Development of norms for executive functions in typically-developing Indian urban preschool children and its association with nutritional status

Executive functions (EFs) are essential and important for achieving success in children’s everyday lives and play a fundamental role in children’s cognitive, academic, social, emotional and behavioral functioning. A cross-sectional study was carried out to develop age- and sex-specific norms for EFs using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) among 2- to 5-year-olds from urban Bangalore, India. In addition, the association between EFs and anthropometric measures, a marker of nutritional status, is also examined. Primary caregivers of 412 children, equally distributed by age and sex, participated. Raw scores for each domain and indices were converted to standard t-scores and percentiles were computed. A t-score at or above 63 corresponding to the 90th percentile was considered as the cutoff for executive dysfunction in this sample. The prevalence of executive dysfunction is 10% based on the Global Executive Composite score of the BRIEF-P. The cutoff score for identifying executive dysfunction using existing United States (US) norms is higher compared to the cutoff score obtained in the current study. Therefore, using US norms for Indian children could result in the prevalence of executive dysfunction been underestimated. Multiple linear regression analysis revealed that stunted and underweight children have significantly elevated EF scores after adjusting for age, sex and socioeconomic status (SES; p < .01). A greater understanding of EFs in preschool children is important for the early identification of executive dysfunction and implementing interventions to improve their future prospects. This study also shows that undernourished children are more likely to have executive dysfunction.     

Executive function and weight status in children: A one-year longitudinal perspective

There is considerable evidence for an association between obesity and impaired executive function (EF) in adolescents and adults. However, little research has examined EF in overweight or obese children. Furthermore, data on EF in underweight individuals is lacking. In addition, there is no consensus on the directionality of the relationship between Body Mass Index (BMI) and EF, and longitudinal studies are rare. Thus, the present study examined whether children differ in their performance on a battery of EF tasks depending on their weight status (underweight, normal-weight, overweight), and investigated the longitudinal cross-lagged associations between EF and BMI. Hot EF (delay of gratification, affective decision-making), cool EF (attention shifting, inhibition, working memory [WM] updating), and BMI were assessed in 1,657 German elementary-school children at two time points, approximately one year apart. Overweight children exhibited slightly poorer attention shifting, WM updating, and affective decision-making abilities as compared to normal-weight children. Unexpectedly, they did not show any deficits in inhibition or delay of gratification. EF levels of underweight children did not differ significantly from those of normal-weight children. Furthermore, poor attention shifting and enhanced affective decision-making predicted a slightly higher BMI one year later, and a higher BMI also predicted poorer attention shifting and WM updating one year later. The latter association between BMI and subsequent EF scores, however, diminished when controlling for socioeconomic status. Results indicate that hot and cool EF plays a role in the weight development of children, and might be a promising factor to address in preventive interventions.