Depression and learning problems in children: Executive function impairments and inattention as mediators

Transdiagnostic Attentional Deficits Are Associated with Depressive and Externalizing Symptoms in Children and Adolescents with Neuropsychiatric Disorders

OBJECTIVE

Although inattention, impulsivity, and impairments to vigilance are most associated with attention-deficit/hyperactivity disorder (ADHD), transdiagnostic attentional deficits are prevalent across all psychiatric disorders. To further elucidate this relationship, the present study investigated parent-reported neuropsychiatric symptom correlates of attention deficits using the factor structure of the Conners' Continuous Performance Test (CPT-II), a neuropsychological test of attention.

METHOD

Two-hundred and eighteen children and adolescents (7-21 years old) completed the CPT-II as part of standard clinical protocol during outpatient pediatric neuropsychology visits. The factor structure of the CPT-II was determined with a principal component analysis (PCA) using Promax rotation. Pearson correlation analyses and regression models examined the relationship between the generated factor structure, parent-reported clinical symptoms, and pre-determined clinical diagnoses.

RESULTS

Results from the PCA suggested a three-factor model best supported the structure of the CPT-II, and were subsequently defined as inattention, impulsivity, and vigilance. Performance-based inattention was significantly correlated with parent-reported hyperactivity, aggression, conduct problems, and depression. Parent-reported depressive symptoms and conduct problems were the strongest correlates of performance-based inattention, not hyperactivity or aggression. Performance-based inattention was significantly associated with an ADHD diagnosis but not a depression or anxiety diagnosis.

CONCLUSIONS

Findings suggest attentional deficits are not specific to any one disorder. To enhance the identification, classification, and treatment of neuropsychiatric disorders, both researchers and clinicians alike must diminish the importance of categorical approaches to child/adolescent psychopathology and continue to consider the dimensionality of transdiagnostic characteristics such as inattention.

Differentiating pure cognitive disengagement syndrome and attention-deficit/hyperactivity disorder-restrictive inattentive presentation with respect to depressive symptoms, autistic traits, and neurocognitive profiles

This study aimed to differentiate "pure" cognitive disengagement syndrome (CDS) from attention-deficit/hyperactivity disorder-restrictive inattentive presentation (ADHD-RI) by examining their neurocognitive profiles and associations with autistic traits (ATs) and depressive symptoms. A cross-sectional study was conducted involving three groups: pure CDS (n = 24), ADHD-RI (n = 32), and controls (n = 31). Participants underwent neuropsychological assessments using Computerized Neurocognitive Assessment Software (CNS) Vital Signs, alongside evaluations for ATs with the Autism Spectrum Screening Questionnaire, depressive symptoms with the Children's Depression Inventory, and CDS symptoms with the Barkley Child Attention Scale. A semi-structured interview was also conducted with all participants and their parents to ensure the diagnostic validity of the groups. Findings indicated no dimensional symptomatological distinctions between CDS and ADHD-RI, except for CDS symptoms, and demonstrated no significant differences in neurocognitive test profiles between CDS and ADHD-RI, except for the neurocognition index and reaction time. ATs and depressive symptoms did not significantly differ between the pure CDS and ADHD-RI groups but were significantly elevated in both groups compared to controls. The ADHD-RI group exhibited significantly worse performance than CDS concerning the neurocognition index and reaction time, and worse than controls regarding the neurocognition index, reaction time, psychomotor speed, and complex attention. This study elucidates that ADHD-RI and "pure" CDS have substantially overlapping neurocognitive and phenotypic profiles despite certain minor differences, which is detrimental to subjects with ADHD-RI in terms of overall neurocognition and reaction time. It can be argued that, compared to "pure" CDS, executive dysfunction might be slightly more specific to ADHD-RI, while depressive symptoms and ATs are common in both psychological constructs.

Nicotine Pouch Use and Adolescents' and Children's Grades in School, National Youth Tobacco Survey 2022-23

BACKGROUND

The prefrontal cortex is not fully developed in middle/high school students, therefore many substances, including nicotine, have the potential to affect it, impair learning, and hinder academic performance. Nicotine in pouches is an emerging, heavily marketed, explicit public health concern. Adolescents may not know of the risks associated with nicotine pouches, especially with social media and marketing claims that they help with weight loss, athletic abilities, mood, and focus. The purpose of this study is to examine the relationship between nicotine pouches and poor academic performance in middle/high school students.

METHODS

Data for this cross-sectional study were from the 2022 and 2023 U.S. National Students Tobacco Survey (n = 39,575) of students in grades 6-12 (mean age, 14.7 years). Current nicotine pouch use was defined as self-reporting its use for ≥1 day in the past thirty days. School grades were the self-reported grades in school during the past 12 months with two categories (A/B and C/D/F). Covariates included sex, race/ethnicity, English/not English language spoken at home, social media use, and depression.

RESULTS

Current nicotine pouch use was 0.9%. Middle/high school students' nicotine pouch use was associated with C/D/F grades (unadjusted odds ratio: 2.50 [95% confidence interval: 1.49, 4.27], p = 0.0007; adjusted odds ratio: 2.07 [95% confidence interval 1.17, 3.69], p = 0.0132).

CONCLUSION

Lower academic performance (mostly C/D/F grades) was associated with middle/high school students' use of nicotine pouches. Longitudinal research is needed in this new area of tobacco-derived product development.

Exploring associations between ADHD symptoms and emotional problems from childhood to adulthood: shared aetiology or possible causal relationship?

BACKGROUND

ADHD symptoms are associated with emotional problems such as depressive and anxiety symptoms from early childhood to adulthood, with the association increasing with age. A shared aetiology and/or a causal relationship could explain their correlation. In the current study, we explore these explanations for the association between ADHD symptoms and emotional problems from childhood to adulthood.

METHODS

Data were drawn from the Twins Early Development Study (TEDS), including 3675 identical and 7063 non-identical twin pairs. ADHD symptoms and emotional symptoms were reported by parents from childhood to adulthood. Self-report scales were included from early adolescence. Five direction of causation (DoC) twin models were fitted to distinguish whether associations were better explained by shared aetiology and/or causal relationships in early childhood, mid-childhood, early adolescence, late adolescence, and early adulthood. Follow-up analyses explored associations for the two subdomains of ADHD symptoms, hyperactivity-impulsivity and inattention, separately.

RESULTS

The association between ADHD symptoms and emotional problems increased in magnitude from early childhood to adulthood. In the best-fitting models, positive genetic overlap played an important role in this association at all stages. A negative causal effect running from ADHD symptoms to emotional problems was also detected in early childhood and mid-childhood. When distinguishing ADHD subdomains, the apparent protective effect of ADHD symptoms on emotional problems in childhood was mostly driven by hyperactivity-impulsivity.

CONCLUSIONS

Genetic overlap plays an important role in the association between ADHD symptoms and emotional problems. Hyperactivity-impulsivity may protect children from emotional problems in childhood, but this protective effect diminishes after adolescence.

A Virtual Reality Platform for Evaluating Deficits in Executive Functions in Deaf and Hard of Hearing Children-Relation to Daily Function and to Quality of Life

Background: Childhood hearing loss is a common chronic condition that may have a broad impact on children's communication and motor and cognitive development, resulting in functional challenges and decreased quality of life (QoL). Objectives: This pilot study aimed to compare executive functions (EFs) as expressed in daily life and QoL between deaf and hard-of-hearing (D/HH) children and children with typical hearing. Furthermore, we examined the relationship between EFs and QoL in D/HH children. Methods: The participants were 76 children aged 7-11 yr: 38 D/HH and 38 with typical hearing. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Pediatric Quality of Life Inventory (PedsQL), while the child performed a shopping task in the virtual action planning supermarket (VAP-S) to reflect the use of EFs in daily activity. Results: D/HH children showed significantly poorer EFs (as measured by BRIEF and VAP-S) and reduced QoL. Difficulties in EFs were correlated with lower QoL. BRIEF scores were significant predictors of QoL domains. Conclusions: Difficulties in EFs may characterize children with D/HH and reduce their QoL. Therefore, EFs should be screened and treated. VAP-S and BRIEF are feasible tools for evaluating EFs that reflect children's challenges due to EF difficulties in real-life contexts.

The association between depressive symptoms and executive function in type 1 diabetes population: A scoping review

PURPOSE

The purpose of this study was to explore the existing literature on the relationship between depressive symptoms and executive function in patients with type 1 diabetes (T1DM) across the lifespan.

METHODS

The scoping review followed the PRISMA protocol by using three databases: PubMed, CINAHL, and PsycINFO on May 14, 2023. Primary research that included reported executive function and the association with depressive symptoms was included in the review.

RESULTS

Of 1470 de-duplicated publications identified, nine articles were included in the review. Five studies evaluated the T1DM population, while four studies evaluated T1DM and type 2 diabetes (T2DM) as an aggregate result. Three studies indicated an association between depressive symptoms and executive function in adults with T1DM, and four studies indicated an association between depressive symptoms and executive function in adults with either T1DM or T2DM. In general, participants who reported depressive symptoms also exhibited poor executive function. However, two studies did not find an association between depressive symptoms and executive function.

CONCLUSION

In summary, the seven studies in this review suggest that individuals with T1DM who report depressive symptoms are at a higher risk of poor executive function; a clear association between depressive symptoms and executive function in individuals with T1DM remains inconclusive. There is a need to explore this relationship in the future.

Internalizing problems in individuals with reading, mathematics and unspecified learning difficulties: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis to examine if individuals with reading difficulties (RD), mathematics difficulties (MD), or unspecified learning difficulties (ULD) experience internalizing problems (i.e., anxiety, depression, somatic complaints, and social withdrawal) to the same extent, and if the effect sizes are influenced by moderators (age, internalizing problems type, anxiety type, rater type, selection criteria, and attention control). We reviewed 2,806 studies published in English between January 2000 and April 2023. Our final sample consisted of 96 studies that reported effect sizes or data to calculate them (a total of 120 unique samples, 83,260 participants, age range = 7.3 - 34.8 years). Risk of bias and sensitivity were assessed. A random-effects model analysis revealed a significant and moderate overall effect size (Hedge's g = -.54), indicating that individuals with RD, MD or ULD experience more internalizing problems than their chronological-age (CA) controls. Follow-up analyses showed that neither learning difficulties type nor age of participants were significant moderators, but selection criteria (diagnosis versus screening) and internalizing problems type were. These findings suggest that individuals with RD do not differ from those with MD or ULD in internalizing problems, and all fare poorly compared to CA controls.

A data science approach to optimize ADHD assessment with the BRIEF-2 questionnaire

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. A key challenge associated with this condition is achieving an early diagnosis. The current study seeks to anticipate and delineate the assessments offered by both parents and teachers concerning a child's behavior and overall functioning with the Behavior Rating Inventory of Executive Function-2 (BRIEF-2). Mothers, fathers, and teachers of 59 children diagnosed or in the process of being assessed for ADHD participated in this study. The responses provided by 59 mothers, 59 fathers, and 57 teachers to the BRIEF-2 questionnaire were collected. The performance of various feature selection techniques, including Lasso, decision trees, random forest, extreme gradient boosting, and forward stepwise regression, was evaluated. The results indicate that Lasso stands out as the optimal method for our dataset, striking an ideal balance between accuracy and interpretability. A repeated validation analysis reveals an average positive correlation exceeding 0.5 between the inattention/hyperactivity scores reported by informants (mother, father, or teacher) and the predictions derived from Lasso. This performance is achieved using only approximately 18% of the BRIEF-2 items. These findings underscore the usefulness of variable selection techniques in accurately characterizing a patient's condition while employing a small subset of assessment items. This efficiency is particularly valuable in time-constrained settings and contributes to improving the comprehension of ADHD.

The concurrent and longitudinal impact of sleep on mind wandering in early adolescents

Mind wandering refers to task-unrelated thoughts that can interfere with ongoing tasks and could be sleep-driven across childhood. The present study investigated the mechanisms of the association between early adolescents' sleep and mind wandering with emotional symptoms and executive function as potential mediators. A total of 257 early adolescents (baseline aged 9-13 years old; 131 boys) completed the questionnaires consisting of the Pittsburgh Sleep Quality Index, mind wandering, depression and anxiety symptoms, and executive function. Cross-sectional and longitudinal data revealed a sequential mediation pathway of emotional symptoms and executive function in the association between sleep and mind wandering. The mediating effect of emotional symptoms in the link between sleep quality and mind wandering was significant among boys but not girls.

The Neurobiology of Infant Attachment-Trauma and Disruption of Parent-Infant Interactions

Current clinical literature and supporting animal literature have shown that repeated and profound early-life adversity, especially when experienced within the caregiver-infant dyad, disrupts the trajectory of brain development to induce later-life expression of maladaptive behavior and pathology. What is less well understood is the immediate impact of repeated adversity during early life with the caregiver, especially since attachment to the caregiver occurs regardless of the quality of care the infant received including experiences of trauma. The focus of the present manuscript is to review the current literature on infant trauma within attachment, with an emphasis on animal research to define mechanisms and translate developmental child research. Across species, the effects of repeated trauma with the attachment figure, are subtle in early life, but the presence of acute stress can uncover some pathology, as was highlighted by Bowlby and Ainsworth in the 1950s. Through rodent neurobehavioral literature we discuss the important role of repeated elevations in stress hormone corticosterone (CORT) in infancy, especially if paired with the mother (not when pups are alone) as targeting the amygdala and causal in infant pathology. We also show that following induced alterations, at baseline infants appear stable, although acute stress hormone elevation uncovers pathology in brain circuits important in emotion, social behavior, and fear. We suggest that a comprehensive understanding of the role of stress hormones during infant typical development and elevated CORT disruption of this typical development will provide insight into age-specific identification of trauma effects, as well as a better understanding of early markers of later-life pathology.

Effects of RhoA on depression-like behavior in prenatally stressed offspring rats

Depression is a common mental disease that can lead to suicide when severe. Exposure to prenatal stress (PS) can lead to depression-like behavior in offspring, but the mechanism is unclear. RhoA (Ras homology family member A) plays an important role in stress-induced changes in synaptic plasticity, participating in the development of depression by activating the downstream effector ROCK (Rho-associated protein kinase). This study explored the influence in the expression of RhoA and downstream molecules ROCK1/2 in prenatally stressed rats, and the effect of RhoA inhibitor simvastatin on depression-like behavior induced by PS. Depression-like behavior in offspring was detected by sucrose preference test, forced swimming test, and open-field test. The mRNA and protein expression of RhoA and ROCK1/2 in the hippocampus and prefrontal cortex of offspring rats were detected by qRT-PCR and western blotting, respectively. Our results showed that PS causes depression-like behavior in offspring rats, associated with elevated expression of RhoA, ROCK1/2 in the hippocampus and prefrontal cortex. After administration of simvastatin to PS rats, the expression of RhoA and ROCK2 was significantly reduced, alleviating depression-like behavior. Our study demonstrated that RhoA participates in the depression-like behavior in prenatally stressed offspring rats, which may be a potential target for antidepressant therapy.