Early executive functioning predicts externalizing problems in neurodiverse preschoolers

Children with autism spectrum disorder (ASD) often exhibit externalizing problems, which have been linked with increased anxiety and depression, peer rejection, and parental stress. Identification of early predictors of externalizing behaviors in autism will facilitate identification of vulnerable children and implementation of early preventative interventions. There is ample evidence that executive functioning, social functioning, and temperament are predictive of later externalizing problems in general populations, but less is known about these relations in ASD and other neurodiverse populations, particularly in the early preschool years. To address this gap, we assessed the relations between executive functioning, social functioning, and temperament at age 3 and externalizing problems at age 5 in a sample of neurodiverse children with ASD and other neurodevelopmental disorders and delays. Analyses revealed that severity of early executive functioning impairment predicted increased externalizing problems. Severity of social autism symptoms moderated this relationship such that the effect of executive functioning on externalizing problems decreased as autism symptoms increased. These findings suggest that executive functioning is an important target for identifying and developing interventions for vulnerable children and underscore the necessity of considering severity of autism symptoms when researching the development of externalizing problems in children with neurodevelopmental disorders.

Limited usefulness of neurocognitive functioning indices as predictive markers for treatment response to methylphenidate or neurofeedback@home in children and adolescents with ADHD

Introduction

Earlier studies exploring the value of executive functioning (EF) indices for assessing treatment effectiveness and predicting treatment response in attention-deficit/hyperactivity disorder (ADHD) mainly focused on pharmacological treatment options and revealed rather heterogeneous results. Envisioning the long-term goal of personalized treatment selection and intervention planning, this study comparing methylphenidate treatment (MPH) and a home-based neurofeedback intervention (NF@Home) aimed to expand previous findings by assessing objective as well as subjectively reported EF indices and by analyzing their value as treatment and predictive markers.

Methods

Children and adolescents (n = 146 in the per protocol sample) aged 7-13 years with a formal diagnosis of an inattentive or combined presentation of ADHD were examined. We explored the EF performance profile using the Conners Continuous Performance Task (CPT) and the BRIEF self-report questionnaire within our prospective, multicenter, randomized, reference drug-controlled NEWROFEED study with sites in five European countries (France, Spain, Switzerland, Germany, and Belgium). As primary outcome for treatment response, the clinician-rated ADHD Rating Scale-IV was used. Patients participating in this non-inferiority trial were randomized to either NF@home (34-40 sessions of TBR or SMR NF depending on the pre-assessed individual alpha peak frequency) or MPH treatment (ratio: 3:2). Within a mixed-effects model framework, analyses of change were calculated to explore the predictive value of neurocognitive indices for ADHD symptom-related treatment response.

Results

For a variety of neurocognitive indices, we found a significant pre-post change during treatment, mainly in the MPH group. However, the results of the current study reveal a rather limited prognostic value of neurocognitive indices for treatment response to either NF@Home or MPH treatment. Some significant effects emerged for parent-ratings only.

Discussion

Current findings indicate a potential value of self-report (BRIEF global score) and some objectively measured neurocognitive indices (CPT commission errors and hit reaction time variability) as treatment markers (of change) for MPH. However, we found a rather limited prognostic value with regard to predicting treatment response not (yet) allowing recommendation for clinical use. Baseline symptom severity was revealed as the most relevant predictor, replicating robust findings from previous studies.

A longitudinal investigation of parental ratings and performance metrics for executive functioning and symptom severity in clinically referred youth with ADHD

There remains a knowledge gap concerning the persistence of attention deficit hyperactivity disorder (ADHD) over the longer term. The current study aimed to investigate the change in parent-rated, and performance-based metrics of executive functioning (EF) and the relationship between these EF metrics and ADHD symptoms in individuals with ADHD from childhood/adolescence to young adulthood. This was done by examining possible improvements in parent-rated EF and performance-based measures of inattention and inhibition over a three-year interval and their relationship to ADHD outcomes in 137 clinically referred youth with ADHD (mean age = 12.4 years, SD = 3.1). Participants' parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Swanson-Nolan-Pelham Scale at baseline and follow-up. Participants completed the Conners' Continuous Performance Test, Version II (CPT II) at baseline and follow-up. Statistical analyses were performed with Linear Mixed Models. The sex- and age-standardized measures Commission and Hit reaction time (RT) subscales of the CPT II and parent-rated metacognitive, and behavior regulation composites of the BRIEF were largely stable between measuring points. CPT Omissions, Hit RT standard error (reaction time variability), and parent-rated ADHD symptom scores improved slightly. BRIEF composites and reaction time variability were related to ADHD symptoms using longitudinal data. Overall, behavioral aspects of EF, as observed by parents in the home context, appear to play a significant role in the trajectory of childhood ADHD.

Behavior ratings of executive functions index multiple domains of psychopathology and school functioning in child psychiatric outpatients

Behavior rating scales of executive functions (EFs) are convenient and associate with academic and other outcomes; however, prior studies indicate limited correlations with psychometric tests of EFs. To better understand their potential for clinical utility, we examined the extent to which parent ratings on the Behavior Rating Inventory of Executive Function (BRIEF) related to psychopathology constructs and psychometric test scores in a sample of N = 692 psychiatric outpatients aged 8-17. Then, in a subsample of the youth (N = 261), we related the BRIEF, psychopathology constructs, and psychometric test scores to teacher ratings of school functioning. BRIEF scales were significantly associated with multiple types of psychopathology including ADHD, autism spectrum, mood, anxiety, conduct, oppositional defiant, and psychotic disorders. While the BRIEF showed limited associations with psychometric EF tests, its Global Executive Composite score explained additional variance in teacher-reported functioning beyond what was predicted by clinical diagnoses (additional explained variance of 9.9% in study skills) and psychometric tests (additional explained variance of 2.1% in learning problems and 4.5% in study skills). The Global Executive Composite was not significantly related to teacher-rated school functioning after psychiatric symptoms were accounted for. These findings support further investigation of the unique contribution of the BRIEF in clinical practice.

Symptom-guided multimodal neuroimage fusion patterns in children with attention-deficit/hyperactivity disorder and its potential "brain structure-function-cognition-behavior" pathological pathways

The "brain-cognition-behavior" process is an important pathological pathway in children with attention-deficit/hyperactivity disorder (ADHD). Symptom guided multimodal neuroimaging fusion can capture behaviorally relevant and intrinsically linked structural and functional features, which can help to construct a systematic model of the pathology. Analyzing the multimodal neuroimage fusion pattern and exploring how these brain features affect executive function (EF) and leads to behavioral impairment is the focus of this study. Based on gray matter volume (GMV) and fractional amplitude of low frequency fluctuation (fALFF) for 152 ADHD and 102 healthy controls (HC), the total symptom score (TO) was set as a reference to identify co-varying components. Based on the correlation between the identified co-varying components and EF, further mediation analysis was used to explore the relationship between brain image features, EF and clinical symptoms. This study found that the abnormalities of GMV and fALFF in ADHD are mainly located in the default mode network (DMN) and prefrontal-striatal-cerebellar circuits, respectively. GMV in ADHD influences the TO through Metacognition Index, while fALFF in HC mediates the TO through behavior regulation index (BRI). Further analysis revealed that GMV in HC influences fALFF, which further modulates BRI and subsequently affects hyperactivity-impulsivity score. To conclude, structural brain abnormalities in the DMN in ADHD may affect local brain function in the prefrontal-striatal-cerebellar circuit, making it difficult to regulate EF in terms of inhibit, shift, and emotional control, and ultimately leading to hyperactive-impulsive behavior.

Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study

Introduction

The use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.

Methods

This is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).

Results

13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.

Discussion

Future studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.

Assessment of transition readiness to predict health care utilization during transition to adult care in sickle cell disease

BACKGROUND

Transition-age patients with sickle cell disease (SCD) are at risk for poor outcomes associated with incomplete transition readiness and neurocognitive deficits. Study objectives were to: 1) test if a SCD-specific measure of self-management skills was associated with transition outcomes and 2) evaluate if caregiver-reported executive functioning was associated with self-management skills and transition outcomes among youth with SCD.

RESEARCH DESIGN AND METHODS

Youth/caregivers were selected from a longitudinal cohort study. Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF); caregivers and youth completed the Self-Management Skills Checklist (SMSC) at a median age of 16.8 ± 0.6 years. Non-parametric tests compared SMSC and transition outcomes. Regression assessed the incremental validity of SMSC in predicting transition outcomes.

RESULTS

In total, 95 participants (54% male, 55% severe genotype) completed the SMSC assessment. Most participants (87%) transferred to adult care within six months and 87% were retained for at least 12 months. BRIEF and caregiver-reported SMSC assessments were weakly, negatively correlated (ρ = -0.25, p = 0.0392) but were not significant in predicting transition outcomes (p > 0.05).

CONCLUSIONS

The SMSC and executive function did not predict adult care engagement. Development of readiness assessments that predict care engagement and reflect self-efficacy is important for monitoring transition-aged patients with SCD.

Assessment of 'Cool' and 'Hot' Executive Skills in Children with ADHD: The Role of Performance Measures and Behavioral Ratings

Executive dysfunction is an underlying characteristic of Attention Deficit/Hyperactivity Disorder (ADHD). Therefore, this study explored which measures of executive functions (EF) may lead to a better diagnostic prediction and evaluated whether participants were adequately assigned to the ADHD group based on the identified predictors. Seventeen 6- to 10-year-old children with ADHD were matched with 17 typically developing peers (TD) by age, gender, and non-verbal intelligence. Performance-based measures and behavior ratings of 'cool' and 'hot' EF were used. As expected, there was a significant group effect on the linear combination of measures, indicating that children with ADHD showed significant difficulties with EF compared to the TD group. In fact, significant differences were found in measures of short-term and working memory, planning, delay aversion, and EF-related behaviors, as reported by parents and teachers. However, the discriminant function analysis only revealed three significant predictors: the General Executive Composite of the Behavior Rating Inventory of Executive Function (Parent and Teacher Forms) and the Delay of Gratification Task, with 97.1% correct classifications. These findings highlight the importance and contribution of both behavioral ratings and 'hot' measures of EF for the characterization of ADHD in children.

Inhibitory control within the context of early life poverty and implications for outcomes

Early life poverty confers risk for unfavorable outcomes including lower academic achievement, behavioral difficulties, and neurodevelopmental disorders. Disruptions in inhibitory control (IC) have been posed as one mechanism to explain the relationship between early life poverty and deleterious outcomes. There is robust research to suggest that early life poverty is associated with development of poorer IC. Further, poorer IC in children is related to decreased academic achievement and social competence, and increased externalizing and internalizing behavior. There is some parent-report evidence to suggest that IC is a mediator of the relationship between poverty and externalizing behaviors, as well as some limited evidence to suggest that IC is a mediator between poverty and academic achievement. Future work should aim to determine whether early life poverty's relation to IC could be explained by verbal ability which is thought to be central to the development of effective IC. In addition, future neuroimaging work should utilize IC fMRI tasks to identify key neural mechanisms that might contribute to a relationship between early life poverty and IC.

Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea

STUDY OBJECTIVES

Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea.

METHODS

Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis.

RESULTS

The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing.

CONCLUSIONS

Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention.

TRIAL REGISTRATION

Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.

Brain Network Connectivity and Executive Function in Children with Previous Infantile Hydrocephalus

INTRODUCTION

Infantile hydrocephalus is a condition in which there is an abnormal build-up of cerebrospinal fluid in the ventricles within the first few months of life, which puts pressure on surrounding brain tissues. Compression of the developing brain increases the risk of secondary brain injury and cognitive disabilities.

METHODS

In this study, we used diffusion-weighted imaging and resting-state functional MRI to investigate the effects of ventricle dilatation on structural and functional brain networks in children with shunted infantile hydrocephalus and examined how these brain changes may impact executive function.

RESULTS

We found that children with hydrocephalus have altered structural and functional connectivity between and within large-scale networks. Moreover, hyperconnectivity between the ventral attention and default mode network in children with hydrocephalus correlated with reduced executive function scores. Compared to typically developing age-matched control participants, our patient population also had lower fractional anisotropy in posterior white matter.

DISCUSSION

Overall, these findings suggest that infantile hydrocephalus has long-term effects on brain network connectivity, white matter development, and executive function in children at school-age. Future work will examine the relationship between ventricular volumes prior to shunt placement in infancy and brain network development throughout childhood.

Personalized at-home neurofeedback compared to long-acting methylphenidate in children with ADHD: NEWROFEED, a European randomized noninferiority trial

BACKGROUND

Neurofeedback is considered a promising intervention for the treatment of attention-deficit hyperactivity disorder (ADHD). NEWROFEED is a prospective, multicentre, randomized (3:2), reference drug-controlled trial in children with ADHD aged between 7 and 13 years. The main objective of NEWROFEED was to demonstrate the noninferiority of personalized at-home neurofeedback (NF) training versus methylphenidate in the treatment of children with ADHD.

METHODS

The NF group (n = 111) underwent eight visits and two treatment phases of 16 to 20 at-home sessions with down-training of the theta/beta ratio (TBR) for children with high TBR and enhancing the sensorimotor rhythm (SMR) for the others. The control group (n = 67) received optimally titrated long-acting methylphenidate. The primary endpoint was the change between baseline and endpoint in the Clinician ADHD-RS-IV total score in the per-protocol population (90 NF/59 controls).

TRIAL REGISTRATION

US National Institute of Health, ClinicalTrials.gov #NCT02778360.

RESULTS

Our study failed to demonstrate noninferiority of NF versus methylphenidate (mean between-group difference 8.09 90% CI [8.09; 10.56]). However, both treatment groups showed significant pre-post improvements in core ADHD symptoms and in a broader range of problems. Reduction in the Clinician ADHD-RS-IV total score between baseline and final visit (D90) was 26.7% (SMD = 0.89) in the NF and 46.9% (SMD = 2.03) in the control group. NF effects increased whereas those of methylphenidate were stable between intermediate and final visit.

CONCLUSIONS

Based on clinicians' reports, the effects of at-home NF were inferior to those of methylphenidate as a stand-alone treatment.

European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment

In 2011 a working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines for Tourette syndrome (TS). Now, we present an updated version 2.0 of these European clinical guidelines for Tourette syndrome and other tic disorders, part I: assessment. Therefore, the available literature has been thoroughly screened, supplemented with national guidelines across countries and discussions among ESSTS experts. Diagnostic changes between DSM-IV and DSM-5 classifications were taken into account and new information has been added regarding differential diagnoses, with an emphasis on functional movement disorders in both children and adults. Further, recommendations regarding rating scales to evaluate tics, comorbidities, and neuropsychological status are provided. Finally, results from a recently performed survey among ESSTS members on assessment in TS are described. We acknowledge that the Yale Global Tic Severity Scale (YGTSS) is still the gold standard for assessing tics. Recommendations are provided for scales for the assessment of tics and psychiatric comorbidities in patients with TS not only in routine clinical practice, but also in the context of clinical research. Furthermore, assessments supporting the differential diagnosis process are given as well as tests to analyse cognitive abilities, emotional functions and motor skills.

The mediating role of ADHD symptoms between executive function and social skills in children with neurofibromatosis type 1

Children with neurofibromatosis type 1 (NF1) often experience executive dysfunction, attention deficit/hyperactivity disorder (ADHD) symptoms and poor social skills, however, the nature of the relationships between these domains in children with NF1 is unclear. This study investigated these relationships using primary caregiver ratings of executive functions, ADHD symptoms and social skills in children with NF1. Participants were 136 children with NF1 and 93 typically developing (TD) controls aged 3-15 years recruited from 3 multidisciplinary neurofibromatosis clinics in Melbourne and Sydney, Australia, and Washington DC, USA. Mediation analysis was performed on primary outcome variables: parent ratings of executive functions (Behavior Rating Inventory of Executive Function, Metacognition Index), ADHD symptoms (Conners-3/Conners ADHD Diagnostic and Statistical Manual for Mental Disorders Scales) and social skills (Social Skills Improvement System-Rating Scale), adjusting for potential confounders (full scale IQ, sex, and social risk). Results revealed significantly poorer executive functions, elevated ADHD symptoms and reduced social skills in children with NF1 compared to controls. Poorer executive functions significantly predicted elevated ADHD symptoms and poorer social skills. Elevated ADHD symptoms significantly mediated the relationship between executive functions and social skills problems although did not fully account for social dysfunction. This study provides evidence for the importance of targeting ADHD symptoms as part of future interventions aimed at promoting prosocial behaviors in children with NF1.

Mind wandering and executive dysfunction predict children's performance in the metronome response task

Mind wandering is a ubiquitous experience during adulthood and has received significant scholarly attention in recent years. Relatively few studies, however, have examined the phenomenon in children. Building on recent work, the current study examined the frequency and validity of children's reports of mind wandering while completing a minimalistic task previously unused in past child research-the Metronome Response Task (MRT) [Journal of Experimental Psychology: Human Perception and Performance (2013), Vol. 39, pp. 1-5]. Furthermore, the current study examined how parent reports of executive dysfunction in daily life relate to children's reports of mind wandering and behavioral performance in the MRT. A total of 81 children aged 7-9 years completed the MRT, the demands of which simply involved pressing a key on a computer keyboard in concert with the unwavering tones of a metronome. Sporadic experience-sampling probes gauged whether children were on-task or mind wandering. Parents also reported on their children's day-to-day difficulties with executive functioning across several domains. A series of multilevel models revealed that children reported being on-task more frequently then mind wandering and that children were more variable and less synchronous in their keypresses preceding reports of mind wandering than preceding reports of being on task. In addition, parent-reported difficulties with behavioral regulation predicted higher rates of mind wandering, whereas both behavioral dysregulation and metacognitive difficulties predicted lower MRT performance. These findings suggest that children are able to reliably report on their experiences of mind wandering in boredom-inducing contexts and advance our understanding of the factors underlying children's experience of mind wandering under real-world conditions.

The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population

OBJECTIVE

In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering-TOMM Trial 1-differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion.

METHOD

This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5-6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF.

RESULTS

The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization.

CONCLUSIONS

This study highlights the importance of utilizing PVTs when evaluating concussion recovery.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

Equine-Assisted Services for Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Objective: This systematic review evaluated equine-assisted activities and therapies (EAATs), formerly referred to as equine-assisted services (EAS), in children and youth (ages 6-18 years) with attention-deficit/hyperactivity disorder (ADHD), according to the International Classification of Functioning, Disability, and Health. Methods: Electronic database searches were conducted of studies from inception through December 2020. Results: A total of 12 articles were included: 8 noncontrolled prospective studies and 4 randomized-controlled trials (RCTs). Furthermore, seven of moderate methodological quality studies and five of moderate high methodological quality studies were included. Evidence was found for the effectiveness of various forms of EAS, including equine-assisted physical therapy (EAPT) and therapeutic riding (TR). Improvements in body functions and structures (n = 10) were found in the domains of mental and neuromusculoskeletal functions, as well as functions of the cardiovascular system using EAPT (n = 6). Limited evidence was found regarding the positive effect on activity and participation (n = 4) following TR interventions. Quality of life (QoL) was improved in both TR and EAPT (n = 4). Conclusion: There seems to be preliminary evidence that EAS may be beneficial in promoting the physiological functions of body systems for children with ADHD. The influence on participation and QoL still requires further evidence. More generally, further controlled studies, including bigger sample sizes, are needed to understand the specific effects of different EAS on the core symptoms and consequence of ADHD.

The clinical utility of the behavior rating inventory of executive function in preschool children with a history of perinatal stroke

The current study examined the utility of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P) in capturing emerging deficits in executive function in preschool children with a history of perinatal stroke. Parents and teachers of 55 clinically referred preschool children (3-5 years of age) provided ratings using the BRIEF-P. Both parent (M = 56.02, p = .001) and teacher ratings (M = 58.61, p = .002) indicated significant scale elevations for working memory compared to the normative sample, albeit below the clinically elevated range. Parent and teacher ratings were low-to-moderately correlated (r = .05-.55). Greater deficits in working memory (r = -.58), inhibition (r = -.45), and planning/organization (r = -.51), as rated by teachers, were associated with lower intellectual functioning. Parents' ratings were not associated with intellectual functioning. Further, no neurological or personal characteristics were associated with ratings of executive function. The current study demonstrates children with a history of perinatal stroke are, on average, following a normal trajectory of executive function development according to BRIEF-P ratings. The needs for multi-informant ratings and performance-based measures to comprehensively assess executive functioning in preschoolers with a history of stroke are discussed.

Are Parent- and Teacher-Reported Executive Function Difficulties Associated With Parenting Stress for Children Diagnosed With ADHD?

Objective: To examine the relationship between parenting stress and parent- and teacher-reported executive function difficulties (EFDs) for childhood ADHD. Method: A secondary analysis using linear regression was conducted on parent- and teacher-completed Behavior Rating Inventory of Executive Function and Parenting Stress Indexes for 5- to 12-year-olds (n = 243) with ADHD. Results: The linear combination of teacher- and parent-reported EFDs accounted for 49% of the variance in child-related parenting stress. Teacher-reported school-based EFDs were relatively inconsequential, having accounted for only 3% of this variance. This stress is best explained by EFDs with emotional control in the school environment and parent-reported EFDs with emotional control, inhibit, monitor, and shift. Conclusion: Parent-reported EFDs, and less so school-based EFDs, are related to parenting stress, but only in regard to EFDs likely underpinning behavioral outbursts and those likely underpinning the daily hassles of providing specialized care to children with ADHD.

The comparison of cool and hot executive functions profiles in children with ADHD symptoms and normal children

The study aimed to compare cool and hot executive functions profiles in children with ADHD symptoms and normal children. The statistical population consisted of all boys with ADHD symptoms and normal children in elementary school in Isfahan. In causal-comparative study, 200 participants were selected by multi-stage random sample method. Data were collected from Children Symptoms Inventory (CSI-4), Behavior Rating Inventory of Executive Function (BRIEF) and demographic inventory. Data were analyzed by using an analysis of covariance and Kruskal-Wallis test. There is significant difference between groups mean in variable of executive functions and all of their subscales (P < 0.05). Results from paired comparisons showed that in comparison with both subgroups of predominantly inattentive and predominantly hyperactive/ impulsive, combined subgroup indicate more damage to executive functions and all of subscales. In addition, subgroups of HD and AD are damaged more than normal group in executive functions and their subscales. Subgroups of HD and AD did not show any significant difference in inhibition, shifting and emotional control subscales (BRI). However, there were significant differences in initiation, monitoring, planning/organizing of materials subscales and total executive function. Negative mean difference in some variables indicates that in comparison with HD, AD has more problems in these subscales (MCI) and total executive function. Performing such studies can help to understand the underlying causes of treatment that has not been addressed so far in relation to this disorder and facilitate the establishment of optimal mechanisms and methods in treatment and standardization of psychological treatments.

Initial Examination of the BRIEF2 in Clinically Referred Children With and Without ADHD Symptoms

Objective: Clinical utility of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) was examined in 1,381 clinically referred youth (62.5% male, 5 to 18 years) with and without ADHD symptoms. Method: Participants included children with restricted inattentive symptoms (IA only), restricted hyperactivity/impulsivity symptoms (HI only), symptoms in both domains (Combined), and non-ADHD clinical comparison. Results: Greater hyperactivity (Combined, HI only) was associated with higher Behavior Regulation (BRI) and Emotion Regulation (ERI) scores, whereas greater inattentiveness (IA only, Combined) was associated with higher Cognitive Regulation scores. Effect sizes were largest for Inhibit, Working Memory, and Organization of Materials scales; these scales discriminated children with and without ADHD symptoms and restricted inattentive and hyperactive presentations. Conclusion: The BRIEF2 distinguishes associated features of ADHD and the day-to-day executive impact. Sensitivity was consistently poorer than specificity. The referred nature of the sample and examination of restricted presentations suggest additional work is needed to examine whether ERI and BRI are dissociable.

Dimensional structure of the BRIEF2 and its relations with ADHD symptoms and task performance on executive functions in Chinese children

This study examined the dimensional structure of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) in a Chinese sample of children with attention-deficit/hyperactivity disorder (ADHD)-related concerns and the correlations of the BRIEF2 with the children's ADHD symptoms and their performance on executive function (EF) tasks. Participants were 339 Chinese children aged 6-15 (M = 9.18 years, SD = 2.33; boys: 78.2%) recruited from 35 schools in Hong Kong. The results from confirmatory factor analyses revealed the best fit for a three-factor nine-scale model compared to a two-factor or single-factor model. Significant correlations were found between the BRIEF2 parent and teacher forms for the Behavioral Regulation Index and Cognitive Regulation Index, but not for the Emotion Regulation Index. Associations between performance on an EF task and the rating of the corresponding subscale on the BRIEF2 purportedly measuring the same EF construct were not consistently observed. Lastly, the BRIEF2 showed good convergent validity with the ratings of ADHD symptoms on the Swanson, Nolan, and Pelham Rating Scale Version IV (SNAP-IV). This study provided plausibly the first evidence on the dimensional structure of the BRIEF2 Parent and Teacher Forms in an Asian sample and confirmed the factorial validity of the Chinese version of the BRIEF2.

Executive Functioning and Activity in Children: a Multimethod Examination of Working Memory, Inhibition, and Hyperactivity

Two primary methods of quantifying executive functioning include self- or other-reports (i.e., questionnaire-based EF) and cognitive test performance (i.e., task-based EF). Despite their lack of concordance with one another and relatively inconsistent associations with attention-deficit/hyperactivity disorder (ADHD) symptoms, both approaches have been utilized in attempts to advance our understanding of the role of EF in symptoms of ADHD. The current study is the first to incorporate a direct assessment of behavior (i.e., actigraphy) to further clarify the relation between EF and hyperactivity using a multi-method approach in a sample of children with a range of ADHD symptoms. Fifty-two children between the ages of 8 and 12 completed a testing session during which performance on working memory and inhibition computerized tasks, as well as actigraphy data, were collected. Additionally, parent reports of hyperactivity/impulsivity, working memory, and inhibition were obtained. As expected, questionnaire-based measures of working memory and inhibition were strongly associated with parent-reported hyperactivity/impulsivity, whereas only the latter was associated significantly with mechanically assessed movement. In contrast, task-based working memory performance was more strongly associated with parent-reported hyperactivity/impulsivity relative to task-based inhibition. Further, both task-based working memory and task-based inhibition were similarly associated with mechanically-assessed movement. Finally, compared to questionnaire-based EF, both measures of task-based EF accounted for more variance in objectively-assessed movement. Collectively, these results highlight the measurement issues in the present literature, the importance of careful task and questionnaire design, and the value that alternative approaches (e.g., actigraphy) may provide with respect to advancing our understanding of EF.

Readers Recruit Executive Functions to Self-Correct Miscues During Oral Reading Fluency

Reading fluency undoubtedly underlies reading competence; yet, the role of executive functions (EF) is less well understood. Here, we investigated the relationship between children's reading fluency and EF. Children's (n = 82) reading and language performance was determined by standardized assessments and EF by parental questionnaire. Results revealed that production of more miscues was explained by poorer reading and language performance and EF. Yet, self-correcting a miscue was predicted by better EF, beyond reading and language abilities. Intriguingly, EF partially mediated the relationship between reading and self-correction, suggesting that self-correction reflects parallel recruitment and coordination of domain-specific and domain-general processes.

Parent versus teacher ratings on the BRIEF-preschool version in children with and without ADHD

Caregiver rating scales represent an important component of comprehensive child neuropsychological assessments for conditions such as Attention-deficit/Hyperactivity Disorder (ADHD); however, low inter-rater reliability (parent vs. teacher) often complicates interpretation. It has been challenging to identify the factors contributing to inter-rater variability, particularly when parents and teachers complete slightly different versions of the same rating scale. The present study examined the associations between parent- and teacher-reported executive functions in 84 children, ages 4-5 years, with and without symptoms of ADHD, using the Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P). Use of the BRIEF-P allows for direct comparison of symptom ratings because parents and teachers complete the exact same measure. Significant associations between raters were observed on 4 of 5 BRIEF-P subscales when rating children with ADHD, but on only 1 subscale when rating typically developing (TD) children. The Shift scale in particular displayed low, non-significant inter-rater association in both groups. Significant group-by-rater interactions were observed for Working Memory and Plan/Organize scales, and driven by larger inter-rater T-score discrepancies in the TD group, such that teachers rated children as having more symptoms than parents. Conversely, examination of raw scores reflected no significant rater differences in the TD group, but significant or nearly significant differences on multiple scales in the ADHD group, such that parents rated more symptoms than teachers. Inter-rater associations for the BRIEF-P appear to vary based on who is being rated (i.e., children with or without ADHD), the specific subscales, and whether standardized or raw scores are analyzed.

Virtual Remediation Versus Methylphenidate to Improve Distractibility in Children With ADHD: A Controlled Randomized Clinical Trial Study

Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.

Executive Function and Dysregulated Eating Behaviors in Pediatric Obesity

Objective

To examine the association between caregiver proxy report of executive function (EF) and dysregulated eating behavior in children with obesity.

Methods

Participants were 195 youth with obesity aged 8-17 years, and their legal guardians. Youth height, weight, demographics, depressive symptoms, eating behaviors, and EF were assessed cross-sectionally during a medical visit. Analyses of covariance, adjusted for child age, gender, race/ethnicity, standardized BMI, depressive symptoms, and family income were used to examine differences in youth EF across caregiver and youth self-report of eating behaviors.

Results

Youth EF differed significantly by caregiver report of eating behavior but not youth self-report. Post hoc analyses showed that youth with overeating or binge eating had poorer EF than youth without these eating behaviors.

Conclusions

Executive dysfunction, as reported by caregivers, in youth with obesity may be associated with dysregulated eating behaviors predictive of poor long-term psychosocial and weight outcomes. Further consideration of EF-specific targets for assessment and intervention in youth with obesity may be warranted.

Confirmatory Factor Analysis of the BRIEF-2 Parent and Teacher Form: Relationship to Performance-Based Measures of Executive Functions and Academic Achievement

We conducted two empirical studies to (1) explore the dimensionality of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2) parent and teacher forms, (2) examine the association between the parent and teacher reports, and (3) analyze the relationship between the BRIEF-2 ratings and performance-based measures of executive functions (EFs) (including working memory, inhibition, and shifting tasks) and academic achievement in children. In Study 1 (n = 212 parents; n = 111 teachers), confirmatory factor analysis (CFA) showed that a three-factor solution that included the indices of (1) behavior regulation, (2) emotion regulation, and (3) cognitive regulation best fit the data. In Study 2 (n = 275 8- to 12-year-old Spanish-speaking children), selective and low correlations were found between performance- and rater-based measures of EFs. In addition, low to moderate correlations were found between parent and teacher reports. However, the three indices of both forms of the BRIEF-2 were associated with the diverse academic domains analyzed, although differences emerged depending on the informant (teacher vs. parent). Our results support the hypothesis that the two EF measures document different underlying processes. The clinical and educational implications of considering both perspectives in the assessment of EFs in children with typical development and in children with neurodevelopmental disorders are discussed.

Executive function and probabilities of engaging in long-term sedentary and high calorie/low nutrition eating behaviors in early adolescence

PURPOSE

Consumption of high calorie/low nutrition (HCLN) foods, as well as high levels of sedentary behavior (SB), may play a substantial role in the development of childhood overweight and obesity. However, the choice to engage or not engage in this behavior may be impacted by limits in executive functioning (EF) - a set of higher order functions related to decision making, planning, and inhibitory processes.

METHODS

The present study, as part of a large multiple health risk behavior trial designed to prevent substance use and obesity, evaluated the relationship between specific subdomains of EF and long-term patterns of HCLN food consumption and SB among a population of elementary school students (n = 709).

RESULTS

Utilizing a form of mixture modeling based on a latent transition analysis framework, subdomains of EF were found to influence the probability that students would report high levels of HCLN food consumption and SB over a thirty-month period. Gender and socioeconomic status further influenced the likelihood that students with poor EF would repeatedly engage in these unhealthy behaviors.

CONCLUSIONS

HCLN food consumption and SB in childhood can lead to an increased risk of becoming overweight or obese. Findings suggest that long term EF training, as well as the creation of environments that support appropriate decision-making, could be an important focus of future health promotion and education.

Personalized at-home neurofeedback compared with long-acting methylphenidate in an european non-inferiority randomized trial in children with ADHD

BACKGROUND

Neurofeedback (NF) has gained increasing interest among non-pharmacological treatments for Attention Deficit Hyperactivity Disorder (ADHD). NF training aims to enhance self-regulation of brain activities. The goal of the NEWROFEED study is to assess the efficacy of a new personalized NF training device, using two different protocols according to each child's electroencephalographic pattern, and designed for use at home. This study is a non-inferiority trial comparing NF to methylphenidate.

METHODS

The study is a prospective, multicentre, randomized, reference drug-controlled trial. One hundred seventy-nine children with ADHD, aged 7 to 13 years will be recruited in 13 clinical centres from 5 European countries. Subjects will be randomized to two groups: NF group (Neurofeedback Training Group) and MPH group (Methylphenidate group). Outcome measures include clinicians, parents and teachers' assessments, attention measures and quantitative EEG (qEEG). Patients undergo eight visits over a three-month period: pre-inclusion visit, inclusion visit, 4 "discovery" (NF group) or titration visits (MPH group), an intermediate and a final visit. Patients will be randomized to either the MPH or NF group. Children in the NF group will undergo either an SMR or a Theta/Beta training protocol according to their baselineTheta/Beta Ratio obtained from the qEEG.

DISCUSSION

This is the first non-inferiority study between a personalized NF device and pharmacological treatment. Innovative aspects of Mensia Koala™ include the personalization of the training protocol according to initial qEEG characteristics (SMR or Theta/Beta training protocols) and an improved accessibility of NF due to the opportunity to train at home with monitoring by the clinician through a dedicated web portal.

TRIAL REGISTRATION

NCT02778360 . Date registration (retrospectively registered): 5-12-2016. Registered May 19, 2016.

Characterizing and decomposing the neural correlates of individual differences in reading ability among adolescents with task-based fMRI

To better characterize the neural correlates of the full spectrum of reading ability, this fMRI study examined how variations in reading ability correlate with task-based brain activity during reading among a large community sample of adolescents (N = 234). In addition, complimentary approaches taking advantage of empirical as well as independent meta-analytic information were employed to isolate neural substrates of domain-general executive processes that are predictive of reading ability. Age-related differences in brain activity were also examined. Better reading was associated with increased activation in left anterior and inferior temporal regions and parts of orbitofrontal cortex, along with reduced activation in the thalamus and left frontal eye field (FEF). Converging evidence suggests that FEF activity corresponds to executive processes during reading. In contrast, activity in temporal regions is likely to reflect cognitive processes specific to reading. Older adolescents also demonstrated increased activation in an orbitofrontal region that overlaps with the aforementioned age-independent, reading-related regions, along with reduced activity in parietal and occipital regions. These results suggest that comparedto poor readers, proficient readers benefit from efficient reading-specific processes and require less executive effort, implemented via the FEF, during a reading comprehension task.

When theory met data: Factor structure of the BRIEF2 in a clinical sample

Objective: The BRIEF2 is the recent revision of a frequently employed measure of executive behaviors; however, no research has yet addressed the validity of the new measure's theoretical design.Method: The present study examined the factor structure of the BRIEF2 in 5212 clinically referred youth (66% male, 5-18 years) via exploratory (EFA) and confirmatory (CFA) factor analyses of item-level responses.Results: Results from the EFA suggested the BRIEF2 has fewer factors than would be suggested by the nine theoretically derived scales. While the theoretical CFA model, that omitted item-level information, demonstrated the best fit, when the item-level information was employed there was a decrement in model fit statistics and several extremely high loadings suggested scale-level redundancy in measurement. When the scales were omitted, and the items were loaded directly onto the indices, there was very little change in item-level factor loadings.Conclusions: Findings suggest fewer than nine scales are needed and that clinical interpretation of the BRIEF2 may be more appropriate at the index, rather than scale, level.

A novel unstructured performance-based task of executive function in children with attention-deficit/hyperactivity disorder

OBJECTIVE

Executive functions (EFs) have been assessed with performance-based measures and rating scales. Research has shown a lack of association between these two methods. One factor that might contribute to this difference is the structure provided on performance-based measures that is not provided on rating scales. This study examined the role of structure on self-directed task completion, an aspect of EF, using a novel unstructured performance-based task (UPT).

METHOD

Children aged 8-12 years (38 attention-deficit/hyperactivity disorder, ADHD; 42 typically developing) and their caregivers participated. We compared performance on the UPT, performance-based measures of EF (Stroop test and Trail-Making Test), and a rating scale to assess EF (Barkley Deficits in Executive Functioning Scale-Children and Adolescents, BDEFS-CA).

RESULTS

Group differences were found across all measures. Significant associations emerged between the UPT and Stroop test, Trail-Making Test, and BDEFS-CA, but no significant associations were found between the Stroop test or Trail-Making Test and the BDEFS-CA. In regression analyses, performance-based tasks and the rating scale both uniquely predicted UPT performance. The UPT was a significant predictor of group status when entered with performance-based tasks, but the UPT did not enter as a significant predictor when entered with the rating scale.

CONCLUSION

The UPT is a promising measure to assess self-directed task completion in children with ADHD.

Brain activity in struggling readers before intervention relates to future reading gains

Neural markers for reading-related changes in response to intervention could inform intervention plans by serving as a potential index of the malleability of the reading network in struggling readers. Of particular interest is the role of brain activation outside the reading network, especially in executive control networks important for reading comprehension. However, it is unclear whether any intervention-related executive control changes in the brain are specific to reading tasks or reflect more domain general changes. Brain changes associated with reading gains over time were compared for a sentence comprehension task as well as for a non-lexical executive control task (a behavioral inhibition task) in upper-elementary struggling readers, and in grade-matched non-struggling readers. Functional MRI scans were conducted before and after 16 weeks of reading intervention. Participants were grouped as improvers and non-improvers based on the consistency and size of post-intervention gains across multiple post-test measures. Engagement of the right fusiform during the reading task, both before and after intervention, was related to gains from remediation. Additionally, pre-intervention activation in regions that are part of the default-mode network (precuneus) and the fronto-parietal network (right posterior middle temporal gyrus) separated improvers and non-improvers from non-struggling readers. None of these differences were observed during the non-lexical inhibitory control task, indicating that the brain changes seen related to intervention outcome in struggling readers were specific to the reading process.

Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention

BACKGROUND

Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in ADHD and to concerns about overlap with mood disorders.

METHODS

We sought to clarify the nature of emotional symptoms in ADHD by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for ADHD. We reviewed the various terms used to define emotional symptoms in ADHD, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self-regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of ADHD treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with ADHD.

RESULTS

Emotional symptoms are common and persistent in youth and adults with ADHD. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (EI), and deficient emotional self-regulation (DESR) may be sufficiently specific for ADHD to function as diagnostic criteria.

CONCLUSIONS

Emotional symptoms in ADHD cause clinically significant impairments. Although there is a solid theoretical rationale for considering EI and DESR to be core symptoms of ADHD, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD.

Preschool Executive Function Predicts Childhood Resting-State Functional Connectivity and Attention-Deficit/Hyperactivity Disorder and Depression

BACKGROUND

Measures of executive function (EF), such as the Behavior Rating Inventory of Executive Function, distinguish children with attention-deficit/hyperactivity disorder (ADHD) from control subjects, but less work has examined relationships to depression or brain network organization. This study examined whether early childhood EF predicted new onset or worsening of ADHD and/or depression and examined how early childhood EF related to functional connectivity of brain networks at school age.

METHODS

Participants included 247 children who were enrolled at 3 to 6 years of age from a prospective study of emotion development. The Behavior Rating Inventory of Executive Function Global Executive Composite score was used as the measure of EF in early childhood to predict ADHD and depression diagnoses and symptoms across school age. Resting-state functional magnetic resonance imaging network analyses examined global efficiency in the frontoparietal, cingulo-opercular, salience, and default mode networks and six "hub" seed regions selected to examine between-network connectivity.

RESULTS

Early childhood EF predicted new onset and worsening of ADHD and depression symptoms across school age. Greater EF deficits in preschool predicted increased global efficiency in the salience network and altered connectivity with four regions for the dorsal anterior cingulate cortex hub and one region with the insula hub at school age. This altered connectivity was related to increasing ADHD and depression symptoms.

CONCLUSIONS

Early executive deficits may be an early common liability for risk of developing ADHD and/or depression and were associated with altered functional connectivity in networks and hub regions relevant to executive processes. Future work could help clarify whether specific EF deficits are implicated in the development of both disorders.

Executive functioning in adolescent anorexia nervosa: Neuropsychology versus self- and parental-report

There is limited research concerning the relationship between neuropsychological assessment and self-report of executive functioning in adolescent anorexia nervosa (AN); available studies demonstrate only low to moderate correlations. Therefore, this study examines the association between neuropsychological test performance and self-report in AN. Forty adolescent inpatients with AN completed an extensive neuropsychological assessment, including set-shifting, central coherence, and questionnaires assessing executive functioning in daily life (BRIEF-SR). Their parents filled out an analog version (BRIEF-PF). Statistical analyses revealed low to medium positive and negative correlations between neuropsychological measures and BRIEF subscales. Similarly, self- and parental ratings were only slightly positively correlated, with patients scoring significantly higher than their parents on two subscales. The results support previous findings of modest correlations between self-report and performance-based testing and emphasize the importance of a multiple format assessment of executive functioning in adolescent AN.

Comparisons of the BRIEF parental report and neuropsychological clinical tests of executive function in Fetal Alcohol Spectrum Disorders: data from the UK national specialist clinic

Extant literature is sparse with regards to the relationship between caregiver reports and neuropsychological tests of executive functioning in Fetal Alcohol Spectrum Disorders (FASD). The goal of this paper was determining the clinical utilities of executive functioning measures used in the United Kingdom national FASD clinic. We examined relationships between outcomes on the Behavior Rating Inventory of Executive Function (BRIEF) and the Delis-Kaplan Executive Function System (D-KEFS), as part of an ongoing service evaluation. Profiles of executive functioning measures were reported in order to contribute to delineating a profile of executive dysfunction in FASD. Caregivers of 49 people with FASD completed the Parent BRIEF, and 61 people with FASD were administered the D-KEFS. Pearson's Correlations between all 11 BRIEF scales and the 18 selected D-KEFS subscales showed little relationship. The BRIEF showed a profile of clinically significant elevations in all three Index scores and seven out of the eight Scale scores. Several D-KEFS tests showed below average executive functioning. Both executive function measures have separate clinical utility in demonstrating executive function deficits in FASD. The sample population used in this study also show a similar pattern to FASD populations internationally, suggesting a similar neuropsychological profile is seen in the United Kingdom. However, caregiver reports display little relationship to neuropsychological tests. These measures likely monitor different aspects of executive functioning in different settings. Future research should focus on identifying tests that better relate findings from clinical settings to behavior in daily life.

Reliability and Validity of the Before-School Functioning Scale in Children With ADHD

OBJECTIVE

Children with ADHD frequently manifest behavioral difficulties in the morning prior to school. We sought to assess the reliability and validity of the Before-School Functioning Questionnaire (BSFQ) as a measure of morning behaviors impaired by ADHD.

METHOD

We used pre-treatment data from a randomized crossover study of 6- to 12-year-old participants comparing the methylphenidate transdermal delivery system (MTS) with a placebo transdermal system (PTS) for a total of 4 weeks.

RESULTS

The BSFQ investigator-rated scale shows very good internal homogeneity (Cronbach's α = .91), good test-retest reliability ( r = .60), good concurrent validity ( r range = .42-.86), and a strong treatment effect (effect size = -.93). The self-rated BSFQ showed lower levels of reliability and validity.

CONCLUSION

The investigator-rated BSFQ should be used in future trials of ADHD medications aimed at assessing efficacy in the morning before school.

Higher IQ in juvenile myoclonic epilepsy: Dodging cognitive obstacles and "masking" impairments

Executive deficits and impulsiveness are extensively reported in juvenile myoclonic epilepsy (JME). Previous literature suggests that intelligence may mediate these deficits. In this study, we evaluated and compared the performance of adults with JME with high and low intelligence quotient (IQ) and controls on tasks for executive function (EF) and impulsive traits. We investigated the neuropsychological performance of 53 adults with JME and below average IQ (57% women; 26.9 [±7.88] years; mean IQ: 89.8 [±5.1]), 26 adults with JME and average or above average IQ (53.8% women; 28.2 [±9.33] years; mean IQ: 110.7 [±8.3]), 38 controls with below average IQ (55% women; 28.4 [±8.4] years; mean IQ: 90.1 [±5.8]), and 31 controls with average or above average IQ (61.3% women; 32.20 [±11.3] years; mean IQ: 111.6 [±10.5]) with a comprehensive battery of neuropsychological tests that measure executive/attentional function. Impulsive traits were assessed using the Cloninger et al.'s Temperament and Character Inventory (novelty seeking (NS) domain). The group with JME with higher IQ presented worse performance compared with controls with higher IQ on Controlled Oral Word Association (COWA) and Wisconsin Card Sorting Test (WCST) (errors). This group showed worse performance than controls with lower IQ on Stroop Color-Word Test (SCT) 1, Trail Making (TM) A, COWA, and WCST (errors). Patients with lower IQ showed worse performance than controls with higher IQ on Digit Span Forward (DSF), Digit Span Backward (DSB), SCT1, SCT2, SCT3, TM A, COWA, and WCST (errors and failure to maintain set). Patients with lower IQ showed worse performance than controls with lower IQ on DSF, DSB, SCT1, SCT2, SCT3, TM A, TM B, COWA, and WCST (errors and failure to maintain set). Patients from groups with low and high IQ showed higher scores than controls with higher and lower IQ on impulsivity for NS1 and NS2 (except for patients with higher IQ versus controls with lower IQ). Adults with JME and higher IQ show less evidence of EF deficits compared with those with JME and below average IQ, suggesting that a higher degree of intellectual efficiency may act as a compensatory mechanism. However, it does not minimize some aspects of impulsive traits. Patients with JME and higher cognitive reserve may create strategies to dodge their cognitive obstacles. In this context, intelligence may protect and, at the same time, "mask" impairments that could be detected earlier.

Executive Function in Deaf Children: Auditory Access and Language Access

Purpose

Deaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions.

Method

We use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF.

Results

Parent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant.

Conclusions

These results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.

The Relations Between Temperament, Character, and Executive Functions in Children With ADHD and Clinical Controls

OBJECTIVE

The purpose of this study was to investigate the overlap between executive functions and temperament as measured by two questionnaires and to examine characteristic profiles in children with ADHD and clinical controls.

METHOD

Parents of 111 clinically referred children, half of whom were diagnosed with ADHD and half with other or no diagnoses, completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Cloninger Junior Temperament and Character Inventory (JTCI).

RESULTS

Factor analysis of both instruments resulted in three common factors representing aspects of (1) cognitive regulation, (2) behavioral regulation, and (3) anxious/rigid tendencies. Factor (4) represented strengths and positive resources and loaded on JTCI scales only. Both instruments discriminated significantly between ADHD and non-ADHD children. Conduct disorder/oppositional defiant disorder (CD/ODD) but not ADHD accounted for problems in BRIEF Emotional Control and Self-Monitor and JTCI low Cooperativeness.

CONCLUSION

The two instruments only partially overlap and may complement each other.

Executive Function as a Risk Factor for Incisor Trauma

BACKGROUND/AIM

Executive function is the ability to guide behavior to achieve goals or complete tasks. This study explored the relationship between executive function, as assessed by the Behavior Rating Inventory of Executive Function Parent Form Questionnaire (BRIEF® ) and incisor trauma.

MATERIAL AND METHODS

This study included children in the mixed dentition with recent incisor trauma (n=28) and a control group (n=30) without recent incisor trauma. Subjects' parents completed the BRIEF® , while a clinical examination assessed subjects' occlusal relationships. Parents also completed a custom questionnaire that investigated their child's medical history and daily activities. Fisher Exact and unpaired t-tests compared BRIEF® scores, occlusal characteristics, medical history, and reported daily activities of the two groups.

RESULTS

The trauma group had a greater percentage of participants with a Class II dental relationship (p=0.01). There was no significant difference between groups with respect to mean BRIEF® t-scores within the Global Executive Composite. There was a statistically significant difference between groups with respect to the percentage of subjects with clinically significant (≥65) BRIEF® t-scores within the Inhibit (p=0.05) and Emotional Control (p=0.02) subscales and Behavioral Regulation Index (p=0.02). There were no statistically significant differences between groups with respect to age, gender, overbite, overjet, medical history, body mass index, or daily activities.

CONCLUSIONS

Children in the mixed dentition with a Class II dental relationship are at greater risk for incisor injury, as well as those involved in outdoor activities. Specific executive dysfunctions such as impulsivity and poor emotional control may increase the risk for incisor trauma. This article is protected by copyright. All rights reserved.