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.     

Cognitive estimations as a measure of executive dysfunction in childhood epilepsy

Children and adolescents with epilepsy are known to demonstrate executive function deficits. Despite prior work that has shown that cognitive estimation tasks are sensitive to executive dysfunction in children, such tasks have not been studied in children with epilepsy. This is particularly important given the fact that executive tasks have heretofore shown poor ecological validity, and it has been speculated that estimation tasks may show stronger ecological validity than other executive tests. One hundred and thirteen clinically referred children and adolescents with epilepsy were included. The Biber Cognitive Estimations Test was sensitive to cognitive dysfunction, with about half showing impairments on this task in comparison to age-matched normative data; the most frequently impaired subscales were quantity estimation and time estimation. Moreover, the Biber Cognitive Estimation Test showed moderate correlations with not only overall intellectual functions and academic achievement but also other commonly administered tests of executive functions, including digit span, Trailmaking, and the Tower of London but not with the contingency naming test. Cognitive estimations were also modestly correlated with age of epilepsy onset but not other epilepsy-severity variables such as number of antiepilepsy drugs (AEDs) or seizure frequency. Unfortunately, the hypothesis that the Biber Cognitive Estimation Test would show strong ecological validity was not supported, as it showed weak relations with parent-reported executive function deficits. The significance and limitations of this investigation are discussed.     

Parent-report and performance-based measures of executive function assess different constructs

A total of 405 children of 5–18 years of age were administered performance-based and parent-report measures of executive function (EF), and measures of motor, attention, reading, and mathematics performance. Attention, reading, and mathematics abilities were associated with a parent-report measure of EF. Reading and mathematics abilities were also associated with performance-based measures of EF, including the Animal Sorting, Inhibition, and Response Set subtests of the Developmental NEuroPSYchological Assessment-II. In contrast, motor functioning was only associated with performance-based measures of EF. Findings suggest that different constructs of EF are measured by parent-report versus performance-based measures, and that these different constructs of EF are associated with different neurodevelopmental processes.     

Attention and executive function in children with and without single-suture craniosynostosis

Children with single-suture craniosynostosis (SSC) have higher rates of learning disabilities and related neurocognitive problems than unaffected peers. Executive function (EF) and attention are thought to be areas of particular vulnerability, though studies to date have been limited by small sample sizes and a lack of control groups. We evaluated 179 school-aged children with SSC (cases) and 183 unaffected controls at an average age of 7 years using clinician-administered and parent and teacher report measures of EF and attention. Among children with SSC, we examined differences as a function of suture location (sagittal, metopic, unicoronal, or lambdoid) and age of corrective surgery. We used linear regression analyses, adjusted for potential confounders, to compare the two groups on all outcome measures. Cases scored lower than controls on most measures, though the magnitude of these differences was small and most were statistically insignificant. The largest relative deficit was on a measure of inhibitory control. Results changed little in sensitivity analyses adjusting for potential attrition bias and for the effects of developmental and academic interventions. Among cases, there were few differences in relation to the location of suture fusion or timing of surgery. Overall, we found limited evidence of broad deficits in EF or attention in children with SSC relative to unaffected controls. Neurocognitive development for children with SSC appears to be variable, across affected children and outcomes assessed. Further research is needed to understand the potential sources of this variability.     

Latent structure of executive function in five- and six-year-old children: A longitudinal study

This longitudinal study analyses the structure of executive function in children assessed at five and six years of age and examines the longitudinal relationships between the executive function dimensions identified at the two age levels. Confirmatory factor analysis was used to examine the latent structure of executive function at both age levels. The best fit to the data at both age levels was a two-factor model in which inhibition was distinguished, while working memory and shifting emerged as a unitary component. Some variables show a moderate longitudinal stability and the inhibitory control tasks display reduced continuity across ages.     

Parenting,corpus callosum,and executive function in preschool children

In this longitudinal population-based study (N?=?544), we investigated whether early parenting and corpus callosum length predict child executive function abilities at 4 years of age. The length of the corpus callosum in infancy was measured using postnatal cranial ultrasounds at 6 weeks of age. At 3 years, two aspects of parenting were observed: maternal sensitivity during a teaching task and maternal discipline style during a discipline task. Parents rated executive function problems at 4 years of age in five domains of inhibition, shifting, emotional control, working memory, and planning/organizing, using the Behavior Rating Inventory of Executive Function-Preschool Version. Maternal sensitivity predicted less executive function problems at preschool age. A significant interaction was found between corpus callosum length in infancy and maternal use of positive discipline to determine child inhibition problems: The association between a relatively shorter corpus callosum in infancy and child inhibition problems was reduced in children who experienced more positive discipline. Our results point to the buffering potential of positive parenting for children with biological vulnerability.     

Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.     

The role of inhibitory control in behavioral and physiological expressions of toddler executive function

A total of 81 toddlers (24-27 months of age) participated in a biobehavioral investigation of inhibitory control. Maternal report measures of inhibitory control were related to laboratory tasks assessing inhibitory abilities under conditions of conflict, delay, and compliance challenge as well as toddler verbal ability. In addition, unique variance in inhibitory control was explained by task-related changes in brain electrical activity at lateral frontal scalp sites as well as concurrent inhibitory task performance. Implications regarding neural correlates of executive function during early development and a central organizing role of inhibitory processing during toddlerhood are discussed.     

Bi-directional relations between behavioral problems and executive function: Assessing the longitudinal development of self-regulation

During childhood, the ability to limit problem behaviors (i.e., externalizing) and the capacity for cognitive regulation (i.e., executive function) are often understood to develop in tandem, and together constitute two major components of self-regulation research. The current study examines bi-directional relations between behavioral problems and executive function over the course of childhood and adolescence. Relying on a diverse sample of children growing up in low-income neighborhoods, we applied a random intercept cross-lagged panel model to longitudinally test associations between behavioral problems and executive function from age 4 through age 16. With this approach, which disaggregated between- and within-child variation, we did not observe significant cross-lagged paths, suggesting that within-child development in one domain did not strongly relate to development in the other. We also observed a moderate correlation between the stable between-child components of behavioral problems and executive function over time in our preferred model, suggesting that these two domains may be relatively distinct when modeled from early childhood through adolescence.     

Demographic and familial predictors of early executive function development: Contribution of a person-centered perspective

Executive function (EF) skills are integral components of young children’s growing competence, but little is known about the role of early family context and experiences in their development. We examined how demographic and familial risks during infancy predicted EF competence at 36 months of age in a large, predominantly low-income sample of nonurban families from Pennsylvania and North Carolina in the United States. Using latent class analysis, six ecological risk profiles best captured the diverse experiences of these families. Profiles with various combinations of family structure, income, and psychosocial risks were differentially related to EF. Much of the influence of early risks on later EF appears to be transmitted through quality of parent-child interactions during infancy. Findings suggest that early family environments may prove to be especially fruitful contexts for the promotion of EF development.     

Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence

High levels of ADHD symptoms are related to severe negative outcomes, which underscore the importance of identifying early markers of these behavior problems. The main aim of the present study was therefore to investigate whether neuropsychological deficits in preschool are related to later ADHD symptoms and academic achievement, over and above the influence of early ADHD symptom levels. The present study is unique because it includes a broader range of predictors compared to previous studies and the participants are followed over time for as long as 13 years (i.e., ages 5–18 years). Preschool data included measures of executive functioning and reaction time variability as well as emotional reactivity and emotion regulation of both positive and negative emotions. When controlling for early ADHD symptom levels, working memory, reaction time variability, and regulation of happiness/exuberance were significantly related to inattention whereas regulation of happiness/exuberance and anger reactivity were significantly related to hyperactivity/impulsivity. Furthermore, working memory and reaction time variability in preschool were significantly related to academic achievement in late adolescence beyond the influence of early ADHD symptoms. These findings could suggest that it is possible to screen for early neuropsychological deficits and thereby identify children who are at risk of negative outcomes. Furthermore, our results suggest that interventions need to look beyond executive functioning deficits in ADHD and also target the role of emotional functioning and reaction time variability. The importance of including both the positive and negative aspects of emotional functioning and distinguishing between emotion regulation and emotional reactivity was also demonstrated.     

Complementary assessments of executive function in preterm and full-term preschoolers

Executive functions (EFs) are interrelated cognitive processes that have been studied in relation to behavior, attention, academic achievement, and developmental disorders. Studies of EF skills assessed through parent report and performance-based measures show correlations between them ranging from none to modest. Few studies have examined the relationship between EF skills measured through parent report and performance-based measures in relation to adaptive function. The present study included preschool children born preterm as a population at high risk for EF impairments. Preschool children (N = 149) completed a battery of EF tasks that assess working memory, response inhibition, idea generation, and attention shifting or cognitive flexibility. Parents reported on children’s EF and adaptive skills. Preterm children showed more parent-rated and performance-based EF impairments than did full-term children. The combined use of either parent report or performance-based measures resulted in the identification of a large number of children at risk for EF impairment, especially in the preterm group. Both parent report and performance-based EF measures were associated with children’s adaptive function. EF skills are measurable in young child'ren, and we suggest that EF skills may serve as targets for intervention to improve functional outcomes. We recommend the use of both parent report and performance-based measures to characterize children’s EF profiles and to customize treatment.     

The development of analogy making in children: Cognitive load and executive functions

The aim of the current study was to investigate the performance of 6-, 8-, and 14-year-olds on an analogy-making task involving analogies in which there are competing perceptual and relational matches. We hypothesized that the selection of the common relational structure requires the inhibition of other salient features, in particular, perceptual matches. Using an A:B::C:D paradigm, we showed that children’s performance in analogy-making tasks depends crucially on the nature of the distractors. Children chose more perceptual distractors having a common feature with C compared with A or B (Experiment 1). In addition, they were also influenced by unstructured random textures. When measuring reaction times instead of accurate responses, only the 8-year-olds’ reaction times were significantly influenced by perceptual distractors. The 6-year-olds seemed to select the first match they noticed, and the 14-year-olds were not influenced (or much less influenced) by featural distractors. These results are compatible with an analogy-making account based on varying limitations in executive functioning at different ages.     

Effects of the EXAT neuropsychological multilevel intervention on behavior problems in children with executive function deficits

This is a clinical intervention study of children with executive function (EF ) deficits. A neuropsychological multimodal group intervention called EXAT (rehabilitation of EX ecutive function and AT tention) was developed at the Psychology Clinic of the University of Tampere. Based on the principles of neuropsychological rehabilitation and behavioral modification, EXAT combines child group training, parent training, and teacher consultations. The aims of this study were to investigate behavior problems before and after the intervention in children attending EXAT and in controls, and to compare intervention effects in hyperactive, inattentive, and EF subgroups based on the primary deficit described in the referral. The participants were 86 children (6–12 years) with a mean IQ of 91.4 attending EXAT and 45 controls. The participants’ parents and teachers completed the Conners’ Rating Scales‐Revised. In addition, the Strengths and Difficulties Questionnaire was completed by the parents attending EXAT . The parents reported statistically significant decreases with medium effect sizes for the CPRS ‐R subscales for impulsivity, hyperactivity, and oppositional behavior. In the controls within the same time interval, there was increase in restless and impulsive behavior, and a decrease in total problems. The teachers reported positive changes after the intervention in ADHD symptoms and anxiousness/shyness, but the effects sizes were small. The intervention effects were larger in the hyperactive subgroup. Positive intervention effects were related to a younger age, lower IQ , and simultaneous learning support. In conclusion, EXAT – a structured multilevel group intervention – has positive effects on children's behavior regulation skills by decreasing impulsivity and restless behavior.     

Examining the relationship between performance-based and questionnaire assessments of executive function in young preterm children: Implications for clinical practice

The aim of this study was to determine whether specific performance-based executive function assessment tools were associated with executive functioning in everyday life as reported by parents and teachers of four- to five-year-old preterm and term children. At the age of 4 years, 141 preterm children born <33 weeks’ gestation and 77 term children were assessed using performance-based intelligence (WPPSI-III) and executive function (EF) assessment tools (NEPSY-II, Day-Night and Shape School tasks). The assessment results were compared with the parent and teacher completed questionnaires of EF (BRIEF-P) when the children started kindergarten at the age of 4 to 5 years. The performance-based intelligence and EF assessment results were not consistently associated with the parent and teacher reports of EF in everyday life for either preterm or term groups. Clinical implications of using and interpreting performance-based EF assessment tools and EF questionnaires are discussed with a particular focus on young preterm children at the commencement of formal schooling.     

Age trends in early behavioral predictors of serious antisocial behaviors

A risk group of disruptive boys (N=65) identified in kindergarten was assessed using the same procedures at ages 6–7, 8–9, and 10–11. Criteria used to define the predictors and criterion variable were the same at all assessment times. Severity was addressed by comparing different forms of behaviors, considering the extent of harmful consequences to others (aggressiveness was considered as most harmful, whereas inattention was considered as least harmful), manifestation in multiple settings, and extreme scores (manipulation of cutoff scores). Different assessment strategies (direct observations, ratings) and different informants (trained observers, mothers and teachers) were used. Aggressiveness as rated by mothers was highly stable from age 6 to age 11. Inattention as rated by teachers was stable only from age 6 to age 9, whereas no stability was found for observations of task inappropriate behaviors. Taskinappropriate behaviors observed in mother-child interactions and in multiple settings at age 6–7 were significant predictors of self-reported antisocial behaviors at age 12, but this prediction was not repeated at ages 8–9 and 10–11. Teacher ratings of inattention at ages 6–7 and 8–9 were also significant predictors of self-reported antisocial behaviors at age 12. The predictive power was much lower when mothers' ratings of aggressiveness were used. Findings from the present study support the hypothesis that some antisocial behavior precursors are age dependent, in that they are more characteristic of certain age groups than of others. Implications for the selection of assessment screening procedures are discussed.     

Relationships between cognitive and behavioral measures of executive function in children with brain disease.

This study addressed the clinical and construct validity of the Behavior Rating Inventory of Executive Function. (BRIEF: Gioia, Isquith, Guy, & Kenworthy, 2000), a questionnaire designed to tap behavioral aspects of executive functions in children. BRIEF profiles in early treated phenylketonuria (PKU; n=44), early treated hydrocephalus (n=45), frontal focal lesions (n=20) and controls (n=80) were examined. Clinical validity was supported through significant between-group comparisons, especially between the frontal focal lesion group and other groups. To examine construct validity, raw scores on cognitive executive function measures including the Contingency Naming Test (CNT), Rey Complex Figure (RCF), Tower of London (TOL), and Controlled Oral Word Association Test (COWAT), were correlated with BRIEF scale scores. Few significant correlations were found, indicating cognitive and behavioral measures appear to tap different constructs within the executive function domain. A dissociation was found between behavioral and cognitive impairments in the frontal as opposed to PKU and hydrocephalus groups. This is discussed in relation to underlying pathology, the cognitive measures used, and possible limitations in the BRIEF's usefulness for measuring behavioral executive dysfunction in groups only mildly affected by neurological compromise.     

Individual differences in ERP measures of executive function in early childhood: Relation to low-risk preterm birth and parent-reported behavior

Although behavioral studies have demonstrated that executive function (EF) develops rapidly during early childhood, few studies have investigated neural systems supporting EF during the preschool years. These systems are sensitive to variations in children’s early life experiences, including preterm birth. The current study collected behavioral and event related potential (ERP) data during an EF task (directional Stroop) in a sample of 150 full-term and low-risk preterm children aged 4-years. Children’s IQ and processing speed (WPPSI-III), and parent report of EF (BRIEF-P), were also measured. Forty-nine children born full-term and 43 low-risk preterm children provided useable ERP data. Similar to prior studies with adults and older children, preschool-aged children showed modulation of ERP components (N2, P3) by cognitive conflict. Effects of trial type were also present for early attentional components (N1 and P2). Exploratory analyses demonstrated that ERP measures of EF were correlated with individual differences in cognitive and behavioral functioning in both full-term and low-risk preterm populations. Future research investigating the neural correlates of early measures of EF in low-risk preterm children and other at-risk groups is warranted to better understand how trajectories of EF development are altered in the first years of life.     

Logic in the study of psychiatric disorders: executive function and rule-following

Executive function has become an important concept in explanations of psychiatric disorders, but we currently lack comprehensive models of normal executive function and of its malfunctions. Here we illustrate how defeasible logical analysis can aid progress in this area. We illustrate using autism and attention deficit hyperactivity disorder (ADHD) as example disorders, and show how logical analysis reveals commonalities between linguistic and non-linguistic behaviours within each disorder, and how contrasting sub-components of executive function are involved across disorders. This analysis reveals how logical analysis is as applicable to fast, automatic and unconscious reasoning as it is to slow deliberate cogitation.

Trait impulsiveness and executive function in healthy young adults

Performance-based neuropsychological tests are often used to assess planning and impulse control, but the extent to which these measures reflect trait impulsiveness or specific dimensions of trait impulsiveness is not clear. This study used the Barratt Impulsiveness Scale-11 (BIS-11; [Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51, 768–774.]) to examine the relationship between various dimensions of trait impulsiveness and performance on several executive function tests in healthy young adults. Total BIS-11 scores correlated with performance on measures of planning and impulse control. Higher non-planning impulsiveness scores, which indicate poorer self-control and lower cognitive complexity, correlated most strongly with performance on a maze test that measures planning and impulse control (r = .58). These results provide support for the convergent validity of pencil-and-paper maze-based measures of planning and impulse control.