Relating Worry and Executive Functioning During Childhood: The Moderating Role of Age

Preadolescent externalizing and internalizing symptoms are differentially related to drift-diffusion model parameters and neural activation during a go/no-go task

Background:

Mental health disorders are among the leading causes of disability in childhood and adolescence. Notably, mental health disorders commonly co-occur, indicating that critical mechanisms may relate to multiple forms of psychopathology. One potential transdiagnostic mechanism that has been examined in youth is inhibitory control. However, previous neuroimaging research on inhibitory control in youth has typically not examined transdiagnostic symptom dimensions or used computational modeling to quantify subcomponent processes that affect inhibition.

Methods:

In the present study, a diverse sample of preadolescents who were oversampled for psychopathology risk (N = 86, ages 8–12) completed a Go/No-Go task during an fMRI scan. Parents completed a series of questionnaires that were used to capture externalizing and internalizing symptom dimensions. Drift-diffusion modeling (DDM) was applied to preadolescents’ task behavior, and model parameters were linked with neural activation using two contrasts: successful inhibition and failed inhibition.

Results:

During successful inhibition, bilateral inferior temporal gyrus (ITG) activation was related to non-decision time, and ITG activation was associated with externalizing and internalizing symptoms. During failed inhibition, insula and putamen activation were associated with drift rates, as well as with internalizing symptoms, independent of externalizing symptoms.

Conclusions:

Results indicate that distinct cognitive processes are related to broader psychopathology symptom dimensions in preadolescents. Future studies should assess relations among computational parameters and clinical risk in youth, which may reveal important prevention and/or intervention targets.

Refining our Understanding of Anxiety in Autistic Youth: Examining the Role of Behavioral Inflexibility

Prior research has demonstrated that cognitive inflexibility is associated with anxiety in autistic individuals. Everyday patterns of behavioral inflexibility (e.g. observable inflexible behavior in the context of the need to change or adapt and that is manifested in real-world everyday settings) is common in autism and can be distinguished from performance on discrete cognitive tasks that tap flexible attention, learning, or decision-making. The purpose of this study was to extend this prior work on inflexibility in autism but with measures specifically developed with input from stakeholders (caregivers and clinicians) for autistic youth designed to measure everyday behavioral inflexibility (BI). We characterized anxiety in a large sample of autistic (N = 145) and non-autistic youth (N = 91), ages 3 to 17 years, using the Parent Rated Anxiety Scale for Autism Spectrum Disorder (PRAS-ASD). Further, we sought to understand how BI, measured via the Behavioral Inflexibility Scale (BIS), predicted anxiety compared to other variables known to increase anxiety in youth (chronological age, IQ, autism diagnosis, assigned sex at birth). Autistic youth had higher parent-related anxiety and BI compared to non-autistic youth. BI was the strongest predictor of anxiety scores, irrespective of diagnosis. Overall, our findings highlight the importance of BI to the understanding of anxiety in autistic youth.

Children's Expressions of Worry During the COVID-19 Pandemic in Sweden

Objective

Sweden is an international exception in its public health response to the COVID-19 pandemic, with a higher number of deaths, albeit not pediatric, compared with other Nordic countries. The objective of this study was to investigate what worries children and adolescents living in Sweden expressed in relation to the pandemic.

Methods

Using an anonymous web-survey, 1,047 children (4–12 years; N = 717) and adolescents (13–18 years; N = 330) responded to five background and four open-ended questions, one of which was: Is there anything that you are worried about when it comes to ‘Corona’? The responses were coded using manifest content analysis. Interrater reliability was .95, assessed on the code level.

Results

Worry was common (77%); mostly (60%) related to disease or death of elderly relatives, parents, the child him/herself or general worry for the elderly/risk groups. Existential worry (15%) comprised worries about the future, including economy and worries about the world perishing or the contagion becoming uncontrollable. A developmental trajectory was evident in the nature of responses. Adolescents’ worries about the future included missing out on their youth and employment. They also worried about society (6%), for example, the future of democracy and the world economy. There was no indication of socioeconomic status or geographic area (urban vs. rural) affecting the presence of worrisome thoughts.

Conclusions

Worry about “Corona” was common. Universal preventative mental health intervention is warranted and could be conducted in the school setting. Intervention could be tailored by age, covering discussion on financial aspects with adolescents.

The relationship between executive functioning and repetitive negative thinking in youth: A systematic review of the literature

Repetitive negative thinking (RNT) and executive functioning (EF) deficits are each characteristic of many forms of youth psychopathology. Extensive work has examined the relationship between rumination, a form of RNT, and EF in adults. However, less is known about the relationship between RNT more broadly and EF in youth, for whom these constructs are developing and emerging. Here, we systematically and qualitatively reviewed 27 studies on the associations between EF (e.g., shifting, inhibition, working memory) and RNT (e.g., rumination, worry, obsessions) in youth. All forms of RNT were more commonly positively associated with questionnaire-reported EF problems in daily life, most frequently in the domain of shifting. Task-based assessments of EF were less consistently associated with RNT in youth, with no strong pattern of presence vs. absence of associations. Further, limited longitudinal work has been conducted on this topic to date. This review integrates initial work with regard to RNT and EF deficits in a still-developing population, and discusses clear future need for longitudinal, multi-method assessments of the relationship between RNT and EF subtypes in youth.

Relating mindfulness and executive function in children

Despite the important role of cognitions in mindful awareness, research on the cognitive processes underlying mindfulness in young populations is scarce. This study explores the association between the core executive functions (i.e. inhibition, working memory, and shifting) and mindfulness within the same model in a sample of children. Seventy-two parent-child dyads participated in the study. Difficulties with executive functioning and child mindfulness level were assessed. Inhibition, working memory, and shifting were significantly correlated with mindfulness. Furthermore, moderate to good fit was found in a model testing the association between mindfulness and the latent executive function variable composed by the three executive functions, and individual executive functions demonstrated significant loadings in relation to the latent variable. In a model relating mindfulness to each individual executive function, mindfulness was uniquely associated with inhibition, working memory, and shifting. The application of current theoretical models of mindfulness to child populations and clinical implications are discussed.

Subjective Executive Function Weaknesses Are Linked to Elevated Internalizing Symptoms Among Community Adolescents

Adolescence is a period of high risk for the emergence of problems with anxiety and depression. Theory and research suggest that executive function deficits accompany internalizing and externalizing problems, although more evidence is required to understand these relationships. This study employed a commonly used rating scale of executive function, the Brief Rating Inventory of Executive Function, and examined relationships with self- and parent-reported internalizing and externalizing problems among a community sample of 299 adolescents. The sample was 56.2% female, with a mean age of 16.22 years (SD = 2.36 years). Analyses revealed strong associations between poorer self- and parent-reported executive function skills and the severity of anxiety and depression symptoms. Problems with executive function were also associated with externalizing symptoms. These results indicate that subjective ratings of executive function capture important aspects of cognitive problems that are highly relevant to adolescent psychopathology in a transdiagnostic fashion.

A Cognitive Model of Pathological Worry in Children and Adolescents: A Systematic Review

Worry is common in children and adolescents, yet some youth experience excessive worries that persist over time and cause significant distress. Whilst the literature on worry and generalised anxiety disorder (GAD) in adults is well established, relatively less is known about the cognitive mechanisms underlying child and adolescent worry. An influential cognitive model of adult pathological worry (Hirsch and Matthews in Behav Res Therapy 50:636–646, 10.1016/j.brat.2012.06.007, 2012) proposes that negative information-processing biases, reduced executive functions, and verbal worry are critical in the aetiology of GAD in adults. The current systematic review investigated whether this cognitive model of worry could be extended to understand child and adolescent worry. Following a systematic search of the literature and screening for eligibility, 30 studies were identified. Evidence indicates that negative information-processing biases and reduced executive functions play an important role in worry and GAD in children and adolescents. However, evidence that children and adolescents experience verbal worry is inconclusive. Building upon Hirsch and Matthews' cognitive model (Behav Res Therapy 50:636–646, 10.1016/j.brat.2012.06.007, 2012), we propose a model of child and adolescent worry to provide a guiding framework for future research. We conclude that cognitive models of worry should incorporate a developmental framework in order to provide greater insight into the mechanisms uniquely associated with worry in children and adolescents and help to identify the cognitive processes to target for early interventions and treatments.

Relationships Among Executive Dysfunction, Constructive Worrying, and Worry Responses in Older Adults

Worry is a ubiquitous human experience and core symptom of anxiety. The present study examined the extent to which specific aspects of worry are related to perceived executive dysfunction in older adults. A total of 100 older adult participants (M age = 68.82 years; range = 65-79 years) completed the Worry Behaviors Inventory, the Coolidge Axis II Inventory Executive Dysfunctions Scale, and the Constructive and Unconstructive Worry Questionnaire. Multiple regression analyses found that worry constructiveness and response behaviors were predictive of executive dysfunction. Specifically, greater avoidance behaviors and unconstructive worry were uniquely predictive of greater executive dysfunctions. Thus, findings indicate that worry constructiveness and approaches to worry management are significantly related to cognitive functioning in older adults. These findings imply a need to assess both worry and executive dysfunction to more accurately determine causal factors regarding anxiety and cognitive decline in older adults.

Online cognitive behavior therapy for adolescents with excessive worry: a multiple baseline design feasibility study

BACKGROUND

One in twenty adolescents experience excessive worry and evidence-based psychological therapies are not sufficiently widespread to reach most of those affected. In this multiple baseline evaluation, we assess the feasibility and preliminary efficacy of a scalable, online cognitive-behavioral intervention for adolescents with excessive worry (BIP worry).

METHODS

Thirteen adolescents (age 13-17) with excessive worry underwent the 10-week online BIP worry intervention. The treatment also included an online intervention for parents. Completion rates, treatment satisfaction, and adverse events were measures of feasibility. Clinical outcomes included worry severity, symptoms of other anxiety and depression, and general functioning. To control for time and spontaneous fluctuations in symptoms, adolescents were randomized to a 2-, 6-, or 10-week baseline phase prior to treatment. A short measure of worry severity was administered weekly during the baseline and treatment phases. Outcomes were assessed before the baseline-phase, at pre-treatment, post-treatment, and at 1- and 3-month follow-ups.

RESULTS

Twelve of 13 included adolescents, together with their parents, participated in BIP worry, with a mean completion rate of 9.8 of the 10 treatment modules. Adolescents reported an average of 4.4 exposures per week as homework during treatment. High levels of treatment adherence, credibility, and satisfaction, and no serious adverse events were reported. Therapists averaged 21 min per week communicating with each family. Linear mixed effects models indicated significant improvements in worry, anxiety, and general functioning from pre- to post-treatment, with these gains maintained at 1- and 3-months follow-up. Reductions in worry severity during treatment were significantly larger than during the baseline phase. The results from the multiple baseline evaluation suggested an association between the introduction of the BIP worry intervention and subsequent symptom change for some but not all adolescents.

CONCLUSIONS

BIP worry is a feasible and potentially effective treatment. As the treatment is scalable and involves limited therapist contact, it represents a low-cost method for treating adolescents with excessive worry and anxiety. Further investigation under randomized controlled trial (RCT) conditions is warranted.

Emotional Control Mediates the Association Between Dimensions of Perfectionism and Worry in Children

Previous research has shown that perfectionism predicts for increased worry in children. Theoretically, children with high levels of perfectionism may show a decreased ability to control their emotions during times of perceived failure. Children may then worry as a maladaptive attempt to cope with intense emotions. The current study sought to test the mediating role of emotional control on the relation between perfectionism dimensions and worry in children. Participants were 66 parent-child dyads. Children were 7-13 years (50 % male; 77.3 % Caucasian, 9.1 % African American). Overall the model fit the data well. Results indicated that perfectionism domains predicted for emotional control deficits and increased worry. Emotional control also partially mediated the relation between perfectionism dimensions and worry. These results suggest that emotional control may be one mechanism through which perfectionism exerts its effect on worry and perfectionistic children may worry due to difficulty controlling their emotional responses.