Assessment of executive functions in school-aged children: A narrative review

Advances in complex thinking and neurotechnologies in education: a bibliometric analysis of research trends

Neuroscience research to decode cognitive and emotional processes has been widely embraced in education. The development of methodologies, case studies, and new technologies have advanced our understanding of students' complex thinking. Despite these advancements, long-term analysis at the convergence of neurosciences, education, and complex thinking remains limited. To address this gap, we conducted a bibliometric review using the prism method, spanning from 1960 to 2023 to map research trends, thematic evolutions, and future challenges. Our analysis of 3792 Scopus-indexed studies using advanced data visualization techniques yielded the following findings: (1) a predominant focus on critical thinking, with creativity driving innovative approaches that enhance problem-solving; (2) growing integration of neurotechnologies-such as EEG and neuroimaging-to assess and optimize cognitive engagement in educational settings; (3) an increasing emphasis on metacognition, highlighting its role as a reflective thinking strategy that fosters cogntive control and higher-order thinking; and (4) emerging research on executive functions, particularly their role in fostering decision-making and cognitive flexibility in learning environments. These findings contribute to the understanding of cognitive processes and inform practical applications in education, including the design of personalized learning strategies, real-time cognitive assessment tools, and neurotechnology-supported pedagogical models. The study advocates an interdisciplinary approach, integrating neuroscientific insights into complex thinking to enhance cognitive processing within STEAM education.

Adaptation and psychometric properties of the Head-Toes-Knees-Shoulders task in young Iranian children

Executive functions (EF) lay the foundation for healthy development. However, few reliable and valid measures of EF have been developed among children in less developed countries such as Iran. The present study addressed this gap by examining the factor structure, score variation, and psychometric properties of a short EF task, the Head-Toes-Knees-Shoulders (HTKS), among children from two metropolitan cities (Isfahan and Tehran) in Iran. Participants (N = 693; 58% male; Mage = 5.88 years) were recruited through a convenience sampling approach and tested with the HTKS along with other performance-based EF measures and parent reports of EF difficulties. Confirmatory factor analyses showed that both one-factor and two-factor structures were acceptable and that a one-factor solution was optimal. Results demonstrated significant variability in scores and age-related differences in EF skills, with higher scores observed in older children. The task indicated acceptable internal consistency, interrater agreement, and test-retest stability. For construct validity, the HTKS was significantly related to other performance-based measures of EF, tapping into working memory, cognitive flexibility, and planning skills after controlling for child's age, gender, parental education, and city. Together, these findings underscore the promise of the HTKS task as a brief, economical, and easily administered EF task that reliably and validly captures variation in EF skills among Iranian children.

Executive function skills predict motor competence in preschool children

BACKGROUND

Motor competence and executive function skills develop actively at preschool age. Both are important for socialization, school achievements, and well-being. However, the association between motor competence and executive functions has not yet been fully investigated in preschool children. This study aimed to explore which executive function skills may be predictors of motor competence and its components.

METHODS

Two hundred seventy-two typically developing 5- to 6-year-old children (46% girls) participated in this study. The motor competence assessment tool 'Movement Assessment Battery for Children-2' was used on the Russian sample for the first time.

RESULTS

The study revealed that higher motor inhibition, working memory, and age were significant predictors of higher motor competence, manual dexterity, and balance skills. Higher aiming and catching skills were predicted only by higher motor inhibition and age. The study also revealed that girls had higher manual dexterity and balance skills than boys. And boys had higher than girls aiming and catching skills.

CONCLUSION

The obtained result with the largest effect size allows us to assume that training in motor inhibition could probably help improve movement difficulties, especially in manual dexterity skills.

CLINICAL TRIAL NUMBER

Not applicable.

Relationships between executive functions and vocabulary knowledge in Spanish-speaking children with and without developmental language disorder

Developmental language disorder (DLD) is often associated with deficits in executive functions (EFs). One common area of language difficulty in DLD is the development of vocabulary knowledge and it has been suggested that EF abilities may be linked to this difficulty. However, an explanation for this relationship remains unclear. The rationale for the current study examined the relationship between EFs and two aspects of vocabulary knowledge, receptive vocabulary size and vocabulary depth, in Spanish-speaking children with and without DLD. Vocabulary skills, the EFs of interference control, response inhibition, verbal and nonverbal working memory, and switching, were assessed in a total of 204 children aged 6-8 years: 105 with DLD and 99 with typical development (TD). Relationships were assessed using multiple regression models and path analysis, including EF as predictors, receptive vocabulary size and vocabulary depth as outcome or mediating variables, and age and non-verbal intelligence as covariates. In children with DLD, the EFs verbal working memory and switching were directly associated with receptive vocabulary size and indirectly with vocabulary depth. This indirect relationship was mediated by receptive vocabulary size. In contrast, no EFs were associated with receptive vocabulary size, and vocabulary depth in the TD group. These results suggest that verbal working memory and cognitive flexibility play a role in the cognitive mechanisms linked to vocabulary development in school children with DLD. Intervention programs aimed at improving vocabulary in this population should include EF activities.

Pediatric central nervous system (CNS) tumors cognitive and psychosocial assessment: key highlights from the Italian (AIEOP) consensus conference

Pediatric central nervous system (CNS) tumors represent one of the most intricate challenges faced by children and their families in the context of cancer illness. In Italy, the psychosocial working group (GDL) of the AIEOP, composed by professionals (psycho-oncologists/neuropsychologists) involved in the care pathways of patients with CNS tumors, has initiated a consensus process regarding the psychological/neuropsychological assessment of CNS patients to improve accessibility to standardized and shared protocols. Standardized psychological and neuropsychological instruments are proposed in the document, which provides for a selection in a tailor-made approach that is simultaneously shared by various centers.

Revisiting working memory 50 years after Baddeley and Hitch: A review of field-specific conceptualisations, use and misuse, and paths forward for studying children

As trained educational and developmental psychologists who study the role of working memory in educational outcomes, we know the various assumptions made about definitions and measurements of this cognitive ability. Considering the popularity of the Baddeley and Hitch working memory model in these fields, we raise challenges related to measurement, overlap with executive function, and adopting working memory measurement approaches from adult models. We propose that researchers consider how working memory tasks might tap multiple other abilities. This is problematic in the context of child cognitive development and in understanding which factors explain educational outcomes in children. We recommend giving greater attention to the central executive, acknowledging the overlap between the central executive and executive function in study design, and investigating a developmental model in the context of the broader abilities evoked in measurement. These recommendations may provide a fuller understanding of working memory's mechanistic role in children's learning and development and assist in developing reasonable adjustments for specific aspects of working memory for children who struggle.

What does the Developmental Neuropsychological Assessment-II (NEPSY-II) measure in children ages 7 to 12? A structural and psychometric analysis

The Developmental Neuropsychological Assessment - II (NEPSY-II) is a widely used assessment battery in pediatric settings, but its internal structure has not been adequately examined. This study employed a rational, empirical approach to examine the construct validity of 23 NEPSY-II subtest scores from children ages 7-12 (M = 9.99, SD = 2.76) in the NEPSY-II norming sample (N = 600; 50% girls). Competing higher-order models based on prior research, hypothesized NEPSY-II domains, and conceptual subtest classifications were evaluated via confirmatory factor analysis and a sequential approach to model comparisons. The results supported the multidimensionality of NEPSY-II subtests and the organization of subtests by hypothesized neuropsychological domains. The best fitting model included a general factor and four first-order factors. Factor loadings from the general factor to first-order factors were very strong. However, general factor loadings for most subtests were less than .50 (range = .21-.69, M = .44), and domain-specific effects for all subtests, independent of the general factor, were even lower (range = .00-.45, M = .44). Interestingly, all subtests demonstrated strong subtest-specific effects, but it is not clear what construct(s) the subtest-specific effects represent. Findings support NEPSY-II authors' emphasis on subtest-level interpretations rather than composite-level interpretations and highlight that NEPSY-II subtest scores should be interpreted carefully and with caution.

Contributions of Attachment and Cognitive Functioning on ADHD Symptoms in Children

ADHD is a neurodevelopmental disorder with multifactorial origins. Several studies have shown that parent-child attachment impacts the expression of ADHD symptoms, while others have highlighted the influence of cognitive impairments on ADHD symptoms. However, few studies have simultaneously examined the respective contributions of child attachment and cognitive functions to ADHD, which is the aim of this study. We included 45 children with ADHD from a university hospital and 44 typically developing children from regular schools. Child attachment was evaluated using a self-report questionnaire, the French Attachment Security Scale (ASS-Fr), and a narrative interview, the Cartes pour l'évaluation de l'Attachement et de la Mentalisation chez l'Enfant (CAME). Cognitive assessment involved both objective and subjective measures. Perceived attachment security to both parents and disorganized attachment were significantly associated with ADHD symptoms, but these relationships were mediated by externalizing symptoms and executive function difficulties. The relationships between attachment and ADHD symptoms are indirect and mediated by the presence of externalizing symptoms and executive function impairments.

An event-related potential study of P300 in preschool children with attention deficit hyperactivity disorder

Objective

To study the characteristics of event related potential P300 in preschool children with attention deficit hyperactivity disorder (ADHD) aged 4-6 years (4≤ age <6), and to explore the differences in cognitive function compared with healthy children. To explore a new method for the study of cognitive function in preschool children with ADHD.

Methods

A total of 73 preschool children aged 4-6 years were selected from the outpatient clinic of Neurology Department, the ADHD-specialized Clinic and Health Care Department of the Children's Hospital Affiliated to the Capital Institute of Pediatrics from March 2021 to May 2024. They were divided into the ADHD group (45 cases) and healthy children group (28 cases). Event related potential P300 was measured in all children and the amplitude and latency of the wave were compared between the two groups separately.

Results

The latency of P300 at all the recording electrodes (Fz, Cz, Pz, Oz, C3, C4) in the ADHD group was significantly longer than controls (p < 0.05). The wave amplitudes of children with ADHD were significantly higher than controls at Pz and Oz points.

Conclusion

The differences between two groups in P300 test show that preschool children with ADHD present longer latency at central line of the brain and bilateral central lobes compared with healthy children, and higher amplitude at the central parietal lobe and central occipital lobe. It may suggest that attention cognition has already impaired in preschool children with ADHD.

Associations Between Motor Competence and Executive Functions in Children and Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Motor competence and executive functions co-develop throughout childhood and adolescence, and there is emerging evidence that improvements in motor competence may have cognitive benefits in these populations. There is a need to provide a quantitative synthesis of the cross-sectional, longitudinal and experimental studies that have examined the association between motor competence and executive functions in school-aged youth.

OBJECTIVES

The primary aim of our systematic review was to synthesise evidence of the association between motor competence and executive functions in school-aged children and adolescents (5-18 years). Our secondary aim was to examine key moderators of this association.

METHODS

We searched the PubMed, PsycINFO, Scopus, Ovid MEDLINE, SPORTDiscus and EMBASE databases from inception up to 27 June 2023. We included cross-sectional, longitudinal and experimental studies that assessed the association between motor competence (e.g., general motor competence, locomotor skills, object control skills and stability skills) and executive functions (e.g., general executive functions, inhibition, working memory and cognitive flexibility) in children and adolescents aged 5-18 years.

RESULTS

In total, 12,117 records were screened for eligibility, and 44 studies were included. From the 44 included studies, we meta-analysed 37 studies with 251 effect sizes using a structural equation modelling approach in the statistical program R. We found a small positive association (r = 0.18, [95% confidence interval (CI) 0.13-0.22]) between motor competence and executive functions. The positive associations were observed in cross-sectional (r = 0.17, [95% CI 0.13-0.22]), longitudinal (r = 0.15, [95% CI 0.03-0.28]) and experimental studies (r = 0.25, [95% CI 0.01-0.45]). We also found that general motor competence (r = 0.25, [95% CI 0.18-0.33]), locomotor (r = 0.15, [95% CI 0.09-0.21]), object control (r = 0.14, [95% CI 0.08-0.20]) and stability (r = 0.14, [95% CI 0.08-0.20]) skills were associated with executive functions. We did not find any moderating effects for participants' age on the associations between motor competence and executive functions.

CONCLUSIONS

Our findings suggest a small-to-moderate positive association between motor competence and executive functions in children and adolescents. The small number of experimental studies included in this review support the assertion that interventions targeting children's motor competence may be a promising strategy to improve their executive functions; however, more research is needed to confirm these findings. Future studies should explore the underlying mechanisms linking motor competence and executive functions as their comprehension may be used to optimise future intervention design and delivery.

PROSPERO REGISTRATION

CRD42021285134.

Executive functions and their relationship with age: Insights from a novel neuropsychological Assessment Battery in Children-a pilot study

Executive functions (EFs) are a set of cognitive processes that enable individuals to manage and coordinate their thoughts and actions toward achieving specific goals. EFs include planning, organizing, initiating, and monitoring actions, and have been found to improve with age due to the maturation of the brain, especially during childhood. Therefore, our correlational study sought to determine the relationship between the performance in executive functions and age in 79 children (36 girls, 45.6%) throughout development, between the ages of 6 and 12 (mean = 9.25; SD = 2.05), using a battery designed in Chile: BEFE (Batería de Evaluación de las Funciones Ejecutivas: Executive Function Assessment Battery) based on traditional neuropsychological tests to evaluate Working Memory, Inhibitory Control, Cognitive Flexibility, and Planning skills. Our results showed various correlations between the variables age and performance in various behavioral parameters, demonstrating an increase in the number of correct responses (positive correlation) and/or a decrease in errors (negative correlation) with age (6-12) in the subtests that correspond to dimensions of Cognitive Flexibility (Semantic and Phonological Fluency, Card Sorting Game, and Tracing Tasks), Inhibitory Control (ENA-F and Sentence Completion), Working Memory (Audio-verbal WM Forward and Ordering, and Visuospatial WM Forward and Backward), and Planning (La Portada de Antofagasta and FISA Maps). These results are consistent with previous empirical evidence and support the notion of a developmental relationship between EF performance and age. Additionally, this study contributes to understanding EF development in culturally specific contexts, highlighting the importance of contextually relevant assessment tools in evaluating cognitive development.

A Novel Battery to Assess "Cool" and "Hot" Executive Functions: Sensitivity to Age Differences in Middle Childhood

The main goal of the current work was to assess the age sensitivity of a novel battery of cool and hot Executive Function (EF) tasks developed for the middle childhood period: the Executive Brain Battery (EBB). To this end, we carried out a first study in which the EBB was administered to six age groups ranging from 6 to 11. Additionally, in a second study, we compared children at the end of middle childhood (age 11 years) and adult performance in the EBB. Results showed that tasks included in the EBB were suitable for all age groups, with more age-related changes being found in cool than hot EF tasks. Moreover, at the end of middle childhood, children reach an adult-like performance in most of these cool and hot tasks. The present findings extend previous research suggesting that cool and hot EFs exhibit different patterns of age-related growth in middle childhood. Additionally, the EEB could become a useful tool for research on EFs during middle childhood that could be adapted for a wide range of populations.

Cognitive performance in children and adolescents with primary hypertension and the role of body mass

Objective

Primary hypertension has been shown to affect cognitive functions in adults but evidence in the pediatric population remain scarce and equivocal. We aimed to compare cognitive functioning between children diagnosed with primary hypertension and normotensive controls, with a focus on the role of different blood pressure (BP) parameters and body mass.

Methods

We conducted a single-center, prospective, cross-sectional study of children and adolescents (6-17 years old) with primary hypertension and age- and sex-matched normotensive controls. All participants underwent office BP, ambulatory BP monitoring (ABPM), and central BP measurements using an oscillometric device. Neurocognitive assessment consisted of evaluation of (i) intelligence quotient (IQ), (ii) categorical and phonemic fluency, (iii) verbal memory (verbal-logical story recall), and (iv) non-verbal computerized cognitive assessment.

Results

The study included a total of 59 patients with primary hypertension (14 ± 3 years) and 37 normotensive controls (14 ± 3 years). Participants in the primary hypertension group had a significantly higher body mass index z-score (BMIz: 2.1 ± 1.4 vs. 0.7 ± 0.9, p < 0.001), and 85% received antihypertensive therapy. Participants with primary hypertension showed worse performance in the domains of reaction speed, attention and processing speed, visual memory, new learning, and phonemic fluency. After adjusting for BMIz, only the differences in the reaction speed tasks remained significant. None of the BP parameters was associated with cognitive outcomes after adjustment for age, sex, and BMIz. BMIz associated with tasks of visual memory, new learning, spatial planning, and working memory, independent of age and sex.

Conclusion

Children and adolescents diagnosed with primary hypertension exhibit worse performance in the cognitive domains of reaction speed, attention, processing speed, visual memory, and new learning. These differences to healthy controls can be partially attributed to accompanying increase of body mass.

Patient-reported cognitive impairments and objective neuropsychological deficits in young sarcoma patients undergoing chemotherapy and its comparison to healthy controls: A tertiary health care study from India

The study aims to investigate the patient-reported cognitive deficits and objective neuropsychological functions in younger adult (YA) sarcoma patients (16-40 years of age). Ninety patients and 30 age-matched healthy controls from a single tertiary healthcare hospital, were recruited into four groups: Pre-chemotherapy (Pre Cx), During chemotherapy (During Cx), Post-chemotherapy (Post Cx) and Controls. Neurocognitive functions were assessed subjectively using FACT-Cog v3 questionnaire; objectively using ACE-III and neuropsychological tests (NPT). FACT-Cog scores of During Cx (P = .041) and Post Cx (P = .008) groups were significantly lower than Pre Cx group. ACE-III scores of During Cx (P = .048) and Post Cx (P = .043) groups were lower as compared to Pre Cx group. In addition, reaction times and accuracies of the NPT (Flanker's, Sternberg's and Emotional Stroop tests) were worse (P < .05) in During Cx and Post Cx groups as compared to either Pre Cx or control groups. In the Post Cx group, the dose of chemotherapy showed significant negative correlation with the Sternberg reaction time (P = .040) as well as the scores of language (P = .047), and attention (P = .044) domains of ACE-III. Observations demonstrate that cancer/chemotherapy-related neurocognitive deficits fail to improve even after cessation of treatment, and high dosage of chemotherapy used, could be an underlying factor. This emphasizes the need for developing 'model of care' in these patients for monitoring the side effects, and possible titration in the therapeutic regimen for sarcoma in YA.

The association between working memory, teacher-student relationship, and academic performance in primary school children

Introduction

Early relationships with teachers play an important role in children's development and significantly influence students' cognitive and academic performance. Studies suggest that working memory (WM) is a strong predictor of academic achievement, especially of reading and arithmetic outcomes. The associations between teacher-student relationship (TSR) quality, children's WM skills and their academic performance have been reported in numerous observational studies. However, the potentially bidirectional and temporal nature of the relationships between these constructs is understudied.

Methods

The purpose of this study was to investigate the relationships between primary school children's WM and TSR by applying a cross-lagged design and measuring these constructs at three time points throughout the academic year. More exploratively, this study investigated how WM and TSR bidirectionally relate to children's academic performance.

Results

The findings of this study revealed a temporal relationship between WM and TSR: between WM-related problems in the classroom at baseline and conflict at 3-month follow-up, and between closeness at 3-month follow-up and WM-related problems in the classroom at 5-month follow-up. Moreover, the findings showed a bidirectional relationship between arithmetic performance and WM-related problematic behaviour.

Discussion

This study highlights that relationships between the teacher and students play an important role in supporting students' cognitive and academic development. Importantly, this study suggests that children with WM problems may benefit from interventions that focus on improving their relationships with teachers. Additionally, the findings propose that interventions targeting WM may also have positive effects on children's academic performance.

Best Practices and Methodological Strategies for Addressing Generalizability in Neuropsychological Assessment

Generalizability considerations are widely discussed and a core foundation for understanding when and why treatment effects will replicate across sample demographics. However, guidelines on assessing and reporting generalizability-related factors differ across fields and are inconsistently applied. This paper synthesizes obstacles and best practices to apply recent work on measurement and sample diversity. We present a brief history of how knowledge in psychology has been constructed, with implications for who has been historically prioritized in research. We then review how generalizability remains a contemporary threat to neuropsychological assessment and outline best practices for researchers and clinical neuropsychologists. In doing so, we provide concrete tools to evaluate whether a given assessment is generalizable across populations and assist researchers in effectively testing and reporting treatment differences across sample demographics.