Inhibitory mechanisms in Down syndrome: is there a specific or general deficit?

Unraveling Down Syndrome: From Genetic Anomaly to Artificial Intelligence-Enhanced Diagnosis

Down syndrome arises from chromosomal non-disjunction during gametogenesis, resulting in an additional chromosome. This anomaly presents with intellectual impairment, growth limitations, and distinct facial features. Positive correlation exists between maternal age, particularly in advanced cases, and the global annual incidence is over 200,000 cases. Early interventions, including first and second-trimester screenings, have improved DS diagnosis and care. The manifestations of Down syndrome result from complex interactions between genetic factors linked to various health concerns. To explore recent advancements in Down syndrome research, we focus on the integration of artificial intelligence (AI) and machine learning (ML) technologies for improved diagnosis and management. Recent developments leverage AI and ML algorithms to detect subtle Down syndrome indicators across various data sources, including biological markers, facial traits, and medical images. These technologies offer potential enhancements in accuracy, particularly in cases complicated by cognitive impairments. Integration of AI and ML in Down syndrome diagnosis signifies a significant advancement in medical science. These tools hold promise for early detection, personalized treatment, and a deeper comprehension of the complex interplay between genetics and environmental factors. This review provides a comprehensive overview of neurodevelopmental and cognitive profiles, comorbidities, diagnosis, and management within the Down syndrome context. The utilization of AI and ML represents a transformative step toward enhancing early identification and tailored interventions for individuals with Down syndrome, ultimately improving their quality of life.

Motor Skills and Executive Functions in Pediatric Patients with Down Syndrome: A Challenge for Tailoring Physical Activity Interventions

Down syndrome (DS) is one of the most common chromosomal disorders. In addition to this variety of dysmorphic features. DS is also associated with a wide range of diseases and related comorbidities affecting different organs and systems. These comorbidities, together with societal and environmental influences, have a negative impact on physical activity in people with DS. Low levels of physical activity and energy expenditure have been identified as crucial players in worsening the acquisition of motor skills and executive functions. Executive functions are critical for the many skills (creativity, flexibility, self-control, and discipline) impacting our quality of life and make it possible to control impulses, mentally play with ideas, and stay focused. We proposed a broad overview of the available literature regarding motor skills and executive functions in pediatric patients with DS to understand the specific challenges for tailoring physical activity interventions. Motor skill interventions are effective in improving motor competence and performance on cognitive, emotional, and physical aspects in children with DS. Interventions based on executive functions in DS subjects are effective to contrast the cognitive decline and improve the everyday use of executive functions in youth and adults. Targeted interventions are mandatory for maximizing the benefits of physical activity, minimizing potential risks, and ultimately improving the overall health outcomes and quality of life for individuals with DS.

Psychometric properties of inhibitory control measures among youth with Down syndrome

BACKGROUND

Inhibitory control measures have been commonly used when assessing individuals with Down syndrome. However, minimal attention has been devoted to evaluating the appropriateness of specific assessments for use in this population, potentially leading to erroneous conclusions. This study aimed to examine the psychometric properties of measures of inhibitory control among youth with Down syndrome. We sought to examine the feasibility, presence of floor or practice effects, test-retest reliability, convergent validity and correlations with broader developmental domains of a set of inhibitory control tasks.

METHODS

A sample of 97 youth with Down syndrome aged 6 to 17 years old participated in verbal and visuospatial tasks of inhibitory control including the Cat/dog Stroop, Neuropsychological Assessment Second Edition (NEPSY-II) Statue, National Institutes of Health (NIH) Toolbox Cognition Battery (TCB) Flanker, Leiter-3 Attention Sustained, and the Test of Attentional Performance for Children (KiTAP) Go/No-go and Distractibility subtests. Youth also completed standardised assessments of cognition and language, and caregivers completed rating scales. Psychometric properties on the tasks of inhibitory control were evaluated against a priori criteria.

RESULTS

Apart from demonstrating negligible practice effects, adequate psychometric properties were not observed for any inhibitory control measure within the current sample's age range. One task with low working memory demands (NEPSY-II Statue) generally had better psychometric properties than the other tasks assessed. Subgroups of participants with an IQ greater than 30 and age more than 8 years were shown to be more likely to be able to complete the inhibition tasks.

CONCLUSIONS

Findings suggest better feasibility for analogue tasks rather than computerised assessments of inhibitory control. Given the weak psychometrics of several common measures, future studies are required to evaluate other inhibitory control measures, specifically those with reduced working memory demands for youth with Down syndrome. Recommendations for use of the inhibitory control tasks among youth with Down syndrome are provided.

Associations of Motor Performance and Executive Functions: Comparing Children with Down Syndrome to Chronological and Mental Age-Matched Controls

Background. Children with Down syndrome (DS) exhibit lower motor and cognitive performance than typically developing children (TD). Although there is a relationship between these two developmental domains, only a few studies have addressed this association in children with DS compared to groups of the same chronological age (CA) or mental age (MA) within one study. This study aimed to fill this research gap. Method and Procedures. The Movement Assessment Battery for Children-2 and the Trail-Making Test was used to assess motor and cognitive performances in 12 children (M = 10.5 ± 10.08) with DS, 12 CA-matched, and 12 MA-matched controls. Results. There are significant group differences in the motor dimension (total test score; p < 0.001, η²_p = 0.734), for processing speed (p < 0.001, η²_p = 0.396), and cognitive flexibility (p < 0.001, η²_p = 0.498). Between TD-CA and both other groups, the differences in the magnitude of correlations for the motor dimension balance are also significant (compared to DS: z = −2.489; p = 0.006, and to TD-MA: z = −3.12; p < 0.001). Conclusions. Our results suggest that the relationships depend on the studied cognitive and motor skills. It seems crucial to select a wide range of tasks for both domains that are as isolated as possible for future studies, to better understand the relationships between cognitive and motor skills in children with DS.

Updated profiles of everyday executive function in youth with Down syndrome using the BRIEF-2

BACKGROUND

Executive function difficulties in youth with Down syndrome (DS) are well recognised using informant-report measures. However, the profile of relative challenges and strengths has not yet been evaluated using the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2), which includes a new internal factor structure.

METHOD

Using the BRIEF-2, profiles of everyday parent-reported executive function (EF) were evaluated in youth with DS (n = 34) and compared with age-based and sex-based norms. EF profiles were also compared across raters (parent vs. teacher, n = 20) and relative to mental age-matched typically developing controls (ns = 19 in each group).

RESULTS

Although within-group differences were not revealed on indexes, significant differences were found among BRIEF-2 scales. Across raters, teachers reported significantly more difficulties than parents. Compared with mental age-matched typically developing controls, the DS group was rated more poorly on some but not all BRIEF-2 scales.

CONCLUSIONS

At the scale, but not the index level, the BRIEF-2 identifies a variegated EF profile in children with DS. For several of the scales, significant differences were noted relative to both chronological age expectations (using norms) and mental-age expectations (using a developmentally matched comparison group). At the scale level, the BRIEF-2 continues to be a sensitive tool for identifying executive function difficulties as well as profiles of relative strengths and weaknesses in children with DS.

Executive functions and adaptive behaviour in individuals with Down syndrome

BACKGROUND

Previous research has explored executive functions (EFs) and adaptive behaviour in children and adolescents with Down syndrome (DS), but there is a paucity of research on the relationship between the two in this population. This study aims to shed light on the profile of EFs and adaptive behaviour in DS, exploring the differences by age and investigating the relationship between these two domains.

METHOD

Parents/caregivers of 100 individuals with DS from 3 to 16 years old participated in the study. The sample was divided into preschoolers (3-6.11 years old) and school-age children (7-16 years old). Parents/caregivers completed either the Preschool Version of the Behaviour Rating Inventory of Executive Function (for children 2-6.11 years old) or the Second Edition of the same Inventory (for individuals 7 + years old). Adaptive behaviour was assessed with the Vineland Adaptive Behaviour Scale - Interview, Second Edition.

RESULTS

Findings suggest that individuals with DS have overall difficulties, but also patterns of strength and weakness in their EFs and adaptive behaviour. The preschool-age and school-age children's EF profiles differed slightly. While both age groups showed Emotional Control as a relative strength and Working Memory as a weakness, the school-age group revealed further weaknesses in Shift and Plan/Organise. As concerns adaptive behaviour, the profiles were similar in the two age groups, with Socialisation as a strength, and Communication and Daily Living Skills as weaknesses, but with a tendency for preschoolers to obtain intermediate scores for the latter. When the relationship between EFs and adaptive behaviour was explored, Working Memory predicted Communication in the younger group, while in the older group the predictors varied, depending on the adaptive domains: Working Memory was a predictor of Communication, Inhibit of Daily Living Skills, and Inhibit and Shift of Socialisation.

CONCLUSION

As well as elucidating the EF profiles and adaptive behaviour in individuals with DS by age, this study points to the role of EFs in adaptive functioning, providing important information for targeted interventions.

Language and executive functioning in young adults with Down syndrome

BACKGROUND

This study examined the association between executive functioning and language in young adults with Down syndrome (DS).

METHOD

Nineteen young adults with DS (aged 19-24 years) completed standardised measures of overall cognition, vocabulary, verbal fluency and executive function skills.

RESULTS

Friedman's analysis of variance (χ² (3) = 28.15, P < .001) and post hoc comparisons indicated that, on average, participants had a significantly lower overall non-verbal than verbal cognitive age equivalent and lower expressive than receptive vocabulary skills. Using Spearman correlations, performance on a verbal measure of cognition inhibition was significantly negatively related to receptive vocabulary (ρ = -.529, adjusted P = .036) and verbal fluency (ρ = -.608, adjusted P = .022). Attention was significantly positively correlated with receptive (ρ = .698, adjusted-p = .005) and expressive (ρ = .542, adjusted P = .027) vocabulary. Verbal working memory was significantly positively associated with receptive vocabulary (ρ = .585, adjusted P = .022) and verbal fluency (ρ = .737, adjusted P = .003). Finally, visuospatial working memory was significantly associated with receptive vocabulary (ρ = .562, adjusted P = .027).

CONCLUSIONS

Verbal and non-verbal measures of executive functioning skills had important associations with language ability in young adults with DS. Future translational research is needed to investigate causal pathways underlying these relationships. Research should explore if interventions aimed at increasing executive functioning skills (e.g. attention, inhibition and working memory) have the potential to lead to increases in language for young adults with DS.

Evaluating working memory outcome measures for children with Down syndrome

BACKGROUND

There is a critical need for the psychometric evaluation of outcome measures to be used in clinical trials targeting cognition in Down syndrome (DS). This study examines a specific cognitive skill that is of particular importance in DS, working memory, and the psychometric properties of a set of standardised measurements to assess working memory in individuals with DS.

METHODS

Ninety children and adolescents ages 6 to 18 years old with DS were assessed on a selection of verbal and visuospatial working memory subtests of standardised clinical assessments at two time points to examine feasibility, distributional qualities, test-retest reliability and convergent validity against a priori criteria. Caregivers also completed an adaptive behaviour questionnaire to address working memory subtests' associations with broader developmental functioning.

RESULTS

The Stanford Binet-5 Verbal Working Memory, Differential Ability Scales-2 Recognition of Pictures, Stanford Binet-5 Nonverbal Working Memory and Wechsler Intelligence Scale for Children-5 Picture Span measures met the most psychometric criteria overall across the full age and IQ range of the study. Although Differential Ability Scales-2 Recall of Sequential Order and Differential Ability Scales-2 Recall of Digits Backward met the fewest a priori criteria, follow-up analyses suggested greater feasibility in specific age and IQ ranges.

CONCLUSIONS

Several working memory measures appear to be psychometrically sound and appropriate for use in clinical trials for children with DS, especially when focusing on raw scores. However, floor effects on standard scores and feasibility of some measures were problematic. Guidelines for use of the working memory subtests with this population are provided.

A meta-analysis of the executive function components inhibition, shifting, and attention in intellectual disabilities

BACKGROUND

Executive function is a concept for higher-order cognitive functions, which have the role of controller and modulator of cognitive abilities. The consensus in the literature is that people with an intellectual disability perform significantly lower on executive function tasks than groups matched on chronological age. The comparison with groups matched on mental age is less clear. Therefore, the objective of this meta-analysis was to investigate to what extent executive function is impaired in people with intellectual disability compared with a typically developing control group matched on mental age. It was also investigated if the executive function component and intellectual disability aetiology moderated the effect.

METHODS

Eligibility criteria were participants with intellectual disability (IQ ≤ 75) without a dual diagnosis; a comparison group matched on mental age; executive function outcome reported in a group comparison study design with n ≥ 10. Working memory tasks and ratings of executive function were not included. The literature search yielded 6637 potentially interesting articles. Twenty-six studies (with 99 effect sizes) including 1395 participants were included in the quantitative synthesis.

RESULTS

A multilevel random-effects meta-analysis found that people with intellectual disability performed statistically significantly lower than the mental age-matched group on the executive function tasks, g = -0.34, 95% confidence interval = [-0.53, -0.16]. However, the heterogeneity between effect sizes was large. The intellectual disability aetiology moderator was significant, but it only reduced the heterogeneity marginally.

CONCLUSION

The overall conclusion is that individuals with an intellectual disability have more problems with executive function tasks than mental age-matched controls. Limitations are the large unexplained variance and the remarkably high number (69) of different tests that were used, which make more detailed conclusions problematic. This meta-analysis implies that future studies need to be of better quality, to have higher power, and to a higher degree use the same executive function tests.

[Formula: see text] The role of distinct executive functions on adaptive behavior in children and adolescents with Down syndrome

Difficulties in executive function are a relatively well-characterized feature of the neuropsychological profile in Down syndrome (DS), yet the impact of these challenges on aspects of daily functioning remain poorly understood. We examined the role of specific executive functions on domains of adaptive behavior in children and adolescents with DS. Participants included 68 children and adolescents with DS between 6-17 years old (mean chronological age = 12.56 years; SD = 3.22) and their caregivers. Parent reported executive function skills were measured using the BRIEF-2 and adaptive behavior was measured using the Vineland Adaptive Behavior Scales-III. Results identified working memory as a significant predictor of Communication, Daily Living, and Socialization skills, and Shifting significantly predicted Daily Living and Socialization. Findings demonstrate the relation between executive functions and adaptive behavior and highlight the effects of working memory on aspects of daily functioning for individuals with DS.

Inhibitory Abilities in Individuals with Down Syndrome: Investigation of Interference Suppression Using an Adapted Version of Navon Task

Only a few studies have investigated inhibitory sub-components in individuals with Down syndrome (DS). This study investigates interference suppression, through global-local processes, in 50 people with DS matched for mental age (MA) with 63 typically developing children (MA = 23.6 and 6.8 years respectively). We adapted and administered a non-verbal Navon-shape task with high-familiarity symbols. For both groups, results showed equal performance on global vs. local items in the congruent condition, whereas significantly better performance on global conditions when faced with incongruent items. A greater impairment in incongruent responses emerged for both groups and more so for individuals with DS.

Inhibitory Dimensions and Delay of Gratification: A Comparative Study on Individuals with Down Syndrome and Typically Developing Children

While previous research on inhibition in people with Down syndrome (DS) reported contradictory results, with no explicit theoretical model, on the other hand, a more homogeneous impaired profile on the delay of gratification skills emerged. The main goal of the present study was to investigate response inhibition, interference suppression, and delay of gratification in 51 individuals with DS matched for a measure of mental age (MA) with 71 typically developing (TD) children. Moreover, we cross-sectionally explored the strengths and weaknesses of these components in children and adolescents vs. adults with DS with the same MA. A battery of laboratory tasks tapping on inhibitory sub-components and delay of gratification was administrated. Results indicated that individuals with DS showed an overall worse performance compared to TD children on response inhibition and delay of gratification, while no differences emerged between the two samples on the interference suppression. Additionally, our results suggested that older individuals with DS outperformed the younger ones both in response inhibition and in the delay of gratification, whereas the interference suppression still remains impaired in adulthood. This study highlights the importance of evaluating inhibitory sub-components considering both MA and chronological age in order to promote more effective and evidence-based training for this population.

The discrepant effect of acute stress on cognitive inhibition and response inhibition

This study aimed to investigate how acute stress impinges on individual's cognitive inhibition and response inhibition abilities. Electroencephalography was adopted when 35 healthy adult females performing the No Go Flanker task before and after the Trier Social Stress Test. Both inhibition processes evoked N2 and P3 components, but only the response inhibition evoked the late positive potential (LPP), indicating the response inhibition needed continuous cognitive effort to inhibit the prepotent response. The N2 and the P3 amplitudes were decreased, while the LPP amplitudes were increased under acute stress. These results suggested that acute stress caused the detrimental effect by occupying cognitive resources. Contrastingly, individuals actively regulated and made more efforts to counteract the detrimental effect of acute stress on response inhibition. Thus, acute stress impaired cognitive inhibition but did not affect response inhibition.

Meta-analysis on inhibition from childhood to young adulthood in people with Down syndrome

BACKGROUND

Few studies have investigated inhibition in people with Down syndrome (DS), indicating contradictory results.

AIM

This meta-analysis investigated if people with DS show more severe difficulties on inhibition, compared to typically developing (TD) children matched on a measure of mental age (MA).

METHODS AND PROCEDURES

Literature search included studies conducted before March 2019, combining the following keywords: "Down syndrome" with "Inhibition", "Interference control", "Effortful control", "Impulsivity", "Self-regulation", and "Executive functions". Descriptive information was coded, according to inclusions criteria. Meta-analysis of standardized differences between DS and TD groups' means was performed. Relevant moderators were also considered.

OUTCOMES AND RESULTS

Eight studies were included in the meta-analysis, including 161 people with DS and 160 TD children. The results indicated that people with DS showed significantly lower inhibition abilities when they are matched on MA with TD children, instead no significant differences emerged when this matching was not provided. A high heterogeneity across studies was estimated.

CONCLUSIONS AND IMPLICATIONS

This meta-analysis indicates that people with DS show, on average, an inhibition deficit compared to TD matched children, albeit not a severe one. These results suggest the importance of investigating in depth inhibition processes in people with DS from childhood to young adulthood.

Executive function in Down syndrome: A meta-analysis

BACKGROUND

Executive function (EF) refers to a set of cognitive processes involved in goal-oriented behavior-especially inhibition, attention shifting, and working memory. EF has been identified as a probable area of difficulty in Down syndrome (DS), but the exact nature of the difficulty has not been well-established.

AIMS

The meta-analysis sought to confirm or disconfirm EF as an area of difficulty in DS and elucidate an EF profile.

METHODS AND PROCEDURES

A random-effects meta-analysis was conducted on 57 studies that compared a group with DS to a typically developing (TD) mental age matched group on one or more executive function tasks. Heterogeneity was examined and moderators analyzed.

OUTCOMES AND RESULTS

The overall mean weighted effect size was large (d = -0.87), indicating poorer EF in groups with DS vs TD groups. Heterogeneity was significant, and moderator analysis revealed an EF profile with a very large effect for verbal WM/STM, a large effect for shifting, and moderate effects for inhibition and nonverbal WM/STM. Skewness analysis suggested that mean effect sizes might have been dampened, especially for WM/STM and shifting.

CONCLUSIONS AND IMPLICATIONS

Individuals with DS display a pronounced difficulty in EFs; implications for interventions and future research are discussed.

Executive function in down syndrome children in Bogotá, Colombia

The study aim was to characterize executive function in 114 children with Down syndrome from a reference institution in Bogotá, Colombia. Children were screened with the Battelle Developmental Inventory to establish their developmental age. Eighty children with an equivalent mental age of 2-5.11 years were allocated to groups of 20 according to their mental age. Parents and teachers then completed the Behavior Rating Inventory of Executive Function-Preschool Version. We found a high variability and a low correlation between parent and teacher ratings. In general, children showed a specific profile characterized by weakness in the domains of working memory, shifting, planning, and organization, and strengths in the emotional control domain. These findings indicate a characteristic pattern of executive function in children with Down syndrome. This profile could form the basis for the planning of clinical assessment programs.

A Representational Approach to Executive Function Impairments in Young Adults with Down Syndrome

Based on a representational perspective, this paper examines executive functioning in Down syndrome. Sixteen young adults with Down syndrome, 16 mental age- and 16 age-matched controls were compared on script sequencing and sorting tasks. Participants were asked to reestablish the sequential structure of script actions given with or without irrelevant actions. Impairments in script information processing were observed only in young adults with Down syndrome, who performed more slowly than controls, making mistakes in ordering actions, but rejecting aberrant elements. These data are consistent with the view that Down syndrome impairs the syntactic but not semantic dimension of script representation.

Functioning of Cognitive Memory Inhibition Processes in People with Down Syndrome: An Empirical Study

Cognitive inhibition is part of executive functions. When it exercises control over memory processes, it has the function of regulating the accessibility of memories and allows interference to be resolved. The impairment of its functioning has been related to the presence of forgetfulness of relevant information. In this research, we study the functioning of cognitive memory inhibition processes in people with intellectual disabilities in tasks of delayed visual recognition and analyze the influence of age. For this purpose, 36 people with Down syndrome (mean age = 33.44, standard deviation = 7.54, 50% females) and 36 people with neurotypical development (mean age = 33.55, standard deviation = 7.52, 50% females) participated. The results reflected a lower effectiveness in the group of people with Down syndrome, F(1, 68) = 159.09, p < .001, $ {\upeta}_{\mathrm{p}}^2 $ = .70. The people in the group with Down syndrome had difficulties in interference resolution, both in the subgroup of young people (p = .014, $ \hat{\updelta\ } $= 0.88) and in the subgroup of older people (p = .022, $ \hat{\updelta\ } $= 0.67). The impairment of cognitive inhibition in people with Down syndrome warrants the need to develop specific intervention programs for this process.

The Effect of Probabilistic Context on Implicit Temporal Expectations in Down Syndrome

One of the most important sources of predictability that human beings can exploit to create an internal representation of the external environment is the ability to implicitly build up subjective statistics of events’ temporal structure and, consequently, use this knowledge to prepare for future actions. Stimulus expectancy can be subjectively shaped by hierarchically nested sources of prediction, capitalizing on either local or global probabilistic rules. In order to better understand the nature of local-global proactive motor control in Down Syndrome, in the present study a group of participants with Down Syndrome (DS group; n = 28; mean age 29.5 ± 13 years; range 10–54) and a group of typically developing participants matched by either gender or mental age (TD-MA group; n = 28; 5.6 ± 1 years; range 4–8) were administered a novel motor preparation task, defined as the Dynamic Temporal Prediction (DTP) task. In the DTP, the temporal preparation to imperative stimuli is implicitly shaped by the local increase of expectancy. This is manipulated trial-by-trial as a function of the preparatory foreperiod interval (Stimulus-Onset Asynchrony or SOA). In addition, temporal preparation can be also implicitly adjusted as a function of global predictive context, so that a block-wise SOA-distribution bias toward a given preparatory interval might determine a high-order source of expectancy, with functional consequences on proactive motor control adjustment. Results showed that in both groups motor preparation was biased by temporal expectancy when this was locally manipulated within-trials. By contrast, only the TD-MA group was sensitive to global rule changes: only in this cohort was behavioral performance overall impacted by the SOA probabilistic distribution manipulated between-blocks. The evidence of a local-global dissociation in DS suggests that the use of flexible cognitive mechanisms to implicitly extract high-order probabilistic rules in order to build-up an internal model of the temporal properties of events is disrupted in this developmental disorder. Moreover, since the content of the information to be processed in the DTP task was neither verbal nor spatial, we suggest that atypical global processing in Down Syndrome is a domain-general rather than specific aspect characterizing the cognitive profile of this population.

A comprehensive examination of the memory profile of youth with Down syndrome in comparison to typically developing peers

Down syndrome (DS) is associated with significant memory deficits beyond overall global cognitive impairment. Although a number of studies have examined memory abilities in adults and teens with DS, very few studies have examined memory abilities in children with DS. Additionally, research has yet to examine prospective memory (i.e., remembering to carry out an action in the future) in youth with DS. Consequently, the current study aimed to comprehensively examine the memory profile, including learning, immediate recall, delayed recall and prospective memory, of youth with DS (n = 22, age M = 11.43) in comparison to typically developing, mental-age (MA) matched children (n = 20, age M = 5.04) Consistent with past research, the results indicated that youth with DS performed significantly below MA-expectations on tasks of immediate verbal recall, learning across trials, and prospective memory, and there was a trend toward youth with DS performing below MA-expectations on delayed recall tasks. However, youth with DS did not differ significantly from MA-matched peers on immediate visual recall, rate of learning across trials, or proportion of items recalled on verbal and visual memory tasks following a delay (i.e., proportion relative to their own recall performance prior to the delay). These results highlight the relative strengths and challenges experienced by youth with DS on different learning and memory tasks. The implications of these findings for educators and caregivers are discussed.

Different abilities needed at home and school: The relation between executive function and adaptive behaviour in adolescents with Down syndrome

Studies have shown that executive function abilities are related and have predictive power over adaptive behaviour in both typical and atypical populations. This study examined the relationship between executive functioning and adaptive behaviour in adolescents with Down syndrome, as it has not been studied before in this population. We propose and test a model of how each core EF (i.e., working memory, inhibition, and flexibility) contributes to each domain of AB (i.e., conceptual, social, and practical). We found that parent reported Conceptual skills were related to working memory, while teacher reported Conceptual and Practical skills were related to inhibition and flexibility. We hypothesise that these findings are related to the different requirements and expectations of the home and school environments: the more predictable home environment requires the adolescent to rely on working memory for his everyday activities, while the changing and challenging school environment requires the inhibition common behaviours and to flexibly change actions to be successful.

Inhibitory Processes and Fluid Intelligence: a Performance at Early Years of Schooling

Inhibition constitutes one of the main executive functions and it is important to more complex skills such as fluid intelligence. Actually, there is an agreement on distinguishing three inhibitory types: perceptual, cognitive and response inhibition. Several studies show the differential engagement of these inhibitory types in different skills. However, there is no registered evidence about the differential relation of inhibitory types with fluid intelligence. This inquiry is especially important during the first school years, since in this stage, inhibitory processes would already be differentiated, and inhibitory processes and fluid intelligence are linked to the performance of children in the school setting. For these reasons, the goal of this work is to study the relation and contribution of perceptual, cognitive, and response inhibition with fluid intelligence, in children in the first years of primary school. For that purpose, a sample of children from six to eight years old (N = 178) was tested with a perceptual inhibition task (perception of similarities and differences task); a cognitive inhibition task (proactive interference task); a response inhibition task (stop signal task); and a fluid intelligence task (progressive matrices task). We observed significant correlations between perceptual and response inhibition and fluid intelligence (controlling for age), but only perceptual inhibition explains significantly part of the performance in the fluid intelligence task. This study provides data about the specific contribution, during childhood, of an inhibitory type to fluid intelligence and contributes empirical evidence in support of the non-unitary approach of inhibition.

Inhibitory Processes Training for School-age Children: Transfer Effects

Inhibition refers to a basic executive component that can be conceptualized as consisted of different inhibitory processes (i.e., perceptual, cognitive and response inhibition). These processes emerge during the first years of life, and since then are involved in different relevant every day activities. Different individual and contextual factors can modulate their developmental trajectories. The possibility of train in separate ways each inhibitory process is a subject of analysis. In such a context, the aims of this work were: (a) to design, implement and evaluate training of perceptual, cognitive and response inhibition processes, in a sample of school-aged children (6 to 8 years old); and (b) to analyze near, far, short- and long-transfer effects. An experimental design with three training groups (one for each inhibitory process) and an active control group was implemented. Near transfer effects were not observed. We found effects on a visuospatial working memory task in the short term, after the training in the response and cognitive inhibition, and effects on a fluid intelligence task in both the short and long term after the training in cognitive inhibition. The results contribute to a conceptualization of multidimensional inhibitory processes and the plausibility of training them during childhood.

A Novel Framework to Measure Executive Function in Down Syndrome With Applications for Early Clinical Diagnosis of Dementia

Executive function (EF) decline is a consistent early sign of Alzheimer's disease (AD) among adults with Down syndrome (DS), which means that baseline measures of EF for individuals with DS are vital to allow detection of meaningful decline. We developed a framework to extract measures of three core components of EF (memory updating, inhibitory, and temporal components) within one task. Increases in memory load, inhibitory load, and temporal demands led to significant increases in reaction times and significant decreases in accuracy among 18 adults with DS and 18 typically developing matched individuals; thus, the expected effects of all three manipulations were detected. Good test-retest reliability indicated that this framework has the potential to provide a simple, baseline EF measure for individuals with DS.

Reliability of Informant-Report Measures of Executive Functioning in Children With Down Syndrome

The current study evaluates the psychometric properties of the Behavior Rating Inventory of Executive Function (BRIEF) with children with Down syndrome. Caregivers of 84 children with Down syndrome rated their child's behavior with the BRIEF. Teacher ratings were obtained for 57 children. About 40% of children with Down syndrome were reported by parents, and 70% by teachers, to exhibit clinically significant challenges with executive functioning. Distribution of scores was normal, internal consistency for subscales was questionable to primarily excellent, and inter-rater reliability was poor to good. Normative data conversions controlled for age, IQ, and gender differences, with some exceptions. The study findings suggest that the BRIEF and its subscales generally performed in a psychometrically sound manner among children with Down syndrome.

Does the Development of Syntax Comprehension Show a Premature Asymptote Among Persons With Down Syndrome? A Cross-Sectional Analysis

Uncertainty persists regarding the post-childhood trajectory of syntactic acquisition of persons with Down syndrome (DS). In some studies, asymptote is reached in the early teens, whereas others find syntax continuing to develop at least into early adulthood. This study addressed the issue using a cross-sectional approach. Receptive syntax and vocabulary were tested in 62 children, adolescents and young adults with DS matched on chronological age and cognitive level with 62 participants with intellectual disability (ID) of undifferentiated etiology. On both tests there were significant effects of chronological age and diagnosis, but the chronological age × diagnosis interactions were nonsignificant. We concluded that comprehension of vocabulary and syntax does not asymptote prematurely in individuals with DS relative to those with other forms of ID.

Cognitive Functioning in Children with Down Syndrome: Current Knowledge and Future Directions

Infants and children with Down syndrome (DS) can look forward toward bright futures, as individuals with DS are living healthier, more productive lives than ever due to medical advances, opportunities for early and continued intervention, and inclusive education. Despite these advances, infants and children with DS experience challenges in specific domains of cognitive functioning relative to their typically developing (TD) peers. Over the long term, individuals with DS are also more likely to develop Alzheimer's disease relative to the general population. Understanding cognitive functioning early in life may be important in charting cognitive decline over time. This chapter synthesizes the literature on cognitive functioning in infants and children with DS specific to general intelligence or IQ, language development, recall memory, and executive functioning, with additional focus on critical issues and future directions. These research findings provide important information for understanding cognitive competencies and intervention opportunities for children with DS and also serves to provide a foundation from which to plan longitudinal studies examining stability and change in cognitive functioning over time.

Impact of sleep on executive functioning in school-age children with Down syndrome

BACKGROUND

Sleep problems have an impact on executive functioning in the general population. While children with Down syndrome (DS) are at high risk for sleep problems, the impact of these sleep problems on executive functioning in school-age children with DS is less well documented. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports and neuropsychology assessments of executive functioning among school-age children with DS.

METHOD

Thirty school-age children with DS wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Children completed a neuropsychology assessment of their inhibitory control, ability to shift and working memory. Their parents and teachers completed rating scales to assess these same constructs of executive functioning.

RESULTS

Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire (CSHQ), but not actigraph-measured sleep period or efficiency, were predictive of parent reports of concerns with inhibitory control, shifting and working memory, and of teacher reports of inhibitory control. No measure of sleep was predictive of executive functioning as measured by the neuropsychology assessment.

CONCLUSION

The study findings corroborate the preliminary literature that parent-reported sleep problems are related to executive functioning in school-age children with DS, particularly in the area of inhibitory control across home and school. These findings have implications for understanding contributing factors to academic performance and school behaviour in school-age children with DS.

Response Inhibition and Interference Suppression in Individuals With Down Syndrome Compared to Typically Developing Children

The present study aims to investigate inhibition in individuals with Down Syndrome compared to typically developing children with different inhibitory tasks tapping response inhibition and interference suppression. Previous studies that aimed to investigate inhibition in individuals with Down Syndrome reported contradictory results that are difficult to compare given the different types of inhibitory tasks used and the lack of reference to a theoretical model of inhibition that was tested in children (see Bunge et al., 2002; Gandolfi et al., 2014). Three groups took part in the study: 32 individuals with Down Syndrome (DS) with a mean age of 14 years and 4 months, 35 typically developing children 5 years of age (5TD), and 30 typically developing children 6 years of age (6TD). No difference emerged among the groups in fluid intelligence. Based on a confirmatory factor analysis, two different inhibition factors were identified (response inhibition and interference suppression), and two composite scores were calculated. An ANOVA was then executed with the composite inhibitory scores as dependent variables and group membership as the between-subject variable to explore the group differences in inhibition components. The 6TD group outperformed the 5TD group in both response inhibition and interference suppression component scores. No differences were found in both inhibition components between the DS group and 5TD. In contrast, the 6TD group outperformed the DS group in both response inhibition and in the interference suppression component's scores. Summarizing, our findings show that both response inhibition and interference suppression significantly increased during school transition and that individuals with DS showed a delay in both response inhibition and interference suppression components compared to typically developing 6-year-olds, but their performance was similar to typically developing 5-year-olds.

Memory profiles in Down syndrome across development: a review of memory abilities through the lifespan

Down syndrome (DS) is associated with a variety of cognitive impairments, notably memory impairments. Due to the high prevalence rates of early-onset dementia associated with DS, it is imperative to understand the comprehensive development of memory impairments beginning in childhood and into adulthood, as this may help researchers identify precursors of dementia at earlier stages of development and pinpoint targets for memory intervention. The current paper provides a systematic, developmentally focused review of the nature of memory difficulties in DS across the lifespan. Specifically, this review summarizes what is known about long-term, short-term, and working memory abilities (distinguishing between verbal and nonverbal modalities) in DS, compared to both mental age-matched typically developing peers and individuals with other forms of intellectual disability (ID) at three developmental stages (i.e., preschool, adolescence, and adulthood). Additionally, this review examines the degree of impairment reported relative to typically developing mental age-matched peers in the existing literature by examining effect size data across memory domains as a function of age. With few exceptions, memory abilities were impaired across the lifespan compared to mental age-matched typically developing peers. Relative to other groups with ID, research findings are mixed. Our review of the literature identified a scarcity of memory studies in early childhood, particularly for STM and WM. In adulthood, research was limited in the LTM and WM domains and very little research has compared memory abilities in older adults with DS to those with typical development. Looking to the future, longitudinal studies could provide a better understanding of the developmental trajectory of memory abilities in DS, and the possible associations between memory abilities and real-world functioning. This research could ultimately inform interventions to improve independence and overall quality of life for those with DS and their families.

Environment learning from virtual exploration in individuals with down syndrome: the role of perspective and sketch maps

BACKGROUND

Spatial knowledge about an environment is an important determinant of ability to move effectively within it and of personal autonomy. Individuals with Down's syndrome (DS) have difficulty managing configural visuospatial information.

METHOD

Twenty-nine individuals with DS and 29 typically developing (TD) children, matched for mental age, learned about environments through virtual exploration using a route or survey view. A sketch map of the environment was or was not presented before exploration. Then the acquisition of configural knowledge (landmark locations) and route retracing were tested.

RESULTS

Individuals with DS were able to acquire configural knowledge through virtual exploration in all presentation conditions, and generally performed no worse than matched TD children. However, they were not able to benefit from the conditions that facilitated acquisition of configural knowledge in TD children, that is, seeing a sketch map before exploring and exploring in survey (rather than route) view. As regards route retracing, individuals with DS paused more often than controls and tended to travel longer paths, which made them slower overall.

CONCLUSIONS

DS reduces children's ability to benefit from additional survey information and may be related to difficulty in elaborating configural/simultaneous information.

Negative emotion evoked by viewing snakes has a motivating effect on cognitive processing in human children with or without intellectual disability

BACKGROUND

It is well known that prioritization of the processing of threatening stimuli generally induces deleterious effects on task performance. However, a study recently reported that emotion (possibly fear) evoked by viewing images of snakes exerts a facilitating effect upon making judgments of the images' color in neurotypical adults and schoolchildren. Here, the author has attempted to confirm the relevance of this notion in children with and without intellectual disability.

METHODS

The author here compared the reaction time required to name the colors of snake and flower images between children with Down syndrome (DS) and mental age matched, typically-developing (TD) children.

RESULTS

Snake images were responded to faster than flower images in both the groups, while the children with DS tended to respond more slowly overall.

CONCLUSIONS

As in TD children, negative emotion can have a motivating effect on cognitive processing in children with DS. Some implications of the findings are pointed out with respect to the lower-level task persistence as a characteristic motivational orientation in children with DS.

Visuo-spatial knowledge acquisition in individuals with Down syndrome: The role of descriptions and sketch maps

Few studies on individuals with Down syndrome (DS) have explored how they learn space. The present study examines space learning from verbal descriptions in individuals with DS, and explores the role of external cues (such as a sketch map). Twenty-eight individuals with DS and 28 matched typically-developing (TD) children listened to route or survey descriptions with or without seeing a corresponding sketch map (Description+Sketch Map [D+SM] and Description alone [D], respectively). After hearing each description, they performed tasks that involved recognizing, arranging sequentially, and locating landmarks. The results showed that individuals with DS performed less well in recognizing landmarks and arranging them sequentially. The D+SM condition produced general benefits in both groups' accuracy, though the improvement in locating landmarks was greater in the TD than in the DS group. In both groups, the D+SM condition prompted a better performance than the D condition when participants arranged landmarks sequentially after hearing a description from a route perspective, but not from a survey perspective. Overall, our results show that individuals with DS benefited when a spatial description was associated with a corresponding sketch map, albeit to a lesser degree than TD children. The findings are discussed in the light of the literature on DS and on spatial cognition in the TD domain.

Executive function and academic achievement in primary - grade students with Down syndrome

BACKGROUND

Executive function (EF) plays a critical role in academic outcomes in typically developing children, but the contribution of EF to academic performance in Down syndrome (DS) is less well understood. This study evaluated differences in early academic foundations between primary school aged children with DS and non-verbal mental-age matched typically developing (TD) children. Additionally, the contribution of EF domains to academic outcomes was evaluated in each group.

METHOD

Participants with DS (n = 29) and mental-age matched TD participants (n = 23) were administered the Woodcock Johnson- III NU Tests of Academic Achievement, as well as a laboratory-based EF battery, including measures of working memory, shifting, inhibition and object-planning.

RESULTS

Findings indicated a difference in early academic foundations profile between children with DS and mental-age matched TD children. Patterns of EF contributions towards academic outcomes were also observed across groups.

CONCLUSIONS

Aspects of EF are critical to academic achievement in DS but differentially so relative to typical development. Implications for educational instruction are discussed.

Implications of the idea of neurodiversity for understanding the origins of developmental disorders

Neurodiversity, a term initially used mostly by civil and human rights movements since the 1990s, refers to the notion that cognitive as well as emotional properties characteristic of developmental disorders such as autism spectrum disorders (ASD) are not necessarily deficits, but fall within normal behavioural variations exhibited by humans. The purpose of the present article is to examine the relevance of this notion to scientific research on ASD. On the assumption that one crucial survival advantage of intelligent activity is vigilance toward dangers in the external world, and such vigilance must work in the social domain as well as in the non-social domain, the author argues that the pattern of operation of an individual person's mind can be categorized according to the domain toward which that individual is more oriented. Individuals with ASD, overall, do not rely upon their social relationships but rather are predisposed to process perceived non-social objects in more depth, which manifests itself as hyper-sensation and hyper-attention to detail. It can be assumed that underconnectivity among cortical areas and subcortical areas underlies such mental operation neurologically. One of the main predictions based on this assumption is that all facets of psychological function are susceptible to disruption in ASD. Indeed, it has traditionally been thought that there are such general deficits in this disorder. However, contrary to the prevalent belief that people with ASD lack empathy, in fact people with ASD are capable of empathizing with the minds of others if those others are people with ASD. Thus, the neurological underconnectivity in ASD certainly leads some processing of information in the mind to work with less coordination, but has in fact contributed to providing Homo sapiens with behavioural variants. Finally, the clinical implications of the advantages of viewing ASD as a variation in neurodiversity are discussed.

Guanfacine Use in Children With Down Syndrome and Comorbid Attention-Deficit Hyperactivity Disorder (ADHD) With Disruptive Behaviors

The purpose of this study was to characterize children with Down syndrome and attention-deficit hyperactivity disorder (ADHD) with disruptive behaviors using the Aberrant Behavior Checklist (ABC), and to measure the treatment effects of guanfacine on maladaptive behaviors. Subjects were enrolled from a group of outpatients who visited our clinic between 2002 and 2007. Subjects (N = 23) were children with Down syndrome ages 4 to 12 years (mean 7.4 ± 4.1), who met criteria for ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition The Aberrant Behavior Checklist Irritability and Hyperactivity subscales each showed a significant decrease (P < .0001) at follow-up. The mean decline on Hyperactivity was 25% (-7.8 points), and for Irritability, 25% (-3.5 points). The mean composite score also declined by 24% (-12 points). Effect size differences on Irritability were moderate, whereas differences on Hyperactivity and composite score appeared large. Clinically important target behaviors were reduced. Medication was generally well tolerated and the incidence of treatment emergent side effects remained low.

Dissociations in Cortical Morphometry in Youth with Down Syndrome: Evidence for Reduced Surface Area but Increased Thickness

Detailed descriptions of cortical anatomy in youth with Down syndrome (DS), the most common genetic cause of intellectual disability (ID), are scant. Thus, the current study examined deviations in cortical thickness (CT) and surface area (SA), at high spatial resolution, in youth with DS, to identify focal differences relative to typically developing (TD) youth. Participants included 31 youth with DS and 45 age- and sex-matched TD controls (mean age ∼16 years; range = 5-24 years). All participants completed T1-weighted ASSET-calibrated magnetization prepared rapid gradient echo scans on a 3-T magnetic resonance imaging scanner. Replicating prior investigations, cortical volume was reduced in DS compared with controls. However, a novel dissociation for SA and CT was found-namely, SA was reduced (predominantly in frontal and temporal regions) while CT was increased (notably in several regions thought to belong to the default mode network; DMN). These findings suggest that reductions in SA rather than CT are driving the cortical volume reductions reported in prior investigations of DS. Moreover, given the link between DMN functionality and Alzheimer's symptomatology in chromosomally typical populations, future DS studies may benefit from focusing on the cortex in DMN regions, as such investigations may provide clues to the precocious onset of Alzheimer's disease in this at-risk group.

Building an adaptive brain across development: targets for neurorehabilitation must begin in infancy

Much progress has been made toward behavioral and pharmacological intervention in intellectual disability, which was once thought too difficult to treat. Down syndrome (DS) research has shown rapid advances, and clinical trials are currently underway, with more on the horizon. Here, we review the literature on the emergent profile of cognitive development in DS, emphasizing that treatment approaches must consider how some "end state" impairments, such as language deficits, may develop from early alterations in neural systems beginning in infancy. Specifically, we highlight evidence suggesting that there are pre- and early postnatal alterations in brain structure and function in DS, resulting in disturbed network function across development. We stress that these early alterations are likely amplified by Alzheimer's disease (AD) progression and poor sleep. Focusing on three network hubs (prefrontal cortex, hippocampus, and cerebellum), we discuss how these regions may relate to evolving deficits in cognitive function in individuals with DS, and to their language profile in particular.

Relationship between motor skill competency and executive function in children with Down's syndrome

BACKGROUND

Previous studies suggest that children with Down's syndrome (DS), a genetically based neurodevelopmental disorder, demonstrate motor problems and cognitive deficits. The first aim of this study was to examine motor skills and executive functions (EFs) in school-age children with DS. The second aim was to investigate the relationship between these two performance domains.

METHODS

The Test of Gross Motor Development (TGMD-2), the Movement Assessment Battery Children-2 checklist (MABC2-checklist) and the Trail-Making Test for young children (Trails-P) were used to assess motor and cognitive performances of 18 children (11 boys, 7 girls) with DS aged between 7 and 11 years (9.06 ± 0.96) and an age- and sex-matched sample of 18 typically developing (TD) children (11 boys, 7 girls; 8.99 ± 0.93).

RESULTS

Individuals with DS showed the expected difficulties in attentional control, response suppression and distraction, as well as in locomotor and object control skills, as indicated by poorer performance than TD individuals. Motor performance (bottom-up as well as top-down measures) and EF correlated positively, with regard to the group with DS only though. In the most complex task (distraction), the children of the DS group achieving lower locomotor scores showed lower efficacy scores on the Trails-P. Additionally, strong relationships were found for the perspective of teachers on all sections of the MABC2-Checklist and EF.

CONCLUSION

The findings from this study suggest that children with DS are not only impaired in higher-order EF, but showing also deficits in locomotor and object control skills. This study stresses the importance of early interventions facilitating cognitive abilities and motor skills.

Treating verbal working memory in a boy with intellectual disability

The present case study investigates the effects of a cognitive training of verbal working memory that was proposed for Davide, a 14-year-old boy diagnosed with mild intellectual disability. The program stimulated attention, inhibition, switching, and the ability to engage either in verbal dual tasks or in producing inferences after the content of a short passage had been encoded in episodic memory. Key elements in our program included (1) core training of target cognitive mechanisms; (2) guided practice emphasizing concrete strategies to engage in exercises; and (3) a variable amount of adult support. The study explored whether such a complex program produced "near transfer" effects on an untrained dual task assessing verbal working memory and whether effects on this and other target cognitive mechanisms (i.e., attention, inhibition, and switching) were long-lasting and produced "far transfer" effects on cognitive flexibility. The effects of the intervention program were investigated with a research design consisting of four subsequent phases lasting 8 or 10 weeks, each preceded and followed by testing. There was a control condition (phase 1) in which the boy received, at home, a stimulation focused on the visuospatial domain. Subsequently, there were three experimental training phases, in which stimulation in the verbal domain was first focused on attention and inhibition (phase 2a), then on switching and simple working memory tasks (phase 2b), then on complex working memory tasks (phase 3). A battery of neuropsychological tests was administered before and after each training phase and 7 months after the conclusion of the intervention. The main finding was that Davide changed from being incapable of addressing the dual task request of the listening span test in the initial assessment to performing close to the normal limits of a 13-year-old boy in the follow-up assessment with this test, when he was 15 years old.

Annual research review: Rare genotypes and childhood psychopathology--uncovering diverse developmental mechanisms of ADHD risk

BACKGROUND

Through the increased availability and sophistication of genetic testing, it is now possible to identify causal diagnoses in a growing proportion of children with neurodevelopmental disorders. In addition to developmental delay and intellectual disability, many genetic disorders are associated with high risks of psychopathology, which curtail the wellbeing of affected individuals and their families. Beyond the identification of significant clinical needs, understanding the diverse pathways from rare genetic mutations to cognitive dysfunction and emotional-behavioural disturbance has theoretical and practical utility.

METHODS

We overview (based on a strategic search of the literature) the state-of-the-art on causal mechanisms leading to one of the most common childhood behavioural diagnoses - attention deficit hyperactivity disorder (ADHD) - in the context of specific genetic disorders. We focus on new insights emerging from the mapping of causal pathways from identified genetic differences to neuronal biology, brain abnormalities, cognitive processing differences and ultimately behavioural symptoms of ADHD.

FINDINGS

First, ADHD research in the context of rare genotypes highlights the complexity of multilevel mechanisms contributing to psychopathology risk. Second, comparisons between genetic disorders associated with similar psychopathology risks can elucidate convergent or distinct mechanisms at each level of analysis, which may inform therapeutic interventions and prognosis. Third, genetic disorders provide an unparalleled opportunity to observe dynamic developmental interactions between neurocognitive risk and behavioural symptoms. Fourth, variation in expression of psychopathology risk within each genetic disorder points to putative moderating and protective factors within the genome and the environment.

CONCLUSION

A common imperative emerging within psychopathology research is the need to investigate mechanistically how developmental trajectories converge or diverge between and within genotype-defined groups. Crucially, as genetic predispositions modify interaction dynamics from the outset, longitudinal research is required to understand the multi-level developmental processes that mediate symptom evolution.

Symptoms of attention-deficit/hyperactivity disorder in Down syndrome: effects of the dopamine receptor D4 gene

This study examined individual differences in ADHD symptoms and executive function (EF) in children with Down syndrome (DS) in relation to the dopamine receptor D4 (DRD4) gene, a gene often linked to ADHD in people without DS. Participants included 68 individuals with DS (7-21 years), assessed through laboratory tasks, caregiver reports, and experimenter ratings. Saliva samples were collected from the DS group and 66 children without DS to compare DRD4 allele distribution, showing no difference between the groups. When the sample with DS was stratified for ethnicity (n  =  32), the DRD4 7-repeat allele significantly related to parent and experimenter ratings, but not to laboratory assessments. These results suggest that nontrisomy genetic factors may contribute to individual differences in ADHD symptoms in persons with DS.

Rule-based category learning in Down syndrome

Rule-based category learning was examined in youths with Down syndrome (DS), youths with intellectual disability (ID), and typically developing (TD) youths. Two tasks measured category learning: the Modified Card Sort task (MCST) and the Concept Formation test of the Woodcock-Johnson-III ( Woodock, McGrew, & Mather, 2001 ). In regression-based analyses, DS and ID groups performed below the level expected for their nonverbal ability. In cross-sectional developmental trajectory analyses, results depended on the task. On the MCST, the DS and ID groups were similar to the TD group. On the Concept Formation test, the DS group had slower cross-sectional change than the other 2 groups. Category learning may be an area of difficulty for those with ID, but task-related factors may affect trajectories for youths with DS.

Gait profiles as indicators of domain-specific impairments in executive control across neurodevelopmental disorders

In neurodevelopmental disorders, unique profiles of executive control and attention appear to co-occur with poor motor coordination. However, less is known about how syndrome-specific cognitive profiles interact with motor control and impact behavioural outcomes in neurodevelopmental disorders such as Williams syndrome (WS) and Down syndrome (DS). Here we aimed to examine the extent to which specific components of executive function interact with gait control when performing cognitive dual-tasks (verbal fluency, digit span) in WS and DS. Spatiotemporal gait characteristics and intra-individual variability of gait were assessed in individuals with WS who were matched on spatial ability to individuals with DS, and chronologically age (CA) matched controls. During the concurrent verbal fluency task, the WS group had greater dual-task costs on spatiotemporal gait parameters and variability than CA controls. Conversely, individuals with DS had selective gait interference during the concurrent digit span task when compared to CA controls, but only under increased demands on cognitive control where there was greater variability in step timing in DS. The interrelationships between cognitive-motor interference and behavioural measures of executive functioning appeared to differentiate between WS and DS, and emphasise the importance of task modality in unpacking the executive control profile in these neurodevelopmental disorders. These findings support the notion that associated cerebellar-cortico abnormalities may produce quite distinct profiles of executive control across cognitive and motor domains that impact on behavioural outcomes in neurodevelopmental disorders.