Preexisting Executive Function Deficits and Change in Health Behaviors During the COVID-19 Pandemic

A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial

Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6-8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2 . The approved Stage 1 protocol is available here: https://osf.io/kzfwn .

A biobehavioural and social-structural model of inflammation and executive function in pediatric chronic health conditions

Evidence indicates that pediatric chronic health conditions (CHCs) often impair executive functioning (EF) and impaired EF undermines pediatric CHC management. This bidirectional relationship likely occurs due to biobehavioural and social-structural factors that serve to maintain this feedback loop. Specifically, biobehavioural research suggests that inflammation may sustain a feedback loop that links together increased CHC severity, challenges with EF, and lower engagement in health promoting behaviours. Experiencing social and environmental inequity also maintains pressure on this feedback loop as experiencing inequities is associated with greater inflammation, increased CHC severity, as well as challenges with EF and engagement in health promoting behaviours. Amidst this growing body of research, a model of biobehavioural and social-structural factors that centres inflammation and EF is warranted to better identify individual and structural targets to ameliorate the effects of CHCs on children, families, and society at large. This paper proposes this model, reviews relevant literature, and delineates actionable research and clinical implications.

Engineering Virtuous health habits using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize 'successful aging' among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals' ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to 'top-down' training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to 'bottom-up' approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands.

The combined value of executive functions and self-regulated learning to predict differences in study success among higher education students

Introduction

Self-regulated learning (SRL) has traditionally been associated with study success in higher education. In contrast, study success is still rarely associated with executive functions (EF), while it is known from neuropsychological practice that EF can influence overall functioning and performance. However some studies have shown relationships between EF and study success, but this has mainly been investigated in school children and adolescents. EF refer to higher-order cognitive processes to regulate cognition, behavior, and emotion in service of adaptive and goal-directed behaviors. SRL is a dynamic process in which learners activate and maintain cognitions, affects, and behaviors to achieve personal learning goals. This study explores the added value of including EF and SRL to predict study success (i.e., the obtained credits).

Methods

In this study, we collected data from 315 first-year psychology students of a University of Applied Sciences in the Netherlands who completed questionnaires related to both EF (BRIEF) and SRL (MSLQ) two months after the start of the academic year. Credit points were obtained at the end of that first academic year. We used Structural Equation Modeling to test whether EF and SRL together explain more variance in study success than either concept alone.

Results

EF explains 19.8% of the variance, SRL 22.9%, and in line with our hypothesis, EF and SRL combined explain 39.8% of the variance in obtained credits.

Discussion

These results indicate that focusing on EF and SRL could lead to a better understanding of how higher education students learn successfully. This might be the objective of further investigation.

Youth pre-pandemic executive function relates to year one COVID-19 difficulties

Introduction

The first year of the COVID-19 pandemic presented a series of stressors that could relate to psychological difficulties in children and adolescents. Executive functioning (EF) supports goal achievement and is associated with life success, and better outcomes following early life adversity. EF is also strongly related to processing speed, another predictor of life outcomes.

Methods

This longitudinal study examined 149 youths' pre-pandemic EF and processing speed abilities as predictors of self-reported emotional, cognitive, and social experiences during the first year of the COVID-19 pandemic. EF and processing speed were measured with a total of 11 behavioral tasks. The COVID-era data was collected during two timepoints, during early (May-July 2020) and mid- (January-March of 2021) pandemic.

Results

Better pre-pandemic EF skills and processing speed abilities predicted more mid-COVID-19 pandemic emotional and cognitive difficulties. On the other hand, better switching (a subcomponent of EF) and processing speed abilities predicted more mid-pandemic social interactions. EF and processing speed abilities did not relate to the well-being reports from the initial months of the pandemic. Our EF - but not processing speed - results were largely maintained when controlling for pre-pandemic mental health burden, socioeconomic status (SES), and gender.

Discussion

Better cognitive abilities may have contributed to worse mid-pandemic functioning by supporting the meta-cognition needed for attending to the chaotic and ever-changing pandemic news and advice, leading to higher stress-induced worry and rumination. Our study highlights a potential downside of higher EF - often largely viewed as a protective factor - in youth.

The use of mobile apps and fitness trackers to promote healthy behaviors during COVID-19: A cross-sectional survey

OBJECTIVES

To examine i) the use of mobile apps and fitness trackers in adults during the COVID-19 pandemic to support health behaviors; ii) the use of COVID-19 apps; iii) associations between using mobile apps and fitness trackers, and health behaviors; iv) differences in usage amongst population subgroups.

METHODS

An online cross-sectional survey was conducted during June-September 2020. The survey was developed and reviewed independently by co-authors to establish face validity. Associations between using mobile apps and fitness trackers and health behaviors were examined using multivariate logistic regression models. Subgroup analyses were conducted using Chi-square and Fisher's exact tests. Three open-ended questions were included to elicit participants' views; thematic analysis was conducted.

RESULTS

Participants included 552 adults (76.7% women; mean age: 38±13.6 years); 59.9% used mobile apps for health, 38.2% used fitness trackers, and 46.3% used COVID-19 apps. Users of mobile apps or fitness trackers had almost two times the odds of meeting aerobic physical activity guidelines compared to non-users (odds ratio = 1.91, 95% confidence interval 1.07 to 3.46, P = .03). More women used health apps than men (64.0% vs 46.8%, P = .004). Compared to people aged 18-44 (46.1%), more people aged 60+ (74.5%) and more people aged 45-60 (57.6%) used a COVID-19 related app (P < .001). Qualitative data suggest people viewed technologies (especially social media) as a 'double-edged sword': helping with maintaining a sense of normalcy and staying active and socially connected, but also having a negative emotional effect stemming from seeing COVID-related news. People also found that mobile apps did not adapt quickly enough to the circumstances caused by COVID-19.

CONCLUSIONS

Use of mobile apps and fitness trackers during the pandemic was associated with higher levels of physical activity, in a sample of educated and likely health-conscious individuals. Future research is needed to understand whether the association between using mobile devices and physical activity is maintained in the long-term.

Evidence for validity of the epidemic-pandemic impacts inventory (brief healthcare module): Internal structure and association with other variables

The COVID-19 pandemic has subjected healthcare workers to enormous stress. Measuring the impact of this public health emergency is essential to developing strategies that can effectively promote resilience and wellness. The Epidemic-Pandemic Impacts Inventory Supplemental Healthcare Module-Brief Version (EPII-SHMb) was developed to measure impacts among occupational cohorts serving on the front lines of healthcare. While this instrument has been utilized in COVID-19 related studies, little is known about its psychometric properties. This study collects evidence for validity of the EPII-SHMb by evaluating its internal structure and how its scores associate with other variables. Physicians and nursing staff across a large New York health system were cross-sectionally surveyed using an online questionnaire between June and November 2020. Exploratory factor analysis resulted in a 3-factor solution, identifying factors Lack of Workplace Safety (7 items), Death/Dying of Patients (3 items), and Lack of Outside Support (2 items). Internal consistency was high overall and within physician/nursing and gender subgroups (Cronbach's alpha: 0.70 - 0.81). Median scores on Death/Dying of Patients were higher among those who directly cared for COVID-19 patients or worked in COVID-19 hospital units. These results are promising. Additional studies evaluating other dimensions of validity are necessary.

Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program

Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.

Coping under stress: Prefrontal control predicts stress burden during the COVID-19 crisis

The coronavirus (COVID-19) pandemic has confronted millions of people around the world with an unprecedented stressor, affecting physical and mental health. Accumulating evidence suggests that emotional and cognitive self-regulation is particularly needed to effectively cope with stress. Therefore, we investigated the predictive value of affective and inhibitory prefrontal control for stress burden during the COVID-19 crisis. Physical and mental health burden were assessed using an online survey, which was administered to 104 participants of an ongoing at-risk birth cohort during the first wave in April 2020. Two follow-ups were carried out during the pandemic, one capturing the relaxation during summer and the other the beginning of the second wave of the crisis. Prefrontal activity during emotion regulation and inhibitory control were assessed prior to the COVID-19 crisis. Increased inferior frontal gyrus activity during emotion regulation predicted lower stress burden at the beginning of the first and the second wave of the crisis. In contrast, inferior and middle frontal gyrus activity during inhibitory control predicted effective coping only during the summer, when infection rates decreased but stress burden remained unchanged. These findings remained significant when controlling for sociodemographic and clinical confounders such as stressful life events prior to the crisis or current psychopathology. We demonstrate that differential stress-buffering effects are predicted by the neural underpinnings of emotion regulation and cognitive regulation at different stages during the pandemic. These findings may inform future prevention strategies to foster stress coping in unforeseen situations.

Changes in Physical Activity and the Occurrence of Specific Symptoms of "Long-COVID Syndrome" in Men Aged 18-25

The aim of this study was to assess the occurrence of non-specific symptoms of “long-COVID syndrome” depending on the physical activity undertaken resulting from the imposed forms of study (distance learning–contact learning); 136 men aged 21.5 ± 1.58 from universities educating students of medical faculties were examined. The difference between the universities was mainly due to the nature of the classes undertaken (classes remotely-hybrid form) in the period from March 2020 to February 2021. Among the respondents, 17% in Group I and 16% in Group II were infected with the SARS-CoV-2 virus, including 50% in Group I with moderate symptoms, and in Group II—most people 45% with mild symptoms. The conducted research clearly shows the impact of the COVID-19 pandemic on students. They show a number of important problems, such as reduced physical activity, as well as increased body weight and time spent in front of the monitor. They also make it clear that the health consequences of the pandemic affect both people who were infected with the SARS-CoV-2 virus and those who did not suffer from this infection.

Distance Learning Effects Among Italian Children and Parents During COVID-19 Related School Lockdown

Background: During the COVID-19 pandemic, both children and their parents experienced consequences related to distance learning (DL). However, positive and negative effects have varied greatly among families, and the specific factors explaining these differences in experiences are still underexplored. In this study, we examined children's executive functions (EF) and parents' psychological well-being in relation to negative and positive effects of DL on both children and their parents. Method: Participants were 637 Italian parents (92% mothers) with a child (48% male) aged between 6 and 19 years involved in DL due to school closures during the first wave of the COVID-19 pandemic. Data were collected using an online survey. We performed three fixed-order hierarchical multiple regression analyses with child age and sex, children's EF deficits, and parents' psychological well-being as independent variables, and DL-related negative effects (on the child and on the parent) and DL-related positive effects as dependent variables. Results: The results of the regression analyses showed that for negative effects of DL, younger age and greater EF deficits explained most part of the variance. Specifically, regarding negative effects on children, the most important factor was EF deficits, whereas regarding negative effects on parents, child age was the most important factor. For positive effects of DL, all variables explained only a small part of the variance. Child age was the most important factor, but EF deficits and parents' psychological well-being also had a significant impact. Conclusions: The effects of DL during school closures vary widely across families. Our findings indicate that intervention efforts need to consider background variables, child factors, as well as parent factors when supporting families with homeschooling in times of pandemic.

Adverse Collateral Effects of COVID-19 Public Health Restrictions on Physical Fitness and Cognitive Performance in Primary School Children

The aim of the present study was to evaluate whether the COVID-19-related confinement and social restrictions affected the levels of physical fitness and academic achievement in primary school French children. A total of 206 primary school children (106 before confinements and 100 after restrictions) completed a test battery evaluating their anthropometric characteristics, body compositions, activity preferences, cognitive performances and physical fitness. The performance of the Standing Long Jump was better at T0 (169.9 ± 142.5 cm) compared to T1 (135.2 ± 31.4 cm) (p = 0.0367), and the Medicine Ball Throw performance declined from T0 to T1 (297.3 ± 81.1 cm vs. 249 ± 52 cm; p < 0.0001). Motor skills (26.9 ± 6.2 s vs. 30.9 ± 5.4 s; p < 0.0001), the shuttle-run test (stages completed), Maximal Aerobic Speed, and the estimated VO_2max were lower at T1 compared to T0 (p < 0.0001). Executive functioning was found to be greater at T0 compared to T1 (p < 0.0001). Explicit liking or wanting for sedentary or physical activities did not change between T0 and T1. Both overall physical fitness and cognitive performance drastically declined among primary school French children with the COVID-19-related public health restrictions, which reinforces the need to urgently develop preventive strategies in anticipation of further mitigation measures.

The effects of a physical and cognitive training intervention vs. physical training alone on older adults' physical activity: A randomized controlled trial with extended follow-up during COVID-19

BACKGROUND

Executive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown.

METHODS

Data from a single-blinded, parallel-group randomized controlled trial (PASSWORD-study, ISRCTN52388040) were utilized. Participants were 70-85 years old community-dwelling men and women from Jyväskylä, Finland. PT (n = 159) included supervised resistance, walking and balance training, home-exercises and self-administered moderate activity. PTCT (n = 155) included PT and cognitive training targeting executive functions on a computer program. Physical activity was assessed with a one-item, seven-scale question. Executive functions were assessed with color-word Stroop, Trail Making Test (TMT) B-A and Letter Fluency. Changes in physical activity were modeled with multinomial logistic models and the impact of executive functions on physical activity with latent change score models.

RESULTS

No significant group-by-time interaction was observed for physical activity (p>0.1). The subjects were likely to select an activity category higher than baseline throughout the study (pooled data: B = 0.720-1.614, p<0.001-0.046). Higher baseline Stroop predicted higher physical activity through all subsequent time-points (pooled data: B = 0.011-0.013, p = 0.015-0.030). Higher baseline TMT B-A predicted higher physical activity at 6m (pooled data: B = 0.007, p = 0.006) and during COVID-19 (B = 0.005, p = 0.030). In the PT group, higher baseline Letter Fluency predicted higher physical activity at 12m (B = -0.028, p = 0.030) and follow-up (B = -0.042, p = 0.002).

CONCLUSIONS

Cognitive training did not have additive effects over physical training alone on physical activity, but multicomponent training and higher executive function at baseline may support adaptation to and maintenance of a physically active lifestyle among older adults.