Performance-based Measures Of Executive Function Research Articles

24 Adaptive Functioning and Academic Achievement in Survivors of Childhood Acute Lymphoblastic Leukemia

Objective:Executive functioning (EF) and socioeconomic status (SES) are associated with functional outcomes (adaptive functioning and academic achievement) in healthy controls and pediatric populations with executive dysfunction. However, these relationships have yet to be investigated in survivors of childhood acute lymphoblastic leukemia (ALL), a population with EF impairment resulting from disease and treatment characteristics. The objective of this study was to examine the associations of functional outcomes with EF and SES (neighborhood-specific variables and academic support) in survivors of childhood ALL.Participants and Methods:Forty-four participants (38.6% female, 72.7% non-Hispanic White, ages 6-17) previously diagnosed with low-risk or standard-risk pre-B cell ALL and treated with chemotherapy-only were included. Participants were evaluated on performance-based measures of EF (cognitive flexibility, verbal fluency, working memory, and processing speed) and academic achievement (word reading and math calculation), and parent-ratings of EF and adaptive functioning. All measures were expressed as T-scores with lower scores indicating better performance. Neighborhood-specific variables were based on participants’ zip codes and census block group, and included area deprivation index (ADI) and child opportunity index (COI). Lower ADI and COI indicate lesser deprivation and greater opportunity. Individualized education plan (IEP) status was used as a proxy of academic support, coded dichotomously as with or without IEP. Percentages of participants showing impairments in functional outcomes were calculated using a cutoff of > 1 SD above the normative mean. Partial correlations were conducted while controlling for age at evaluation, age at diagnosis, sex, and verbal IQ, to examine whether participants with poorer performance-based and parent-rated EF would show reduced functional outcomes. Multiple regression analyses were conducted to evaluate whether neighborhood-specific variables and IEP status would predict functional outcomes while controlling for covariates.Results:Compared to population norms, survivors of childhood ALL showed worse functional outcomes. Within adaptive functioning, 45.5% of participants showed impairment in activities of daily living and leadership. Adaptive functioning was significantly positively correlated with parent-rated, but not performance-based, EF (r=0.694, p<0.001). Compared to female survivors, male survivors were at increased risk for adaptive functioning difficulties (r=-0.401, p<0.05). Impairments for word reading and math calculation were 25% and 41.7%, respectively. Greater math calculation was associated with better verbal fluency (r=0.378, p<0.05) and processing speed (r=0.439, p<0.05). Older participants at evaluation (/3=-0.580, p<0.001) and those without IEP support (ß=0.465, p<0.05) showed better word reading. Lower ADI predicted better verbal fluency (ß=0.282, p=0.041), however, neighborhood-specific variables were not associated with functional outcomes.Conclusions:Prior findings indicate that performance-based measures and parent-ratings assess different constructs of EF. Thus, adaptive functioning may relate more to the behavioral construct of EF than its cognitive construct. Current findings also suggest that male survivors are at increased risk for reduced adaptive functioning, consistent with recent reports that male survivors of ALL are at greater risk for specific neurocognitive outcomes. Overall, functional outcomes may be more strongly related to EF than neighborhood-specific variables. Long-term goals include early screening of adaptive and academic difficulties, targeted intervention, and neuropsychological monitoring to support pediatric survivors’ neurocognitive and psychosocial development.

91 Personality Traits Account for Variability in Self-Reported Executive Functioning but not Objective Executive Performance.

Objective:This study evaluated the relation between five-factor model (FFM) personality traits and intra-individual variability (IIV) in executive functioning (EF) using both subjective self-report and objectives measures of EF.Participants and Methods:165 university participants (M=19 years old, SD=1.3; 55.2% White, 35.2% African American, 72.7% female) completed the Barkley Deficits in Executive Functioning Scale-Long Form (BDEFS), IPIP-NEO Personality Inventory, Trail-Making Test (TMT) Parts A and B, and the Neuropsychological Assessment Battery (NAB) EF module. A participant’s IIV was calculated as the standard deviation around their own mean performance. Objective EF IIV was computed from T-scores for performance on Trails A, Trails B, and the NAB EF module. Subjective EF IIV was computed from T-scores for performance across BDEFS domains.Results:Pearson r correlations were used to evaluate the relation between subjective and objective IIV and FFM traits of personality. Subjective EF IIV was positively correlated with FFM neuroticism [r=.48; p<.001] and negatively correlated with FFM conscientiousness [r=-.43; p<.001], extraversion [r=-.18; p=.023] and agreeableness [r=-.22; p=.004]. There were no significant associations between FFM traits and objective EF IIV performance. There was additionally no significant relation between subjective EF IIV performance and objective EF IIV.Conclusions:Personality traits were associated with individual variability on a self-reported measure of EF but not on performance-based EF measures. These results suggest that IIV for the BDEFS was influenced by personality traits, particularly neuroticism and conscientiousness, and may reflect method variance. It was notable that IIV was not correlated between subjective and objective EF measures.

Do Performance-Based Measures and Behavioral Ratings of Executive Functioning Complement Each Other in Predicting Reading and Mathematics in Chinese?

We examined what executive functioning (EF) components predict reading and mathematics within the same study and whether the effects of behavioral ratings of EF overlap or complement those of performance-based measures. One hundred and nine Grade 2 Mandarin-speaking Chinese students from Chengdu, China (55 girls, 54 boys, Mage = 8.15 years), were assessed on measures of EF (planning, inhibition, shifting, and working memory), speed of processing, reading and mathematics. Parents also rated their children's EF skills using the Childhood Executive Functioning Inventory. Results of hierarchical regression analyses showed that only working memory among the performance-based EF measures predicted reading and mathematics. In addition, none of the behavioral ratings of EF made a significant contribution to reading and mathematics after controlling for mother's education and speed of processing. Taken together, these findings suggest that working memory is a domain general predictor of academic achievement, but only when measured with cognitive tasks.

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.

A-199 The Barkley Deficits in Executive Functioning Scale (BDEFS): Personality index or a measure of executive functioning?

Abstract Objective: The BDEFS was compared to objective executive functioning (EF) measures as well as five-factor model (FFM) personality traits. Methods: One hundred sixty-five participants (M=19 years old, SD=1.3; 72.7% female, 55.2% White, 35.2% African American, 4.8% Asian) completed IPIP-NEO Personality Inventory, BDEFS-Long Form, Neuropsychological Assessment Battery (NAB) EF module, and Trail-Making Test (TMT) Parts A and B. Results: EF measures were reduced to a single-factor score using EFA (TMT A and B; NAB Mazes, Categories, and Word Generation subtests) accounting for 34% of the variance. Regression predicting BDEFS total score from the EF factor score was not significant [F(1,163)=.182; p =.67, r2=.001]. Stepwise multiple regression predicting BDEFS total score from FFM traits identified three significant predictors (neuroticism: β=.390, extraversion: β=.239, and conscientiousness: β=-.572) that accounted for 54% of the variance [F(5,159)=36.78; p<.001, r2=.54]. Stepwise regression predicting the EF factor score from FFM traits was not significant [F(5,159)=.57; p=.721, r2=.018]. Conclusions: Performance-based EF measures were not related to BDEFS total score supporting that different constructs are being measured. Personality traits accounted for a majority of variance in BDEFS performance but minimal variance for performance-based EF performance. These results suggest that personality traits are strongly related to an individual’s appraisal of executive dysfunction.

Self-regulation task in young school age children born preterm: Correlation with early academic achievement

BackgroundChildren born preterm are at risk for difficulties in executive function (EF), however there are limited tools to assess EF in young children and it is not fully understood how these early deficits are related to emerging academic skills. AimsTo examine (a) early EF differences in young children born preterm, (b) how a measure of behavioral self-regulation correlates with other measures of EF in children born preterm, and (c) how this measure relates to academic outcomes in children born preterm. Study designLongitudinal cohort study. SubjectsThirty-three healthy children born preterm (25–32 weeks gestation) and 14 children born full term were assessed before starting kindergarten at age 5 and again at ages 6 and 7 years. Outcome measuresEach assessment included a measure of behavioral self-regulation, the Head Toes Knees Shoulders task (HTKS), performance-based measures of EF, parent rating scales of EF and behavior problems, a measure of motor ability, and academic measures. ResultsChildren born preterm performed worse on all measures of self-regulation, EF, parent-report, academic outcomes, and motor ability across time. The HTKS had weak to moderate correlations with parent-report and performance-based measures of EF, moderate to strong correlations with academic performance, and was not correlated with motor ability. ConclusionThis study shows the predictive value of early EF measures on functional academic outcomes and their potential as targets of effective interventions in this high-risk population.

Executive functioning in pediatric acute lymphoblastic leukemia: CHEXI parent-report vs performance-based assessment

Several studies have emphasized the need for comprehensive neuropsychological assessment in pediatric cancer. To date, no study has analyzed Executive functions (EF) in children with Acute Lymphoblastic Leukemia (ALL) undergo treatment by means of both the Childhood Executive Functioning Inventory (CHEXI), parent form and performance-based measures. The aims of the present study were: (1) to explore the sensitivity of ratings vs. cognitive measures of EF to identify executive functions deficits in children with ALL and (2) to analyze the relationship between the parent-rated data and performance-based measures of EF in children with ALL. We assessed EF in typically developing (TD) children (n = 70) and children with ALL (n = 20) aged 6 to 12 years by means of performance-based measures of EFs (including working memory, cognitive flexibility, and inhibition) and the CHEXI parent form, also including IQ, depression, and anxiety measures. When controlling for age, IQ, depression and anxiety, children with ALL exhibited greater difficulties than their TD peers on working memory, cognitive flexibility (spontaneous and reactive) and inhibitory control tasks. Equally, at a behavioral level, differences between groups were observed regarding the CHEXI’s inhibition and WM subscales. However, the CHEXI parent related poorly to EF performance-based measures, supporting earlier research that suggests that ratings and laboratory measures would assess distinct underlying mental constructs. Overall, our results stress the importance of considering both measures when assessing EF in children with ALL as they would offer distinctive but relevant information. The clinical implications of findings are discussed.

Autism Traits Predict Self-reported Executive Functioning Deficits in Everyday Life and an Aversion to Exercise

Are Autism Quotient (AQ) scores related to executive functioning (EF)? We sampled 200 students of normal intelligence and examined the relationship between AQ scores and: (a) 5 self-ratings of EF, (b) 5 performance-based measures of EF, and (c) 5 types of activities or experiences that are assumed to recruit EF and sometimes enhance EF. Our findings reveal that as AQ scores increase, self-rated EF ability decreases. AQ scores and self-reported EF measures do not correlate with objective EF task performance. Furthermore, AQ scores were shown to be negatively associated with many specific types of physical activity. As AQ scores increase, individuals report fewer positive reasons for exercise and more rationalizations for not engaging in more exercise.

A-064 Executive Functioning in an Acute Pediatric Neurocritical Care Population Recently Discharged from the PICU: Exploring the Associations among Parent Report and Individual Performance Measures

Abstract Objective An emerging literature has identified that PICU survivors face a host of long-term physical, cognitive, emotional, and psychosocial difficulties that stem from the underlying concern and side effects of critical care intervention. Research shows that executive functioning (EF) is particularly vulnerable to sequelae. This study sought to understand associations between parent-report of daily life EF and performance-based measures following neurocritical care. Method Twenty-three children ages 8–16 (M = 12.66 years; 39% male) were screened as part of an integrated (neuropsychology and pediatric critical care) acute phase (3–6-week post-discharge) follow-up clinic. Injuries included children with traumatic brain injury (n = 19), or acquired brain injury (i.e., anoxic brain injury, AVM, acute cerebellitis, hemorrhagic stroke; n = 4). EF outcomes were assessed using the Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2), Delis-Kaplan Executive Function System (D-KEFS) Trail Making Test and Verbal Fluency Test, Children’s Memory Scale Digits Backwards, and Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Coding and Symbol Search subtests. Bivariate correlations were used to examine associations among parent-report of EF and performance-based measures of EF in our neurocritical care population. Results Analyses demonstrated significant (□ = .05) correlations between the WISC-V Coding subtest and the BRIEF-2 Shift scale (r = −.44) and Global Executive Composite (GEC; r = −.59). Correlations between D-KEFS Category Fluency and BRIEF-2 Initiate (r = −.51), Working Memory (r = −.44), and GEC (r = −.55) were significant. Inverse correlations demonstrate agreement. Conclusion In the acute recovery phase following neurocritical care, parent-report and specific performance-based measures are only moderately associated, demonstrating the importance of multi-method assessment to detect potential acquired deficits to inform rehabilitation.

Association of self-reported executive function and mood with executive function task performance across adult populations

Executive function (EF) impacts behavior associated with health outcomes. EF can be measured using self-report and/or performance measures, but the correlations between these types of measures are mixed in the extant literature. This study examined self-report and performance-based measures of EF using data from 6 studies, including community and clinical populations (410 participants, ages 19–80, 71% female). Partial correlations revealed significant relationships between performance on the Trail making, Delay Discounting, and Stop Signal tasks with self-reported EF (p < .006 after controlling for age). Mood scores were significantly related to all self-reported domains of EF (p < .0001), and mood and EF scores were correlated over time. When also controlling for mood, correlations between delay discounting and stop signal tasks with self-reported EF remained significant (p < .006). Finally, examining EF scores in participants with and without clinically elevated mood scores showed a wider distribution of self-reported EF scores among those with clinically elevated mood symptoms than among those without. We conclude that self-reported EF is associated with tasks measuring delay discounting and response inhibition in our large, heterogenous population and that assessing EF may be particularly important for those with high levels of mood symptoms.

Goal management training as a cognitive remediation intervention in depression: A randomized controlled trial

BackgroundMajor depressive disorder (MDD) is associated with deficits in executive functioning (EF) that may have a detrimental effect on everyday functioning. Despite this, there are no established cognitive remediation interventions available targeting EF in MDD. Hence, the primary aim of the present pre-registered randomized controlled trial was to evaluate the effectiveness of Goal Management Training (GMT), a metacognitive and strategy-based cognitive remediation intervention to improve EF in MDD. MethodsSixty-three participants with current or previous mild or moderate MDD and self-reported executive deficits were included and randomized to nine sessions of either GMT (two hours, once weekly; n = 35) or computerized cognitive training (one hour, twice weekly; n = 28). Assessments were conducted at baseline (T1), immediately following training (T2), and at six-month follow-up (T3). The primary outcome measure was The Behavior Rating Inventory of Executive Function – Adult version, pertained to daily life EF. Secondary outcome measures included additional EF assessments (performance-based measures and questionnaires), and depressive symptom severity. ResultsForty-three participants completed treatment. Both groups improved following training, and linear mixed model analyses revealed no statistically significant differences between the groups for any outcome measure. Additional exploratory within-group analyses revealed a statistically significant reduction of everyday executive dysfunction and reduced depressive symptoms at the six-month follow-up in GMT only. LimitationsThe study was single-blind, and the sample size was modest. ConclusionsOur findings indicate comparable improvements in everyday and performance-based measures of EF, in addition to reductions in depressive symptoms following both GMT and CCT.

Investigation of the Clinical Utility of the BRIEF2 in Youth With and Without Intellectual Disability.

Executive function (EF) difficulties are commonly found in youth with intellectual disability (ID). Given mixed results from studies using performance-based EF measures, the EF profile has not been well characterized for this population. No published work has examined the clinical utility of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) in distinguishing EF in ID. We hypothesized that the BRIEF2 would show greater elevations in youth with ID compared to the Average IQ comparison group. Participants included a large sample of 504 youth (157 in ID group; aged 8-18 years) referred for (neuro)psychological evaluation (2015-2019) and identified as meeting criteria for either ID or Average IQ comparison group. Significant elevations were found across BRIEF2 indices and scales. Only mild elevations were noted in selective cognitive regulation scales within the Average IQ group. Groups differed significantly across all EF dimensions, with greater differences observed in behavioral regulation (Self-Monitoring, Inhibition), Shift, and Working Memory. An elevated but less variable pattern of index scores was noted in ID, while the overall pattern of scaled scores appeared similar between groups. The less variable and consistently elevated profile may suggest fewer EF dimensions in individuals with ID than the model proposed in the test manual. Similar profiles between groups may reflect differences in severity, rather than differences in constructs measured by the EF factors, per se. Additional examination is needed to confirm potential structural differences in EF for youth with ID as measured by BRIEF2, with a clinical implication for greater efficiency of EF assessment in this population.

Brief Report: Performance-Based Executive Functioning Abilities are Associated with Caregiver Report of Adaptive Functioning in Autism Spectrum Disorder.

Executive functioning is thought to contribute to adaptive behavior skills development in individuals with autism spectrum disorder (ASD). However, supporting data are largely based on caregiver reports of executive functioning. The current study evaluated whether performance-based measures of executive functioning (working memory and inhibition) explained unique variance in parent-reported adaptive functioning among youth with ASD without an intellectual disability. Both spatial and verbal working memory were associated with adaptive functioning, particularly communication and daily living skills. Our findings demonstrate a robust relationship between working memory and adaptive functioning that translates across different measurement modalities. This preliminary study highlights that targeting executive functioning may be a critical component of an adaptive function training program.

The association between sedentary behavior and cognitive ability in older adults.

Executive functions (EF) are a grouping of cognitive abilities essential for daily life. Previous research has shown that physical activity (PA) may in fact preserve EF in older adults, but the link between sedentary behavior (SB) and cognitive ability has been less explored. The purpose of this study was to examine the relationship between SB and cognition (executive function and memory) in older adults. Seventy five older adults (74.6 ± 9years) self-reported their sedentary time (ST) and PA, as well as EF ability (paper-based measure of EF). Participants also completed several performance-based measures of EF and a memory task. Older adults who were less sedentary had superior EF and memory (e.g., Stroop time was significantly faster in less sedentary adults (34.7s ± 1.9) compared to more sedentary adults (39.6s ± 1.8), p = .02). Regression analysis showed that total ST was associated with several measures of EF after adjusting for age, and physical activity (e.g., Stroop time β =  .005 (.002, .009). Less cognitively demanding SB (TV viewing and napping) was associated with worse performance on most EF and in the memory task. Performing a hobby was also associated with lower levels of EF and memory. For example, the building times for the Lego task were positively related to napping (r2 = .34), watching TV (r2 = .27), and performing a hobby (r2 = .46). Associations of ST with cognitive abilities were more pronounced in older adults who engaged in less PA. These results suggest that SB may play an important role in cognitive abilities of older adults. Longitudinal studies using performance-based assessments of EF are needed. Lara Coelho and Kayla Hauck contributed equally to the manuscript.

Ecological validity of performance-based measures of executive functions: Is face validity necessary for prediction of daily functioning?

Predicting patients' ability to engage in instrumental activities of daily living (IADLs) is an important part of neuropsychological evaluation of older adults. Executive functioning (EF) is the neurocognitive domain most strongly associated with performance of IADLs. However, performance-based tests of EF have long been criticized for having poor ecological validity, largely because of their imperfect association with functional outcomes and their low face validity. However, past research has not examined whether high face validity improves a test's ability to predict IADLs. The present study examined this question. Fifty community-dwelling older adults completed 2 measures of EF that have been previously shown to be related to performance on IADL tasks: the Pillbox Test (a test with high face validity) and the Push-Turn-Taptap task (PTT; a test with low face validity). As an outcome variable, weekly pill counts were conducted across 8 weeks as an index of real-world daily medication management. Hierarchical linear regression analyses and receiver operating characteristic (ROC) curve analyses using medication management as the dependent variable revealed that the PTT outperformed the Pillbox Test both in accounting for variance in medication management and in classifying participants according to their medication management accuracy. The present study does not support the notion that face validity, in and of itself, improves the ability of performance-based EF tests to predict functional outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Confirmatory Factor Analysis of the BRIEF-2 Parent and Teacher Form: Relationship to Performance-Based Measures of Executive Functions and Academic Achievement

We conducted two empirical studies to (1) explore the dimensionality of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2) parent and teacher forms, (2) examine the association between the parent and teacher reports, and (3) analyze the relationship between the BRIEF-2 ratings and performance-based measures of executive functions (EFs) (including working memory, inhibition, and shifting tasks) and academic achievement in children. In Study 1 (n = 212 parents; n = 111 teachers), confirmatory factor analysis (CFA) showed that a three-factor solution that included the indices of (1) behavior regulation, (2) emotion regulation, and (3) cognitive regulation best fit the data. In Study 2 (n = 275 8- to 12-year-old Spanish-speaking children), selective and low correlations were found between performance- and rater-based measures of EFs. In addition, low to moderate correlations were found between parent and teacher reports. However, the three indices of both forms of the BRIEF-2 were associated with the diverse academic domains analyzed, although differences emerged depending on the informant (teacher vs. parent). Our results support the hypothesis that the two EF measures document different underlying processes. The clinical and educational implications of considering both perspectives in the assessment of EFs in children with typical development and in children with neurodevelopmental disorders are discussed.

Associations Between Neuroticism and Executive Function Outcomes: Response Inhibition and Sustained Attention on a Continuous Performance Test.

There are known relationships between psychopathology, personality, and executive function (EF), though the association between personality and EF, independent of psychopathology, remains understudied. The present study investigated relationships between Five Factor Model personality traits and indices of response inhibition, sustained attention, and response variability on a continuous performance test (CPT) among 50 healthy adults (male = 27, female = 23; Mage = 19.9 years, range 18-24 years) of primarily Caucasian descent (58.0%). Participants performed an open-source CPT, the Psychology Experiment Building Language Battery Test of Attentional Vigilance (TOAV), and completed self-ratings of conscientiousness, extraversion, and neuroticism on an inventory developed from the public-domain International Personality Item Pool. After controlling for the influences of age, gender, and other personality traits, neuroticism was significantly associated with faster error reaction time and a higher frequency of multiple responses. Neuroticism was also nominally predictive of more frequent commission errors and faster correct and mean reaction time. The present findings indicate that neuroticism is associated with error-prone behavioral performance on a CPT, suggesting that a propensity to experience negative emotions may manifest as impulsivity and hyperactivity on performance-based measures of EF.

Parental Involvement and Executive Function in Emerging Adults with Type 1 Diabetes.

To examine (a) changes in parental involvement across early emerging adulthood, (b) whether yearly fluctuations in parental involvement were associated with adherence and glycated hemoglobin (HbA1c) over time, and (c) whether higher involvement was more beneficial for those with poorer executive function (EF). A total of 228 high school seniors (M age = 17.76) with type 1 diabetes reported on mothers' and fathers' acceptance, knowledge of diabetes activities, disclosure to mothers and fathers regarding diabetes, and adherence at four yearly time points. At baseline, participants completed performance-based measures of EF. HbA1c was collected from assay kits. Growth curve models revealed significant declines in disclosure to fathers and mothers' and fathers' knowledge of diabetes activities; no changes were found in mothers' or fathers' acceptance nor disclosure to mothers. Multilevel models indicated significant between-person effects for nearly all aspects of parental involvement with more acceptance, knowledge, and disclosure associated with better HbA1c and adherence. Within-person effects for disclosure to fathers, and mothers' and fathers' knowledge indicated that in years when emerging adults perceived higher amounts of these types of involvement (compared with their own average), HbA1c was lower. Within-person effects were found for acceptance to mothers, disclosure to mothers and fathers, and mothers' diabetes knowledge for adherence. Disclosure to fathers and mothers' knowledge of diabetes activities were especially beneficial for HbA1c for those with poorer EF performance. Parental involvement in diabetes management remains important during the high-risk time of emerging adulthood, especially for those with poorer EF.

A novel unstructured performance-based task of executive function in children with attention-deficit/hyperactivity disorder

ABSTRACTObjective: Executive functions (EFs) have been assessed with performance-based measures and rating scales. Research has shown a lack of association between these two methods. One factor that might contribute to this difference is the structure provided on performance-based measures that is not provided on rating scales. This study examined the role of structure on self-directed task completion, an aspect of EF, using a novel unstructured performance-based task (UPT).Method: Children aged 8–12 years (38 attention-deficit/hyperactivity disorder, ADHD; 42 typically developing) and their caregivers participated. We compared performance on the UPT, performance-based measures of EF (Stroop test and Trail-Making Test), and a rating scale to assess EF (Barkley Deficits in Executive Functioning Scale–Children and Adolescents, BDEFS–CA).Results: Group differences were found across all measures. Significant associations emerged between the UPT and Stroop test, Trail-Making Test, and BDEFS–CA, but no significant associations were found between the Stroop test or Trail-Making Test and the BDEFS–CA. In regression analyses, performance-based tasks and the rating scale both uniquely predicted UPT performance. The UPT was a significant predictor of group status when entered with performance-based tasks, but the UPT did not enter as a significant predictor when entered with the rating scale.Conclusion: The UPT is a promising measure to assess self-directed task completion in children with ADHD.

Executive Function, Eating Behavior, and Preoperative Weight Loss in Bariatric Surgery Candidates: An Observational Study

Background: Individual differences in executive function may influence eating behavior, weight loss (WL), and WL maintenance in obesity treatment. Executive function, which designates top-down cognitive control processes, has been related to eating behaviors which may impact weight, and has been found to be predictive of WL in both behavioral WL programs and after bariatric surgery. Currently, we lack knowledge on the role of executive function in the period before bariatric surgery. If executive function impacts eating behavior and WL in the preoperative period, it may be a target for clinical attention in this stage. Objectives: We aimed to examine the relationship between objective performance-based measures of executive function, eating patterns, and WL in the preoperative period. Method: Baseline data in an ongoing observational longitudinal study of bariatric surgery patients were used. Eighty patients completed neuropsychological testing and self-report questionnaires 4 weeks prior to surgery. Results: We found that working memory predicted WL before surgery and inhibitory control predicted adherence to dietary recommendations. Conclusion: Our study indicates that executive function may play a role in short-term WL and dietary adherence prior to surgery, suggesting that executive function in the preoperative period deserves an extended research focus.