Parent-reported Executive Functioning Research Articles

Executive Difficulties and Depressive Symptoms Predict Future Acute Pain Emergency Visits and Hospitalizations in Children with Sickle Cell Disease

Patients with sickle cell disease (SCD) commonly experience episodes of disabling vaso-occlusive pain leading to emergency department (ED) visits or hospitalizations. SCD is also associated with significant neurocognitive risk due to overt stroke, silent cerebral infarcts, and chronic insufficiencies in oxygen and/or glucose delivery to the brain. Neurocognitive deficits are observed early in life and are often characterized by deficits in executive functioning skills (e.g., planning, organizing, attention). The patterns of progressive chronic medical complications and functional limitations associated with SCD place children at higher risk of experiencing depressive symptoms. Research in patients with SCD has suggested that the experience of pain is associated with executive skills and depression in children with SCD. However, studies have yet to explore the bidirectional relationship between these constructs. It is important to understand the directionality and causal nature of this relationship using a longitudinal approach to optimize treatment approaches. The primary objective of this study was to investigate associations between pain-related ED visits or hospitalizations with future parent-reported executive functioning and depression; conversely we examined how executive difficulties and depression predicted subsequent pain-related visits. All patients were enrolled in the St. Jude longitudinal cohort study, the Sickle Cell Clinical Research Intervention Program (SCCRIP; Hankins et al., Pediatric Blood & Cancer 2018). The number of ED visits or hospitalizations due to pain-related reasons in the year pre- and post-assessment were obtained retrospectively from chart review. This data was then cleaned, validated, and merged with other data sets. Parent ratings of executive skills were collected using the Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite scale. Depressive symptoms were measured using the parent version of the Behavior Assessment System for Children 2 nd or 3 rd Edition (Depression scale). Multivariable generalized linear regression was used to examine associations between the number of pain-related hospitalizations with executive difficulties and depressive symptoms after adjusting for age, sex, sickle genotype, current hydroxyurea treatment, and geocoded social vulnerability. P-values <0.05 were considered significant. We included 374 patients with SCD (60% HbSS/HbSβ 0-thalassemia; see Table 1). The mean age of participants at the time of psychological evaluation was 11.84 years (SD=3.39; Range= 8-18). In the year prior to the assessment, patients experienced an average of 0.27 pain events requiring a visit to the ED (SD=0.97, Range=0-11). In the year post evaluation, there were an average of 0.36 events (SD=1.08, Range=0-9). Hospitalizations due to pain occurred an average of 0.09 times (SD=0.37, Range=0-3) in the year before the evaluation and 0.11 times (SD=0.35, Range=0-2) post-evaluation. The number of pain events leading to ED visits or hospitalization in the year prior to the evaluation were not associated with future depressive symptoms or executive difficulties. However, parent-rated executive difficulties and symptoms of depression were positively associated with future ED visits (p=0.033 and p=0.032) and hospitalizations (p=0.005 and p=0.009) in the year following the evaluation (Table 2). Executive functioning difficulties and depressive symptoms predicted greater frequency of future ED visits and hospitalizations among children with SCD. Hospital visits due to acute SCD pain did not predict future executive difficulties or depressive symptoms. Behavioral and pharmacological treatments targeting depressive symptoms and executive difficulties should be tested to decrease the frequency of acute care visits due to pain in SCD.

38 Fine Motor Skills in Pediatric Frontal Lobe Epilepsy are Associated with Executive Dysfunction and ADHD Symptomatology

Objective:Pediatric patients with frontal lobe epilepsy (FLE) have higher rates of attention deficit hyperactivity disorder (ADHD), as well as executive functioning (EF) and fine motor (FM) challenges. Relations between these constructs have been established in youth with ADHD and are supported by FM and EF skill involvement in frontal-subcortical systems. Still, they are not well understood in pediatric FLE. We hypothesized that poorer FM performance would be related to greater executive dysfunction and ADHD symptomatology in this group.Participants and Methods:47 children and adolescents with FLE (AgeM=12.47, SD=5.18; IQM=84.07; SD=17.56; Age of Seizure OnsetM=6.85, SD=4.64; right-handed: n=34; left-handed: n=10; Unclear: n=3) were enrolled in the Pediatric Epilepsy Research Consortium dataset as part of their phase I epilepsy surgical evaluation. Participants were selected if they had unifocal FLE and completed the Lafayette Grooved Pegboard (GP). Seizure lateralization (left-sided: n=19; right-sided: n=26; bilateral: n=2) and localization were established via data (e.g., EEG, MRI) presented at a multidisciplinary team case conference. Patients completed neuropsychological measures of FM, attention, and EF. Parents also completed questionnaires inquiring about their child’s everyday EF and ADHD symptomatology. Correlational analyses were conducted to examine FM, EF, and ADHD relations.Results:Dominant hand (DH) manual dexterity (GP) was related to parent-reported EF (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2]-Global Executive Composite [GEC]: r(15) =-.70, p<.01, d=1.96). While not statistically significant, medium to large effect sizes were found for GP DH and parent-reported inattention (Behavior Assessment System for Children, Third Edition [BASC-3]-Attention Problems: r(12)=-.39, p=.17, d=.85) and hyperactivity/impulsivity (BASC-3-Hyperactivity: r(11)= -.44, p=.13, d=.98), as well as performance-based attention (Conners Continuous Performance Test, Third Edition -Omission Errors: r(12)=-.35, p=.22, d=.41), working memory (Wechsler Intelligence Scale for Children - Fifth Edition [WISC-V]-Digit Span [DS]: r(19)=.38, p=.09, d=.82) and cognitive flexibility (Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency Category Switching: r(13)=.46, p=.08, d=1.04); this suggests that these relations may exist but that our study was underpowered to detect them. Non-dominant hand (NDH) manual dexterity was related to performance-based working memory (WISC-V-DS: r(19)=.50, p<.01, d=1.12) and cognitive flexibility (D-KEFS-Trails Making Test Number-Letter Switching: r(17)=.64, p<.01, d=1.67). Again, while underpowered, medium to large effect sizes were found for GP NDH and parent-reported EF (BRIEF-2 GEC: r(15) =-.45, p=.07, d=1.01) and performance-based phonemic fluency (D-KEFS-Letter Fluency: r(13)=.31, p=.20, d=.65).Conclusions:Our findings suggest that FM, EF, and ADHD are related in youth with FLE; however, these relations appear to vary by skill and hand. We posit that our findings are due in part to the frontal-cerebellar networks given their anatomic proximity between frontal motor areas and the dorsolateral prefrontal cortex - as well as their shared functional involvement in these networks. Future studies should evaluate the predictive validity of initial FM skills for later executive dysfunction and ADHD symptomatology in FLE. If such relations emerge, contributions of early FM interventions on EF development should be examined. Further replication of these findings with a larger sample is warranted.

11 Social Determinants of Health in Pediatric Brain Tumor Survivors: Associations between Neighborhood Opportunity and Neurocognitive and Psychological Outcomes

Objective:A growing body of research demonstrates that social determinants of health (SDOH) are important predictors of neurocognitive and psychological outcomes in survivors of pediatric brain tumor (PBT). Existing research has focused primarily on individual level SDOH (e.g., family income, education, insurance status). Thus, more information is needed to understand community level factors which may contribute to health inequities in PBT survivors. This study aimed to examine the effects of specific aspects of neighborhood opportunity on cognitive and emotional/behavioral outcomes among PBT survivors.Participants and Methods:The sample included clinically-referred PBT survivors who completed a neuropsychological evaluation (N=199, Mage=11.63, SD= 4.63, 56.8% male, 71.8% White). Data included an age-appropriate Wechsler Scale and parent-report questionnaires (Behavior Rating Inventory of Executive Function, Child Behavior Checklist). Nationally-normed Child Opportunity Index (COI) scores were extracted for each participant from electronic medical records based on home address using Census tract geocoding. The COI measures neighborhood-level quality of environmental and social conditions that contribute to positive health. It includes three component scores assessing distinct aspects of opportunity, which include educational opportunity (e.g., educational quality, resources, and outcomes), health/environmental opportunity (e.g., access to healthy food, healthcare, and greenspace) and social/economic opportunity (e.g., income, employment, poverty). Stepwise linear regression models were examined to identify significant predictors of cognitive/psychological outcomes associated with PBT; the three COI indices were entered as predictors and retained in the model if they significantly contribute to variance in the outcome.Results:Lower educational opportunity was associated with lower processing speed performance (Wechsler Processing Speed Index: t = 2.47, p = 0.02) and increased parent-reported executive functioning problems (BRIEF GEC: t = -2.25, p = 0.03; BRIEF Working Memory: t = -2.45, p = 0.02) and externalizing problems (CBCL Externalizing: t = -2.19, p = 0.03). Lower social/economic opportunity was associated with lower working memory performance (Wechsler Working Memory Index: t = 2.63, p < 0.01) and increased parent-reported internalizing problems (CBCL Internalizing: t = -2.38, p = 0.02). Health/environmental opportunity did not emerge as a primary predictor of any of the examined cognitive/psychological outcomes. Exploratory analyses examining the impact of age on associations between COI and cognitive/psychological outcomes found a significant moderation effect of age on the relationship between educational opportunity and processing speed (t = 2.35, p = 0.02) such that this association was stronger at older ages. There were no other moderation effects by age.Conclusions:Consistent with a growing body of literature demonstrating the impact of social and environmental contexts to health outcomes, these results show inequities in neurocognitive and psychosocial outcomes in PBT survivors related to neighborhood-level SDOH. Examination of specific neighborhood factors highlight educational and social/economic factors as particularly important contributors to neurocognitive/psychological risk for survivors. The identification of these specific and potentially modifiable risk factors is crucial to inform individual-level problem-prevention following oncological treatment, as well as community-level policy and advocacy efforts.

Impaired neurocognitive functioning 3months following diagnosis of high-risk acute lymphoblastic leukemia: A report from the Children's Oncology Group.

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer diagnosis. Cognitive late effects develop in 20%-40% of ALL survivors, but the course of declines is unclear. The aim of this paper is to characterize cognitive functioning, and its association with patient-reported outcomes, early in treatment. A total of 483 children with high-risk ALL, aged 6-12years at diagnosis, consented to the neurocognitive study embedded in a prospective therapeutic trial, Children's Oncology Group (COG) AALL1131. A computerized neurocognitive battery (Cogstate) was administered 3months post diagnosis assessing reaction time, visual attention, working memory, visual learning, and executive functioning. Parent-reported executive functioning and patient-reported physical symptoms were also collected. Data from 390 participants (mean age at diagnosis=9.2years, 55.4% male) were obtained. Relatively few patients reported pain (16.0%) or nausea (22.6%), but a majority (68.5%) reported feeling at least some fatigue at testing. Mean Cogstate Z-scores were within normal limits across tasks; however, rates of impairment (Z-scores ≤ -1.5) for reaction time, working memory, visual learning, and visual attention were all higher than expected compared to the standardization sample. Patients reporting fatigue were significantly more likely to have impaired reaction time and visual attention compared to those reporting no fatigue. Findings support feasibility of computerized cognitive assessments and suggest higher-than-expected rates of impaired cognitive performance early during treatment for pediatric ALL, notably within 3months of diagnosis, suggesting intervention efforts may be indicated. These results also highlight acute factors that may impact reliability of "baseline" assessments conducted soon after diagnosis.

The Impact of Cumulative Anesthesia Exposure on Neurocognitive Outcomes in Children with High-Risk Precursor B Acute Lymphoblastic Leukemia: A Multicenter Children's Oncology Group Study

Background: Following contemporary therapy, a substantial proportion of children with acute lymphoblastic leukemia (ALL) have long-term neurocognitive impairments of executive function, attention, and memory. Known risk factors for these impairments include treatment with cranial radiation, exposure to intrathecal and systemic methotrexate, acute toxicities during active treatment, as well as younger age, lower socioeconomic status, and female sex. Anesthesia exposure may be an additional risk factor and importantly, one that is potentially modifiable risk factor. We evaluated the impact of cumulative anesthesia exposure on neurocognitive outcomes one-year post treatment in a multicenter cohort of children with ALL. Methods: This study an embedded aim in the Children's Oncology Group AALL1131 trial for patients ages >1 to <31 years of age with high-risk B ALL. In a subgroup of consenting patients aged 6-12 years, receiving care at 73 centers in America, Canada, New Zealand and Australia, prospective uniform assessments of neurocognitive function were performed using a validated computerized battery (Cogstate) and parent-reported executive functioning using the Behavior Rating Inventory of Executive Functioning at baseline (3 months post diagnosis), during treatment, and one year post therapy completion. All neurocognitive scores were converted to age-adjusted z-scores (expected mean=0, standard deviation =1.0), with lower scores reflecting worse performance. Exposure to all anesthetic agents was abstracted retrospectively from medical records from time of study enrollment to one year post therapy for all patients who completed treatment and the neurocognitive assessments at baseline and post therapy. For each anesthetic, data collected included the medications, dose, and route of anesthetic agents, duration of anesthesia, and the indication for anesthesia. Results: 155 children met eligibility and were included in this analysis (n=82 [59%] males, mean age 9.10 years [range 6.0-12.8]). Three patients (1.9%) received cranial radiation. The median number of anesthetic episodes per patient was 27 (range 1-37); the most common indication was lumbar puncture with or without the administration of intrathecal therapy (median 24, range 0-32). Though multiple anesthetic agents were utilized, almost all patients were exposed to propofol (151/155, 97%). The mean cumulative dose of propofol for exposed patients was 109.6 mg/kg. At one year post therapy, the proportion of children with impairment (age-adjusted scores ≥ 1.5 standard deviations below the mean) was significantly higher compared to a standardized population in multiple domains including reaction time, sustained attention, working memory and executive function. In multivariable analysis accounting for baseline neurocognitive score, age, sex, race/ethnicity, socioeconomic status and leukemia risk group, cumulative exposure to propofol was associated with poorer reaction time/processing speed (decrease of 0.05 Z-score per 10 mg/kg propofol exposure, 95th CI 0.003, 0.09; p=0.035) and impaired executive function (decrease of 0.23 Z-score per 10 mg/kg propofol exposure, 95th CI 0.003-0.46; p=0.048). Conclusion: In a multicenter cohort of children treated for high-risk ALL and with variable anesthesia exposure, cumulative anesthesia exposure, as reflected by propofol total dosing (mg/kg) was an independent risk factor for impairments in neurocognitive function measured by both performance based and parent report one year post therapy. Anesthesia exposure is a modifiable risk and opportunities to minimize use, when feasible, in this group of patients should be systematically pursued.

Executive and social functioning in pediatric posterior fossa tumor survivors and healthy controls.

Executive and social functioning difficulty is well established in pediatric brain tumor survivors. Few studies have compared posterior fossa (PF) tumor survivors in comparison to their peers. The relationship between attention, processing speed, working memory, fatigue, and executive and social functioning was investigated to better understand the factors that impact executive and social functioning in PF tumor populations. Sixteen medulloblastomas, 9 low-grade astrocytomas (LGAs), and 17 healthy controls recruited from 4 sites completed measures of working memory and processing speed, and self-reported fatigue. One parent completed questionnaires on executive and social functioning. There were no significant differences among all 3 groups on parent-reported executive and social functioning; of note, parents of LGA survivors expressed greater concerns regarding behavioral and cognitive regulation than did parents of medulloblastoma survivors and healthy controls. Parent-reported attention was related to parent-reported emotion, behavior, and cognitive regulation. Worse self-reported fatigue was associated with greater emotional dysregulation for the 2 PF tumor groups. Parents of PF tumor survivors described their children as performing similarly to their peers in most facets of executive and social functioning. While LGA survivors are traditionally thought to have more favorable outcomes, our finding of parent-reported executive functioning concerns to be worse for this group highlights the importance of long-term follow-up for all PF tumor survivors. Additionally, significant effects of attention on aspects of executive functioning in PF tumor survivors may inform current clinical practice and the future development of more effective interventions.

Parent ratings of executive functioning in pediatric survivors of medulloblastoma and pilocytic astrocytoma

The present study compared parent-rated executive functioning in pediatric medulloblastoma (MB) and pilocytic astrocytoma (PA) survivors. Although standard care for both includes surgical resection, children with MB additionally receive chemotherapy and craniospinal irradiation. Given well-documented neurocognitive late effects associated with the latter, we anticipated poor parent-reported executive functioning in MB survivors. Parents/guardians of 36 MB survivors and 20 PA survivors completed the Behavior Rating Inventory of Executive Functioning (BRIEF). PA survivors were younger at diagnosis (t[51.97] = 3.07, p < .001, d = 0.86) and demonstrated higher IQ (t[54] = −3.51, p < .001, d = 0.95). However, relative to the MB group, the PA group was rated as having significantly more problems on all BRIEF scales (all p ≤ .05; d = 0.30 − 1.10), except the Shift scale. Additionally, all mean BRIEF scores for MB survivors were within normal limits, whereas for PA survivors, all mean BRIEF scores except for Organization of Materials were significantly discrepant from normative means. Overall, PA survivors were rated as demonstrating poorer executive function than MB survivors. Five theories are discussed as possible explanations for these surprising findings: two related to group differences, two related to potential sources of parental bias, and one related to the nature of questionnaire-based assessment. All these theories represent directions for future research. Parent questionnaires such as the BRIEF may have real-world implications for pediatric brain tumor survivors. Future research should explore factors affecting parent ratings of executive functioning in these populations, along with comparison to performance-based measures.

Dual Language Learning Predicts Improved Executive Functioning in Youth with Autism.

Previous findings show executive functioning advantages associated with dual language learning (DLL) among neurotypical individuals, yet few studies have investigated these effects in youth with autism spectrum disorder (ASD). The present study investigated effects of DLL and socioeconomic status (SES) on parent-reported executive functioning, verbal ability, and social-emotional functioning using a sample of DLL (n = 53) and monolingual (n = 106) youth with ASD without intellectual disability, matched on gender and full-scale IQ scores. After controlling for the effects of SES, results showed that monolingual youth had better outcomes on verbal ability, while DLL youth had fewer parent-reported problems with executive functioning and unusual behaviors. These findings indicate that bilingualism may mitigate executive functioning deficits in youth with ASD.

Language not auditory experience is related to parent-reported executive functioning in preschool-aged deaf and hard-of-hearing children.

Much research has found disrupted executive functioning (EF) in deaf and hard‐of‐hearing (DHH) children; while some theories emphasize the role of auditory deprivation, others posit delayed language experience as the primary cause. This study investigated the role of language and auditory experience in parent‐reported EF for 123 preschool‐aged children (M age = 60.1 months, 53.7% female, 84.6% White). Comparisons between DHH and typically hearing children exposed to language from birth (spoken or signed) showed no significant differences in EF despite drastic differences in auditory input. Linear models demonstrated that earlier language exposure predicted better EF (β = .061–.341), while earlier auditory exposure did not. Few participants exhibited clinically significant executive dysfunction. Results support theories positing that language, not auditory experience, scaffolds EF development.

Executive functioning profiles in adolescence: Using person-centered approaches to understand heterogeneity

The current study investigated patterns in executive functioning (EF) skills in adolescents (N = 991; 48.8% male; 81% White; mage = 14.91) and examined how EF profiles were associated with adolescent wellbeing. Eight EF skills, comprising foundational, complex, and affective EF, were assessed via self-rated EF, parent-reported EF, and neuropsychological tasks. A latent profile analysis (LPA) revealed four distinct EF profiles representing unique constellations of higher, lower, or mixed performance across all eight EF skills. When compared across domains, profiles characterized by higher foundational and complex EF skills exhibited positive, contemporaneous associations with academics, mental health, and health behaviors. Profiles characterized by discordant or mixed performance also exhibited unique strengths, such as positive peer relationships. Findings indicate that person-centered approaches to examining EF may reveal important sources of heterogeneity that have functional significance for health and wellness.

Relationship Between Parent and Teacher Reported Executive Functioning and Maladaptive Behaviors in Children With Down Syndrome.

The current study evaluates the concurrent relationship between parent ratings of executive functioning and maladaptive behavior among children and adolescents with Down syndrome and then repeats this evaluation using teacher reports. Parents and teachers of 63 school-age children with Down syndrome rated the child's executive functioning (Behavior Rating Inventory of Executive Function) and behaviors (Achenbach Child Behavior Checklist). For parent and teacher ratings, elevated behavior dysregulation predicted higher levels of rule-breaking, aggressive, and externalizing behavior. For teacher ratings, elevated behavior dysregulation also predicted higher levels of inattention problems. Among both parent and teacher ratings, greater metacognitive difficulties predicted challenges with attention. Understanding the relationship between these constructs has important implications for targets of intervention and developing preventative strategies.

Cognitive Functioning and Educational Support Plans in Youth With Sickle Cell Disease.

Children with sickle cell disease (SCD) face academic challenges because of direct and indirect disease-related events. This study examined the proportion of youth with SCD with educational plans and whether cognitive functioning is associated with educational support. Ninety-one youth (7 to 16 y) with SCD completed the WISC-V; caregivers reported educational support (504 Plan/Individualized Education Program) and completed the Behavior Rating Inventory of Executive Function. χ2 square and t test analyses explored whether overall intelligence (full-scale intelligence quotient [FSIQ]), relative weaknesses in processing speed and working memory (> 1SD below FSIQ), and parent-reported executive functioning were associated with educational plans. Participants with a FSIQ<90 were more likely to have support (74%) compared with youth with a FSIQ≥90 (47%; P=0.012). Those with FSIQ≥90 and FSIQ=80 to 89 were less likely to have support (47%, 58%, respectively) compared with those with FSIQ≤79 (89%; P=0.004). Relative weaknesses in processing speed were associated with educational support (83% vs. 52%, P=0.018) as well as behavioral aspects of executive functioning (Ps<0.05). Despite universal eligibility for a 504 Plan, 42% of youth with SCD in our sample did not have educational support. Significant deficits in intellectual functioning, processing speed, and parent-observed executive functioning are associated with having a plan, but children with subtle deficits seem less likely to be identified for educational support.

Brief Report: Role of Parent-Reported Executive Functioning and Anxiety in Insistence on Sameness in Individuals with Germline PTEN Mutations.

This study aimed to characterize the relationship between insistence on sameness (IS), executive functioning (EF) and anxiety among individuals with PTEN mutations and individuals with macrocephalic ASD. The sample included 38 individuals with PTEN mutation and ASD diagnosis (PTEN-ASD; Mage = 8.93years, SDage = 4.75), 23 with PTENmutationwithout ASD (PTEN-no ASD; Mage = 8.94years; SDage = 4.85) and 25 with ASD and macrocephaly but with noPTENmutation (Macro-ASD; Mage = 11.99years; SDage = 5.15). The final model accounted for 45.7% of variance in IS, with Set-Shifting EF subdomain as a unique independent predictor (t = 4.12, p < 0.001). This investigation provides the first preliminary evidence for the EF-anxiety-IS interrelationship in individuals with PTEN mutations and with macrocephalic ASD.

The association of parent-reported executive functioning, reading, and math is explained by nature, not nurture.

According to the hybrid model (van Bergen, van der Leij, & de Jong, 2014), the significant association among executive functioning (EF), reading, and math may be partially explained by parent-reported EF's role as a common risk and/or protective factor in reading and math (dis)abilities. The current study used a sample of 434 twin pairs (Mage = 12.12) from Florida to conduct genetically sensitive modeling on children's parent-reported EF, reading, and math skills to determine the common and unique etiological influences among the three domains. EF was measured through parent report and reading and math were measured with standardized test scores drawn from Florida's Progress Monitoring and Reporting Network as well as standardized parent-administered assessments collected by mail. Our trivariate Cholesky modeling showed that no matter which parent-reported EF component was modeled, the overlap of parent-reported EF with reading and math was explained by common genetic influences. Supplemental analysis suggested that this might in part be due to general parent report of problem behaviors. Additionally, significant environmental influences, with higher shared environmental overlap than previous work, were also found for reading and math. Findings indicate that poor parent-reported EF is a common cognitive risk factor for reading and math disabilities, which is driven by a shared genetic basis among all three domains. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Longitudinal Development of Executive Functioning and Spoken Language Skills in Preschool-Aged Children With Cochlear Implants.

Purpose Auditory deprivation has downstream effects on the development of language and executive functioning (EF) in prelingually deaf children with cochlear implants (CIs), but little is known about the very early development of EF during preschool ages in children with CIs. This study investigated the longitudinal development of EF and spoken language skills in samples of children with normal hearing (NH; N = 40) or CIs (N = 41) during preschool ages. Method Participants were enrolled in the study between ages 3 and 6 years and evaluated annually up to the age of 7 years. Mixed-effects models were used to evaluate and predict growth of spoken language and EF skills over time. Results Children with CIs scored lower than NH peers on language measures but improved significantly over time. On performance-based neurocognitive measures of controlled attention, inhibition, and working memory, children with CIs scored more poorly than the sample of NH peers but comparable to norms, whereas on a parent report behavior checklist, children with CIs scored more poorly than both NH peers and norms on inhibition and working memory. Children with CIs had poorer EF than the sample of NH peers in most domains even after accounting for language effects, and language predicted only the verbal working memory domain of EF. In contrast, EF skills consistently predicted language skills at subsequent visits. Conclusions Findings demonstrate that, despite significant improvement over time, some domains of EF (particularly parent-reported EF) and language skills in children with CIs lag behind those of children with NH during preschool ages. Language delays do not fully explain differences in EF development between children with CIs and NH peers during preschool ages, but EF skills predict subsequent language development in children with CIs.

Supplemental Material for The Association of Parent-Reported Executive Functioning, Reading, and Math Is Explained by Nature, Not Nurture

Supplemental Material for The Association of Parent-Reported Executive Functioning, Reading, and Math Is Explained by Nature, Not Nurture

Measurement of executive functioning with the National Institute of Health Toolbox and the association to anxiety/depressive symptomatology in childhood/adolescence

ABSTRACT Introduction Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the association of The National Institute of Health (NIH) Toolbox to clinical neuropsychological measures and to childhood, anxiety/depressive symptomatology. Methods: One-hundred eight children and adolescents completed the three EF measures from the NIH Toolbox (List Sorting Working Memory Test [LSWMT], Dimensional Change Card Sorting Test [DCCST], and Flanker Test of Attention and Inhibition [Flanker]) in an outpatient neuropsychology program. These tests were compared to established measures of EF in terms of linear correlations and detection of impairment. Heaton’s Global Deficit Score (GDS) was utilized to calculate impairment. The Toolbox-EF measures were paired with parent-reported EF symptoms (Behavior Rating Inventory of Executive Function [BRIEF2]) to identify the role of EF in childhood anxiety/depressive symptomatology. Results Toolbox-EF measures displayed medium sized correlations with their clinically comparable counterparts, and generally did not differ in their detection of impairment. Toolbox-GDS was associated with depression diagnosis and clinically significant child-reported anxiety and depressive symptoms. Together, Toolbox/BRIEF2 accounted for 26.8–30.9% of elevated depressive symptom variance, but only 13.2-14% of elevated anxiety symptom variance. Further, EF impairment was associated with depression across self report, parent report, and clinical diagnosis. Discussion The NIH Toolbox-EF measures display comparable psychometric properties to clinically available EF measures in a pediatric (primarily psychiatric) neuropsychology setting. The Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood.

Sleep and parent-reported executive functioning in typically developing and drug-naïve ADHD children

Sleep and parent-reported executive functioning in typically developing and drug-naïve ADHD children

High occurrence of sleep problems in survivors of a childhood brain tumor with neurocognitive complaints: The association with psychosocial and behavioral executive functioning.

Survivors of childhood brain tumors are prone to sleep and neurocognitive problems. Effective interventions to improve neurocognitive functioning are largely lacking. In general, sleep problems are negatively related to neurocognitive functioning, but this relationship is unclear in survivors of childhood brain tumors. Therefore, the occurrence of sleep problems, potential risk factors, and the relation between sleep and executive functioning were evaluated. Baseline data of a randomized controlled trial on the effectiveness of neurofeedback were used. Childhood brain tumor survivors 8-18 years of age with parent-reported neurocognitive complaints ≥2 years after treatment were eligible. Parents completed the Sleep Disturbance Scale for Children. Executive functioning was assessed by parents and teachers (Behavior Rating Inventory of Executive Functioning). Multiple linear regression analyses were used to examine sociodemographic and medical characteristics and emotional difficulties and hyperactivity/inattention (Strength and Difficulties Questionnaire) as potential risk factors for sleep problems, and to assess the association between sleep and executive functioning. Forty-eight percent of survivors (n=82, 7.0±3.6 years post diagnosis, age 13.8±3.2years) had sleep problems and scored significantly worse than the norm on the subscales Initiating and Maintaining Sleep, Excessive Somnolence, and the total scale (effect sizes 0.58-0.92). Emotional problems and/or hyperactivity/inattention were independent potential risk factors. Sleep problems were associated with worse parent-reported executive functioning. Sleep problems occur among half of childhood brain tumor survivors with neurocognitive problems, and are associated with worse executive functioning. Future studies should focus on the development of sleep interventions for this population, to improve sleep as well as executive functioning.

A Growth Mixture Modeling Study of Learning Trajectories in an Extended Computerized Working Memory Training Programme Developed for Young Children Diagnosed With Attention-Deficit/Hyperactivity Disorder

This study explored (1) whether growth mixture modelling (GMM) could identify different trajectories of learning efficiency during a working memory (WM) training programme for young children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), compared with a typically developing (TD) control group, and (2) if learning trajectories and outcomes were different for simple and complex training tasks. Children completed simple visuospatial short-term memory (VSSTM) and complex visuospatial WM (VSWM) tasks for 15 minutes a day, 5 days a week and for 8 weeks. Parent-reported executive functioning, and children’s WM and attention control, educational achievement, and IQ were measured prior to (T1), immediately following (T2) and three months after training (T3). GMM analysis showed that WM training was represented as one learning curve, and there was no difference for the trajectories of the ADHD and TD groups. The learning trajectory for the VSSTM tasks across groups was represented as one learning curve and for the VSWM tasks there were three learning curves. Learning for the VSSTM tasks and for most children in the VSWM tasks was characterized by an inverted-U shape, indicating that training was effective for up to 15 sessions, was stable and declined thereafter, highlighting an optimal training timeframe. For the VSWM tasks, the two remaining groups showed either a U-shaped or a high inverted U-shaped trajectory, with the latter group achieving the highest T1T2 change score (i.e., children showed a lower starting point and the most gain in terms of learning and post-training performance). There were no broader benefits of training at post-test or follow-up. Further research should explore who would benefit most from intensive cognitive training, as well as the potential benefits for mental health and well-being. Keywords. WM training, learning trajectories, young children, Attention-Deficit/Hyperactivity Disorder (ADHD), Growth Mixture Modelling (GMM).