tapping inhibition, working memory, and cognitive flexibility), we first show improved model convergence and acceptance when operationalizing EF through single tasks' scores (e.g., incongruent trials, Flanker task) relative to difference scores (e.g., incongruent minus congruent trials, Flanker task). Furthermore, we show that response times exhibit poor model convergence and acceptance compared not only to accuracy but also drift rate. The latter, a well-known indicator in drift-diffusion models, is found to present the best trade-off between convergence and acceptance to model EF with CFA. Finally, we examine how various operationalizations of performance in EF tasks impact CFA model comparison in the assessment of EF structure and discuss the theoretical foundations for these results. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Inclusion of individuals with Down syndrome in auditory research

This talk will provide an overview of the procedures, challenges, and key findings of Project INCLUDE at Boys Town National Research Hospital. Funded by a trans-NIH initiative to investigate health conditions that affect individuals living with Down syndrome, the goal of Project INCLUDE at Boys Town National Research Hospital is to characterize how speech, language, and hearing develop across the lifespan. Individuals living with Down syndrome have been inadequately represented in auditory research, which has likely contributed to health care disparities. The exclusion of individuals with Down syndrome in prior research is particularly concerning given the high prevalence of hearing loss and otologic disease observed in this population. Results from an ongoing experiment investigating masked speech recognition outcomes will be presented. Participants are school-age children and young adults with Down syndrome and age-matched participants who are neurotypical. Data collection includes clinical audiological measures and standardized assessments of speech, language, and executive function, facilitating comparisons with other cohorts affiliated with the NIH-wide initiative. Recommendations for recruitment, details on the formation of a community advisory board, and community-based testing initiatives will be discussed.

Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging.

Executive function (EF) impairments are prevalent post stroke and are associated with white matter (WM) damage on MRI. However, less is known about the relationship between poststroke EF and WM damage on CT imaging. To investigate the relationship between poststroke EF and WM damage associated with stroke lesions and WM hypointensities (WMHs) on clinically acquired CT imaging. This study analyzed data from the Oxford Cognitive Screening Program, which recruited individuals aged ≥18 years with a confirmed stroke from an acute stroke unit. The individuals completed a follow-up assessment 6 months post stroke. We included individuals with a CT scan showing a visible stroke who completed follow-up EF assessment using the Oxford Cognitive Screen-Plus rule-finding task. We manually delineated stroke lesions and quantified then dichotomized WM damage caused by the stroke using the HCP-842 atlas. We visually rated then dichotomized WMHs using the Age-Related White Matter Changes Scale. Among 87 stroke survivors (M age = 73.60 ± 11.75; 41 female; 61 ischemic stroke), multivariable linear regression showed that stroke damage to the medial lemniscus ( B = -8.86, P < 0.001) and the presence of WMHs ( B = -5.42, P = 0.005) were associated with poorer EF 6 months post stroke after adjusting for covariates including age and education. Poorer EF was associated with WM damage caused by stroke lesions and WMHs on CT. These results confirm the importance of WM integrity for EF post stroke and demonstrate the prognostic utility of CT-derived imaging markers for poststroke cognitive outcomes.

The contributions of executive functioning to handwritten and keyboarded compositions in Year 2 children

Writing is a multifaceted skill, recruiting varied cognitive processes that involve working memory, attention shifting and inhibition, also known as executive functioning (EF). Despite emerging research examining associations between EF and handwritten composition, the mediating role of transcription skills on the relation between EF and text composition remains underexplored. Even less is understood about the nature of these potential mediation mechanisms in keyboard-based text composing, a writing modality that is becoming pervasive during the first years of schooling. This study investigated whether the automaticity of inscription skills (handwriting and keyboarding) and spelling mediate the relation between children’s EF and text composition across two modes (paper and keyboard-based text composing) on a sample of 544 Year 2 Australian children. Assessments of EF, inscription skills, spelling, and text composition were measured concurrently. Indirect pathways were tested via structural equation modelling. Findings indicated that across text composition modes, handwriting automaticity, keyboarding automaticity and spelling mediated the relationship between children’s EF and writing composition (i.e., compositional fluency and quality). The findings of this study extend current understanding of associations between cognitive processes and text composition in the junior years by examining keyboard-based text composing.

Cognitive functioning in adolescents with severe obesity undergoing bariatric surgery or intensive non-surgical treatment in Sweden (AMOS2): a multicentre, open-label, randomised controlled trial

Severe obesity during childhood is associated with cognitive deficits. Studies in adults have suggested improvements in executive functioning and memory after bariatric surgery. Our aim was to explore changes in cognitive function in adolescents over two years after bariatric surgery or intensive non-surgical treatment. The Adolescent Morbid Obesity Surgery 2 (AMOS2) is a multicentre, open-label, randomised controlled trial in which adolescents (aged 13-16 years) with severe obesity (defined as body mass index (BMI) ≥35kg/m2) at three specialised obesity centres in Sweden, were randomly assigned to receive bariatric surgery or intensive non-surgical treatment. Herein we report the results of the prespecified exploratory endpoint of change in cognitive functioning. Inclusion in AMOS2 required Tanner pubertal stage ≥3, previous participation in lifestyle obesity treatment for at least one year, and passed assessment form a paediatrician and a paediatric psychologist. Adolescents with severe intellectual disability or other severe, pervasive developmental disorder were excluded. Participants underwent baseline assessment of general intellectual ability, executive functioning, and memory before randomisation. Tests were administrated by clinical psychologists and repeated at one- and two-year follow-up timepoints. Differences in means between groups during follow-up are provided with confidence intervals. The trial is registered at ClinicalTrials.gov, NCT02378259. Between October 28 2015 and June 7 2017, 46 adolescents (74% girls), with a mean age of 15.8 (±0.92) years and a mean BMI of 42.8 (±5.4) kg/m2, were included and randomised (23 to bariatric surgery and 23 to intensive non-surgical treatment). At baseline 23/46 (50%) of the adolescents had general intellectual functioning classified as borderline or below. For 15/18 (83%) aspects of cognitive functioning, no significant differences in change over two years were identified between groups; Immediate (average difference during follow-up 1.0 [95% CI:-2.6 to 4.6]) and Delayed (0.5 [95% CI:-0.6 to 1.6]) Verbal Recall, Category Fluency (1.1 [95% CI:-1.6 to 3.8]) and Switching (1.5 [95% CI:-0.0 to 2.9]), Number (-6.0 [95% CI:-12.3 to 0.3]) and Letter (0.1 [95% CI:-5.2 to 5.3]) Sequencing, Number-Letter Switching (-10.3 [95% CI:-26.4 to 5.8]), Motor Speed (-8.3 [95% CI:-17.5 to 0.9]), Colour Naming (-1.9 [95% CI:-4.2 to 0.3]), Inhibition (-3.6 [95% CI:-9.6 to 2.5]), Inhibition Switching (-6.7 [95% CI:-15.3 to 1.9]), Mazes (-0.5 [95% CI:-4.9 to 3.9]), Digit Span Forward (0.1 [95% CI:-0.6 to 0.9 ]) and Backward (0.6 [95% CI:-0.4 to 1.6 ]), and Estimated IQ (0.4 [95% CI:-3.9 to 4.8]; all p>0.05). Three sub-tests assessing fundamental cognitive skills improved more over two years in operated adolescents than in intensive non-surgical treatment; Letter Fluency (average difference during follow-up 3.8 [95% CI: 0.1-7.5]; p=0.046), Visual Scanning (-6.5 [95% CI:-11.6 to-1.5]; p=0.011), and Word Reading (-1.9 [95% CI:-3.3 to-0.4]; p=0.011). In contrast to non-randomised studies in adults, we could not demonstrate an association of bariatric surgery and its accompanying significant weight loss with overall greater improvement in executive functions and memory in adolescents over two years compared with a non-surgical group without weight loss. However, lack of statistical power is a potential limitation. The clinical relevance of greater improvements in basic cognitive skills needs to be explored. Sweden's innovation agency (VINNOVA), Swedish Research Council, Joanna Cocozza foundation for paediatric research, The Skane University Hospital Psychology Research and Development Grant, Tore Nilsson's Foundation, SUS Foundations and Donations, and Mary von Sydow's Foundation.

Assessment of Executive Functions in School Considering Motor and Sociodemographic Factors: A Joint Vision for School-Based Occupational Therapists and School Staff

Executive functions (EFs) and motor skills are essential for many school and daily tasks. Many school-based occupational therapists need help addressing EFs. The current study aims to provide new insights into the relationship between executive functions and motor development by considering confounding factors. Ninety-six second-grade children were tested in one state-funded (public) school and another state-subsidised private school. Children were assessed with the Movement Assessment Battery for Children-2 (MABC-2), Neuropsychological Assessment of Executive Functions in Children, and Test of Perception of Differences–R. Families completed a sociodemographic questionnaire, and teachers completed a previous questionnaire and subsequently evaluated the information the occupational therapist provided. Mixed results were obtained regarding the correlation between motor and executive skills. Furthermore, children who received worse scores on the MABC-2 had more difficulties on the EFs tests. The Impulsivity Control Index was not correlated with any motor variable. Our results show that sociodemographic variables (except gender) correlate more with EFs than motor skills. The teachers showed a high degree of agreement with the occupational therapist (4.0 ± 0.8), even in children with good academic performance. They expressed the need for additional training and classroom interventions. A joint vision of motor-executive functioning can facilitate the design of effective interventions, especially in schools with more disadvantaged populations.

One Score to Rule Them All? Comparing the Predictive and Concurrent Validity of 30 Hearts and Flowers Scoring Approaches.

The Hearts and Flowers (H&F) task is a computerized executive functioning (EF) assessment that has been used to measure EF from early childhood to adulthood. It provides data on accuracy and reaction time (RT) across three different task blocks (hearts, flowers, and mixed). However, there is a lack of consensus in the field on how to score the task that makes it difficult to interpret findings across studies. The current study, which includes a demographically diverse population of kindergarteners from Boston Public Schools (N = 946), compares the predictive and concurrent validity of 30 ways of scoring H&F, each with a different combination of accuracy, RT, and task block(s). Our exploratory results provide evidence supporting the use of a two-vector average score based on Zelazo et al.'s approach of adding accuracy and RT scores together only after individuals pass a certain accuracy threshold. Findings have implications for scoring future tablet-based developmental assessments.

Design of a video game for assessment of executive functions in deaf and hearing children

This study investigates the effectiveness of a computerized cognitive test battery embedded within a video game to assess executive functions (EF) in deaf and hearing children. We evaluated a diverse cohort of 290 elementary school students aged 5 to 13 years (mean age = 8.86, SD = 1.96), comprising 74 sign language users, 14 Spanish-speaking deaf participants, 23 children with mixed communication methods, and 179 typically hearing individuals. Our statistical analysis focused on item discrimination, reliability, and criterion validation of the game-based assessments. The results indicated high reliability and effective discrimination of EF across the game’s three primary stages. External validation was conducted using the Matrices Test, educational attainment, and age as variables. A significant positive correlation (r = 0.377, p < 0.001) was observed between the Matrices Test scores and game-based achievement scores. Furthermore, linear regression analysis revealed education (Standardized Beta = 0.339) and age (Standardized Beta = 0.179) as significant predictors of performance in these scores. This study underscores the value of integrating computerized cognitive assessments within a video game environment for comprehensive neuropsychological evaluations, highlighting its potential in diverse child populations.

Irony Understanding in Children With Attention-Deficit/Hyperactivity Disorder: A Comparative Analysis.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can significantly impact a child's daily life and academic performance. Some studies have noted challenges in social cognition among children with ADHD, specifically in aspects like emotion perception and processing, empathy, Theory of Mind, and pragmatics. One of the lesser-explored aspects of ADHD is its potential impact on higher-level language skills, such as irony understanding. Our goal in this study was to compare irony comprehension in two groups: schoolchildren with normal development and schoolchildren with ADHD. We performed a comparative cross-sectional study on a total of 35 children aged between 6 and 12 years: 17 with ADHD and 18 not neurodevelopmentally impaired. Irony comprehension was evaluated using an assessment method validated for the Portuguese population: Turtle on the Island - Battery of Assessment of Executive Functions in Children (TI-BAFEC). We also applied the EACE (Emotional Awareness and Coping in Children) scale. It is the Portuguese adaptation of the Assessment of Children's Emotion Skills and assesses children's emotional knowledge. We obtained two comparable groups concerning sociodemographic data. The analysis of the data, using the Mann-Whitney U Test, showed that in all parameters, the control group consistently exhibited superior performance compared to the ADHD group. However, only TI-BAFEC (p = 0.005) and emotional behavior (p = 0.007) showed a significant statistical variance between the two groups. This article shows that children with ADHD encounter challenges in grasping irony. However, the underlying cognitive processes contributing to these difficulties warrant further investigation.

Three Virtual Reality Environments for the Assessment of Executive Functioning Using Performance Scores and Kinematics: An Embodied and Ecological Approach to Cognition.

Virtual reality (VR) is an attractive technology for cognitive assessment, as it provides a more embodied experience compared with typical test situations, such as those using paper and pencil. In addition, VR can immerse individuals in complex situations similar to real-life ones, thereby improving the ecological validity (i.e., face validity) of the assessment. VR also offers improved scoring of tests as it facilitates the tracking of kinematic information and the temporal tracking of activities. This study assesses the correlation between scores on executive function assessments using standard neuropsychological tasks in paper-and-pencil format, on a tablet, and in three immersive VR environments, each designed to involve specific aspects of executive function. This study also aims to assess the correlation between these performance scores and a set of kinematic measures (speed, duration, and distance traveled by the hand) collected in VR. The outcomes, including performance scores and kinematic measures, correlate both with traditional assessment methods (such as paper and pencil, and computerized 2D tests) and with each other, suggesting their potential usefulness in clinical and research contexts. The discussion focuses on the advantages of embodied, situated, and spatialized tests for cognitive assessment and the benefits of kinematic tracking in VR tests for the quality of this assessment.

Executive functions assessment in very preterm children at school age: A pilot study about a clinical and experimental approach

While the survival rate of very preterm (VPT) infants has increased in the last decades, they are still at risk of developing long-term neurodevelopmental impairments, especially regarding self-regulatory abilities, and goal-directed behaviors. These skills rely on executive functions (EFs), an umbrella term encompassing the core capacities for inhibition, shifting, and working memory. Existing comprehensive tests are time-consuming and therefore not suitable for all pediatric neuropsychological assessments. The Flanker task is an experimental computer game having the advantage to last less than ten minutes while giving multiple EFs measures. Here, we tested the potency of this task in thirty-one VPT children aged 8–10 years during their clinical assessment. First, we found that VPT children performed in the norm for most clinical tests (i.e., WISC-V, BRIEF, and NEPSY) except for the CPT-3 where they were slower with more omission errors, which could indicate inattentiveness. Second, some Flanker task scores were correlated with standardized clinical testing without resisting to multiple comparisons correction. Finally, compared to full-term children, VPT children showed poorer performance in global EFs measure and lower accuracy in the Flanker task. These findings suggest that this child-friendly version of the Flanker task demonstrated a reasonable sensitivity in capturing EFs with good discrimination between VPT and term children despite VPT children’s mild difficulties. It may represent a promising tool for neuropsychological assessments and be suitable as a screening test, providing further validating larger studies. Moreover, while VPT schoolchildren globally display normal intelligence, subtle difficulties that seem to relate to EFs are observed.