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.     

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.     

Cognitive and emotional aspects of self-regulation in preschoolers

The goal of the present study was to examine the contribution of executive function (EF) and social cognition to individual differences in emotion regulation (ER) in preschool children. Sixty 3-, 4-, and 5-year-old children were administered a battery of EF tasks, two theory of mind tasks, a measure of verbal ability, and an ER task. In addition, parents completed the Behavior Rating Inventory of Executive Functioning—Preschool Version (BRIEF-P). Performance on the theory of mind tasks as well as parental ratings of executive function was not related to performance on the ER task. However, a component of EF (i.e., inhibition) approached significance with children's displays of positive behaviors during the ER task. Verbal ability was related to the regulation of positive but not negative emotions. Parental ratings of shifting accounted for a significant amount of variance in parental ratings of ER, even after controlling for verbal ability. The findings are discussed in the context of different conceptualizations of the developmental relation between ER and EF.     

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.     

Reprint of ‘Age-related changes in executive control and their relationships with activity performance in handwriting’

Deterioration in the frontal and prefrontal cortex associated with executive functions (EF) occurs with age and may be associated with changes in daily performance. The aim of the present study was to describe changes occurring with age in Executive Functions (EF) and handwriting activity, as well as to analyze relationships between age, EF and handwriting performance. The study population included 80 healthy participants (aged 31 to 76+) living in the community. After answering five questions about their writing habits, the participants completed the Behavioral Assessment of the Dysexecutive Syndrome (BADS). In addition, they performed a handwriting task on a digitizer included in the Computerized Penmanship Evaluation Tool (ComPET), which provides kinematic measures of the handwriting process. Significant differences were found between the four age groups for both EF and temporal and spatial handwriting measures. A series of regressions indicated that age predicted 35% of the variance of the BADS profile score (EF control) and 32% of the variance of in-air time while writing. The results of this study indicated age effect on both EF control and handwriting performance. Possible implications for further research and clinical evaluation and intervention are discussed.     

Executive Control Functions in Degenerative Dementias: A Comparative Review

This paper reviews the literature concerning executive control impairments in degenerative dementias. The construct of executive control functioning is examined, as is the neuroanatomy of frontal–subcortical networks, believed to underlie executive function (EF) impairments. The pattern of EF impairments in Alzheimer's disease (AD) which affects temporal and parietal brain regions most severely is contrasted with observed executive dysfunctions in patients with dementias involving degeneration of primarily frontal and frontal–subcortical brain areas. EF impairments are present in each of these types of dementing illnesses. Although EF impairments are present in AD, they are less prominent than the memory disorder in the neuropsychological profile of the disease and tend to become more pronounced later in the course of the illness. In contrast, patients with frontal or frontal–subcortical dementia may demonstrate executive dysfunction, which occurs earlier in the disease progression and may be initially more severe.     

Executive function in preschoolers: a review using an integrative framework

During the last 2 decades, major advances have been made in understanding the development of executive functions (EFs) in early childhood. This article reviews the EF literature during the preschool period using an integrative framework. The framework adopted considers EF to be a unitary construct with partially dissociable components (A. Miyake et al., 2000). The authors focus on 3 EF components: working memory, response inhibition, and shifting. For the present purposes, the central executive is conceived of as a central attention system that is involved in all EF component operations. Research to date suggests that elementary forms of the core EF components are present early during the preschool period. Changes in EF during the latter half of the preschool period appear to be due to the development of attention and integration of component EFs. Finally, the review outlines a number of areas that warrant further investigation if researchers are to move forward in understanding early EF development.     

The Contribution of Executive Function to Source Memory Development in Early Childhood

Age-related differences in episodic memory judgments assessing recall of fact information and the source of this information were examined. The role of executive function (EF) in supporting early episodic memory ability was also explored. Four- and 6-year-old children were taught 10 novel facts from two different sources (experimenter or puppet), and memory for both fact and source information was later tested. Measures of working memory, inhibitory control, and set shifting were obtained to produce an indicator of children's EF. Six-year-olds recalled more fact and source information than did 4-year-olds. Regression analyses revealed that age, language ability, and EF accounted for unique variance in children's fact recall and source recall performance. These findings suggest a link between episodic memory and EF, and we propose that developmental investigations should further explore this association.     

Processing speed and executive functions in cognitive aging: How to disentangle their mutual relationship?

The processing-speedtheory and the prefrontal-executivetheory are competing theories of cognitive aging. Here we used a theoretically and methodologically-driven framework to investigate the relationships among measures classically used to assess these two theoretical constructs. Twenty-eight young adults (18-32 years) and 39 healthy older adults (65-80 years) performed a battery of nine neuropsychological and experimental tasks assessing three executive function (EF) components: Inhibition, Updating, and Shifting. Rate of information processing was evaluated via three different experimental and psychometric tests. Partial correlations analyses suggested that 2-Choice Reaction Time (CRT) performance is a more pure measure of processing speed than Digit Symbol Substitution Test (DSST) performance in the elderly. Hierarchical regression analyses showed that, although measures of processing speed and EF components share mutual variance, each measure was independently affected by chronological age. The unique adverse effect of age was more important for processing speed than for EF. The processing-speed theory and the prefrontal-executive theory of cognitive aging were shown not to be mutually exclusive but share mutual variance. This implies the need to control for their mutual relationship before examining their unique potential role in the explanation of age-related cognitive declines. Caution has still to be taken concerning the tasks used to evaluate these theoretical constructs.     

Concordance of teacher-rated and performance-based measures of executive functioning in preschoolers

The most common method used to evaluate child behavior and functioning is rating scales completed by parents and/or teachers. Given that executive functioning (EF) plays a fundamental role in the developing child’s cognitive, behavioral, and social-emotional development, it would be ideal if ratings of EF and performance-based EF measures assess the same construct. However, most studies report a small to negligible association between performance-based measures and ratings of EF. There are few studies investigating this association for preschoolers, and most only include parent ratings. Teachers may be more reliable reporters of EF behaviors due to the higher demand for EF skills in the preschool setting than at home and because teachers may have a better sense of what behaviors are normative. In this study, we reviewed the associations between three EF rating scales completed by teachers on 243 preschool children. Results showed small to moderate correlations with EF measures of inhibition and cognitive flexibility/switching for all three scales, with the strongest associations observed between Child Behavior Rating Scale (CBRS) Behavioral Regulation subscale and child EF measures. Exploratory multivariate path analyses showed that, after controlling for age, sex, and socioeconomic status (SES), Behavioral Regulation significantly predicted performance-based measures of EF and accounted for incrementally more variance in the models. We conclude that in ideal situations, it is best to measure EF using both rating scales and performance-based measures of EF. The CBRS seems to be a sensitive measure of EF in preschoolers and may be a helpful brief screening tool for use with teachers.     

Prospective relations between maternal autonomy support and child executive functioning: investigating the mediating role of child language ability

Although emerging evidence suggests that parental behavior is related to the development of child executive functioning (EF), the mechanisms through which parenting affects child EF have yet to be investigated. The goal of this study was to examine the potential mediating role of child language in the prospective relation between maternal autonomy support and child EF. A total of 53 mother–infant dyads took part in three home visits at 15 months, 2 years, and 3 years, allowing for the assessment of maternal autonomy support (T1), child expressive vocabulary (T2), and child EF (T3). The results suggested that child language played a mediating role in the relation between maternal autonomy support and child performance on EF tasks entailing a strong impulse control component above and beyond child previous EF and family socioeconomic status (SES). In contrast, no such mediating role of language was found with EF tasks tapping mostly into working memory and set shifting. Thus, this study highlights one pathway through which parenting can affect child executive control.     

Factors associated with eating behavior in pre-adolescents

The goals of this study are the preliminary Spanish adaptation and validation of the following questionnaires: the Children's Eating Attitudes Test (ChEAT), the Lawrence Self-Esteem Questionnaire (LAWSEQ) and the Body Esteem Scale (BES). In addition, we studied bodily self-esteem in pre-adolescent children, and their possible relation to certain eating attitudes and general self-esteem. This study is cross-sectional, analytical and observational. The sample was made up of 457 participants, 55.14% boys and 44.86% girls aged between 8 and 12 (M = 10.14, SD = 1.30). A multivariate analysis of variance (Age x Sex) was carried out with the total scores of LAWSEQ, ChEAT, BES, BIA and BMI. Cronbach's alpha reliability coefficient was .76, .80, and .67 for ChEAT, BES, and LAWSEQ, respectively. The boys presented significantly higher total scores in the ChEAT than the girls. Of the sample, 10.4% (n = 45) scored over the cut-off point of the ChEAT: These subjects presented lower general and bodily self-esteem, a slimmer ideal image and a greater discrepancy between their real self and their social self.     

The Body Esteem Scale: construct validity of the female subscales

The female subscales of the Body Esteem Scale (BES) have demonstrated convergent and discriminant validity in two previous studies. However, relationships between BES dimensions, weight, and other body-image measures have not been adequately examined. In this study, 200 women with a mean age of 27.6 years completed the BES, the Eating Disorder Inventory, the Self-Consciousness Scale, the Tennessee Self-Concept Scale, a figure rating task, a phototechnical body-size estimation procedure, and items concerning weight satisfaction and attractiveness. BES Weight Concern was most closely related to weight variables and other body image measures where BES Sexual Attractiveness and Physical Condition were more strongly associated with less specific self-perceptions and attitudes. Results support the construct validity of the BES female subscales and their utility for research in populations at increased risk for body-image or eating-disorder disturbances.     

The Body Esteem Scale: Construct Validity of the Female Subscales

The female subscales of the Body Esteem Scale (BES) have demonstrated convergent and discriminant validity in two previous studies. However, relationships between BES dimensions, weight, and other body-image measures have not been adequately examined. in this study, 200 women with a mean age of 27.6 years completed the BES, the Eating Disorder inventory, the Self-Consciousness Scale, the Tennessee Self-Concept Scale, a figure rating task, a phototechnical body-size estimation procedure, and items concerning weight satisfaction and attractiveness. BES Weight Concern was most closely related to weight variables and other body image measures whereas BES Sexual Attractiveness and Physical Condition were more strongly associated with less specific self-perceptions and attitudes. Results support the construct validity of the BES female subscales and their utility for research in populations at increased risk for body-image or eating-disorder disturbances.     

Using generalizability theory to estimate the relative effect of class size and number of items on the dependability of student ratings of instruction

Previous research on the effect of class size on student ratings of instruction has primarily investigated the effect of class size on the favorableness of these ratings rather than its effect on their reliability (dependability). A few studies have used "generalizability theory" to demonstrate the relative effect of class size on the dependability of student ratings of instruction. The purpose of the present study was to test the validity of the findings of these studies in a different cultural setting using a different student ratings questionnaire. Using a random-effect analysis of variance to estimate the variance components for a design in which students were nested within classes and crossed with items, it was found that the variance component for class size was appreciably larger than that for items. At least 20 students were needed to obtain a generalizability coefficient for relative decisions of .70 or more. Increasing the number of students has a greater effect on generalizability coefficients than increasing the number of items.     

The measurement of executive function at age 5: psychometric properties and relationship to academic achievement

This study examined the psychometric properties and criterion validity of a newly developed battery of executive function (EF) tasks for use in early childhood. The battery was included in the Family Life Project (FLP), a prospective longitudinal study of families who were oversampled from low-income and African American families at the birth of a new child (N = 1,292). Ninety-nine percent (N = 1,036) of children who participated in the age 5 home visit completed 1 or more (M = 5.8, Mdn = 6) of the 6 EF tasks. Results indicated that tasks worked equally well for children residing in low-income and not low-income homes, that task scores were most informative about the ability level of children in the low-average range, that performance on EF tasks was best characterized by a single factor, and that individual differences on the EF battery were strongly related to a latent variable measuring overall academic achievement, as well as to individual standardized tests that measured phonological awareness, letter-word identification, and early math skills.     

Executive functioning profiles from the BRIEF across pediatric medical disorders: Age and diagnosis factors

The objective of the study was to compare executive functioning (EF) profiles across several pediatric medical conditions and explore the influence of age of diagnosis and evaluation. A retrospective, cross-sectional study of 734 children aged 5 to 18 years was conducted across five medical groups (brain tumor, leukemia [ALL], epilepsy [EPI], neurofibromatosis type 1 [NF1], and ornithine transcarbamylase deficiency [OTC-D]), attention deficit hyperactivity disorder (ADHD) controls, and matched healthy controls. We compared groups across the scales of a parent-completed Behavior Rating Inventory of Executive Functioning (BRIEF) using a repeated measures analysis of variance (ANOVA). Separate ANOVAs were conducted to look at age factors. The results showed that the ADHD group differed from all other groups and had the highest level of reported EF problems. The NF1 and OTC-D groups differed significantly from the healthy comparison group for overall EF problems, while the EPI and cancer groups did not. Working memory was the most elevated scale across medical groups, followed by plan/organize. Children with medical disorders were two to four times more likely than healthy controls to have clinically significant problems in several EF domains. There was a main effect for age at diagnosis and age at evaluation. A subset of children with medical disorders were found to have parent-reported EF difficulties, with particular vulnerability noted in working memory and organizational/planning skills. This has relevance for the development of interventions that may be helpful across disorders. Children with particular diagnoses and earlier age of diagnosis and evaluation had greater reported EF problems.     

The role of executive functioning in CBT: a pilot study with anxious older adults

Cognitive behavior therapy (CBT) is an effective treatment for late life anxiety and depression. The successful use of CBT is assumed to rely on cognitive skills known as executive functions (EF; e.g., hypothesis generation, allocation of attention, self-monitoring) governed by the prefrontal cortex. Because older adults sometimes have executive deficits as a consequence of normal aging, EF may be a mediator of CBT outcome in older samples. The current pilot study tested the hypothesis that older adults with executive deficits (as measured by neuropsychological tests) would show decreased therapeutic benefit from CBT for generalized anxiety disorder, as compared to a group with intact EF. Results indicated differential response to CBT within the dysfunction group depending on the stability (and possibly, the etiology) of executive deficits from pre- to posttreatment. Those whose EF scores remained low from pre- to posttreatment did not respond to CBT, while those whose scores improved responded quite well, similar to an Intact EF group. Results indicate that some, but not all, older adults with executive dysfunction show decreased benefit from CBT, and are consistent with the assumption that executive skills are important for the successful use of CBT. However, some participants may show improvement on both mood and cognitive skills during treatment, which is discussed further.     

The adrenergic receptor α-2A gene (ADRA2A) and neuropsychological executive functions as putative endophenotypes for childhood ADHD

There is resurgent interest in the psychiatric literature in endophenotypes, variables thought to more strongly reflect the effects of candidate genes than do manifest disorders. In a sample of 176 children with attention deficit hyperactivity disorder (ADHD) and 52 of their siblings, we examined the validity of several putative endophenotypes for ADHD that represent commonly used clinical measures of multiple cognitive/neuropsychological domains of executive functions (EFs). We review their distributional normality, their relations to ADHD symptoms in probands and unaffected siblings relative to nonADHD controls, and their correlation in siblings. We also tested the EF measures’ associations with the ADRA2A gene and whether they mediated or moderated the associations between ADHD and ADRA2A. Several EF measures showed association with ADRA2A, as well as moderation, but not mediation, of its association with ADHD. Implications of the results for evaluating the validity and utility of putative endophenotype measures and for finding candidate gene effects on ADHD are discussed.     

Identifying component-processes of executive functioning that serve as risk factors for the alcohol-aggression relation

The present investigation determined how different component-processes of executive functioning (EF) served as risk factors for intoxicated aggression. Participants were 512 (246 males and 266 females) healthy social drinkers between 21 and 35 years of age. EF was measured using the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) that assesses nine EF components. After the consumption of either an alcohol or a placebo beverage, participants were tested on a modified version of the Taylor Aggression Paradigm in which mild electric shocks were received from, and administered to, a fictitious opponent. Aggressive behavior was operationalized as the shock intensities and durations administered to the opponent. Although a general BRIEF-A EF construct consisting of all nine components predicted intoxicated aggression, the best predictor involved one termed the Behavioral Regulation Index that comprises component processes such as inhibition, emotional control, flexible thinking, and self-monitoring.