Executive Functioning In Youth Research Articles

Allostatic load, adverse childhood experiences, executive functions, and BMI status in adolescents and young adults.

Chronic stress induces preclinical changes in the metabolic, cardiovascular, and immune systems. This phenomenon, known as allostatic load (AL), can impair executive functions (EF), which may be even more affected in individuals with excess weight due to their characteristic inflammatory state and cardiometabolic changes. Adverse childhood experiences (ACEs) contribute to AL and may influence executive functioning presumably via alterations within the hypothalamic-pituitary axis, including epigenetic modifications. We assess the relationship between AL and EF in youth with and without excess weight, and the effect ACEs on executive functioning. One hundred eighty-two adolescents and young adults (85 with normal weight and 97 with overweight/obesity; 10-21 years) were recruited. The estimated AL index included the following: systolic and diastolic blood pressure, glycated hemoglobin, high- and low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, fibrinogen, and cortisol. ACEs were measured using the Juvenile Victimization Questionnaire. The neuropsychological evaluation included the assessment of inhibition, working memory, and cognitive flexibility processes. AL was not significantly associated with executive functioning, and this relationship did not depend on body-weight status. ACEs, available for 57 of 182 participants, were significantly associated with poorer executive functioning. Our study shows that AL is not associated with executive functioning in adolescents and young adults. Since the current sample was young, we hypothesize that a longer exposure to AL might be required for its negative effects to surface. Nevertheless, exposure to early adversity seems to be associated with poorer executive functioning in youth.

Treating Executive Function in Youth With Attention Deficit Hyperactivity Disorder: A Review of Pharmacological and Non-Pharmacological Interventions

Introduction: Executive function (EF) deficits are common in youth with ADHD and pose significant functional impairments. The extent and effect of interventions addressing EF in youth with ADHD remain unclear. Methods: We conducted a systematic literature review using PRISMA guidelines. Included studies were randomized controlled trials of interventions to treat EF in youth with ADHD. Results: Our search returned 136 studies representing 11,443 study participants. We identified six intervention categories: nonstimulant pharmacological (N = 3,576 participants), neurological (N = 1,935), psychological (N = 2,387), digital (N = 2,416), physiological (N = 680), and combination (N = 366). The bulk of the evidence supported pharmacological interventions as most effective in mitigating EF, followed by psychological and digital interventions. Conclusion: A breadth of treatments exists for EF in youth with ADHD. Pharmacological, psychotherapeutic, and digital interventions had the most favorable, replicable outcomes. A lack of outcome standardization across studies limited treatment comparison. More data on the persistence of intervention effects are necessary.

Cognitive Constructs and Personality Profiles in Youth with Deliberate Self-Harm Behaviours: A Scoping Review

This scoping review explored the relationship between cognitive constructs and personality profiles in deliberate selfharm among youth, with the objective of proposing preventive and intervention strategies based on the findings. The review analysed the correlation between cognitive constructs and Deliberate Self-Harm behaviors in youth with diverse personality profiles. It investigated the role of cognitive distortions, emotional regulation, reasoning, and executive functioning in youth engaged in deliberate self-harm. A comprehensive search using the Scopus database yielded 72 relevant articles for analysis. The prevalence rates of deliberate self-harm among youth range from 7.5% to 46.5%, emphasizing the need for targeted interventions. Promising approaches include cognitive restructuring, mindfulnessbased therapies, and interventions focusing on challenging cognitive distortions to promote adaptive thinking patterns. Training interventions addressing executive functioning skills can effectively target impulsive and risky behaviors. Personality traits such as neuroticism, sensation seeking, borderline personality disorder, and perfectionism require interventions focused on emotional resilience, coping strategies, risk assessment, self-control, and impulse management

White matter microstructure is differently associated with executive functioning in youth born with congenital heart disease and youth born preterm.

Executive function deficits and adverse psychological outcomes are common in youth with congenital heart disease (CHD) or born preterm. Association white matter bundles play a critical role in higher order cognitive and emotional functions and alterations to their microstructural organization may result in adverse neuropsychological functioning. This study aimed to examine the relationship of myelination and axon density and orientation alterations within association bundles with executive functioning, psychosocial well-being, and resilience in youth with CHD or born preterm. Youth aged 16 to 26 years born with complex CHD or preterm at ≤33 weeks of gestational age and healthy controls completed a brain MRI and self-report assessments of executive functioning, psychosocial well-being, and resilience. Multicomponent driven equilibrium single-pulse observation of T1 and T2 and neurite orientation dispersion and density imaging were used to calculate average myelin water fraction (MWF), neurite density index (NDI), and orientation dispersion index values for eight bilateral association bundles. The relationships of bundle-average metrics with neuropsychological outcomes were explored with linear regression and mediation analyses. In the CHD group, lower MWF in several bundles was associated with poorer working memory and behavioral self-monitoring and mediated self-monitoring deficits relative to controls. In the preterm group, lower NDI in several bundles was associated with poorer emotional control and lower MWF in the left superior longitudinal fasciculus III mediated planning/organizing deficits relative to controls. No significant relationships were observed for psychosocial well-being or resilience. The findings of this study suggest that microstructural alterations to association bundles, including lower myelination and axon density, have different relationships with executive functioning in youth with CHD and youth born preterm. Future studies should aim to characterize other neurobiological, social, and environmental influences that may interact with white matter microstructure and neuropsychological functioning in these at-risk individuals.

Development of white matter fiber covariance networks supports executive function in youth

During adolescence, the brain undergoes extensive changes in white matter structure that support cognition. Data-driven approaches applied to cortical surface properties have led the field to understand brain development as a spatially and temporally coordinated mechanism that follows hierarchically organized gradients of change. Although white matter development also appears asynchronous, previous studies have relied largely on anatomical tract-based atlases, precluding a direct assessment of how white matter structure is spatially and temporally coordinated. Harnessing advances in diffusion modeling and machine learning, we identified 14 data-driven patterns of covarying white matter structure in a large sample of youth. Fiber covariance networks aligned with known major tracts, while also capturing distinct patterns of spatial covariance across distributed white matter locations. Most networks showed age-related increases in fiber network properties, which were also related to developmental changes in executive function. This study delineates data-driven patterns of white matter development that support cognition.

Motor Skills and Executive Functions in Pediatric Patients with Down Syndrome: A Challenge for Tailoring Physical Activity Interventions.

Down syndrome (DS) is one of the most common chromosomal disorders. In addition to this variety of dysmorphic features. DS is also associated with a wide range of diseases and related comorbidities affecting different organs and systems. These comorbidities, together with societal and environmental influences, have a negative impact on physical activity in people with DS. Low levels of physical activity and energy expenditure have been identified as crucial players in worsening the acquisition of motor skills and executive functions. Executive functions are critical for the many skills (creativity, flexibility, self-control, and discipline) impacting our quality of life and make it possible to control impulses, mentally play with ideas, and stay focused. We proposed a broad overview of the available literature regarding motor skills and executive functions in pediatric patients with DS to understand the specific challenges for tailoring physical activity interventions. Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and physical aspects in children with DS. Interventions based on executive functions in DS subjects are effective to contrast the cognitive decline and improve the everyday use of executive functions in youth and adults. Targeted interventions are mandatory for maximizing the benefits of physical activity, minimizing potential risks, and ultimately improving the overall health outcomes and quality of life for individuals with DS.

Supplemental Material for A literature review on the effects of exergames on executive function in youth.

Supplemental Material for A literature review on the effects of exergames on executive function in youth.

A Literature Review on the Effects of Exergames on Executive Function in Youth.

Exergames (video games that promote cognitive and physical activity simultaneously) benefit executive function in elderly populations. It has been suggested that exergames may induce larger effects than cognitive or exercise training alone, but few reviews have synthesized the causal factors of exergames on executive function from experimental research with youth. This review investigates (1) the various types of exergames and associated comparison conditions (2) the executive function outcome assessments commonly utilized in exergame research with youth (3) the efficacy of exergames by evaluating experimental studies that compared exergaming to cognitive, exercise, and passive control conditions inclusive of effect sizes and (4) the potential mechanisms underlying the changes in executive function induced from exergames. Eligible outcome data were available from 607 participants across ten studies, with the age of participants ranging from 4-21 (). The findings indicate that exergames improve aspects of executive function from both acute and chronic studies. Despite the high variability of exergame contexts, dosage, populations, and outcome assessments, improvements in executive function comparing exergaming to passive control conditions were exhibited across all studies. While there is evidence of exergaming demonstrating advantages over passive control conditions, evidence is mixed when comparing exergaming to sedentary cognitive and exercise comparison conditions. Potential sources of these mixed results and future directions to address current gaps in the field are identified. As video game and technology use grows exponentially and concerns of childhood sedentary behavior and play deprivation increase, evidence-based practices that promote both physical and cognitive activity are needed.

Everyday executive functioning in pediatric obsessive-compulsive disorder: diagnostic specificity, clinical correlations, and outcome

BackgroundObsessive-compulsive disorder (OCD) typically onsets during childhood or adolescence and difficulties with executive functioning (EF) may be involved in its onset and maintenance. Yet, few studies have examined everyday EF difficulties in youth with OCD and no study has compared EF in youth with OCD to EF in youth with anxiety disorders, leaving the diagnostic specificity of EF unclear.MethodsIn this study, parents of treatment-seeking children and adolescents with OCD (n = 96, Mage = 13.3, SD = 2.7, 59% girls) or anxiety disorders (n = 67, Mage = 14.0, SD = 2.6, 78% girls) reported on their children’s everyday EF using the Behavior Rating Inventory of Executive Function (BRIEF) measure.ResultsCompared to community youth, the two clinical groups showed moderately elevated EF deficits but did not differ significantly from each other. EF deficits were not associated with the major symptom dimensions of OCD, age of OCD symptom onset, duration of OCD symptoms, and OCD severity, and did not predict treatment outcome in OCD.ConclusionsCompared to peers, youth with OCD show moderate difficulties with EF, but very similar difficulties are seen in youth with anxiety disorders, and it is unclear whether these difficulties are of clinical relevance. Among youth with OCD, EF difficulties were not differentially associated with the major symptom dimensions of OCD, which is inconsistent with findings from adults. Difficulties with EF did not predict treatment outcome, indicating that integrating EF modules into OCD treatment may be of limited value, although EF may be important for treatment planning in individual cases.

Serum zinc levels in youth with avoidant/restrictive food intake disorder and anorexia nervosa: Clinical correlation with weight and psychopathology.

Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are characterized by restrictive eating and micronutrient deficiencies. While zinc deficiency has been identified in AN, zinc level in ARFID has not been systematically assessed. Examine serum zinc levels and their association with eating pathology, psychopathology, and executive functioning in youth with ARFID and AN. This study included 28 adolescents (Mage = 13, 75% female) receiving treatment for ARFID (n = 13) and AN (n = 15). Demographic data and intake mood metrics were obtained via chart review. Participants completed the Delis-Kaplan Executive Functioning Systems and their mothers completed the behavior rating inventory of executive function (BRIEF-2). Zinc level was collected via blood draw. Independent samples t-tests, Pearson's chi-square, and Pearson's correlations were used to evaluate between-group differences and the relationship between zinc level and clinical correlates. No between-groups differences emerged in zinc levels, though half the sample demonstrated low levels for their ages. No significant correlations were found between zinc level and demographic data, mood measures, or executive functioning tasks. AN had relatively lower zinc levels, higher eating pathology, and anxiety, though ARFID had a longer duration of illness. Correlations between zinc and BRIEF-2 scores were mixed. This is the first study to systematically assess zinc levels in ARFID. While there were no group differences for zinc levels, 50% of the sample had low zinc levels. Zinc level did not correlate with higher psychopathology. Monitoring zinc levels throughout treatment in the context of anabolic processes can inform treatment strategies.

Computer and tablet assessments of executive function in youth with Down syndrome: feasibility and predictors of performance

Background Feasibility of direct assessments is at the forefront of preparation for future clinical trials targeting cognition and executive functioning for individuals with Down syndrome (DS). This study aimed to assess feasibility and predictors of task completion for computer-facilitated executive function assessments in youth with DS. Methods Participants were 77 individuals with DS 6 to 19 years old. Five computer/tablet-based assessments of executive function were administered. Overall cognitive abilities were directly assessed, and caregivers reported on adaptive behaviours. Results Feasibility of the measures ranged from 33.8 − 75.3%. Participants able to complete each computer/tablet assessment were generally older and had higher adaptive skill levels and higher cognitive abilities compared to those who could not complete the tasks. Chronological age and adaptive behaviours emerged as significant unique contributors to variance of computer/tablet assessment completion. Conclusion Understanding developmental skills that support computer-facilitated assessment completion is important for evaluating the appropriateness of these assessments in individuals with DS. Strategies for increasing feasibility and suggestions for modifications to computer/tablet assessments are discussed.

The effect of mindfulness training on executive function in youth with depression

Youth depression is often associated with impairments in cognitive function, especially in executive function. This study examines the effect of an 8-session-long mindfulness training that can improve executive function in youth with depression. Sixty youths (age range 15–27 years) with depression were selected as participants and were randomized into a mindfulness training group (MTG) and a waitlist-control group (WCG). The MTG received an 8-week mindfulness training while the WCG received no intervention. Both groups performed the Stroop, N-back, and More-odd shifting tasks at baseline and after eight weeks to examine inhibitory control, working memory, and cognitive flexibility of executive function, respectively. The results showed that mindfulness training significantly reduced the Stroop effect size for MTG (p < 0.001), but the effect on the switching cost was not statistically significant (p = 0.975). There was an age effect of mindfulness training on working memory. For young adults, mindfulness training improved accuracy on the N-back task (p < 0.01) and shortened reaction time, although this effect slightly exceeded the significance level (p = 0.075). However, mindfulness training failed to improve the working memory of adolescents with depression. In conclusion, mindfulness training improved inhibitory control in youth with depression. It also improved working memory in young adults with depression, but future studies with large samples are needed to validate the improvement in working memory.

Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population.

Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.

Designed acute physical activity to benefit primary school children’s cognition: Effects of cognitive challenge, bout duration and positive affect

Designed acute physical activity to benefit primary school children’s cognition: Effects of cognitive challenge, bout duration and positive affect

A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions.

Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.

The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

BackgroundFurther knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD).ObjectiveWe aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years).MethodAt baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models.ResultsUsing longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time.ConclusionsThe current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.

Examining deficits in and measures of executive function in youth with ASD

Approximately 41–78% of children diagnosed with an autism spectrum disorder (ASD) also experience documented executive function (EF) deficits. EF skills are a set of mental processes that aid in the areas of attention, problem solving, and self‐control (Czermainski et al., 2015).

Executive Functioning in Pediatric Anxiety and Its Relationship to Selective Serotonin Reuptake Inhibitor Treatment Response: A Double-Blind, Placebo-Controlled Trial.

Objective: To characterize executive function in adolescents with generalized anxiety disorder (GAD) and its relationship to treatment. Methods: Using data from a double-blind, placebo-controlled trial of escitalopram in adolescents (N = 51) 12-17 years of age with GAD, we used the self-report version of the Behavior Rating Inventory of Executive Function (BRIEF-SR) to assess executive function, at baseline, and examined its relationship to treatment response as measured by the Pediatric Anxiety Rating Scale (PARS). Results: For all baseline subscores of the BRIEF-SR, T-scores were significantly elevated in adolescents with GAD compared to an age- and sex-matched normative healthy sample. In escitalopram-treated patients, baseline BRIEF-SR scores for Emotional Control (β = 0.256, 95% credibility interval [CrI]: 0.367 to 0.146, p < 0.001), Working Memory (β = 0.204, CrI: 0.2952 to 0.1134, p < 0.001), Planning/Organizing (β = -0.223, CrI: -0.1021 to -0.3436, p = 0.004), and Task Completion (β = -0.152, CrI: 0.075 to 0.228, p = 0.002) predicted the trajectory of improvement in PARS score over the 8-week trial. For youth who received placebo, only the Inhibit score was significantly, but weakly, associated with response trajectory (β = -0.081, CrI: -0.0167 to -0.1461, p = 0.015). For adolescents who had clinically significant impairment in Emotional Control, Working Memory, Planning/Organizing, and Task Completion (i.e., T-score >65), the trajectory of improvement significantly differed from patients without scores in the clinically significant range. Conclusions: Taken together, these findings point to the potential value of assessing executive function in youth with anxiety disorders as one strategy for guiding treatment selection. These data suggest that executive function may predict treatment response to psychopharmacologic treatment and point to numerous avenues for further personalizing treatment.

P402. Asymmetries in Signal Propagation Across the Cortical Hierarchy Predicts Executive Function in Youth

The structural connectome is wired to engender efficient signal propagation across the cortical hierarchy; sensory signals from our environment arrive at primary visual/motor cortices before propagating up to higher-order systems where they are integrated to enable complex processes such as executive function. Here, we used advanced models of network dynamics to investigate signal propagation across this cortical hierarchy, including modeling asymmetries between bottom-up and top-down signal propagation. We examined whether these transition asymmetries predicted executive function.

Relationships between Depression and Executive Functioning in Adolescents: The Moderating Role of Unpredictable Home Environment.

Although researchers have explored the link between depression and executive functioning (EF), the influence of early-life environmental and relational instability on this association has not been comprehensively assessed in adolescents. This cross-sectional study examined whether unpredictability of home environment in childhood moderated the relationship between depression and EF in adolescents. Participants were 138 adolescents aged 13 to 17 years (72% female; 47.8% White; 47.1% Hispanic). Diagnostic status (major depression versus healthy control) and depression severity were assessed using psycho-diagnostic interviews and self-reports from parents and adolescents. Participants also completed the Questionnaire of Unpredictability in Childhood (QUIC). EF was assessed using self-report (Behavior Rating Inventory of Executive Function, Second Edition; BRIEF2) and a battery of performance-based measures. Results showed that QUIC scores moderated the relationship between depression and BRIEF2 scores, such that high unpredictability was associated with poorer EF for adolescents exhibiting low depression severity. Participants with the highest levels of depression exhibited the poorest EF ratings, regardless of childhood unpredictability. Unpredictability was moderately associated with performance-based measures, but did not interact with depressive symptoms to predict complex performance-based EF. Recommendations include assessing for unpredictable childhood environment and acknowledging this risk factor for poor EF in youth with sub-threshold depression. Treatment implications are discussed with respect to family systems/parenting interventions, as mildly depressed adolescents growing up in unstable homes may be vulnerable to EF difficulties. Further, this study adds to the EF measurement literature by examining associations between self-report and performance-based EF instruments in a diverse sample of adolescents.