Childhood executive functions and ADHD symptoms predict psychopathology symptoms in emerging adults with and without ADHD: a 10-year longitudinal study

Executive functions and ADHD symptoms predict educational functioning in children with ADHD: A two-year longitudinal study

The aim of this two-year longitudinal study was to investigate whether deficits in executive functions (EF) predict impaired everyday functioning after two years in children and adolescents with ADHD. A sample of 135 participants with and without ADHD were assessed with neuropsychological tests of EF and parent ratings of everyday functioning with the Child Behavior Checklist at baseline (Mage = 11.6, SD = 2.0), and after two years (Mage = 13.6, SD = 2.1). Results showed that ADHD symptoms and impaired EF at baseline predicted lower educational functioning when controlling for general cognitive ability (i.e. "IQ") at two-year follow-up. Furthermore, the results indicated that increased ADHD symptoms predicted problems both with social functioning and functioning in leisure activities (i.e. sport/hobbies/chores/jobs), whereas higher IQ predicted better functioning in leisure activities. The current study primarily highlights the importance of detecting and treating ADHD symptoms in order to prevent reduced functional outcomes, and that EF tests may contribute to identify children in need of educational interventions targeting EF deficits.

The trajectory of attention deficit hyperactivity disorder symptoms and its dynamic relationship with inhibitory control

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood, characterized by symptoms of inattention, hyperactivity, and impulsivity. Impaired inhibitory control is observed in the majority of individuals with ADHD. Understanding the relationship between inhibitory control and the developmental trajectory of ADHD is essential for informing clinical prognosis and guiding early interventions.

METHODS

We utilized Latent Growth Curve Modeling (LGCM) to map the developmental course of ADHD symptoms using data from the Adolescent Brain Cognitive Development study. Concurrently, we examined the longitudinal correlation between inhibitory control and ADHD symptoms at corresponding time points. Additionally, a Bivariate Latent Change Score Model (BLCSM) was employed to investigate the relationship between changes in inhibitory control and ADHD symptoms. We also integrated Polygenic Risk Scores (PRS) into the LGCM as predictors to explore the impact of genetic factors associated with inhibitory control and ADHD on the trajectory of ADHD symptoms.

RESULTS

The LGCM analysis demonstrated that baseline inhibitory control influenced both the initial state and the rate of change of ADHD symptoms. Inhibitory control exhibited both concurrent and prospective associations with ADHD symptoms. Notably, the BLCSM revealed that changes in inhibitory control could predict future changes in ADHD symptoms, and vice versa. Dynamic changes in inhibitory control were found to affect future changes in ADHD symptoms. Additionally, the PRS for inhibitory control and ADHD were significantly linked to the initial state and rate of change of ADHD symptoms.

CONCLUSIONS

Our findings underscore a sustained correlation between inhibitory control and ADHD symptoms, highlighting the critical association between inhibitory control and the developmental trajectory of ADHD in children. Furthermore, the predictive value of inhibitory control for ADHD suggests a new avenue for early intervention, potentially improving the prognosis for ADHD patients.

Iowa Gambling Task performance in individuals with schizophrenia: the role of general versus specific cognitive abilities

Objective

We aimed to explore how specific cognitive processes, such as attention and executive functions, account for variance in decision-making measured by Iowa Gambling Task (IGT) performance among individuals with schizophrenia spectrum disorders.

Methods

Adults (N = 65, M age = 25.4) with schizophrenia spectrum disorders participating in a clinical trial (registered at clinicaltrials.gov NCT03048695) completed the IGT, neuropsychological tests of attention, response inhibition, mental flexibility, working memory, and planning, as well as subtests from the Wechsler tests of intelligence to estimate IQ. Associations between performance on specific tasks, a composite score of executive function and attention, and IGT performance measured in two ways, one using the total net score, decks (C+D) - (A+B) and the other as preference for decks with more frequent gains than losses, decks (B+D) - (A+C), were analyzed with correlational and hierarchical regression analysis controlling for estimated IQ and psychotic symptoms, measured by the Positive and Negative Syndrome Scale.

Results

In the regression analyses, the strongest predictor of IGT performance measured as the total net score was estimated IQ (b = 1.43, p <.001). Neither specific cognitive tasks nor the composite score of executive functioning significantly contributed to explaining variance in IGT total net score beyond IQ and symptoms of psychosis. However, IQ and symptoms of psychosis did not predict tendency towards selecting decks with different gain-to-loss frequency, whereas poorer composite executive functioning predicted a pattern of selecting decks A and C with more frequent losses, (b = 8.30, p <.05).

Discussion

The results suggest that both IQ and executive functions contribute to IGT performance, but in distinct ways. Whereas lower IQ may contribute to overall more disadvantageous decision-making, poorer executive functioning may contribute to a more risk-aversive decision-making style. A clinical implication may be that individuals with schizophrenia and lower IQ or poorer executive functioning will have a higher need for support and interventions targeting decision-making.

Executive functioning as a prospective moderator of the relations between maltreatment in childhood and externalizing symptoms and wellbeing from adolescence to young adulthood

Although childhood maltreatment is associated with externalizing symptoms, not all individuals with these experiences develop externalizing behaviors and some exhibit positive adjustment. To address this multifinality, we used latent growth curve modeling to identify trajectories of (a) externalizing symptoms and (b) subjective wellbeing from late adolescence through young adulthood, determine whether types of childhood maltreatment and domains of executive functioning (EF) are associated with initial levels and growth (slopes) of externalizing symptoms or subjective wellbeing, and investigate whether EF moderates these relations. Participants were youth recruited at ages 10-12 (N = 775; 69% male, 31% female; 76% White, 21% Black/African American, 3% multiracial). We examined EF at ages 10-12, childhood maltreatment reported retrospectively at age 25, and externalizing symptoms and subjective wellbeing at multiple points between ages 16 and 28. Experience of childhood maltreatment and certain EF domains were associated with externalizing symptoms and subjective wellbeing at age 16. EF domains were associated with rate of change in externalizing problems, though not in expected directions. EF variables moderated the relation between maltreatment and initial levels of both outcomes and change in externalizing symptoms. Findings have implications for intervention efforts to mitigate externalizing problems and bolster positive adjustment.

Maternal major depression during early pregnancy is associated with impaired child executive functioning at 4.5 years of age

BACKGROUND

Maternal depression is a serious condition that affects up to 1 in 7 pregnancies. Despite evidence linking maternal depression to pregnancy complications and adverse fetal outcomes, there remain large gaps in its identification and treatment. More work is needed to define the specific timing and severity of depression that most urgently requires intervention, where feasible, to protect maternal health and the developing fetus.

OBJECTIVE

This study aimed to examine whether the timing and severity of maternal depression and/or anxiety during pregnancy affect child executive functioning at age 4.5 years. Executive functioning in the preschool years is a strong predictor of both school readiness and long-term quality of life.

STUDY DESIGN

This longitudinal observational pregnancy cohort study included a sample of 323 mother-child dyads taking part in the Ontario Birth Study, an open pregnancy cohort in Toronto, Ontario, Canada. Maternal symptoms of depression and anxiety were assessed at 12 to 16 and 28 to 32 weeks of gestation and at the time of child testing at age 4.5 years using the 4-item Patient Health Questionnaire. Child executive functioning was measured during a home visit using standardized computerized administration of the Flanker test (a measure of attention) and the Dimensional Change Card Sort (a measure of cognitive flexibility). Stepwise linear regressions, controlling for possible confounding variables, were used to assess the predictive value of continuous measures of maternal depression and/or anxiety symptoms at each assessment time on the Flanker test and Dimensional Change Card Sort. Posthoc general linear models were used to assess whether maternal depression severity categories (no symptom, mild symptoms, or probable major depressive disorder) were helpful in identifying children at risk.

RESULTS

Across all children, after controlling for potential confounds, greater maternal depressive symptoms at weeks 12 to 16 weeks of gestation predicted worse performance on both the Flanker test (ΔR2=0.058; P<.001) and the Dimensional Change Card Sort (ΔR2=0.017; P=.018). Posthoc general linear modeling further demonstrated that the children of mothers meeting the screening criteria for major depression in early pregnancy scored 11.3% lower on the Flanker test and 9.8% lower on the Dimensional Change Card Sort than the children of mothers without maternal depressive symptoms in early pregnancy. Mild depressive symptoms had no significant effect on executive function scores. There was no significant effect of anxiety symptoms or maternal antidepressant use in early pregnancy or pandemic conditions or maternal symptoms in later pregnancy or at the time of child testing on either the Flanker or Dimensional Change Card Sort results.

CONCLUSION

This study demonstrated that fetal exposure to maternal major depression, but not milder forms of depression, at 12 to 16 weeks of gestation is associated with impaired executive functioning in the preschool years. Child executive functioning is crucial for school readiness and predicts long-term quality of life. This emphasizes an urgent need to improve the recognition and treatment of maternal major depression, particularly in early pregnancy, to limit its negative effects on the patient and on child cognitive development.

Antecedents and Consequences of Child Externalizing Problems: Differences in Dynamic Parent-Child Processes

Given that noncompliance is the most common externalizing problem during middle childhood and reliably predicts significant conduct problems, innovations in elucidating its etiology are sorely needed. Evaluation of in-the-moment antecedents and consequences of child noncompliance improves traction on this goal, given that multiple theories contend that child noncompliance and parent behavior mutually influence each other through negative reciprocation as well as contingent praise processes. Among a sample of 140 families (child age: 6-10 years; 32.1% female), the present study capitalized on intensive repeated measures of observed child noncompliance and parent negative talk and praise objectively coded during three unique tasks. We employed dynamic structural equation modeling to evaluate within-dyad parent-child behavioral dynamics and between-dyad differences therein. Results provided mixed support for hypotheses and suggested that antecedents and consequences of child noncompliance differed according to task demands and child ADHD symptoms. Contrary to models of coercive cycles, during child-led play, parent negative talk was more likely following prior child noncompliance, but child noncompliance was less likely following prior parent negative talk. As expected, during parent-led play, parent praise was less likely following prior child noncompliance, which was also less likely following prior parent praise. Relative to youth with fewer symptoms, for children with elevated ADHD symptoms, during a challenging clean-up task, child noncompliance was less stable and less contingent on prior parent negative talk. Results are discussed in terms of their implications of real-time parent-child interactions for typical and atypical development of externalizing problems.

Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD.

METHODS

This pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment.

CONCLUSION

The study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.

Construction of Meta-Thinking Educational Program Based on Mental-Brain Simulation (MTMBS) and Evaluating its Effectiveness on Executive Functions, Emotion Regulation, and Impulsivity in Children With ADHD: A Resting-State Functional MRI Study

OBJECTIVE

The aim of present research was to make a Meta-Thinking educational program based on mental-brain simulation and to evaluate its effectiveness on executive functions, emotion regulation and impulsivity in children with ADHD.

METHODS

The research method was Embedded Design: Embedded Experimental Model. The research sample included 32 children with ADHD who were randomly assigned to two experimental and control groups. The intervention was implemented for eight sessions of 1.5 hr for the experimental group, and fMRI images were taken from them, while the control group didn't receive any treatment. Finally, using semi-structured interviews, coherent information was collected from the parents of the experimental group about the changes made. Data were analyzed with SPSS-24, MAXQDA, fMRIprep, and FSL software.

RESULTS

The Meta-Thinking Educational Program had effect on performance of ADHD children and suppressed brain regions related to DMN.

CONCLUSION

The Implementation of this educational program plays a vital role in improving psychological problems of children with ADHD.

Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study

OBJECTIVE

We tested the hypotheses that (1) a diagnosis of ADHD in childhood or adolescence is associated with reduced quality of life (QoL) and everyday functioning in emerging adulthood, and (2) executive function (EF) deficits, internalizing difficulties, and ADHD symptoms predict reduced QoL and more functional impairments.

METHOD

We assessed 85 children and adolescents with ADHD and 50 typically developing (TD) peers at baseline (M_age = 11.6 years, 58% males), 2-year follow-up, and 10-year follow-up with neuropsychological tests of EF and self-reports.

RESULTS

Individuals with ADHD reported lower QoL and functional impairments in emerging adulthood compared to TD peers. More internalizing difficulties and ADHD symptoms at baseline and 2-year follow-up significantly predicted lower QoL and more functional impairments at the 10-year follow-up.

CONCLUSION

ADHD and internalizing difficulties in childhood or adolescence have a negative impact on QoL and everyday functioning in emerging adulthood.