Executive Function Capacity Research Articles

Predicting Learning: Understanding the Role of Executive Functions in Children's Belief Revision Using Bayesian Models.

Recent studies suggest that learners who are asked to predict the outcome of an event learn more than learners who are asked to evaluate it retrospectively or not at all. One possible explanation for this "prediction boost" is that it helps learners engage metacognitive reasoning skills that may not be spontaneously leveraged, especially for individuals with still-developing executive functions. In this paper, we combined multiple analytic approaches to investigate the potential role of executive functions in elementary school-aged children's science learning. We performed an experiment that investigates children's science learning during a water displacement task where a "prediction boost" had previously been observed-children either made an explicit prediction or evaluated an event post hoc (i.e., postdiction). We then considered the relation of executive function measures and learning, which were collected following the main experiment. Via mixed effects regression models, we found that stronger executive function skills (i.e., stronger inhibition and switching scores) were associated with higher accuracy in Postdiction but not in the Prediction Condition. Using a theory-based Bayesian model, we simulated children's individual performance on the learning task (capturing "belief flexibility"), and compared this "flexibility" to the other measures to understand the relationship between belief revision, executive function, and prediction. Children in the Prediction Condition showed near-ceiling "belief flexibility" scores, which were significantly higher than among children in the Postdiction Condition. We also found a significant correlation between children's executive function measures to our "belief flexibility" parameter, but only for children in the Postdiction Condition. These results indicate that when children provided responses post hoc, they may have required stronger executive function capacities to navigate the learning task. Additionally, these results suggest that the "prediction boost" in children's science learning could be explained by increased metacognitive flexibility in the belief revision process.

Cognition and Functional Capacity: An Initial Comparison of Veteran and Non-Veteran Older Adults.

The U.S. Military Veterans aged 65 and older comprise an estimated 43% of the 22 million living Veterans in the United States. Veterans have high rates of physical, psychiatric, and social challenges, but it is not known whether Veteran status confers additional risk for cognitive or functional impairments in later life. Thus, this investigation specifically compared older Veterans with their non-Veteran peers in cognitive functioning and performance-based functional capacity. Participants (N = 110; 29 Veterans and 81 non-Veterans) were part of a larger longitudinal study on biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. The University of California San Diego Institutional Review Board approved the study and all participants provided written informed consent. Participants provided demographic and mental health information and were administered a comprehensive neuropsychological battery. Functional capacity was assessed using the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), which uses financial and communication role-plays to assess everyday functioning skills. Neuropsychological scores were appropriately normed prior to analysis. Multivariate Analyses of Variances with post hoc t-tests and an Analysis of Covariance were used to examine neuropsychological and functional capacity differences, respectively, between Veterans and non-Veterans. Veterans did not differ from non-Veterans in educational attainment (16.4 years versus 15.5 years, P = 0.110), but they were significantly older (mean age 86.9 years ± 5.7, versus 81.74 years ± 6.53; P < 0.001) and were more likely to be male (X2 [1, N = 110] = 62.39, P < 0.001). Thus, though neuropsychological norms already accounted for demographic differences in our participants, age and sex were controlled in the Analysis of Covariance predicting UPSA-B score from Veteran status. Results suggested that, compared to non-Veterans, Veterans had significantly worse performance in the list learning portion of a test of verbal memory (Hopkins Verbal Learning Test-Revised, Total Recall; t = 2.56, P = 0.012, d = 0.56). Veterans and non-Veterans did not significantly differ in performance on the delayed recall portion of the verbal learning test and did not differ on a cognitive screening test (Montreal Cognitive Assessment) or on measures of premorbid intellectual functioning (Wide Range Achievement Test-4 Reading), language (Boston Naming Test, Verbal Fluency), visual memory (Brief Visuospatial Memory Test-Revised), attention/working memory (WAIS-IV Digit Span), processing speed (WAIS-IV Digit Symbol Coding), executive function (Delis-Kaplan Executive Function System Trails and Color-Word Test), or functional capacity (UPSA-B). Because our examination of multiple outcomes might have inflated Type I error, we performed a post hoc adjustment of P values using Benjamini-Hochberg procedures and the group difference in verbal learning remained significant. Despite largely similar function in most domains, Veterans performed significantly more poorly in verbal list learning than their non-Veteran peers. Additional attention should be given to the understanding, assessment, and possible treatment of learning and memory differences in older Veterans, as this may be an area in which Veteran status confers additional risk or vulnerability to decline. This is the first study to compare objective neuropsychological and functional performance between older (age 65+) US Veterans and non-Veterans.

Maternal executive function and stress and children's behavior problem treatment outcomes.

This prospective, observational study was designed to investigate the relationship of mothers' executive function capacities and parenting stress to early dropout, appointment attendance, and outcomes of in-clinic delivery of parent management training to address children's behavior problems. We hypothesized that mothers' executive functions (EFs) would be prospectively and positively associated with adherence to children's behavioral treatment appointments and reduction in children's behavior problems and that mothers' stress levels would be inversely related to these outcomes. Mothers (n = 288) completed the Behavior Rating Inventory of Executive Function for Adults (EF) and Parenting Stress Index at the beginning of treatment. Children were 2-12 years old. Regression models evaluated the extent to which deficits in maternal EF and clinical levels of parenting stress contributed to the three outcomes. The 11% of mothers with clinically significant deficits in executive functioning were significantly (3 times) more likely to drop out early compared to mothers in the normal range. Almost one third of mothers reported clinically significant parenting stress. Their children were half as likely to achieve a positive behavior outcome, although stress was not significantly associated with attendance. Remaining in treatment is fundamental to being able to learn and practice the parenting skills necessary to manage young children's age-inappropriate behavior in positive ways. Clinical consideration of mothers' EF challenges may help prevent early treatment attrition and clinical management of parenting stress may further help improve children's treatment outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of Pre-Training and Role of Working Memory Characteristics in Learning with Immersive Virtual Reality

Immersive virtual reality (IVR) is being incorporated into education, but not all learners have expertise in using this technology. As such, this research examined whether pre-training in IVR can reduce the novelty of this technology and enhance learning from IVR lessons and understand the role of individual differences in managing incoming information (i.e., executive function) and capacity for holding information (i.e., working memory capacity) in learning from an IVR lesson. Participants were split into two conditions; half of the participants played a game in IVR to become knowledgeable about IVR technology and the other half did not play this game. All participants then learned a lesson in IVR, took a posttest, and completed working memory tasks. The results showed that playing the game prior to learning in IVR did not change the learners’ experience of distraction or their learning outcome, indicating that IVR game-playing was not an effective form of pre-training. Additionally, several measures of executive function and working memory capacity were correlated with posttest performance, indicating that students with better executive function learn better with distracting media such as IVR, regardless of pre-training. Theoretical and practical implications are discussed.

Individual differences in executive function affect learning with immersive virtual reality

AbstractBackgroundImmersive virtual reality (IVR) is a new technology that could motivate learners, but also could contain distracting elements that increase cognitive demands on learners. In contrast, learning with conventional media, such as a narrated slideshow could be less motivating, but also less distracting.ObjectivesThis experiment investigates: (1) in what situations executive function and working memory capacity play a role in learning in IVR and a slideshow lesson and (2) whether people learn science content better with IVR or with a narrated slideshow lesson.MethodParticipants watched a lesson on ocean acidification either using a head‐mounted display IVR device or a pre‐recorded narrated slideshow lesson. A week later, they took a test on this material and completed tasks to assess executive function and working memory capacity.Results and ConclusionOn a post‐test, there was no difference between IVR and slideshow lessons, but there were differences in the role of executive function in learning with these two media. For students learning in IVR, executive function correlated significantly with post‐test scores, such that learners with stronger executive function did better on the posttest than those with weaker executive function, while for students learning with a slideshow lesson, executive function and working memory capacity did not correlate significantly with posttest scores. This research indicates that it is important to understand how a learner's attentional controls impact their understanding when using IVR for learning.

Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities.

Many techniques have attempted to provide physical support to ease the execution of a typing task by individuals with developmental disabilities (DD). These techniques have been controversial due to concerns that the support provider's touch can influence the typed content. The most common interpretation of assisted typing as an ideomotor phenomenon has been qualified recently by studies showing that users with DD make identifiable contributions to the process. This paper suggests a neurophysiological pathway by which touch could lower the cognitive load of seated typing by people with DD. The required sensorimotor processes (stabilizing posture and planning and executing manual reaching movements) and cognitive operations (generating and transcribing linguistic material) place concurrent demands on cognitive resources, particularly executive function (EF). A range of developmental disabilities are characterized by deficits in sensorimotor and EF capacity. As light touch has been shown to facilitate postural coordination, it is proposed that a facilitator's touch could assist the seated typist with sensorimotor and EF deficits by reducing their sensorimotor workload and thereby freeing up shared cognitive resources for the linguistic elements of the task. This is the first theoretical framework for understanding how a facilitator's touch may assist individuals with DD to contribute linguistic content during touch-assisted typing.

Experimental expansion of relative telencephalon size improves the main executive function abilities in guppy.

Executive functions are a set of cognitive control processes required for optimizing goal-directed behavior. Despite more than two centuries of research on executive functions, mostly in humans and nonhuman primates, there is still a knowledge gap in what constitutes the mechanistic basis of evolutionary variation in executive function abilities. Here, we show experimentally that size changes in a forebrain structure (i.e. telencephalon) underlie individual variation in executive function capacities in a fish. For this, we used male guppies (Poecilia reticulata) issued from artificial selection lines with substantial differences in telencephalon size relative to the rest of the brain. We tested fish from the up- and down-selected lines not only in three tasks for the main core executive functions: cognitive flexibility, inhibitory control, and working memory, but also in a basic conditioning test that does not require executive functions. Individuals with relatively larger telencephalons outperformed individuals with smaller telencephalons in all three executive function assays but not in the conditioning assay. Based on our findings, we propose that the telencephalon is the executive brain in teleost fish. Together, it suggests that selective enlargement of key brain structures with distinct functions, like the fish telencephalon, is a potent evolutionary pathway toward evolutionary enhancement of advanced cognitive abilities in vertebrates.

Why Doesn’t Executive Function Training Improve Academic Achievement? Rethinking Individual Differences, Relevance, and Engagement from a Contextual Framework

ABSTRACT Performance on lab assessments of executive functions predicts academic achievement and other positive life outcomes. A primary goal of research on executive functions has been to design interventions that improve outcomes like academic achievement by improving executive functions. These interventions typically involve extensive practice on abstract lab-based tasks and lead to improvements on these practiced tasks. However, interventions rarely improve performance on non-practiced tasks and rarely benefit outcomes like academic achievement. Contemporary frameworks of executive function development suggest that executive functions develop and are engaged within personal, social, historical, and cultural contexts. lab-based tasks do not well-capture the real-world contexts that require executive functions and should not be expected to provide generalized benefits outside of the lab. We propose a perspective for understanding individual differences in performance on executive function assessments that focuses on contextual influences on executive functions. We extend this contextual approach to training executive function engagement, rather than training executive functions directly. First, interventions should incorporate task content that is contextually relevant to the targeted outcome. Second, interventions should encourage engaging executive functions through reinforcement and contextual relevance, which may better translate to real-world outcomes than training executive functions directly. While such individualized executive functions interventions do not address systemic factors that greatly impact outcomes like academic achievement, given the extensive resources devoted to improving executive functions, we hypothesize that interventions designed to encourage children’s engagement of executive functions hold more promise for impacting real-world outcomes than interventions designed to improve executive function capacities.

Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report.

The current study verified the association between cognitive process such as attention, executive functioning, and legal capacity in patients with bipolar disorder (BD). The sample consisted of 72 participants, assorted to episodic patients (n = 21), euthymic patients (n = 22), and healthy controls (HCs) (n = 29). We used the following neuropsychological measures: subtests of the Wechsler Abbreviated Intelligence Scale (WASI): vocabulary and matrix reasoning; Continuous Performance Test (CPT); Five Digit Test (FDT); and Rey–Osterrieth Complex Figure (ROCF). Euthymic patients expressed slower processing speed (FDT) compared to HC. They tended to make more errors with slightly worse discrimination, suggesting more impulsiveness (CPT, p < 0.01). On the contrary, episodic patients showed worse discrimination, committed more omissions, were more inconsistent with regard to response speed (CPT-3, p < 0.01), showed more difficulties in organizing their actions (ROCF: copy, p = 0.03), and were more rigid (FDT: flexibility, p = 0.03). The results suggest that bipolar patients in episode express more cognitive impairments that can compromise the quality of legal capacity. These results highlight the need for more protective support for episodic BD patients regarding legal capacity.

The Effects of Resistance Training on Physical Fitness and Neuromotor-Cognitive Functions in Adults With Down Syndrome.

Adults with Down syndrome are an underserved population at high risk for a host of different pathologies from aging and lack of activity.PurposeTo examine the effects of a 10-week resistance training program on measures of motor behavior, cognitive function, mood, and physical fitness.MethodsParticipants (n = 11) were men and women clinically diagnosed with Down syndrome (age: 25.8 ± 6.4 years; height: 151.5 ± 8.3 cm; weight: 67.5 ± 13.0 kg; IQ: 58.3 ± 19.7 units). After familiarization of testing procedures, subjects performed The Arizona Cognitive Test Battery for Down Syndrome, TGMD-2, lower and upper body strength assessments, and body composition via DXA testing, while parental guardians completed cognitive and mood survey assessments (Cognitive Scale for Down Syndrome, Behavioral Rating Inventory of Executive Function, NiSonger Child Behavior Rating Form, Scales of Independent Behavior-Revised, Child Eating Behavior Questionnaire, Social Communication Questionnaire, and Mood and Feelings Questionnaire) at pre and post 10 weeks of periodized resistance training.ResultsSignificant (P ≤ 0.05) improvements in locomotor skills and object control skills were observed post-training. Both locomotor skills (e.g., sprint, gallop, leaping, broad jump) and object control skills (e.g., baseball catch, underhand roll, basketball dribble) were all significantly improved. Facets of cognitive performance significantly improved, specifically executive function and visuospatial working memory capacity, and frontal lobe activity. Mood disturbances significantly decrease. All aspects of physical strength and endurance were improved, i.e., leg press, bench press, sit-ups, push-ups, and chair sit-to-stand post-training. Lean tissue mass was significantly increased post-training.ConclusionThis study dramatically demonstrates that life enhancements for individuals with Down syndrome are achievable with a properly designed resistance training program.

Higher-Order Executive Function in Middle School: Training Teachers to Enhance Cognition in Young Adolescents.

The epoch of adolescent brain development is an ideal time to train complex thinking skills, and middle schools provide an ideal environment to train and foster this acquisition. Unfortunately, few teachers are equipped with enough knowledge of the science of learning and evidence-based methodology, to ensure all students are given sufficient opportunity to develop their cognitive capacity to the fullest. Using our evidenced-based higher-order executive function training program, we trained current teachers to provide cognitive training to their students. The results of this study demonstrate the efficacy of teacher-implemented intervention for immediate improvement in high-level executive function capacities such as gist-reasoning and interpretive statement production. More importantly, we found evidence of far transfer via students’ improved academic performance in all standardized test content areas (Reading, Mathematics, Science, and Social Studies) when compared to their untrained peers. Our findings support the importance of providing intensive professional development that afford educators with a greater understanding of the brain, how we learn, and the importance of evidence-based programs to advance and instill high-level executive function in all students.

Association of executive function capacity with gait motor imagery ability and PFC activity: An fNIRS study

Individual differences exist in gait motor imagery ability. However, little is known about the underlying neural mechanisms. We previously conducted a study using functional near-infrared spectroscopy (fNIRS), which showed that participants who overestimated mental walking times to a greater degree exhibited greater activation in the right prefrontal cortex (PFC). The PFC is implicated in executive functions (EFs), including working memory (WM). Thus, this study investigated whether individual differences in EF capacity are associated with gait motor imagery ability and PFC activity. Thirty volunteers participated (mean age: 21.7 ± 1.8 years) in the study. Their EF capacity was assessed by the Trail Making Test - Part B (TMT-B). We measured the accuracy of gait motor imagery and PFC activity during mental walking using fNIRS, while changing task difficulty by varying the path width. The results showed that the overestimation of mental walking time over actual walking time and right PFC activity increased with an increase in the TMT-B times. These results suggest that the EF capacity, including WM, is strongly associated with gait motor imagery ability and right PFC activity. The brain network that includes the right PFC may play an important role in the maintenance and manipulation of gait motor imagery.

Transcriptional Correlates of Chronic Alcohol Neuroadaptation in Drosophila Larvae.

When presented with the choice, Drosophila melanogaster females will often prefer to lay eggs on food containing a significant amount of alcohol. While, in some cases, this behavioral decision can provide a survival advantage to the developing larvae, it can also lead to developmental and cognitive problems. Alcohol consumption can affect executive functions, episodic memory, and other brain function capacities. However, in the fruit fly, the initial cognitive effects of alcohol consumption have been shown to reverse upon persistent exposure to alcohol. Using an olfactory conditioning assay where an odorant is implemented as a conditioned stimulus and paired with a heat shock as an unconditioned stimulus, a previous study has shown that when exposed to a short acute dose of alcohol, Drosophila larvae can no longer learn this association. Interestingly, upon prolonged chronic alcohol exposure, larvae seem to successfully avoid the conditioned stimulus just as well as control alcohol-naive larvae, suggestive of alcohol-induced neuroadaptations. However, the mechanisms by which Drosophila adapt to the presence of alcohol remains unknown. In this study, we explore the transcriptional correlates of neuroadaptation in Drosophila larvae exposed to chronic alcohol to understand the genetic and cellular components responsible for this adaptation. For this, we employed RNA sequencing technology to evaluate differences in gene expression in the brain of larvae chronically exposed to alcohol. Our results suggest that alcohol-induced neuroadaptations are modulated by a diverse array of synaptic genes within the larval brain through a series of epigenetic modulators.

Maternal Psychological Distress and Executive Functions Are Associated During Early Parenthood - A FinnBrain Birth Cohort Study.

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

Daily Assessment of Executive Functioning and Expressive Suppression Predict Daily Functioning among Community-Dwelling Older Adults.

Executive functioning (EF) is known to be associated with performance of instrumental activities of daily living (IADLs). However, prior research has found that the degree to which EF fluctuates was more predictive of self-reported cognitive and IADL lapses than was average EF performance. One source of such EF fluctuations is engagement in an emotion regulation strategy known as expressive suppression (ES). Importantly, ES has also been shown to relate to IADL performance, presumably due to its impact on EF. However, past research is limited due to assessing IADLs only in the laboratory or via self-report. The present study examined (a) the association of daily EF and ES fluctuations with performance of actual IADL tasks in participants' homes, and (b) whether any significant association between ES fluctuations and daily IADLs would be mediated by daily EF variability. Participants were 52 older adults aged 60 to 95. Over the course of 18 days while at home, participants completed daily IADL tasks as well as daily measures of EF and ES via ecological momentary assessment. Contrary to our hypothesis, average EF across days predicted at-home IADLs above and beyond daily EF variability, which itself was also predictive. ES variability also predicted daily IADLs, and this association was fully mediated by average daily EF. Daily fluctuations in ES appear to have a deleterious impact on performance of IADLs at home, likely due to the impact of such fluctuations on EF, although the average level of EF capacity is also important.

Executive function capacity links future thinking and exercise intent

Objective Environmental barriers limit exercise in adolescents, but the contribution of cognitive barriers are not as well characterized. Previous findings suggest future thinking may predict exercise intent, which has been linked to health and actual exercise. However, these models may be incomplete as they do not systematically incorporate potential cognitive contributions (e.g., executive function capacity) to exercise intent. This study investigated the possible mediating role of executive function capacity in the relation between future thinking and exercise intent. Methods Data for the mediation models was collected from 101 adolescents aged 11–17 (M = 13.09) in a summer enrichment program. Adolescent participants completed self-report measures including Consideration of Future Consequences Scale (CFCS), Intent to Exercise, and Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2). Results This study found that self-reported executive function capacity mediated the relation between future thinking and exercise intent even when controlling for age and subjective socioeconomic status. Conclusions While some exercise interventions aim to increase future thinking, this study provides support for additional research into how interventions may benefit from targeting executive function capacity directly to increase exercise intent and actual exercise.

Explicit Instruction and Executive Functioning Capacity: A New Direction in Cognitive Load Theory

Explicit instruction is a teaching strategy that aims to avoid cognitive overload experienced by students which aims to improve academic performance. Previous research has mentioned working memory as a cognitive capacity that processes information and cognitive control and supports the success of explicit teaching on student academic performance. The core components of the executive function consist of working memory, but also inhibitory control and shifting. This review of the article provides new directions for the development of cognitive load theory on explicit teaching and research on executive function-based information processing aimed at avoiding cognitive load.

Evidence of residual cognitive deficits in young adults with a concussion history from adolescence

The present study investigated executive function and sustained attention of non-athlete, young adults (ages 18–23) with a history of concussion beyond ten months post incident. Cognitive functioning was examined in 24 non-athletic, college students with a concussion history (mean age 21 yrs.; mean time and range post-injury: 4 years, 10–90 months) and 24 non-athletic controls with no history (NH) of concussion. Computerized versions of two cognitive assessment techniques were utilized to examine executive functioning (Stroop) and sustained attention capacity (D2). Primary dependent variables were response time, error score, and sustained attention score. Relationships between dependent variables and concussion metrics were also analyzed. ANOVA’s revealed a significantly higher error rate in concussion history (CH) participants when performing the Stroop task (p < 0.05), including a trend for greater errors in the incongruent task condition (p < 0.05). Group measures did not differ in the sustained attention test (all p > 0.05). Nevertheless, there was a significant relationship between D2 error rate and time since concussion (p < 0.01), showing that D2 error rate was greater for participants with more time since concussion sustainment. Our findings indicate the potential for prolonged cognitive dysfunction linked to decision-making, but not to processing speed, in young adult non-athletes with a CH averaging four years post-injury. These findings may provide evidence of residual cognitive deficits in young adults with a concussion history over time.

Linking inhibitory control to math achievement via comparison of conflicting decimal numbers

The relationship between executive functions (EF) and academic achievement is well-established, but leveraging this insight to improve educational outcomes remains elusive. Here, we propose a framework for relating the role of specific EF on specific precursor skills that support later academic learning. Starting from the premise that executive functions contribute to general math skills both directly – supporting the execution of problem solving strategies – and indirectly – supporting the acquisition of precursor mathematical content, we hypothesize that the contribution of domain-general EF capacities to precursor skills that support later learning can help explain relations between EF and overall math skills. We test this hypothesis by examining whether the contribution of inhibitory control on general math knowledge can be explained by inhibition's contribution to processing rational number pairs that conflict with individual's prior whole number knowledge. In 97 college students (79 female, age = 20.58 years), we collected three measures of EF: working memory (backwards spatial span), inhibition (color-word Stroop) and cognitive flexibility (task switching), and timed and untimed standardized measures of math achievement. Our target precursor skill was a decimals comparison task where correct responses were inconsistent with prior whole number knowledge (e.g., 0.27 vs. 0.9). Participants performed worse on these trials relative to the consistent decimals pairs (e.g., 0.2 vs. 0.87). Individual differences in the Stroop task predicted performance on inconsistent decimal comparisons, which in turn predicted general math achievement. With respect to relating inhibitory control to math achievement, Stroop performance was an independent predictor of achievement after accounting for age, working memory and cognitive flexibility, but decimal performance mediated this relationship. Finally, we found inconsistent decimals performance mediated the relationship of inhibition with rational number performance, but not other advanced mathematical concepts. These results pinpoint the specific contribution of inhibitory control to rational number understanding, and more broadly are consistent with the hypothesis that acquisition of foundational mathematical content can explain the relationships between executive functions and academic outcomes, making them promising targets for intervention.

Effect of Action-Based Cognitive Remediation on cognitive impairment in patients with remitted bipolar disorder: A randomized controlled trial.

Cognitive impairment affects many patients with bipolar disorder (BD), and treatments with replicated pro-cognitive effects are lacking. This study aimed to assess the effect of Action-Based Cognitive Remediation (ABCR) vs control treatment on cognitive impairment in patients with BD. Patients with remitted BD with objective cognitive impairment were randomized to 10weeks of ABCR vs control treatment, and assessed at baseline, after 2weeks of treatment, at treatment completion and at 6months follow-up. The primary outcome was a cognitive composite score. Secondary outcomes were executive function and observer-rated functional capacity. Tertiary measures included additional neuropsychological tests, performance-based functional capacity and quality of life. Data were analysed with linear mixed effects models. In total, 64 participants were randomized; given three dropouts before the baseline assessments, data were analysed for 61 participants (ABCR: n=32, control: n=29). There was no effect on ABCR vs control on the primary cognitive composite score (P-values ≥.60). At treatment completion, there was a large effect of ABCR vs control on the secondary executive function measure (treatment effect= -0.16, 95% CI [-0.27, -0.05], P≤.01, d=0.65), and on subjective cognitive functioning (treatment effect=-5.38, 95% CI [-8.13, -2.67], P≤.001, d=0.80), which disappeared at follow-up. There was no treatment-effect on functioning, and no association between cognitive and functional change. There was no effect of ABCR on the cognitive composite score. However, there was an effect on executive function and subjective cognitive functioning suggesting that ABCR may be relevant for patients with executive dysfunction. ClinicalTrials.gov identifier: NCT03295305.