The role of cognitive control and emotion regulation in predicting mental health problems in children with neurodevelopmental disorders

Exploring the Prevalence of Learning Disabilities in a Community Sample of Children Using the Greek Weschler Intelligence Scale for Children (WISC-V GR)

This study aimed to explore the prevalence of learning disabilities (LDs) and the emotional-behavioral difficulties in 208 children from the Crete region in Greece, and who voluntarily presented themselves for study and were evaluated by a university-based interdisciplinary team of mental health professionals. The Greek version of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V GR) was used, with its five Primary Index scores and full-scale IQ (Verbal Comprehension Index, VCI; Visual Spatial Index, VSI; Fluid Reasoning Index, FRI; Working Memory Index, WMI; and Processing Speed, PCI). Five diagnostic categories were established for the purpose of analysis: (a) no LDs (TD group), (b) Attention Deficit Hyperactivity Disorder (ADHD), (c) Specific Learning Disabilities (SLDs), (d) Extremely Low FSIQ (below 79), and (e) Emotional/Behavioral difficulties. The results revealed a 25.5% prevalence of SLDs, 18.75% ADHD, 8.65% Extremely Low FSIQ, and 5.29% emotional/behavioral problems, suggesting that 58% of the study population struggled with some kind of learning difficulty. Statistically significant differences were observed between the "Extremely Low FSIQ" group, the "SLD", the "ADHD", and the "TD" diagnostic groups in terms of the "VCI", "FRI", and the "FSIQ" scales (p < 0.001). Likewise, the "Extremely Low FSIQ" group differed significantly from the "SLD" and "TD" groups in terms of the "VSI", the WMI, and the "PSI" (p < 0.001). The "Behavioural/emotional" and "SLD" groups differed in terms of "VCI" and "Full scale IQ" (p < 0.001). The analysis indicated that the children with severe learning difficulties differed from the other groups in terms of their cognitive profiles and that they needed tailor-made educational programs and interventions in a typical classroom. This study offers comparative data from a community sample of children, as well as generated initial evidence from non-clinical settings on the usability and the diagnostic accuracy of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V). Further research is suggested. The present study was funded by the Crete Region (MIS 5162111).

Longitudinally Predicting Behavioral Challenges From Executive Functioning in Youth With Down Syndrome

This study explored how caregiver-reported executive functioning domains, assessed by the BRIEF2 at baseline, predicted behavioral challenges reported by caregivers using the CBCL six months later. The sample included 94 youth with Down syndrome, aged 6 to 18 years. Results of hierarchical regression analyses revealed that, after controlling for the effect of IQ, working memory significantly predicted inattentive behaviors, inhibition significantly predicted rule-breaking behaviors, and both inhibition and emotional control significantly predicted aggressive and externalizing behaviors. After controlling for baseline behaviors, only working memory persisted as a significant predictor of inattentive behaviors measured six months later. The findings are discussed by referring to the relevant theories and research and providing clinical implications and recommendations for further studies.

An umbrella review of the characteristics of resiliency-enhancing interventions for children and youth with disabilities

PURPOSE

The current umbrella review aimed to identify key intervention characteristics that have been demonstrated to enhance resiliency in children and youth with disabilities.

MATERIALS AND METHODS

To identify these key ingredients, using JBI guidelines, we conducted comprehensive searches in the fall of 2022 and searches were re-run in June 2023. Using the PICO format, we searched for peer-reviewed review articles that included children and youth with disabilities (6 to 19 years of age), the intervention targeted resiliency, the context was home, school, or community, and the outcome was resiliency enhancement.

RESULTS

The initial searches produced 1031 articles, of which 4 met our inclusion criteria. These articles collectively had reviewed a total of 247 articles representing approximately 2756 participants. We found a wide range of disabilities represented in the studies and many activities that are included in the existing REIs. Our findings identified engagement, self-regulatory processes, capacity building, positive social connectedness, and a customized intervention approach as evidence-based resiliency enhancing features. We propose a model consolidating these findings into a multi-dimensional resiliency process which may help explain successful adaptation.

CONCLUSION

Our proposed model may be helpful in delineating entry points that different REIs have used to generate positive change.

Combination of motor, sensory and affective tasks in an EEG paradigm for children with developmental disabilities

Individuals with neurodevelopmental disorders exhibit overlapping emotional, somatosensory and motor deficits. Although brain processes underlying these impairments have been extensively studied in a separate way, the brain interaction of these inputs is an innovative line of research. Here we present a new EEG methodology for exploring the interactive brain activity of sensorimotor and affective stimuli. The task consists in presenting affective stimuli of different modalities (e.g. affective pictures, affective touch) while simultaneously an arthromotor performs passive joint movements, unseen by the participant. Participants were then required to press one of two buttons to indicate if their joint position agreed with a picture shown in a screen. Pilot data of electroencephalography recordings revealed distinct somatosensory event-related potentials (SEP) when movement was subsequent to affective stimuli, compared to neutral stimuli, as well as a differentiation of SEPs for different neurodevelopmental conditions. Behavioral responses further showed that children with cerebral palsy had more errors to identify their hand position when they were exposed to affective stimuli. This paradigm is a valuable tool to explore the modulative influence of emotion in the sensorimotor brain processing of different populations with joint emotional and sensorimotor impairments, such as children with neurodevelopmental disorders or patients with stroke.•This method allows exploring the interaction between affective and sensoriomotor inputs in an EEG paradigm.

Sensory processing subtypes relate to distinct emotional and behavioral phenotypes in a mixed neurodevelopmental cohort

Children with autism and other neurodevelopmental concerns (NDC) frequently exhibit an array of sensory processing dysfunction phenotypes, posing a significant challenge their adaptive development. Additionally, these children often encounter difficulties with self-regulation, including emotion dysregulation, anxiety, and symptoms associated with attention and hyperactivity. However, further research is required to comprehend how patterns of sensory processing differences across neurodevelopmental conditions may contribute to regulatory control problems. Adopting a transdiagnostic perspective within the Research Domain Criteria (RDoC) framework, this study examined the relationship between clusters of sensory processing phenotypes and differential patterns of self-regulation behaviors. We recruited a sample of 117 participants (8-12 years) with a diverse range of neurodevelopmental concerns including autism, ADHD, anxiety, and sensory processing differences. This study aimed to (1) establish the prevalence of self-regulation problems in a community-recruited cohort of children with diverse NDCs; (2) construct data-driven sensory processing latent subtypes; (3) investigate group differences in emotion dysregulation, anxiety, and ADHD symptoms. Results showed that 39% of NDC children met clinically concerning thresholds for emotion dysregulation, 19% for anxiety, and 62% for ADHD. Second, latent profile analysis identified five sensory processing subtypes categorized by modality: Typical Processing, Intermediate/Mixed, Sensory Over-Responsive, Sensory Seeking, and Sensory Under-Responsive. Notably, the Sensory Over-Responsive group exhibited distinctively elevated anxiety scores, while the Sensory Seeking and Sensory Under-Responsive groups showed heightened ADHD scores. Intriguingly, the Sensory Over-Responsive, Sensory Under-Responsive, and Sensory Seeking subgroups all demonstrated elevated emotion dysregulation scores, suggesting a potential shared mechanism of emotion dysregulation that might elucidate the connection between sensory processing differences and increased anxiety and ADHD behaviors in children with autism and other NDCs.

Understanding Emotional Outbursts: A Cross-Cultural Study in Latin American Children with Autism Spectrum Disorder

OBJECTIVES

One of the behavioral problems strongly associated with emotional dysregulation (ED) in ASD is emotional outbursts (EOs) characterized by a pattern of challenging behavior that varies across individuals and across time. Cultural factors can modulate the expression of EOs. This study aimed to characterize the profile of emotional outbursts (EOs) in children with autism spectrum disorder (ASD) across various countries in Latin America and to identify clinical, emotional, and contextual factors that contribute to the onset and frequency of EOs within this diverse sample.

METHODS

A cross-sectional and cross-cultural study was conducted between 2023 and 2024 comprising samples from five countries in the Latin American Network for Autism-REAL: Argentina, Brazil, Chile, Uruguay, and the Dominican Republic. We studied 689 children with ASD (age x = 8.7 ± 2.6 years) using the Emotional Outburst Questionnaire (EOQ).

RESULTS

We identified different types of EO among children with ASD in our sample. The most frequent was the 'behavioral indicators of emotion' (52.0%) followed by 'increased motor activity' (28.3%), 'non-speech vocalizations', (27.6%), 'mild verbal aggression' (23.8%), and 'avoidance' (21.5%). Children in a bad mood or having a bad day or experiencing irritability were the most significant factors that increased the likelihood of EOs.

CONCLUSIONS

Our results revealed that irritability is an important trigger for EOs and should not be disregarded or underestimated when monitoring the mental health of children with ASD.

Linking a latent variable trait-state-occasion model of emotion regulation to cognitive control

Emotion dysregulation (ED) is a vulnerability factor for affective disorders that may originate from deficits in cognitive control (CC). Although measures of ED are often designed to assess trait-like tendencies, the extent to which such measures capture a time-varying (TV) or state-like construct versus a time-invariant (TI) or trait-like personality characteristic is unclear. The link between the TV and TI components of ED and CC is also unclear. In a 6-wave, 5-month longitudinal study, community participants (n = 1281) completed the Difficulties in Emotion Regulation Scale (DERS-16), a commonly used measure of ED and measures of CC. A latent variable (trait-state-occasion) model showed that the proportion of TI factor variance (.80) was greater than the TV factor variance (.19). Although TV factor stability was significant, the coefficients were small in magnitude. Furthermore, regression weights for the ED TI factor (average β  = -.62) were significant and larger than those for the TV factor (average β  = -.10) in predicting latent CC at each of the six-time points. These findings suggest that ED, as assessed by the DERS-16, is largely TI and this TI component is more strongly linked to CC than the TV component.

Theta activity and cognitive functioning: Integrating evidence from resting-state and task-related developmental electroencephalography (EEG) research

The theta band is one of the most prominent frequency bands in the electroencephalography (EEG) power spectrum and presents an interesting paradox: while elevated theta power during resting state is linked to lower cognitive abilities in children and adolescents, increased theta power during cognitive tasks is associated with higher cognitive performance. Why does theta power, measured during resting state versus cognitive tasks, show differential correlations with cognitive functioning? This review provides an integrated account of the functional correlates of theta across different contexts. We first present evidence that higher theta power during resting state is correlated with lower executive functioning, attentional abilities, language skills, and IQ. Next, we review research showing that theta power increases during memory, attention, and cognitive control, and that higher theta power during these processes is correlated with better performance. Finally, we discuss potential explanations for the differential correlations between resting/task-related theta and cognitive functioning, and offer suggestions for future research in this area.

Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping

Parents of children with ADHD experience significantly more parenting stress in comparison to parents of typically developing children due to the emotional and behavioral difficulties related to ADHD. Additionally, approximately 30% of children with ADHD experience co-occurring anxiety. Parents of children with co-occurring anxiety and ADHD report increased stress due to role restriction and isolation compared to parents of children with ADHD alone. Poor emotional regulatory coping in children with ADHD has been linked to elevated negative affect and irritability, which also contributes to increased stress among parents. The present study examined the direct and indirect associations of child anxiety symptoms and emotional regulatory coping on elevated ADHD symptoms and parenting stress. Participants were 203 children aged 7-12-years-old and their parents. Parents completed a self-report measure of parenting stress and measures of their child's ADHD symptoms, anxiety, and emotional regulatory coping. Additionally, children completed self-report measures of emotional regulatory coping. Model testing indicated that the overall model demonstrated excellent fit to the data. Parameter testing supported an indirect effect of child ADHD symptoms on parenting stress through child anxiety symptoms and an indirect effect of child ADHD symptoms on parenting stress through child emotional regulatory coping. These results suggest that child anxiety and emotion dysregulation in children with ADHD have a negative impact on parental stress. The current study adds to the understanding of the important roles emotional regulatory coping and anxiety play in children with ADHD to contribute to increased parenting stress.

Alexithymia as a mediator of the associations between child maltreatment and internalizing and externalizing behaviors in adolescence

Child maltreatment is a global concern that profoundly affects individuals throughout their lives. This study investigated the relationships between various forms of child maltreatment and behavior problems involving internalization and externalization during adolescence. Data obtained from a diverse sample of 1802 Canadians aged 14-18 years was used to examine the mediating role of alexithymia-a difficulty in recognizing and expressing emotions-in these associations. Results indicated that adolescents who experienced sexual abuse, emotional abuse, and exposure to intimate partner violence (IPV) in their childhood exhibited higher levels of alexithymia, which was correlated with elevated levels of both internalizing and externalizing problems. Physical abuse and parental neglect were only associated with externalizing problems. Gender differences also emerged, with gender-diverse adolescents reporting a higher prevalence of maltreatment, alexithymia, and behavior problems compared with their peers. However, alexithymia's mediating role was consistent across genders. Overall, this study highlights the intricate relationships between child maltreatment, alexithymia, and adolescent behavior problems. The findings of this study how different forms of child maltreatment significantly shape behavioral outcomes and indicate the importance of interventions in enhancing emotional awareness and expression in adolescents with a childhood history of maltreatment.

Emotional Adjustment among Adolescent Students with and without Specific Learning Disabilities

Adolescence is a psychologically vulnerable stage in which problems of emotional adjustment and psychological well-being can appear. The aim of this study is to analyse the relationship and comparison of emotional deficits and resources among adolescents with or without specific learning disabilities. We evaluated 80 students distributed into two groups: 40 adolescents with specific learning disabilities and 40 normative adolescents matched with the previous group in terms of age, sex, and school year. The study variables are internalising problems (anxiety and depression), externalising problems (aggression, anger control, defiant behaviour, and antisocial behaviour), and personal resources (self-esteem, social competence and integration, and awareness of problems), evaluated by means of the SENA test. The results indicate a positive relationship between externalising and internalising problems and a negative relationship between the latter and some personal resources in both groups. We also found that adolescents with specific learning disabilities displayed more internalising and externalising symptoms than their peers, greater awareness of their emotional difficulties, and lower self-esteem and social integration and competence. The findings highlight the need for preventive interventions that promote the psychological well-being and mental health of adolescents within the school setting at an early age.

The Relation between Cognitive and Emotional Processes in Children and Adolescents with Neurodevelopmental Disorders-A Meta-Analysis

BACKGROUND

Up to 80% of children with autism spectrum disorders (ASDs) have mental health issues-either emotional or behavioral problems. The underlying mechanisms are still unknown, even if emotional regulation (ER) is considered to play a major role in child and adolescent psychopathology. Several studies link the ability to regulate the intensity and quality of emotions with executive functioning. Therefore, we aimed to investigate the association between executive functions (EFs) and ER and affective problems in children with ASD.

METHODS

This meta-analysis is based on a literature search of peer-reviewed journals from the following databases: Scopus, ProQuest, Ebsco, Science Direct, Springer Link and Clarivate. We analyzed 15 studies that investigated the link between EF, ER or affective problems (APs) in children and adolescents with ASD aged between 2 and 18 y with ASD. To assess the effect size of the relationship between EF and ER, and EF and AP, 15 studies comprising 54 effect sizes were analyzed.

RESULTS

Our findings revealed a small effect size regarding the association between EF and ER, r = 0.331, p = 0.034, and a small effect size regarding the association between EF and AP, r = -0.213, p = 0.024. No significant moderators were found. The results are presented in regard to the two analyses developed, as well as a short review of the studies included in the meta-analysis.

CONCLUSION

Even if there are several limitations of this study, especially considering the small number of studies included, the results suggest that it is worth considering EF as an underlying mechanism for the appearance of emotional or behavioral problems in children with ASD. These findings have important implications for the development of ASD intervention plans, as well as for increasing awareness among specialists about the importance of executive functions in school adjustment and social functioning.

Differentiation between fetal and postnatal iron deficiency in altering brain substrates of cognitive control in pre-adolescence

BACKGROUND

Early iron deficiency (ID) is a common risk factor for poorer neurodevelopment, limiting children's potential and contributing to global burden. However, it is unclear how early ID alters the substrate of brain functions supporting high-order cognitive abilities and whether the timing of early ID matters in terms of long-term brain development. This study aimed to examine the effects of ID during fetal or early postnatal periods on brain activities supporting proactive and reactive cognitive control in pre-adolescent children.

METHODS

Participants were part of a longitudinal cohort enrolled at birth in southeastern China between December 2008 and November 2011. Between July 2019 and October 2021, 115 children aged 8-11 years were invited to participate in this neuroimaging study. Final analyses included 71 children: 20 with fetal ID, 24 with ID at 9 months (postnatal ID), and 27 iron-sufficient at birth and 9 months. Participants performed a computer-based behavioral task in a Magnetic Resonance Imaging scanner to measure proactive and reactive cognitive control. Outcome measures included accuracy, reaction times, and brain activity. Linear mixed modeling and the 3dlme command in Analysis of Functional NeuroImages (AFNI) were separately used to analyze behavioral performance and neuroimaging data.

RESULTS

Faster responses in proactive vs. reactive conditions indicated that all groups could use proactive or reactive cognitive control according to contextual demands. However, the fetal ID group was lower in general accuracy than the other 2 groups. Per the demands of cues and targets, the iron-sufficient group showed greater activation of wide brain regions in proactive vs. reactive conditions. In contrast, such condition differences were reversed in the postnatal ID group. Condition differences in brain activation, shown in postnatal ID and iron-sufficient groups, were not found in the fetal ID group. This group specifically showed greater activation of brain regions in the reward pathway in proactive vs. reactive conditions.

CONCLUSIONS

Early ID was associated with altered brain functions supporting proactive and reactive cognitive control in childhood. Alterations differed between fetal and postnatal ID groups. The findings imply that iron supplement alone is insufficient to prevent persisting brain alterations associated with early ID. Intervention strategies in addition to the iron supplement should consider ID timing.

The Role of Emotion Regulation and Executive Functioning in the Intervention Outcome of Children with Emotional and Behavioural Problems

Emotional and behavioural problems are closely associated with impairments in regulating emotions and in executive functions (EF). To examine this further, the aim of the present study was to determine whether EF and emotion regulation at baseline would predict emotional and behavioural problem scores post-intervention, and further explore the extent to which emotion regulation mediates these outcomes. Participants were 41 primary school children who exhibited emotional and/or behavioural problems, aged 8 to 11 years. All the children completed measures of emotional and behavioural problems, cognitive emotion regulation, anxiety symptoms, and performed two experimental tasks to measure working memory and response inhibition before and after participating in a transdiagnostic Cognitive Behaviour Therapy-based programme, "Super Skills for Life" (SSL), and at 3-months follow-up. Results revealed significant reduction in the use of maladaptive emotion regulation strategy catastrophising and other blame following the intervention. Additionally, EF and emotion regulation was associated with outcomes for emotional problems and conduct problems. More specifically maladaptive emotion regulation strategy such as catastrophising and other blame was closely related with self-reports of emotional problems, likewise other blame, was also linked with scores of conduct problems. This study provides preliminary empirical support for EF and emotion regulation in predicting outcomes of emotional and behavioural problems in children following intervention.

Working memory function in patients with major depression disorder: A narrative review

Working memory (WM) deficits are recognized as serious cognitive impairment in patients with major depressive disorder (MDD). This review aims to clarify the effects of impaired WM function in patients with MDD and explore non-invasive and effective treatments that can be adopted in clinical practice. This review (1) synthesizes extant literature examining brain function and brain areas in terms of WM in individuals with depression, (2) utilizes the outcomes of the studies presented in this review to discuss the effects of impaired WM function on cognitive processing in individuals with depression, (3) integrates the treatments explored in current studies and (4) provides some suggestions for future research. We found that (1) central executive (CE) components affect the processing of WM, and this might be one of the factors influencing cognitive biases, as it is implicated in repetitive negative thinking and rumination; (2) the left dorsal anterior cingulate cortex (dACC), the left dorsolateral prefrontal cortex (DLPFC) and the regions of the default mode network (DMN) play a vital role in CE functioning; and (3) psychotherapy, cognitive training, exercise and physical therapy can be used as complementary treatments for MDD.

An exploratory study on emotion regulation strategy use in individuals with Williams syndrome, autism spectrum disorder and intellectual disability

Background

Individuals with neurodevelopmental disorders often have atypical emotion profiles, but little is known about how they regulate their emotions. While several studies have examined emotion regulation strategy use in autism spectrum disorder (ASD), only a few have included individuals with intellectual disability (ID) or focused on specific syndromes such as Williams syndrome (WS).

Methods

A parent-reported survey launched during the first months of the COVID-19 pandemic allowed to exploratorily study emotion regulation strategy use and its link to anxiety in individuals with ASD with (N=785) and without ID (N=596), WS (N=261), and Intellectual Disability not otherwise specified (N=649).

Results

Using multilevel analyses, besides revealing specific group differences in emotion regulation strategy use, a variety of strategies (e.g., rumination, avoiding information, repetitive behaviors) were found to be linked to elevated levels of anxiety, while focusing on the positive was linked to lower anxiety levels in all groups. Moreover, only autistic people without ID used humor more frequently while experiencing lower anxiety levels.

Conclusion

This study sheds light on an underexplored area of emotion regulation strategy use in different neurodevelopmental disorders. It also paves the way to further examine emotion regulation in more rigorous ways to better understand emotion regulation in different neurodevelopmental disorders as well as the impact on outcome measures such as anxiety. This exploratory study may help to develop and validate adequate measures to study a broad array of ER strategies used by individuals with neurodevelopmental disorders.

The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

The Importance of Emotional Regulation in Mental Health

Mental health is a critical component of overall well-being and exists on a continuum much like physical health. Although many ways to assess mental health exist outside of either having a disorder or not, practitioners often rely on the presence or absence of symptomatology. The assessment and promotion of emotional regulation in patients is one way to encourage individuals to engage in mental health-promoting behaviors. Specific techniques are discussed that address emotional regulation. Overall, providing patients with the tools to regulate emotional responding will likely have a direct impact on well-being as well as reduce MH symptomology.