Assessment and Development of Executive Function (EF) During Childhood

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood. At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described. A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control”. Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation. The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF. Based on developmental and normative studies, the maturation of executive domains is mapped. Attentional control appears to emerge in infancy and develop rapidly in early childhood. In contrast, cognitive flexibility, goal setting, and information processing experience a critical period of development between 7 and 9 years of age, and are relatively mature by 12 years of age. A transitional period is thought to occur at the beginning of adolescence, and shortly after “executive control” is likely to emerge. In order to confirm our current understanding of EF development and further enhance our understanding of brain-behavior relationships, longitudinal studies incorporating structural and functional neuroimaging are required.     

La représentation du but dans le contrôle exécutif chez l’enfant

Implementation of executive control over thought and action can only be guided by the goals that one desires to reach. Over the last decade, research has pointed out the central role of goal representation in executive control both during childhood and adulthood. The present paper reviews these findings, emphasizing the developmental dynamics observed during childhood. More precisely, it addresses the role of active goal maintenance in working memory, as it has been stressed by developmental and neurocognitive theoretical models. Beyond goal maintenance, the question as to how goal representations are formed in working memory has attracted research efforts lately. With age, children successfully process increasingly subtle environmental cues to infer the current task goal and when task goals need to be updated, as evidenced by the effect of cue transparency on switching and inhibition performance. In addition, the paper addresses how goal representation sheds light on the interplay between executive skills and conceptual knowledge, through the presentation of research in such domains as analogical reasoning, categorical flexibility, and class inclusion quantification. Taken together, these lines of research show that executive control development does not rely exclusively on a growing ability to implement appropriate actions, but it also depends largely on increasingly efficient identification of what such actions should be.     

Development of executive functioning in school-age Tunisian children

Research regarding executive functioning (EF) in children rarely focuses on populations in African or Middle-Eastern Arabic-speaking countries. The current study used a cross-sectional design to examine the developmental trajectories of school-age Tunisian children in three domains of executive control (inhibition of prepotent responses, cognitive flexibility, and working memory) as well as their mutual interactions and the effects of gender and parents’ education level. Inhibitory processes, cognitive flexibility, and working memory were assessed using the Stroop test, a version of the Hayling test adapted for children, simple and alternating tasks of verbal fluency, and verbal and visuospatial span tasks (forward and backward spans). The study population included 120 7- to 12-year-old Tunisian children (60 girls, 60 boys) who were grouped and matched for age, gender, and parents’ education level. The results revealed an overall effect of age on executive performance, whereas gender and parents’ education level showed non-significant effects. In addition, executive indices were significantly associated with fluid intelligence level. Partial correlation analyses (controlled for age) found significant links between indices that assessed the same executive process, except for inhibitory processes; the temporal indices for inhibitory processes showed relative independence. The correlations between indices that assessed distinct executive processes were weaker (but significant). Overall, the results suggest that executive components in school-age Tunisian children operate according to relatively homogeneous developmental trajectories, marked by peaks of maturity that differ according to the assessed index. A transcultural approach to EF is discussed in terms of the unity and diversity of its components.     

Effect of the COMT Val158Met genotype on lateral prefrontal activations in young children

Low executive function (EF) during early childhood is a major risk factor for developmental delay, academic failure, and social withdrawal. Susceptible genes may affect the molecular and biological mechanisms underpinning EF. More specifically, genes associated with the regulation of prefrontal dopamine may modulate the response of prefrontal neurons during executive control. Several studies with adults and older children have shown that variants of the catechol‐O‐methyltransferase (COMT) gene are associated with behavioral performance and prefrontal activations in EF tasks. However, the effect of the COMT genotype on prefrontal activations during EF tasks on young children is still unknown. The present study examined whether a common functional polymorphism (Val158Met) in the COMT gene was associated with prefrontal activations and cognitive shifting in 3‐ to 6‐year‐old children. The study revealed that, compared with children with at least one Met allele (Met/Met and Met/Val), children who were Val homozygous (i) were more able to flexibly switch rules in cognitive shifting tasks and (ii) exhibited increased activations in lateral prefrontal regions during these tasks. This is the first evidence that demonstrates the relationship between a gene polymorphism and prefrontal activations in young children. It also indicates that COMT Val homozygosity may be advantageous for cognitive shifting and prefrontal functions, at least during early childhood, and children who possess this variant may have a lower risk of developing future cognitive and social development issues.     

Executive function and developmental disorders: the flip side of the coin

Several common developmental disorders emerge during early to middle childhood (e.g. autism, attention deficit and hyperactivity disorder) and are associated with impairments in executive function (EF). Contrary to the prevailing view, I suggest that, within populations at-risk, the association with EF is found because individuals with strong EF skills are better able to compensate for atypicalities in other brain systems early in life, and are therefore less likely to receive a diagnosis later in life. I discuss evidence consistent with this view from considerations of individual variability, neuroimaging, and genetics. To the extent that this view is correct, it offers hope for remediation of some later emerging symptoms, as evidence from typical groups indicates that training programs for EF in preschoolers may be effective in improving skills.     

Assessment of executive function in ADHD adolescents: contribution of performance tests and rating scales

This study aimed to analyze performance on measures of neuropsychological and behavioral executive functions (EF) in adolescents with attention deficit hyperactivity disorder (ADHD), and to evaluate the utility of performance-based tests for predicting scores on behavioral EF ratings. One hundred eighteen adolescents (75 ADHD and 43 controls) aged 12–16 years performed neuropsychological tests and completed a behavior rating scale of EF. The ADHD group presented significantly lower scores than controls on Full Scale IQ (FSIQ) and all indexes of the WISC-IV, except the verbal comprehension index (VCI). The ADHD group had significantly lower scores on performance-based tests of working memory, planning and inhibition, and on EF rating scales. Scores on the cognitive EF working memory, planning and flexibility modestly predicted performance on behavioral EF. The results suggest that the combined use of performance-based tests and rating scales provides valuable complementary information that can improve the assessment of executive domains in ADHD.     

Executive Functions in Children and Adolescents with Turner Syndrome: A Systematic Review and Meta-Analysis

Turner syndrome (TS) is a genetic disorder, affecting 1/2500 to 1/3000 live female births, induced by partial or total deletion of one X chromosome. The neurocognitive profile of girls with TS is characterized by a normal Verbal IQ and weaknesses in visual-spatial, mathematics, and social cognitive domains. Executive functions (EFs) impairments have also been reported in these young patients. However, methodological differences across studies do not allow determination of which EFs are impaired and what is the magnitude of these impairments. The aim of this review was to clarify the EF profile of children and adolescents with TS. Sixteen samples, from thirteen studies, were included in the current meta-analysis. EFs measures used in these studies were classified into working memory, inhibitory control, cognitive flexibility, or higher-order EFs tasks in accordance with Diamond’s model, Annual Review of Psychology, 64, 135–168 (2013). Results confirmed that girls with TS had significant executive impairments with effect sizes varying from small (inhibitory control) to medium (cognitive flexibility) and large (working memory, higher-order EFs). Analyses by task revealed that cognitive inhibition may be more impaired than the other inhibitory control abilities. Heterogeneity across cognitive flexibility measures was also highlighted. Between-sample heterogeneity was observed for three tasks and the impact of participants’ characteristics on EFs was discussed. This meta-analysis confirms the necessity to assess, in patients living with TS, each EF by combining both visual and verbal tasks. Results also underline that, when studying girls with TS’ executive profile, it is important to explore the impact of moderator variables, such as IQ, parental socio-economic status, TS karyotype, psychiatric comorbidities, and hormonal treatment status.     

Are sluggish cognitive tempo symptoms associated with executive functioning in preschoolers?

The aim of this study is to investigate whether sluggish cognitive tempo (SCT) symptoms are associated with neurocognitive task performance and ratings of real-world executive functioning (EF) in preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD). The associations between parent- and teacher-rated SCT symptoms and neuropsychological task performance and ratings of EF in 61 4-year-old preschool children (51 boys, 10 girls) with self-regulation difficulties were examined, with regression analyses controlling for the effects of ADHD inattention symptoms. In the study sample, higher teacher-rated SCT symptoms are significantly associated with poorer performance on tasks of visual-perceptual abilities, auditory and visual attention, sustained and selective attention, inhibitory control, pre-numerical/numerical concepts, and slower processing speed, but SCT symptoms are not significantly associated with working memory, attention shifting or cognitive flexibility when controlling for ADHD inattention. Higher parent-rated SCT symptoms are significantly associated with visual-perceptual abilities. ADHD inattention symptoms are more strongly associated than SCT with daily life EF ratings; neither parent- nor teacher-rated SCT symptoms are significantly associated with daily life ratings of inhibition, working memory, or planning/organization after controlling for ADHD inattention. This study suggests that SCT symptoms contribute to EF deficits at least on neurocognitive tasks assessing visual-perceptual/spatial abilities, attention to detail and processing speed, as observed in this sample of young children at risk for ADHD, and may be an important intervention target.     

Common mechanisms of executive attention underlie executive function and effortful control in children

Executive Function (EF) and Effortful Control (EC) have traditionally been viewed as distinct constructs related to cognition and temperament during development. More recently, EF and EC have been implicated in top‐down self‐regulation ‐ the goal‐directed control of cognition, emotion, and behavior. We propose that executive attention, a limited‐capacity attentional resource subserving goal‐directed cognition and behavior, is the common cognitive mechanism underlying the self‐regulatory capacities captured by EF and EC. We addressed three related questions: (a) Do behavioral ratings of EF and EC represent the same self‐regulation construct? (b) Is this self‐regulation construct explained by a common executive attention factor as measured by performance on cognitive tasks? and (c) Does the executive attention factor explain additional variance in attention deficit hyperactivity disorder (ADHD) problems to behavioral ratings of self‐regulation? Measures of performance on complex span, general intelligence, and response inhibition tasks were obtained from 136 preadolescent children (M = 11 years, 10 months, SD = 8 months), along with self‐ and parent‐reported EC, and parent‐reported EF, and ADHD problems. Results from structural equation modeling demonstrated that behavioral ratings of EF and EC measured the same self‐regulation construct. Cognitive tasks measured a common executive attention factor that significantly explained 30% of the variance in behavioral ratings of self‐regulation. Executive attention failed to significantly explain additional variance in ADHD problems beyond that explained by behavioral ratings of self‐regulation. These findings raise questions about the utility of task‐based cognitive measures in research and clinical assessment of self‐regulation and psychopathology in developmental samples.     

Executive functions after age 5: Changes and correlates

Research and theorizing on executive function (EF) in childhood has been disproportionately focused on preschool age children. This review paper outlines the importance of examining EF throughout childhood, and even across the lifespan. First, examining EF in older children can address the question of whether EF is a unitary construct. The relations among the EF components, particularly as they are recruited for complex tasks, appear to change over the course of development. Second, much of the development of EF, especially working memory, shifting, and planning, occurs after age 5. Third, important applications of EF research concern the role of school-age children’s EF in various aspects of school performance, as well as social functioning and emotional control. Future research needs to examine a more complete developmental span, from early childhood through late adulthood, in order to address developmental issues adequately.     

Specifying Associations Between Conscientiousness and Executive Functioning: Mental Set Shifting,Not Prepotent Response Inhibition or Working Memory Updating

Conscientiousness is characterized by self‐control, organization, and goal orientation and is positively related to a number of health and professional outcomes. Thus, it is commonly suggested that conscientiousness should be related to superior executive functioning (EF) abilities, especially prepotent response inhibition. However, little empirical support for this notion has emerged, perhaps due to oversimplified and underspecified modeling of EF. The current study sought to fill this gap by testing relations between conscientiousness and three facets of EF using a nested factors latent variable approach. Participants (N = 420; M_age = 22.5; 50% male; 91% Caucasian) completed a measure of conscientiousness and nine EF tasks designed to tap three related yet distinguishable facets of EF: working memory updating, mental set shifting, and prepotent response inhibition. Structural equation models showed that conscientiousness is positively associated with the EF facet of mental set shifting but not response inhibition or working memory updating. Despite the common notion that conscientiousness is associated with cognitive abilities related to rigid control over impulses (i.e., inhibition), the current results suggest the cognitive ability most associated with conscientiousness is characterized by flexibility and the ability to adapt to changing environmental contingencies and task demands.     

Executive functions in early childhood: The role of maternal and paternal parenting practices

We investigated the association between mothers' and fathers' harsh parenting and sensitive parenting practices and child's executive functions (EF) in early childhood in 607 families. We focused on three broad dimensions of child EF: Emergent metacognition, inhibitory self‐control, and flexibility measured with the parent‐reported Behavior Rating Inventory of Executive Function‐Preschool Version. Less sensitive parenting of the mother and harsher parenting of the father were related to lower scores of emergent metacognition and inhibitory self‐control. Parenting was not associated with child flexibility. This study extends previous research on the association between parenting and EF by the focus on the role of the father and demonstrates independent effects of mother and father on child EF.     

On the relation between theory of mind and executive functioning: A developmental cognitive neuroscience perspective

Theory of mind (ToM) and executive functioning (EF) show marked interrelatedness across childhood, and developmental psychologists have long been interested in understanding the nature of this association. The present review addresses this issue from a cognitive neuroscience perspective by exploring three hypotheses regarding their functional overlap: (1) ToM relies on EF (EF→ToM); (2) EF relies on ToM (ToM→EF); and (3) ToM and EF are mutually related, owing to shared neural structures or networks (ToM?EF). Drawing on evidence from normative brain development, neurodevelopmental and neurodegenerative diseases, patient lesion studies, and brain-imaging studies, we suggest that only a strict version of the ToM?EF proposal of complete neural overlap can be confidently ruled out on the basis of existing evidence. The balance of evidence suggests that separable neurobiological mechanisms likely underlie ToM and EF, with shared mechanisms for domain-general processing that support both abilities. We highlight how future studies may empirically substantiate the nature of the ToM–EF relationship using various biobehavioral approaches.     

Social factors in the development of early executive functioning: a closer look at the caregiving environment

This study investigated prospective links between quality of the early caregiving environment and children's subsequent executive functioning (EF). Sixty-two families were met on five occasions, allowing for assessment of maternal interactive behavior, paternal interactive behavior, and child attachment security between 1 and 2 years of age, and child EF at 2 and 3 years. The results suggested that composite scores of parental behavior and child attachment were related to child performance on EF tasks entailing strong working memory and cognitive flexibility components (conflict-EF). In particular, child attachment security was related to conflict-EF performance at 3 years above and beyond what was explained by a combination of all other social antecedents of child EF identified thus far: child verbal ability and prior EF, family SES, and parenting behavior. Attachment security may thus play a meaningful role in young children's development of executive control.     

Associations between risk factors,developmental outcomes,and executive function in neonatal intensive care unit graduates at 2 years: A retrospective study

This study explores the extent to which medical and sociodemographic variables and cognitive and language skills are associated with executive function (EF) skills in neonatal intensive care unit (NICU) graduates at 24 months of adjusted age. We explored cognitive, language, and EF skills in 42 NICU graduates who participated in a NICU follow-up programme clinic. The association between risk factors and EF and the completion of the EF assessment were explored. Correlational analyses revealed that child gender was associated with EF scores. Analyses revealed cognitive skills, language skills, and multiple gestational births were associated with EF assessment completion. Our findings are among the first to examine EF skills in NICU graduates as young as 24 months of age using a multidimensional, child completed measure. Implications for NICU follow up programmes, the consideration of early interventions aimed to positively affect EF skills, and considerations for future studies are discussed.     

Executive functioning and its relation to ASD and ADHD symptomatology in 22q11.2 deletion syndrome*

Children with 22q11.2 deletion syndrome (22q11DS; velo-cardio-facial-syndrome) are at risk for the developmental disorders, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). In this study, the relation between executive functioning (EF) and the severity of ADHD and ASD symptoms is examined, since EF is known to be important in relation to emotional and behavioral problems. The participants consist of 58 children (38 females) with a mean age of 13.5 years (SD 2.6). Standardized assessment was used to evaluate the severity of ASD and ADHD symptomatology. The major aspects of EF, i.e., cognitive flexibility, inhibition, sustained attention, distractibility, working memory and reaction speed, were evaluated. The profile of EF in 22q11DS was found to be characterized by weaker performance compared to the norms on all subdomains of EF. Poor cognitive flexibility and inhibition, as well as high distractibility, were found to be related to more severe ASD symptoms, while poor quality of sustained attention and high distractibility were found to be related to more severe ADHD symptoms. It is concluded that children with 22q11DS experience impairments in EF, and that the degree of impairment on specific EF subdomains is related to the severity of ASD and/or ADHD symptomatology. These results may help in defining the mediating role of neurocognitive dysfunctions in the development of social and behavioral problems in 22q11DS.     

Development of orbitofrontal function: current themes and future directions

In recent years, an exciting thrust in the developmental research literature has been the focus on "executive" functions (EF). However, the emphasis has been on the more purely cognitive aspects of EF operative in abstract reasoning and problem solving-aspects associated mainly with dorsolateral frontal regions. Although the literature on adult neuropsychology has seen an emerging and growing interest in the study of processes more related to orbitofrontal cortex (OFC), including emotion and personality, research on the development of EF has lagged behind. This special issue of Brain and Cognition is intended to redress this imbalance by bringing together researchers who are studying the nature and development of orbitofrontal function from a wide variety of perspectives.     

Changes and challenges in 20 years of research into the development of executive functions

This review of 20 years of developmental research on Executive Functions (EF) offers a broad‐brushstroke picture that touches on multiple issues including: (i) findings from typical and atypical groups, from infancy to adolescence; (ii) advances in assessment tools and in statistical analysis; (iii) the interplay between EF and other cognitive systems (e.g. those involved in children's developing understanding of mind, and in their processing of reward signals); (iv) integration of cognitive and neuroscience perspectives on EF; and (v) environmental factors that have either a positive influence (e.g. training/intervention programmes; parental scaffolding) or a negative influence (e.g. maltreatment, neglect, traumatic brain injury) on EF. Of the several themes to emerge from this review, two are particularly important; these concern the need to adopt developmental perspectives and the potential importance for intervention work of research on social influences on EF. Specifically, the review highlights both developmental continuities (e.g. in the correlates of EF) and contrasts (e.g. in the nature of EF and its neural substrates) and calls for research that compares developmental trajectories for EF in different groups (e.g. children with autism versus ADHD). In addition, findings from both family‐based research and randomized controlled trials of school‐based interventions highlight the importance of environmental influences on EF and so support the development of interventions to promote EF and hence improve children's academic and social outcomes. Copyright © 2011 John Wiley & Sons, Ltd.     

The roles of different executive functioning skills in young children’s mental computation and applied mathematical problem-solving

This study investigated the relationships of four executive functioning skills (including verbal working memory, spatial working memory, inhibitory control, and cognitive flexibility) with young children’s mental computation and applied mathematical problem-solving. Two hundred and twenty-five Chinese kindergarteners were tested with a battery of general cognitive, executive functioning and mathematics skills. Results showed that when children’s age, gender, non-verbal intelligence, and listening comprehension skills were controlled, verbal working memory and cognitive flexibility were significant correlates of mental computation, whereas verbal working memory, spatial working memory, and cognitive flexibility were significant correlates of applied mathematical problem-solving. Inhibitory control was not significantly associated with the two domains of mathematics under investigation. The findings highlight the differential roles of different executive functioning skills in early mathematical skills and offer practical implication for helping young children in learning complex mathematical skills.     

Cumulative risk,teacher-child closeness,executive function and early academic skills in kindergarten children

We tested the role of teacher-child closeness in moderating the associations between early childhood adversity, measured as a cumulative risk index, and child outcomes during the kindergarten year. Using the ECLSK:11, a national dataset of kindergarteners in the 2010–11 academic year, we examined three dimensions of executive function (cognitive flexibility, inhibitory control, working memory), as well as early reading and math scores, as key skills that facilitate the transition to school. Cumulative risk was negatively associated with all outcomes, and teacher-child closeness was positively associated with all outcomes. Teacher-child closeness moderated the relation between cumulative risk and working memory and cumulative risk and reading scores in a protective manner, but not cognitive flexibility, inhibitory control, or math scores. Implications for research in early childhood adversity and education are discussed.