Executive function and attention in children and adolescents with depressive disorders: a systematic review

Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms

Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n = 212), and children in SDQ typical ranges (n = 30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n = 191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.

Association between the performance of executive function and the remission of depressive state after clinical treatment in patients with depression

BACKGROUND

Previous studies have reported that patients with depression have significant cognitive impairment. The aim of this study is to comprehensively evaluate the impairment of executive functions in patients with depression and whether the cognitive behavior performance of executive function is association with remission of depressive state after clinical treatment.

METHODS

We used cognitive-behavioral test to evaluate the performance of executive functions of 95 inpatients with depression before hospitalization and conducted two follow-up evaluations of their depression status on the 15th day of hospitalization and approximately 9 months after discharge.

RESULTS

The performance of executive function except the accuracy of inhibition control in patients with depression were significantly worse than that of healthy controls. Multivariate linear regression analysis found that the reaction time of working memory not only had a significant linear relationship with the baseline depression scores of patients with depression, but also had a significant linear relationship with the reduced depression scores after two follow-up visits.

LIMITATIONS

We only used cognitive-behavioral data as indicators to evaluate the cognitive performances of participants and only measured three components of executive function.

CONCLUSIONS

The reaction time of working memory was a stable and effective predictor of symptom relief in patients with depression after clinical treatment. These results provide initial evidence for working memory to predict the clinical prognosis of inpatients with depression prospectively, which could be further leveraged to improve intervention approaches and analyze the heterogeneity of depression.

Is there sufficient evidence for the association between executive dysfunction and academic performance in adolescents with major depressive disorder?: a systematic review

Adult depression, undoubtedly associated with executive dysfunction, leads to poor work performance. As depression in adolescents may have a negative impact on school performance, we aimed to analyse the possible relationship between selected executive deficits and academic performance. Executive dysfunctions may have more severe consequences on school performance at high school, as this stage of education requires engagement in long-term goals, whether writing an essay or preparing for an exam. Whilst inhibitory control is necessary at all educational stages, it seems that planning and decision-making play a greater role in high school than in primary school. We reviewed studies on executive functions conducted in adolescents diagnosed with major depressive disorder (MDD) to establish the possible relationship between executive processes and school performance in depressed adolescents. The search identified 5 studies addressing planning and decision-making in adolescents with MDD, but none of those studies reported educational achievement. We identified a considerable gap in the research on the functional impact of depression in adolescents. Identifying the link between specific executive deficits and school performance could guide tailored therapeutic interventions.

Mindfulness enhances cognitive functioning: a meta-analysis of 111 randomized controlled trials

BACKGROUND

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist.

METHOD

Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted.

RESULTS

One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257-0.643; vs. active controls, g = 0.192-0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI).

CONCLUSION

MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy.

Individual and environmental factors in internalizing disorders in children and adolescents

BACKGROUND

Literature has emphasized the role of biopsychosocial factors in internalizing disorders; however, the role of developmental competencies of a child have not been explored much in this context. The current study aimed to understand the differences in developmental competencies, temperament, parenting practices and psychosocial adversities between children with and without internalizing disorders.

METHOD

The sample consisted of 200 children and adolescents aged seven to 18 years, with equal number of those with and without an internalizing disorder; and one of their parents. Psychopathology, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events, family environment and abnormal psychosocial situations were measured using standardized tools.

FINDINGS

Discriminant analysis revealed that temperamental domains of sociability and rhythmicity, developmental competencies of adaptive behaviour and self-concept, parenting practices involving father's involvement and overall positive parenting differentiated the clinical and control groups better. Among psychosocial adversities, family environment domains of cohesion and organization, and subjective stress from life events and abnormal psychosocial situations were the most important discriminators.

CONCLUSION

The current study reveals that specific individual factors involving temperament and developmental competencies and environmental factors involving parenting practices and psychosocial adversities are significantly associated with internalizing disorders. This has implications for the mental health care of children and adolescents with internalizing disorders.

Using Dispositions to Understand Otherwise Intractable Causal Pathways to Psychological Problems During Childhood and Adolescence

Studies of the genetic and environmental factors that make children more or less likely to develop distressing and impairing psychological problems, and studies of the psychobiological pathways through which these causal factors operate, have the goal of improving our understanding of the basic nature of psychological problems to develop better methods of prevention and treatment. For this reason, we have long had our eye on the prize of discovering the causes and psychobiological mechanisms underlying each dimension of psychological problems. There are compelling reasons, however, to seek a different and more achievable prize to understand psychological problems. Dimensions of psychological problems are both far too heterogeneous and too highly correlated to line up with distinct causal pathways. In contrast, a small number of orthogonal cognitive and socioemotional dispositional dimensions are correlated with psychological problems in revealing cross-cutting patterns. Each of these dispositions shares its independent causal pathways with psychological problems and help us understand the complex shared and heterogeneous nature of their causal processes. I outline a strategy for understanding the causes and mechanisms of psychological problems using studies of independently measured dispositions.

Cognitive functioning in children and adolescents with depression: A systematic review and meta-analysis

Although cognitive dysfunction is associated with depression in adults, the link in children and adolescents is unclear. This systematic review and meta-analysis quantifies the association between depression and cognitive function in children and adolescents. Systematic searches were conducted in six databases: Child Development and Adolescent Studies, Ovid MEDLINE, Ovid Embase, Ovid APA PsycINFO, EBSCO CINAHL Plus, Scopus (last search: April 2023). Studies including measures of cognitive outcomes (memory, attention, executive function, processing speed, language) among children (≤18 years) with depression were included. The Joanna Briggs Institute Critical Appraisal Tools were used to determine study risk of bias. Random-effects meta-analyses of study outcomes were performed. Seventeen studies were included (15 were cross-sectional, 1 prospective, 1 randomized control trial). Participants (N = 13,567) were 10 to 17 years old (mean 13.8 ± 2.2 years; 60 % female). Compared with healthy controls, depressed participants had lower performance on tests of working memory (g = -0.40; 95 % CI: -0.67, -0.13), long-term memory (g = -0.48; 95 % CI: -0.72, -0.25), attention (g = -0.15; 95 % CI: -0.26, -0.04), executive function (g = -0.16; 95 % CI: -0.24, -0.08), and language (g = -0.23; 95 % CI: -0.36, -0.09). No performance differences were observed on tests of short-term memory or processing speed. Children and adolescents with depression demonstrated lower performance on tests of working and long-term memory, attention, executive function and language. These findings emphasize the importance of considering cognitive functioning among children with depression, and greater understanding of the effect of treatment on these outcomes. PROSPERO (CRD42022332064).

Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study

BACKGROUND

This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents' cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers.

METHODS

The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children's Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews.

RESULTS

Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents' and mothers' perspectives as associated with adolescents' MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility.

CONCLUSIONS

This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence.

Emotion regulation in adolescents with major depression - Evidence from a combined EEG and eye-tracking study

BACKGROUND

Adolescent major depression (MD) is characterized by deficits in emotion regulation (ER). Little is known about the neurophysiological correlates that are associated with these deficits. Moreover, the additional examination of visual attention during ER would allow a more in-depth understanding of ER deficits but has not yet been applied simultaneously.

METHODS

N = 33 adolescents with MD and n = 35 healthy controls (HCs) aged 12-18 years performed an ER task during which they either a) down-regulated their negative affective response to negative images via cognitive reappraisal or b) attended the images without changing their affective response. During the task, the Late Positive Potential (LPP), gaze fixations on emotional image aspects, and self-reported affective responses were collected simultaneously.

RESULTS

Compared to HCs, adolescents with MD demonstrated reduced ER success based on self-report but did not differ in LPP amplitudes. Participants in both groups showed increased amplitudes in the middle LPP window when they reappraised negative pictures compared to when they attended them. Only in the HC group, increased LPP amplitudes during reappraisal were paralleled by more positive affective responses.

LIMITATION

The applied stimuli were part of picture databases and might therefore have limited self-relevance.

CONCLUSIONS

Increased LPP amplitude during ER in both groups might be specific to adolescence and might suggest that ER at this age is challenging and requires a high amount of cognitive resources. These findings provide an important starting point for future interventional studies in youth MD.

Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study

BACKGROUND

Internalizing symptoms are among the most common psychological symptoms in childhood and adolescence, are highly stable and can cause severe impairment. Current research discusses lower capacities of self-regulation (SR) as risk factors for the development of internalizing symptoms. The present study identifies trajectories of internalizing symptoms in the transition phase from middle childhood to adolescence and examines multiple SR facets as predictors of potentially unfavorable trajectories, also in the presence of other established risk factors.

METHODS

The study utilized a community sample of N = 1453 (52.2% female) German children, who provided data at up to three measurement points (t1: 6-11 years, t2: 7-11 years, t3: 9-13 years). Trajectories of internalizing symptoms were based on parents' ratings of the emotional problems scale of the Strengths and Difficulties Questionnaire. SR facets were assessed using multiple methods and informants. Two multinomial regression analyses were conducted to predict class membership by (1) SR facets and gender and (2) SR facets, gender, and other established risk factors (education status, family adversity, peer problems).

RESULTS

Using growth mixture modelling, we identified three trajectory classes with stable low (n = 1200), increasing (n = 124), and early high decreasing internalizing symptoms (n = 129). In the regression analysis controlling for risk factors, membership in the increasing trajectory was significantly predicted by higher emotional reactivity (OR = 2.65, p < .001), higher cognitive flexibility/set-shifting (OR = 1.48, p = .032), and higher family adversity (OR = 1.38, p = .046). Membership in the early high decreasing trajectory was significantly predicted by higher emotional reactivity (OR = 4.15, p < .001), higher inhibitory control (OR = 1.47, p = .045), lower working-memory updating (OR = 0.69, p = .016), lower delay of gratification (OR = 0.75, p = .028), and higher family adversity (OR = 1.63, p = .001).

CONCLUSIONS

SR facets incrementally and differentially predict potentially unfavorable trajectories of internalizing symptoms from age 6 to 13, surpassing the predictive value of gender or education status. Higher emotional reactivity emerged as the most influential factor, which could therefore be addressed in future prevention and intervention efforts.

A transdiagnostic view on MDD and ADHD: shared cognitive characteristics?

BACKGROUND

Major Depressive disorder (MDD) and Attention Deficit Hyperactivity Disorder (ADHD) are prevalent mental disorders that often co-occur. There is overlap in symptomatology between MDD and ADHD that complicates diagnostics and treatment selection. Hence, to aid diagnostics of single and comorbid disorders, we aimed to examine the discriminative power of common symptom measures and cognitive dysfunction to differentiate between participants diagnosed with MDD, ADHD, ADHD and comorbid MDD and without a mental disorder.

METHODS

Four diagnosed groups were compared: MDD (n = 103), ADHD (n = 78), comorbid MDD + ADHD (n = 29), healthy controls (HC; n = 123). We examined between-group differences and discriminative functions of clinically validated self-report symptom questionnaires, as well as task-based and self-report measures of cognitive dysfunction.

RESULTS

Based on the between group comparisons, all patient groups were characterized by clinically relevant levels of ADHD-symptomatology, executive dysfunction, and diminished cognitive performances in the domain of attention; even the MDD-only group. In addition, based on self-reported symptoms of MDD, ADHD, and executive dysfunction, discriminant function analysis classified all HC correctly (100%) and patients diagnosed with ADHD or MDD relatively well (resp. 85% and 82%). Comorbid MDD + ADHD was poorly differentiated from single MDD or ADHD by the commonly used self-report symptom questionnaires for MDD and ADHD (0% correct predictions), which substantially improved by incorporating the questionnaire on executive functioning (42% correct predictions).

CONCLUSIONS

In both MDD and ADHD, clinical levels of attentional and executive dysfunction were found, while these clinical groups differed in cognitive flexibility, initiating, inhibition and meta-cognition. Comorbid MDD + ADHD was poorly distinguishable from non-comorbid MDD and ADHD based on self-reported symptoms of depression and ADHD. Addition of subjective executive function in the discrimination models resulted in increased discriminative power. Our findings indicate that executive functioning measure can improve the diagnostic process of ADHD and MDD.

Executive functions and borderline personality features in adolescents with major depressive disorder

Background

Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF).

Methods

We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity.

Results

Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries.

Conclusion

On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF.

Clinical trial registration

www.ClinicalTrials.gov, identifier NCT03167307.

The Emotion-Regulation Benefits of Implicit Reappraisal in Clinical Depression: Behavioral and Electrophysiological Evidence

Major depressive disorder (MDD) is characterized by emotion dysregulation. Whether implicit emotion regulation can compensate for this deficit remains unknown. In this study, we recruited 159 subjects who were healthy controls, had subclinical depression, or had MDD, and examined them under baseline, implicit, and explicit reappraisal conditions. Explicit reappraisal led to the most negative feelings and the largest parietal late positive potential (parietal LPP, an index of emotion intensity) in the MDD group compared to the other two groups; the group difference was absent under the other two conditions. MDD patients showed larger regulatory effects in the LPP during implicit than explicit reappraisal, whereas healthy controls showed a reversed pattern. Furthermore, the frontal P3, an index of voluntary cognitive control, showed larger amplitudes in explicit reappraisal compared to baseline in the healthy and subclinical groups, but not in the MDD group, while implicit reappraisal did not increase P3 across groups. These findings suggest that implicit reappraisal is beneficial for clinical depression.

Investigating the Link Between Depression, Cognition, and Motivation in Late Childhood

Research has revealed broad cognitive deficits (e.g., memory, learning) in depression, and that motivation may account for this link. We tested the state (i.e., only present during depression), trait (i.e., underlying vulnerability) and scar (i.e., lasting corollary) hypotheses of cognitive dysfunction in depression. We additionally tested subjective motivation as a mediator of the concurrent depression-cognition link. In a longitudinal sample of 11,878 children ages 9-11, we found no evidence of a concurrent state or longitudinal trait or scar relationship between depression and cognition. The pattern of depression-cognition relationships-which precluded a mediator analysis-in our childhood sample is a departure from previous studies. Our findings indicate that cognitive deficits are not strongly associated with depression in childhood, in contrast with the impairment commonly seen in older individuals with depression.

Psychometric properties of the Teenage Executive Functioning Inventory in a Turkish sample of adolescents: deficits in working memory and inhibition among adolescents

The Teenage Executive Functioning Inventory (TEXI) is a measurement tool that consists of two subscales, working memory and inhibition, and allows both self and parent rating. This study aimed to examine the psychometric properties of the Turkish version of TEXI in a sample of 184 parents and 476 adolescents aged 11 and 18 years and to measure the relationship between executive functions and mental health problems, including attention deficit hyperactivity disorder and major depressive disorder and anxiety disorders. Confirmatory factor analyses showed acceptable/good fit indices and confirmed the two-factor structure for both the adolescent and parent forms. Test-retest results and Cronbach's alpha coefficient showed that the scale had high reliability. The results also showed that deficits in executive functions were associated with various mental health problems in adolescents. The findings demonstrated that a Turkish translation of the TEXI is a valid and reliable tool for evaluating the executive functions of adolescents.

Adolescent Depressive Symptoms: The Role of Late Childhood Frontal EEG Asymmetry, Executive Function, and Adolescent Cognitive Reappraisal

Cognitive reappraisal is adaptive for decreasing symptoms of depression; however, a gap in the research is understanding the childhood processes that contribute to cognitive reappraisal in adolescence. This study examined executive function and frontal electroencephalogram (EEG) asymmetry during late childhood as predictors of adolescent cognitive reappraisal and depressive symptoms. Data were from 123 participants in late childhood (age 10) and adolescence (age 14.5). A moderated mediation model was fit to the data to examine frontal EEG asymmetry as a moderator in the relation between late childhood inhibitory control and adolescent cognitive reappraisal as well as adolescent cognitive reappraisal and adolescent depressive symptoms. Results indicated lower inhibitory control was associated with lower cognitive reappraisal when children had right frontal EEG asymmetry. Lower cognitive reappraisal in turn was associated with higher depressive symptoms for children with right frontal EEG asymmetry. Working memory and cognitive flexibility were also examined but were not significant indicators. Results suggest the potential for targeting inhibitory control and cognitive reappraisal to diminish depressive symptoms particularly among adolescents with right frontal EEG asymmetry.

Psychological and contextual risk factors for first-onset depression among adolescents and young people around the globe: A systematic review and meta-analysis

AIM

Identifying predictors for future onset of depression is crucial to effectively developing preventive interventions. We conducted a systematic review and meta-analysis to identify risk factors for first-onset depression among adolescents and young people.

METHODS

We searched MEDLINE (Ovid), PsycINFO, Cochrane Database, Web of Science, Lilacs, African Journals Online and Global Health (July 2009 to December 2020) for longitudinal studies assessing risk factors for first-onset depression among adolescents and young people aged 10-25 years. Meta-analyses generated summary odds ratio (OR) estimates.

REGISTRATION

PROSPERO CRD42018103973.

RESULTS

Nineteen studies representing 21 unique populations were included in the meta-analysis. Among studies reporting race/ethnicity, 79% of participants were of White/European descent. Seventeen studies were from high-income countries, with only two from an upper-middle-income country (China). Odds for first-onset depression were significantly greater for girls compared to boys (n = 13; OR = 1.78 [1.78, 2.28], p < 0.001) and for youth with other mental health problems at baseline (n = 4; OR = 3.20 [1.95, 5.23], p < 0.001). There were non-significant associations for negative family environment (n = 8; OR = 1.60 [0.82, 3.10], p = 0.16) and parental depression (n = 3; OR = 2.30 [0.73, 7.24], p = 0.16).

CONCLUSIONS

Most longitudinal studies do not report risk factors specifically for first-onset depression. Moreover, predictive data are limited to predominantly White populations in high-income countries. Future research must be more ethnically and geographically representative. Recommendations are provided for consistent and comprehensive reporting of study designs and analyses of risk factors for first-onset depression.

Depressive symptoms and cognitive control: the role of affective interference

Depressive symptoms are characterised by reduced cognitive control. However, whether depressive symptoms are linked to difficulty in exerting cognitive control in general or over emotional content specifically remains unclear. To better differentiate between affective interference or general cognitive control difficulties in people with depressive symptoms, we employed a non emotional (cold) and an emotional (hot) version of a task-switching paradigm in a nonclinical sample of young adults (N = 82) with varying levels of depressive symptoms. Depressive symptoms were linked to greater difficulties in exerting cognitive control in complex situations (mixed-task blocks) compared to simple and semiautomatic situations (single-task blocks) in both task versions. Moreover, greater depressive symptoms were associated with longer latencies in the emotional version of the task across all trial types. Thus, the emotion-specific effect was not modulated by the degree of cognitive control required to perform the task. In sum, depressive symptoms were characterised by a general difficulty to exert cognitive control in both emotional and non emotional contexts and by greater difficulty in even simple attentional processing of emotional material. This study granted novel insights on the extent of cognitive control difficulties in emotional and non emotional contexts for people with depressive symptoms.

Current Evidence and Theories in Understanding the Relationship between Cognition and Depression in Childhood and Adolescence: A Narrative Review

The present narrative review has covered the current evidence regarding the role of cognitive impairments during the early phase of major depressive disorder (MDD), attempting to describe the cognitive features in childhood, adolescence and in at-risk individuals. These issues were analyzed considering the trait, scar and state hypotheses of MDD by examining the cold and hot dimensions, the latter explained in relation to the current psychological theoretical models of MDD. This search was performed on several electronic databases up to August 2022. Although the present review is the first to have analyzed both cold and hot cognitive impairments considering the trait, scar and state hypotheses, we found that current evidence did not allow to exclusively confirm the validity of one specific hypothesis since several equivocal and discordant results have been proposed in childhood and adolescence samples. Further studies are needed to better characterize possible cognitive dysfunctions assessing more systematically the impairments of cold, hot and social cognition domains and their possible interaction in a developmental perspective. An increased knowledge on these topics will improve the definition of clinical endophenotypes of enhanced risk to progression to MDD and, to hypothesize preventive and therapeutic strategies to reduce negative influences on psychosocial functioning and well-being.

Distinct Neural Profiles of Frontoparietal Networks in Boys with ADHD and Boys with Persistent Depressive Disorder

Working memory deficits are common in attention-deficit/hyperactivity disorder (ADHD) and depression-two common neurodevelopmental disorders with overlapping cognitive profiles but distinct clinical presentation. Multivariate techniques have previously been utilized to understand working memory processes in functional brain networks in healthy adults but have not yet been applied to investigate how working memory processes within the same networks differ within typical and atypical developing populations. We used multivariate pattern analysis (MVPA) to identify whether brain networks discriminated between spatial versus verbal working memory processes in ADHD and Persistent Depressive Disorder (PDD). Thirty-six male clinical participants and 19 typically developing (TD) boys participated in a fMRI scan while completing a verbal and a spatial working memory task. Within a priori functional brain networks (frontoparietal, default mode, salience), the TD group demonstrated differential response patterns to verbal and spatial working memory. The PDD group showed weaker differentiation than TD, with lower classification accuracies observed in primarily the left frontoparietal network. The neural profiles of the ADHD and PDD differed specifically in the SN where the ADHD group's neural profile suggests significantly less specificity in neural representations of spatial and verbal working memory. We highlight within-group classification as an innovative tool for understanding the neural mechanisms of how cognitive processes may deviate in clinical disorders, an important intermediary step towards improving translational psychiatry.

Relationships between Depression and Executive Functioning in Adolescents: The Moderating Role of Unpredictable Home Environment

Although researchers have explored the link between depression and executive functioning (EF), the influence of early-life environmental and relational instability on this association has not been comprehensively assessed in adolescents. This cross-sectional study examined whether unpredictability of home environment in childhood moderated the relationship between depression and EF in adolescents. Participants were 138 adolescents aged 13 to 17 years (72% female; 47.8% White; 47.1% Hispanic). Diagnostic status (major depression versus healthy control) and depression severity were assessed using psycho-diagnostic interviews and self-reports from parents and adolescents. Participants also completed the Questionnaire of Unpredictability in Childhood (QUIC). EF was assessed using self-report (Behavior Rating Inventory of Executive Function, Second Edition; BRIEF2) and a battery of performance-based measures. Results showed that QUIC scores moderated the relationship between depression and BRIEF2 scores, such that high unpredictability was associated with poorer EF for adolescents exhibiting low depression severity. Participants with the highest levels of depression exhibited the poorest EF ratings, regardless of childhood unpredictability. Unpredictability was moderately associated with performance-based measures, but did not interact with depressive symptoms to predict complex performance-based EF. Recommendations include assessing for unpredictable childhood environment and acknowledging this risk factor for poor EF in youth with sub-threshold depression. Treatment implications are discussed with respect to family systems/parenting interventions, as mildly depressed adolescents growing up in unstable homes may be vulnerable to EF difficulties. Further, this study adds to the EF measurement literature by examining associations between self-report and performance-based EF instruments in a diverse sample of adolescents.

Neuroplasticity, the Prefrontal Cortex, and Psychopathology-Related Deviations in Cognitive Control

A basic survival need is the ability to respond to, and persevere in the midst of, experiential challenges. Mechanisms of neuroplasticity permit this responsivity via functional adaptations (flexibility), as well as more substantial structural modifications following chronic stress or injury. This review focuses on prefrontally based flexibility, expressed throughout large-scale neuronal networks through the actions of excitatory and inhibitory neurotransmitters and neuromodulators. With substance use disorders and stress-related internalizing disorders as exemplars, we review human behavioral and neuroimaging data, considering whether executive control, particularly cognitive flexibility, is impaired premorbidly, enduringly compromised with illness progression, or both. We conclude that deviations in control processes are consistently expressed in the context of active illness but operate through different mechanisms and with distinct longitudinal patterns in externalizing versus internalizing conditions.

Study of Positive and Negative Affect and Neurocognitive Functioning in Adolescents

The main purpose of the present work was to study neurocognitive performance of adolescents at risk for emotional difficulties. The sample included a total of 1,509 adolescents from stratified random cluster sampling. Derived from this sample, a group of high-risk (n = 92) and a comparison group (n = 92) were selected based on the short version of the Positive and Negative Affect Schedule (PANAS) for comparison on the University of Pennsylvania computerized neuropsychological test battery for children (PENN). A Multivariate analysis of covariance (MANCOVA) was performed taking the scores on the PENN as dependent variables and the two groups derived from the scores of the PANAS (at risk vs. comparison) as a fixed factor. Adolescents at high risk of presenting affectivity problems showed statistically significant differences in several different neurocognitive domains, in accuracy, λ = .820, F(9, 160,000) = 3.913, p < .01, partial η² = .180; speed, λ = .502, F(5, 88,000)= 17.493, p < .01, partial η² = .498; and efficiency, λ = .485, F(4, 89,000) = 23.599, p <.01, partial η² = .515. The high risk group showed lower neurocognitive performance than the comparison group. In addition, a positive statistically significant correlation was found between all the neurocognitive competences (p < .05). Results found in this study reveal that neurocognitive impairments can be shown in adolescents at psychometric high risk for emotional problems before transition to more severe psychological problems.

Cognitive Considerations in Major Depression: Evaluating the Effects of Pharmacotherapy and ECT on Mood and Executive Control Deficits

Deficits in the executive control of attention greatly impact the quality of life of patients diagnosed with major depressive disorder (MDD). However, attentional deficits are often underemphasized in clinical contexts compared with mood-based symptoms, and a comprehensive approach for specifically evaluating and treating them has yet to be developed. The present study evaluates the efficacy of bifrontal electroconvulsive therapy (ECT) combined with drug therapy (DT) in alleviating mood-related symptomatology and executive control deficits in drug-refractory MDD patients and compares these effects with those observed in MDD patients undergoing DT only. The Hamilton Rating Scale for Depression and the Lateralized Attentional Network Test-Revised were administered across two test sessions to assess treatment-related changes in mood-based symptoms and conflict processing, respectively, in patients undergoing ECT + DT (n = 23), patients undergoing DT (n = 33), and healthy controls (n = 40). Although both groups showed an improvement in mood-based symptoms following treatment and a deficit in conflict processing estimated on error rate, a post-treatment reduction of an executive control deficit estimated on RT was solely observed in the ECT + DT patient group. Furthermore, Bayesian correlational analyses confirmed the dissociation of mood-related symptoms and of executive control measures, supporting existing literature proposing that attentional deficits and mood symptoms are independent aspects of MDD. The cognitive profile of MDD includes executive control deficits, and while both treatments improved mood-based symptoms, only ECT + DT exerted an effect on both measures of the executive control deficit. Our findings highlight the importance of considering the improvement in both mood and cognitive deficits when determining the efficacy of therapeutic approaches for MDD.

Mental Health Therapist Perspectives on the Role of Executive Functioning in Children's Mental Health Services

Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspectives regarding addressing executive functioning within community-based mental health services. The current mixed-methods study aims to characterize mental health therapist perspectives regarding the role of executive functioning in youth clinical presentation and the psychotherapy process and outcomes as well as their experience and training related to executive functioning. Forty-three therapists completed a survey about their perspectives about executive functioning and 14 participated in subsequent focus groups to expand survey results. Results indicated that therapists perceive executive functioning challenges as impacting a large portion of children on their caseload, present across multiple mental health conditions, and that executive functioning is frequently a focus of psychotherapy. Therapists also identified executive functioning challenges as a barrier to therapy engagement and effectiveness. However, therapists reported limited knowledge and training as well as significant motivation for executive functioning training, including executive functioning interventions. Findings confirm the significant role of executive functioning in youth presenting for mental health services and the psychotherapy process and outcomes. Findings also highlight the need for further translation of evidence-based interventions and tools. Challenges as well as potential solutions to inform ongoing and future work seeking to translate and implement evidence-based executive functioning interventions in community mental health services are discussed.

Rumination and "hot" executive function of middle school students during the COVID-19 pandemic: A moderated mediation model of depression and mindfulness

BACKGROUND

The outbreak of COVID-19 had a widely negative effect on adolescents' academics, stress, and mental health. At a critical period of cortical development, adolescents' cognition levels are highly developed, while the ability of emotion control is not developed at the same pace. Faced with negative emotions such as stress and social loneliness caused by COVID-19, adolescents' "hot" executive function encounters severer emotional regulation challenges than ever before.

OBJECTIVE

The present study established a moderated mediation model to investigate the impact of rumination on "hot" execution function among Chinese middle school students during the COVID-19 pandemic, and the specific role of depression and mindfulness in the association.

MATERIALS AND METHODS

This cross-sectional study was conducted on 650 students recruited from a province in central China. The participants completed questionnaires and experiment between July 2021 and August 2021. Rumination Responses Scales, Self-rating Depression Scale, and Mindful Attention Awareness Scale were used to measure the level of rumination, depression, and mindfulness. The reaction time and accuracy of the emotional conflict experiment were recorded to reflect the "hot" executive function.

RESULTS

The results of the moderated mediation model indicated that rumination of middle school students significantly and positively predicted depression in adolescents (β = 0.26, p < 0.001). Meanwhile, the indirect effect of depression on the relationship between rumination and "hot" executive function was significant; depression partially mediated this relationship (word-face congruent condition: β = -0.09, p < 0.01; word-face incongruent condition: β = -0.07, p < 0.05). Furthermore, mindfulness buffered the association between rumination and depression, according to moderated mediation analysis (β = -0.11, p < 0.001). For adolescents with low levels of mindfulness, the relationship was substantially stronger.

CONCLUSION

In the context of the COVID-19 pandemic, middle school students' rumination would lead to depression, which can negatively impact their "hot" executive function. Besides, mindfulness could resist the adverse effect of rumination on depression. The educators should pay more attention to students' mental health, provide targeted strategies that boost mindfulness to promote their cognitive flexibility, and thus protect the normal development of their executive function during crisis events.

Assessment of Attentional Processes in Patients with Anxiety-Depressive Disorders Using Virtual Reality

To characterize the attention deficits in one-hundred-fifteen participants, comprising two types of clinical profiles (affective and anxiety disorder), through a test of continuous VR execution. Method: Three tests (i.e., Nesplora Aquarium, BDI, and STAI) were used to obtain a standardized measure of attention, as well as the existence and severity of depression and anxiety, respectively. Results: Significant differences (CI = 95%) were found between the control group and the group with depression, in variables related to the speed of visual processing (p = 0.008) in the absence of distractors (p = 0.041) and during the first dual execution task (p = 0.011). For scores related to sustained attention, patients with depression and those with anxiety did not differ from controls. Our results suggest attentional deficits in both clinical populations when performing a continuous performance test that involved the participation of the central executive system of working memory.

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

This study examines the relationship between depression and learning problems in children, focusing on the mediating role of executive function impairments and inattention. A sample of 115 children, aged 7 to 12 years, who had difficulties in school activities, were tested over the past three years, with different measures assessed by different raters. Regression analyses were employed in analyzing the data. The psychometric tests used were Child Depression Inventory (CDI) and Conners 3rdEdition. Children with a high level of depressive symptoms have also a very high level of learning problems, executive function impairments and inattention. Executive function impairments and inattention add significant explanatory variance for learning problems in school-aged children over and above depression. Executive function impairments and inattention have a partial mediating effect on the relationship between depression and learning problems. The assessment of the executive functions and attention is an important part in the assessment of children with depression; intervention and treatment programs for depression should include components focused on executive functions and attention.

Phase Resetting in the Anterior Cingulate Cortex Subserves Childhood Attention and Is Impaired by Epilepsy

The neural mechanisms that underlie selective attention in children are poorly understood. By administering a set-shifting task to children with intracranial electrodes stereotactically implanted within anterior cingulate cortex (ACC) for epilepsy monitoring, we demonstrate that selective attention in a set-shifting task is dependent upon theta-band phase resetting immediately following stimulus onset and that the preferred theta phase angle is predictive of reaction time during attentional shift. We also observe selective enhancement of oscillatory coupling between the ACC and the dorsal attention network and decoupling with the default mode network during task performance. When transient focal epileptic activity occurs around the time of stimulus onset, phase resetting is impaired, connectivity changes with attentional and default mode networks are abolished, and reaction times are prolonged. The results of the present work highlight the fundamental mechanistic role of oscillatory phase in ACC in supporting attentional circuitry and present novel opportunities to remediate attention deficits in children with epilepsy.

Neurocognitive abilities associated with antisocial behavior with and without callous-unemotional traits in a community sample

OBJECTIVE

Antisocial behavior (aggression, rule breaking) is associated with lower intelligence and executive function deficits. Research has not clarified whether these associations differ with the presence of callous-unemotional (CU) traits, particularly within levels of antisocial behavior observed in the community.

METHOD

We examined whether antisocial behavior and CU traits were differentially associated with intelligence and executive function metrics in 474 adolescent twins (Mean age = 14.18; SD = 2.20) sampled from birth records to represent youth in the community living in neighborhoods with above average levels of poverty. Intelligence was assessed using standardized scores from the Shipley-2. Executive function was assessed using Go/No-Go and Stop Signal tasks.

RESULTS

Neither antisocial behavior, nor CU traits alone, were associated with cognitive functioning when accounting for demographic factors. However, antisocial behavior and CU traits interacted to predict reaction time variability. At low levels of CU traits, antisocial behavior was associated with higher reaction time variability (traditionally thought to reflect worse sustained attention). At high levels of CU traits, antisocial behavior was associated with lower reaction time variability (thought to reflect better sustained attention).

CONCLUSION

Elevated antisocial behavior and CU traits may be characterized by a distinct neurocognitive profile compared to elevated antisocial behavior in isolation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological and neuropsychological underpinnings of attention-deficit/hyperactivity disorder assessment

The identification and diagnosis of attention-deficit/hyperactivity disorder (ADHD) is extremely important in order to help change the trajectory of an individual's life outcomes. A review of the current state of evidence-based assessment of ADHD is dominated by the DSM-5's conceptualization of behaviorally-oriented diagnostic criteria. This assumption that the DSM-5's method for identifying ADHD is the gold standard underlies the research base that evaluates the incremental validity of measures and methods for diagnosing it. That is, when evaluating whether a measure is useful in the identification of ADHD, the 'right answer' is based on the DSM-5's behaviorally-oriented definition. An alternative model for considering the fact that ADHD is a neurodevelopmental disorder, with its roots in executive dysfunction, is proposed. Using neuropsychological and cognitive tests to identify executive functioning problems can be combined with rating scales and interviews to diagnose ADHD in a way that does not ascribe entirely to a behavioral definition of the disorder.

Is concentration an indirect link between social anxiety and educational achievement in adolescents?

Social anxiety is associated with reduced educational achievement. Given that concentration is a predictor of educational achievement, and social anxiety symptoms are associated with reduced concentration in class, this prospective study examined the possibility that social anxiety may impair educational achievement through reduced classroom concentration. A sample of 509 participants (53.8% female; M age: 12.77 years [SD = 0.81]) recruited from secondary schools completed questionnaires assessing social anxiety symptoms, depressive symptoms, and concentration in class. Educational achievement was assessed by internal grades within schools. An indirect effect of social anxiety on later educational achievement via concentration was observed, over and above baseline achievement and depression symptoms; adolescents with higher levels of social anxiety tend to have more difficulties concentrating in class, which in turn is associated with poorer academic outcomes. Findings underscore the challenges socially anxious adolescents will face trying to learn in school, and the need for education providers and clinicians to consider the effect of social anxiety symptoms on concentration and learning.

Effects of Antidepressant Treatment on Symptom Measures of Attention in Adolescents with Depression: A Preliminary Open-Label Study

Objective: The effects of selective serotonin reuptake inhibitor (SSRI) on deficits in attention and executive function in adolescents with major depressive disorder (MDD) are relatively unknown. We aimed to investigate changes in symptom measures of attention in adolescents with MDD treated with escitalopram. Methods: The study included 82 MDD adolescents and 54 healthy controls aged from 12 to 17 years. Symptom measures of attention were assessed using the Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) and Child Behavior Checklist attention problems scale at baseline and during week 8. Adolescents who showed at least 40% improvement in the Children's Depression Rating Scale-Revised (CDRS-R) scores from baseline to week 8 were referred to as "responders." Results: No baseline differences were found between the responders (n = 47) and nonresponders (n = 35) in their age, sex, intelligence quotient, CDRS-R score, and attention measures. Linear mixed models showed significant group-by-time interaction effect in the ADHD-RS inattention subscale score, but not in the other attention measures. Conclusion: Our results suggest that treating depressive symptoms with SSRI may lead to improvements in attention in MDD adolescents. Monitoring changes in symptom measures of attention can be useful when treating adolescents with MDD. ClinicalTrials.gov identifier: NCT03547219.

Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems

Transdiagnostic models of psychopathology suggest that disorders may share common features that could influence their severity. Attention problems and psychomotor restlessness are included in the diagnostic criteria for several disorders, including disorders on the internalizing spectrum, but their transdiagnostic significance has received little attention. The present study identifies patterns of attention problems and restlessness among youth with internalizing problems, in order to understand their clinical significance in terms of internalizing symptom severity and response to cognitive behavioral therapy (CBT). Participants were 142 adolescents age 11-18 clinically referred for mood and/or anxiety problems. Latent class analysis was used to identify patterns of self-reported attention problems and psychomotor restlessness, and classes were compared on internalizing, depression, and anxiety severity. Differences in treatment response were examined in a subset of youth (n = 82; age 14-18) who participated in group CBT. Youth in the Attention Problems class (42% of sample) and youth in the Restless class (15% of sample) endorsed significantly more internalizing, depression, and anxiety problems than youth with Low Symptoms of attention problems or psychomotor restlessness (43% of sample). Youth in the Restless class responded significantly better to CBT than youth in the Low Symptoms of attention problems or psychomotor restlessness class in terms of decrease in overall internalizing problems. Attention problems and psychomotor restlessness appear to be important transdiagnostic markers of severity across the internalizing spectrum; however, they do not limit the effectiveness of CBT and, in the case of psychomotor restlessness, may forecast a good treatment response.

Cognitive Flexibility and Selective Attention's Associations with Internalizing Symptoms in Adolescents: Are they Reciprocal?

Although both executive functions and internalizing symptoms go through important changes during adolescence, the role of executive functions in internalizing symptoms is unclear. Based on developmental cascade models of psychopathology, this study aimed to fill this gap by studying the bidirectional predictive relationship between executive functions (cognitive flexibility and selective attention) and symptoms of depression and social anxiety. A sample of 698 adolescents (40.8% girls) between 12 and 17 years of age (M = 14.59, SD = 1.36) participated in three waves over 1 year. They completed measures of executive functions and internalizing symptoms. Depressive symptoms predicted deficits in executive functions. Conversely, social anxiety symptoms predicted an improvement in cognitive flexibility. These results suggest that executive function deficits are not a risk factor for the development of depressive symptoms but a consequence of them, and there are specific patterns of associations for depressive and social anxiety symptoms.

Verbal Memory Performance in Depressed Children and Adolescents: Associations with EPA but Not DHA and Depression Severity

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been described as positively associated with cognitive functioning. Current meta-analyses have identified eicosapentaenoic acid (EPA) as potentially more effective than docosahexaenoic acid (DHA). An especially vulnerable subgroup that might benefit from these beneficial effects are depressed youths. In this study, we examined associations between red blood cell (RBC) DHA and EPA levels and depression severity and verbal memory performance in a sample of 107 moderately (n = 63) and severely (n = 44) depressed youths. The findings showed that youths with high RBC EPA levels had steeper learning curves compared to those with moderate or low RBC EPA levels (Pillai's Trace = 0.195, p = 0.027, η_p² = 0.097). No associations between RBC DHA levels or depression severity and verbal memory performance were observed. Our results further confirm previous findings indicating a more important role of EPA compared to DHA in relation to cognitive functioning. Future research should further investigate the differential role of EPA and DHA concerning cognitive functioning in depressed youths. Evidence supporting beneficial supplementation effects could potentially establish a recommendation for a natural and easily accessible intervention for cognitive improvement or remission.

Affective Processing Biases in Relation to Past, Current, and Future Depression in Children and Adolescents

BACKGROUND

The affective go/no-go (AGN) task has been used to assess affective biases in attention set-shifting and deficits in inhibitory control of emotional information among depressed youth, but results have been inconsistent. We aimed to test AGN robustness and clarify temporal relationships between depressive symptoms and affective processing in youth.

METHODS

We evaluated AGN performance twice (Time 1 N = 306; Time 2 N = 238) in relation to current, previous, and future depression in the same children/adolescents with depression and those without diagnoses who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) study. Mixed repeated ANCOVAs were powered to detect small-medium group by valence interactions in response latency and errors. Supplemental regression analyses examined depressive symptoms as a continuous variable in relation to AGN performance.

RESULTS

No clear pattern emerged, mirroring the broader AGN literature. In primary analyses, group by valence interactions were only observed at one AGN administration; none replicated across administrations. Similarly, in regression analyses depressive symptoms had no relation to affective processing biases/deficits at AGN Time 1, though some relationships were detected between symptoms and AGN Time 2.

LIMITATIONS

Relatively few youth met criteria for a depressive disorder, though analyses were appropriately powered and supplemental analyses examined depressive symptoms continuously. Comparison groups were not healthy controls at recruitment but were free from any Axis I disorder at AGN administration.

CONCLUSIONS

Given the inconsistency of AGN findings, attention should be focused on tasks that provide more sensitive, robust measures of emotional information processing in depressed youth.

Neurocognitive heterogeneity across the spectrum of psychopathology: need for improved approaches to deficit detection and intervention

Neurocognition is one of the strongest predictors of clinical and functional outcomes across the spectrum of psychopathology, yet there remains a dearth of unified neurocognitive nosology and available neurocognition-targeted interventions. Neurocognitive deficits manifest in a transdiagnostic manner, with no psychiatric disorder uniquely affiliated with one specific deficit. In fact, recent research has identified that essentially all investigated disorders are comprised of 3-4 neurocognitive profiles. This within-disorder neurocognitive heterogeneity has hampered the development of novel, neurocognition-targeted interventions, as only a portion of patients with any given disorder possess neurocognitive deficits that would warrant neurocognitive intervention. The development of criteria and terminology to characterize these neurocognitive deficit syndromes would provide clinicians with the opportunity to more systematically identify and treat their patients and provide researchers the opportunity to develop neurocognition-targeted interventions for patients. This perspective will summarize recent work and discuss possible approaches for neurocognition-focused diagnosis and treatment in psychiatry.

A Cognitive Model of Pathological Worry in Children and Adolescents: A Systematic Review

Worry is common in children and adolescents, yet some youth experience excessive worries that persist over time and cause significant distress. Whilst the literature on worry and generalised anxiety disorder (GAD) in adults is well established, relatively less is known about the cognitive mechanisms underlying child and adolescent worry. An influential cognitive model of adult pathological worry (Hirsch and Matthews in Behav Res Therapy 50:636–646, 10.1016/j.brat.2012.06.007, 2012) proposes that negative information-processing biases, reduced executive functions, and verbal worry are critical in the aetiology of GAD in adults. The current systematic review investigated whether this cognitive model of worry could be extended to understand child and adolescent worry. Following a systematic search of the literature and screening for eligibility, 30 studies were identified. Evidence indicates that negative information-processing biases and reduced executive functions play an important role in worry and GAD in children and adolescents. However, evidence that children and adolescents experience verbal worry is inconclusive. Building upon Hirsch and Matthews' cognitive model (Behav Res Therapy 50:636–646, 10.1016/j.brat.2012.06.007, 2012), we propose a model of child and adolescent worry to provide a guiding framework for future research. We conclude that cognitive models of worry should incorporate a developmental framework in order to provide greater insight into the mechanisms uniquely associated with worry in children and adolescents and help to identify the cognitive processes to target for early interventions and treatments.

Improving Executive Functions at School in Children With Special Needs by Educational Robotics

Children with Special Needs represent a highly heterogeneous group in terms of neurofunctional, behavioral, and socio-cognitive characteristics, but they have in common a frequent impairment of Executive Functions. Educational Robotics is generally dedicated to study the effects of constructing and programming robots based on children's learning and academic achievement. Recently, we found that being engaged in progressively more challenging robot planning and monitoring (ER-Lab) promotes visual-spatial working memory and response inhibition in early childhood during typical development, and that an ER-Lab can be a feasible rehabilitative tool for children with Special Needs. The present study aimed to verify the efficacy of the ER-Lab on Executive Functions in children with Special Needs for the first time by using an RCT within their school environment. To pursue these aims, this study reports the results obtained in 42 first-grade children with Special Needs engaged in school Educational Robotics Laboratories (ER-Lab) to promote Executive Functions by means of enjoyable, intensive, and incrementally more challenging activities requiring them to program a bee-shaped robot called Bee-bot® (Campus Store). Several adaptations were done to meet different motor, cognitive, and social needs. All children were evaluated by means of standardized tests performed by each child before and at the end of the ER-Lab activities. Children with Special Needs had significantly improved inhibition skills, and children with attentional impairment had more benefits in their inhibition of motor responses tasks with respect to children with a language deficit. Results of the study and future perspectives on how ER-Lab programs could become a powerful tool in classrooms with children with special needs are discussed.

Heterogeneity of executive functions among preschool children with psychiatric symptoms

The aim of the present study was to investigate associations between internalizing and externalizing symptoms and deficits in executive functions (EF) as well as to examine the overall heterogeneity of EFs in a sample of preschool children attending a psychiatric clinic (n = 171). First, based on cut-off points signifying clinical levels of impairment on the parent-completed Child Behavior Checklist (CBCL), children were assigned into groups of internalizing, externalizing, combined or mild symptoms and compared to a reference group (n = 667) with regard to day care teacher ratings of EFs on the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P). Second, latent profile analysis (LPA) was employed to identify distinct subgroups of children representing different EF profiles with unique strengths and weaknesses in EFs. The first set of analyses indicated that all symptom groups had more difficulties in EFs than the reference group did, and the internalizing group had less inhibition-related problems than the other symptom groups did. Using LPA, five EF profiles were identified: average, weak average, attentional problems, inhibitory problems, and overall problems. The EF profiles were significantly associated with gender, maternal education level, and psychiatric symptom type. Overall, the findings suggest that the comparison of means of internalizing and externalizing groups mainly captures the fairly obvious differences in inhibition-related domains among young psychiatric outpatient children, whereas the person-oriented approach, based on individual differences, identifies heterogeneity related to attentional functions, planning, and initiating one's action. The variability in EF difficulties suggests that a comprehensive evaluation of a child's EF profile is important regardless of the type of psychiatric symptoms the child presents with.

The Cognitive Neuropsychology of Depression in Adolescents

Purpose of Review

Adolescent depression is a major public health concern associated with severe outcomes. A lack of efficacious interventions has triggered an increase in cognitive neuropsychology research to identify relevant treatment targets for new interventions. This review summarises key neurocognitive findings in adolescent depression and explores the potential of neurocognitive markers as treatment targets in new interventions.

Recent Findings

Studies support difficulties in the voluntary deployment of attention towards and away from emotional stimuli, negative interpretation biases and overgeneralised autobiographical memories in adolescent depression; however, little evidence is given to a general decline in executive function. There is consistent evidence for abnormalities in several distributed neural networks in adolescent depression, including dysfunction in and between the amygdala, medial prefrontal cortex and ventral striatum.

Summary

The relationships between different cognitive biases and abnormalities in specific neural networks remain unclear. Several new experimental interventions targeting these neurocognitive markers await evaluation.

Protocol for a systematic review of the development of depression among adolescents and young adults: psychological, biological, and contextual perspectives around the world

BACKGROUND

Depression is a leading contributor to disability-adjusted life-years because of early onset and chronicity throughout the lifecycle. It is crucial to identify early predictors of depression among adolescents and young people to effectively target prevention. A gap in the literature is a comprehensive systematic review of predictors of depression among adolescents around the globe, especially in low- and middle-income countries LMICs. This review aims to identify evidence for biological, psychological, and contextual risk factors for the development of depression among adolescents and young adults (10-24 years of age) in high-income countries (HICs) and LMICs, ultimately contributing to (a) identification of potential mechanisms underlying depression development, (b) selection of common risk and protective factors as targets for detection, and (c) refinement of risk models that can be evaluated through existing cohorts in HICs and LMICs.

METHODS

This review will follow the Population, Exposure, Comparison, Outcome (PI(E)CO) model and adheres to the PRISMA-P guidelines. A search strategy was developed by a multidisciplinary research consortium. Seven databases (MEDLINE via Ovid, PsycINFO, Cochrane Database of Systematic Reviews, Web of Science, Lilacs, African Journals Online, Global Health) will be searched to identify articles. Independent raters will screen and retrieve articles for inclusion, conduct quality ratings, and extract data. The Systematic Assessment of Quality in Observational Research adapted for Cultural Psychiatry Epidemiology (SAQOR-CPE) will be used to assess quality of observational studies. We will assess for publication bias using funnel plots and statistical methods. We will use narrative synthesis to present results, addressing the study's objectives following the Cochrane Handbook guidelines. Meta-analyses will be used to report summary statistics for association of risk factors with development of depression.

DISCUSSION

This systematic review will summarize evidence-based research that examines the psychological, biological, and contextual factors contributing to the onset of depression in adolescents across the globe. Results will support the development of a model that can be evaluated in existing cohorts around the world.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration CRD42018103973 .

Cognitive and attentional vulnerability to depression in youth: A review

Although depressive disorders are among the most common disorders in youth, highly efficacious treatments for childhood affective disorders are lacking. There is significant need to better understand the factors that contribute to the development and maintenance of depression in youth so that treatments can be targeted at optimal mechanisms. The aim of the current paper was to synthesize research on cognitive and neurobiological factors associated with youth depression, guided by De Raedt and Koster's model (2010) for vulnerability to depression in adults. Consistent with model predictions, there is evidence that attentional impairments are greatest in the context of negative information, relative to positive or neutral information, and some evidence that attentional deficits are associated with rumination in depressed youth. However, we found little evidence for the model's assumption that attentional bias is an etiological and maintenance factor for depression. There are several other model predictions that require additional study as current data are lacking. Overall, De Raedt and Koster's (2010) integrative cognitive and biological framework has tremendous potential to move the field forward in understanding the development of depression in youth. Additional longitudinal studies incorporating measures across biological and cognitive levels of analysis are needed.

Altered Working Memory Processing of Emotion in Adolescents with Dysphoric Symptomatology: An Eye Tracking Study

It has been suggested that altered processing of emotion during cognitive control plays an important role in the etiology of depressive symptoms. The current study investigates the influence of emotional stimuli on working memory (WM) in adolescents with dysphoric symptomatology (DS). Twenty-five adolescents with DS and 40 adolescents with no dysphoric symptomatology (NDS) completed a memory-guided eye movement task. This task assessed the influence of irrelevant affective information on WM processes during high and low cognitive load. Latency analyses showed that, in the high load WM condition, negative distractors disturbed WM performance in adolescents with NDS, but not in adolescents with DS. Accuracy analyses revealed that adolescents with NDS had higher accuracy rates in the presence of positive distractors relative to negative and neutral distractors, and in comparison to adolescents with DS. The findings indicated altered WM performance in the context of emotional distractors in adolescents with DS and may contribute to theoretical knowledge and early prevention of youth depression.

Is Worse Attention a Risk Factor for or a Consequence of Depression, or Are Worse Attention and Depression Better Accounted for by Stress? A Prospective Test of Three Hypotheses

It is unclear whether impaired cognition is a risk factor for depression, a consequence of depression, or whether both depression and impaired cognition are caused by a third underlying process (e.g., stress). These three hypotheses were tested in 523 adolescents assessed annually for depression, attentional functioning, and childhood/recent life stress. Baseline switching, sustained, and selective attention did not predict first onset of depression (foD) or depressive symptoms. Divided attention predicted depressive symptoms only. Piecewise growth modelling indicated that the trajectory of switching attention declined prior to foD; there was evidence of significant recovery in switching attention following foD. Structural equation modelling indicated that impaired switching attention prospectively predicted higher depressive symptoms and that higher depressive symptoms predicted worse selective and switching attention. Further, childhood stress prospectively predicted higher depressive symptoms via switching attention and worse switching attention via depressive symptoms.