The Role of Executive Functioning in Adolescent Rumination and Depression

Early Emergence of Rumination has no Association with Performance on a Non-affective Inhibitory Control Task

Rumination is a vulnerability for depression and potentially linked to inhibitory control weaknesses. We aimed to replicate the association observed in adults between inhibitory control and rumination in adolescents, and to examine putative moderating roles of childhood maltreatment and perceived family cohesion in an adolescent sample at risk for depression due to familial/personal history. Ninety adolescents aged 11-17 (M = 14.6, SD = 1.8) completed self-report scales of rumination, maltreatment, and family cohesion, and performed a task assessing inhibitory control. Hierarchical regression models showed no significant relation between inhibitory control and moderator variables on rumination. However, adolescents who reported higher levels of maltreatment and who perceived lower family cohesion tended to indicate higher levels of rumination (BChilhood Maltreatment = 27.52, 95% CIs [5.63, 49.41], BFamily Cohesion = -0.40, 95% CIs [-0.65, -0.15]). These findings demonstrate an alternative understanding of factors that increase depression onset risk and recurrence in adolescents.

Perceived chronic social adversity and cyberbullying perpetration among adolescents: the mediating role of rumination and moderating role of mindfulness

Backgrounds

The prevalence of cyberbullying has brought about many adverse effects on adolescents' mental health. Although current studies have shown that perceived chronic social adversity (PCSA) is closely related to cyberbullying perpetration among adolescents, the underlying mechanism of the relationship between the two remains relatively unclear. This study investigated the association of PCSA, rumination, mindfulness, and cyberbullying perpetration among adolescents, building upon the general strain theory, the general aggressive model, and the limited resource of self-control theory.

Methods

A sample of 477 Chinese high school students (M age = 15.84 years, SD age = 0.67, 49.69% female) completed the Perceived Chronic Social Adversity Questionnaire, the Ruminative Responses Scale, the Child and Adolescent Mindfulness Measure, and the cyberbullying subscale of the Revised Cyber Bullying Inventory. The current study constructed a moderated mediation model to examine the relationship between PCSA and cyberbullying perpetration among adolescents and assessed the mediating role of rumination and the moderating role of mindfulness.

Results

The results revealed a significant positive correlation between PCSA and cyberbullying perpetration. Rumination mediated the relationship between PCSA and cyberbullying perpetration, whereas mindfulness moderated the latter half of the mediation pathway. Specifically, compared to adolescents with higher mindfulness, the association between rumination and cyberbullying perpetration is greater for adolescents with lower mindfulness.

Conclusion

The results further deepen our understanding of the mechanisms linking subjective perception of negative life events and cyberbullying perpetration among adolescents from the interaction of multiple factors, thus providing a basis for future interventions to encourage adolescents to properly cope with social adversity and promote positive mental health to reduce the risk of cyberbullying.

Perceived parental warmth attenuates the link between perceived parental rejection and rumination in Chinese early adolescents: two conditional moderation models

Background

Prior studies have explored the association between perceived parental rejection-warmth and adolescents' rumination, but it is unclear whether the interaction between perceived parental rejection and warmth can predict adolescents' rumination in a Chinese context and whether this interaction varies by children's gender during the post-COVID-19 era.

Objective

This study aimed to address these issues in Chinese early adolescents from a family system perspective.

Methods

A total of 910 adolescents (M age = 13.63, 48.50% female) from two middle schools in Chongqing and Changsha, China participated in the survey, answering measures for demographics, perceived parental rejection-warmth, and rumination.

Results

The results show that adolescents' rumination was positively related to perceived paternal rejection (r = 0.326, p <.001) and maternal rejection (r = 0.343, p <.001), and negatively related to perceived paternal warmth (r = -.184, p <.001) and maternal warmth (r = -0.125, p <.001). Moreover, perceived maternal warmth significantly moderated the link between perceived paternal rejection and adolescents' rumination (boot effect = -0.066, 95CI% = [-0.124, -0.010]), but this moderating effect is only presented in boys not in girls (boot effect = -0.063, 95CI% = [-0.015, 0.140]). However, perceived paternal warmth moderated the link between perceived maternal rejection and rumination in adolescents (boot effect = -0.052, 95CI% = [-0.103, -0.001]), and this interaction varied by adolescents' gender (boot effect = 0.103, 95CI% = [0.029, 0.177]).

Conclusions

Perceived Parental rejection and parental warmth co-exist in the Chinese family system, and they exert an interactive effect on adolescents' rumination depending on their gender. It implies that both parents should be more accepting, caring, considerate, and warm toward their daughters, and it is also in line with the tradition and status quo of parenting in Chinese families. These findings have implications for Chinese parental co-parenting practices in families with adolescents and adolescence mental health counseling work.

Cognitive flexibility in schizophrenia: A confirmatory factor analysis of neuropsychological measures

Cognitive flexibility (CF) is the ability to adapt cognitive strategies according to the changing environment. The deficit in CF has often been linked to various neurological and psychiatric disorders including schizophrenia. However, the operationalization and assessment of CF have not been unified and the current research suggests that the available instruments measure different aspects of CF. The main objective of the present study was to compare three frequently used neuropsychological measures of CF-Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT) and Stroop Color and Word Test (SCWT) in a population of patients (N = 220) with first-episode schizophrenia spectrum disorders in order to evaluate their convergent validity. The hypothesis of an underlying latent construct was tested via a confirmatory factor analysis. We used a one-factor CF model with scores from WCST, SCWT and TMT as observed variables. The established model showed a good fit to the data (χ² = 1.67, p = 0.43, SRMR = 0.02, RMSEA = 0.0, CFI = 1.00). The highest factor loading was found in WCST as CF explained most of the variance in this neuropsychological measure compared to the other instruments. On the other hand, a TMT ratio index and a SCWT interference demonstrated lowest loadings in the model. The findings suggest that not all the frequently used measures share an underlying factor of CF or may capture different aspects of this construct.

Cognitive impairment and factors influencing depression in adolescents with suicidal and self-injury behaviors: a cross-sectional study

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide attempts (SAs) by adolescent patients with depression have become serious public health problems. There is still insufficient research evidence on the effects of NSSI and SAs on neurocognitive functioning in adolescents. Cognitive function alterations may be associated with SAs and self-injury. NSSI and SAs have different influencing factors.

METHODS

Participants were recruited from outpatient clinics and included 142 adolescent patients with depression (12-18 years old). This cohort included the SAs group (n = 52), NSSI group (n = 65), and depression without SAs/NSSI control group (n = 25). All participants underwent a clinical interview and neuropsychological assessment for group comparisons, and post-hoc tests were performed. Finally, partial correlation analysis was used to explore factors related to changes in cognitive function.

RESULTS

The SAs group performed significantly worse than the control group in executive function and working memory. The depression score was directly proportional to the executive function of the SAs group, whereas cognitive functioning in the NSSI group was associated with borderline traits and rumination.

CONCLUSIONS

These findings suggest that impairment of executive function and working memory may be a common pattern in adolescent depressed patients with SAs. However, borderline traits and rumination may be indicative of NSSI but not SAs.

Exposure to COVID-19 and aggression: the mediating role of anxiety and the moderating role of rumination

The pandemic of COVID-19 is now posing a worldwide hazard to one's health. Exposure to COVID-19 may cause negative emotions like anxiety, which is one of recognized risk factors for aggressive behaviors. This study looked into the effect of exposure to COVID-19 on aggression and how anxiety may act as a mediating factor, as well as lastly how rumination could moderate a variety of indirect paths during the epidemic of COVID-19. According to the current study's findings, which included a sizable sample of Chinese college students (N = 1,518), being exposed to COVID-19 showed a positive connection with aggression and anxiety, as well as rumination. These findings clarify the role that mediators play in the relationship between anxiety and exposure to COVID-19. The results are also helpful for personalizing treatments and putting preventative measures in place to decrease the aggression brought on by exposure to COVID-19. It is explored how lowering rumination and anxiety may be useful in the context of COVID-19 to lessen the psychopathological effects of the condition.

Are Perceived Executive Functions Beneficial for Adolescents Who Experience Peer Victimization?

Peer victimization can lead to dysfunctional cognitions and numerous internalizing psychological problems. Thus, it is essential to identify factors that can moderate the impact of victimization. This study aimed to analyze the potential moderating role of perceived executive functions (PEF) in the impact of peer victimization (traditional and online) on internalizing symptoms (depression and social anxiety), early maladaptive schemas (disconnection/rejection domain), and PEF in adolescents. A two-wave longitudinal study was carried out with 680 Spanish adolescents between 12 and 17 years of age (M = 14.58, SD = 1.36; 41.18% girls). Participants completed measures of self-reported executive functions, traditional and online victimization, early maladaptive schemas of the disconnection/rejection domain, depressive symptoms, and social anxiety symptoms in waves 1 and 2. Traditional and online perpetration was completed only in wave 1. The results indicated that when PEF were high (i.e., adolescents perceive that they have good executive functions), traditional and online victimization predicted more schemas of the disconnection/rejection domain and internalizing symptoms of depression and social anxiety. In non-victims, high PEF showed a protective role in the development of depressive symptoms and schemas of the disconnection/rejection domain. The findings highlight that PEF have a protective role that disappears when victimization (traditional and online) occurs.

Childhood ADHD and Executive Functioning: Unique Predictions of Early Adolescent Depression

Given the increasing prevalence of adolescent depression, identification of its early predictors and elucidation of the mechanisms underlying its individual differences is imperative. Controlling for baseline executive functioning (EF), we tested separate ADHD dimensions (i.e., inattention, hyperactivity-impulsivity) as independent predictors of early adolescent depression, including temporally-ordered causal mediation by academic functioning and social problems, using structural equation modeling. At baseline, participants consisted of 216 children (67% male) ages 6-9 years old with (n = 112) and without (n = 104) ADHD who subsequently completed Wave 2 and 3 follow-ups approximately two and four years later, respectively. Predictors consisted of separate parent and teacher ratings of childhood ADHD and laboratory-based assessments of key EF domains. At Wave 2, parents and teachers completed normed rating scales of youth academic and social functioning; youth completed standardized assessments of academic achievement. At Wave 3, youth self-reported depression. Baseline inattention positively predicted early adolescent depression whereas childhood hyperactivity-impulsivity and EF did not. Neither academic nor social functioning significantly mediated predictions of depression from baseline ADHD and EF. We consider prediction of early adolescent depression from inattention, including directions for future intervention and prevention research.

Repetitive negative thinking is associated with impaired verbal learning but not executive functioning in individuals with eating disorders

Objective

Repetitive negative thinking (RNT) is an important symptom in the development and maintenance of eating disorders (EDs). RNT Research on RNT's effect on cognition in EDs is scarce. This investigation focused on associations between RNT and cognition in individuals with EDs.

Methods

Ruminative Response Scale (RRS) was used from Tulsa-1000 study (T-1000) data (eating disorders-ED, Major Depressive Disorder-MDD, and healthy subjects) who were propensity matched to examine associations with cognitive performance. RNT was examined across groups and we quantified the associations between scores for RNT, depression, executive function, and learning/memory from the T-1000 study. A linear regression analysis was conducted to determine predictors of disability.

Results

RNT was similar in ED and MDD participants, and more intense than in controls. RNT was significantly correlated with verbal learning/memory in the control (r = 0.514, p = 0.006) and ED groups (r = -0.447, p = 0.020), but this relationship had opposite slopes in either group. Increased RNT was associated with decreased verbal learning/memory ability in ED participants while in controls, increased RNT was associated with increased ability. Comorbid depression in the ED group acted as a potential moderator of the above relationship between RNT and EF. Among ED patients, depressive symptom severity was the best predictor of disability.

Discussion

The differential association of RNT with cognitive abilities in ED and MDD patients suggests depression is not a mediator of RNT-mediated cognitive dysfunction in EDs. This necessitates a better understanding of the mechanistic relationship between RNT and diverse types of cognitive functioning.

Childhood maltreatment predicts poorer executive functioning in adulthood beyond symptoms of internalizing psychopathology

BACKGROUND

A history of childhood maltreatment predicts poorer functioning in several domains during childhood, including executive function (EF). While there is also evidence of poorer EF in adults with a history of childhood trauma, results are mixed. Notable limitations of previous research are (a) the use of single indicators of EF, and/or (b) not consistently assessing whether childhood maltreatment predicts poorer EF beyond internalizing psychopathology.

OBJECTIVE

We sought to overcome limitations of prior work by examining relationships between childhood maltreatment and EF in adulthood by using a latent factor of EF derived from multiple indicators and including psychopathology covariates in our analyses.

PARTICIPANTS AND SETTING

The present study included a large sample of community adults (n = 489) who were oversampled for internalizing psychopathology symptoms.

METHODS

Primary analyses examined whether childhood maltreatment (cumulative and subtypes) predicted EF using a latent factor approach and linear mixed effects models. Follow-up analyses assessed the impact of childhood maltreatment on EF beyond internalizing psychopathology symptoms and assessed whether gender moderated relationships between EF and childhood maltreatment.

RESULTS

Greater cumulative maltreatment predicted poorer EF (B = -0.15), and emotional neglect emerged as a unique predictor of EF (B = -0.18). These results remained after controlling for psychopathology symptoms. Gender moderated the relationship between physical abuse and EF, with physical abuse predicting poorer EF among males (B = 0.30), but not females (B = -0.04).

CONCLUSIONS

Overall, results indicate that general EF deficits are related to a history of childhood maltreatment, which is not accounted for by internalizing psychopathology symptoms. Potential implications and future directions are discussed.

The relationship between executive functioning and repetitive negative thinking in youth: A systematic review of the literature

Repetitive negative thinking (RNT) and executive functioning (EF) deficits are each characteristic of many forms of youth psychopathology. Extensive work has examined the relationship between rumination, a form of RNT, and EF in adults. However, less is known about the relationship between RNT more broadly and EF in youth, for whom these constructs are developing and emerging. Here, we systematically and qualitatively reviewed 27 studies on the associations between EF (e.g., shifting, inhibition, working memory) and RNT (e.g., rumination, worry, obsessions) in youth. All forms of RNT were more commonly positively associated with questionnaire-reported EF problems in daily life, most frequently in the domain of shifting. Task-based assessments of EF were less consistently associated with RNT in youth, with no strong pattern of presence vs. absence of associations. Further, limited longitudinal work has been conducted on this topic to date. This review integrates initial work with regard to RNT and EF deficits in a still-developing population, and discusses clear future need for longitudinal, multi-method assessments of the relationship between RNT and EF subtypes in youth.

Considerations for using the Wisconsin Card Sorting Test to assess cognitive flexibility

The Wisconsin Card Sorting Test (WCST) is a popular neurocognitive task used to assess cognitive flexibility, and aspects of executive functioning more broadly, in research and clinical practice. Despite its widespread use and the development of an updated WCST manual in 1993, confusion remains in the literature about how to score the WCST, and importantly, how to interpret the outcome variables as indicators of cognitive flexibility. This critical review provides an overview of the changes in the WCST, how existing scoring methods of the task differ, the key terminology and how these relate to the assessment of cognitive flexibility, and issues with the use of the WCST across the literature. In particular, this review focuses on the confusion between the terms 'perseverative responses' and 'perseverative errors' and the inconsistent scoring of these variables. To our knowledge, this critical review is the first of its kind to focus on the inherent issues surrounding the WCST when used as an assessment of cognitive flexibility. We provide recommendations to overcome these and other issues when using the WCST in future research and clinical practice.

Neurocognitive Correlates of Rumination Risk in Children: Comparing Competing Model Predictions in a Clinically Heterogeneous Sample

The current study examined associations between rumination and executive function difficulties in preadolescent youth, using predictions outlined in the attentional scope and multiple systems models of rumination. This study aimed to (a) extend current conceptual models of rumination to youth, (b) clarify disparate model predictions regarding working memory updating ("updating"), inhibition, and shifting abilities, and (c) examine differential neurocognitive predictions between two forms of rumination, sadness and anger. One hundred and fifty-nine youths oversampled for ADHD and other forms of child psychopathology associated with executive dysfunction (aged 8-13; 53.5% male; 59.1% Caucasian) completed a battery of assessments, including self-report measures of rumination and computerized neurocognitive tasks. Multiple regression analyses were conducted assessing relations between rumination and each executive function, controlling for both sadness and anger rumination to assess their unique associations. Sadness rumination was associated with poorer updating (β = -0.18, p = 0.046) and shifting abilities (β = 0.20, p = 0.03) but not inhibition (β = -0.04, p = 0.62), offering partial support to the attentional scope and multiple systems models. In contrast, anger rumination was associated with better updating abilities (β = 0.20, p = 0.03) but not shifting (β = -0.15, p = 0.11) or inhibition (β = 0.08, p = 0.35). Together, these results suggest (a) developmental differences in the neurocognitive correlates associated with rumination risk in youth compared to findings from the adult literature, and (b) that the executive function correlates of children's responses to negative emotions are affect-specific, such that sadness rumination is associated with difficulties replacing negative thoughts and shifting between mental sets, while anger rumination is associated with a better ability to maintain negative thoughts.

Adaption and pilot implementation of an autism executive functioning intervention in children's mental health services: a mixed-methods study protocol

BACKGROUND

Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally "fit" the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population.

METHODS

This mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled "Executive Functioning for Enhancing Community-based Treatment for ASD," (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings.

DISCUSSION

Tailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04295512.

The developmental origins of ruminative response style: An integrative review

Rumination has been conceptualized as a stable, trait-level response style involving repetitive and passive focus on the symptoms of distress and the possible causes and consequences of those symptoms. This theoretical review examines developmental risk factors of ruminative response style, incorporating a developmental psychopathology perspective. A model integrating these developmental factors within a conceptual framework is proposed, wherein risk factors for distress (i.e., temperamental negative affectivity, stressful environments, parenting, and genetic vulnerability) lead to engagement in rumination. We propose that when rumination is well-practiced, it will consolidate into a trait-like response style, especially among adolescents who experience cognitive control deficits. Reciprocal relationships and moderators that may contribute to the formation of a ruminative response style are also included. To understand how these factors converge and influence the formation of ruminative response styles, we review patterns of stability and change in physical and cognitive development to demonstrate that individual differences in rumination may emerge and consolidate into enduring, trait-level response styles during early adolescence.

Environmental stress and socioeconomic status: Does parent and adolescent stress influence executive functioning in urban youth?

This study examined whether parental and adolescent stress act as mediators between socio-economic status (SES) and adolescent executive functioning (EF) in urban youth. Two hundred and sixty-seven 6th-11th grade students (ages 11-16, 55.4% female; 49.1% Black/African American) attending racially and socioeconomically diverse schools in Chicago, Illinois, completed self-report measures on urban stress and EF. Parents of adolescents completed measures on parental chronic stress and demographic information on the family's socioeconomic status. Results indicated that parent stress was directly related to adolescent stress, while adolescent stress was directly related to behavior components of EF (i.e., emotion control, set shifting, and inhibition). Although parental stress was related to adolescent's ability to shift from one task to another, no relationship was found with adolescent's ability to modulate mood or delay impulsive behaviors. Implications for socio-ecological mental health interventions for youth residing in urban environments are discussed.