Are Executive Functioning Deficits Concurrently and Predictively Associated with Depressive and Anxiety Symptoms in Adolescents?

Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems

LAY ABSTRACT

Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.

Promotive factors associated with reduced anxiety and depression across three years in a prospective clinical cohort of adolescents: Examining compensatory and protective models of resilience

The rates of anxiety and depression increase across adolescence, many experience recurrence after treatment, yet longitudinal studies examining promotive factors are scarce. We prospectively examined the role of the promotive factors structured style, personal and social competencies, family functioning, and social resources in homotypic and heterotypic continuity and discontinuity of anxiety and depression across three years in a clinical sample. Participants were adolescents with anxiety or depressive disorders aged 13-18 years at T1 (N = 717, 44% initial participation rate) and aged 16-21 years at T2 (N = 549, 80% follow-up participation rate). At T1, diagnoses were collected from medical records and participants responded to questionnaires. At T2, semi-structured diagnostic interviews were conducted. Higher levels of all promotive factors were associated with reduced probability of anxiety or depression three years later. The promotive factors were not associated with homotypic continuity of anxiety, whereas personal competence beliefs, social competence, and, less strongly, family functioning were associated with reduced homotypic continuity of depression and heterotypic continuity from depression to anxiety. Analyses with interaction terms did not indicate moderation by the promotive factors. Our findings suggest that bolstering promotive factors may be vital for increasing treatment success and preventing recurrence of anxiety and depression in the transition toward adulthood.

Refining our Understanding of Anxiety in Autistic Youth: Examining the Role of Behavioral Inflexibility

Prior research has demonstrated that cognitive inflexibility is associated with anxiety in autistic individuals. Everyday patterns of behavioral inflexibility (e.g. observable inflexible behavior in the context of the need to change or adapt and that is manifested in real-world everyday settings) is common in autism and can be distinguished from performance on discrete cognitive tasks that tap flexible attention, learning, or decision-making. The purpose of this study was to extend this prior work on inflexibility in autism but with measures specifically developed with input from stakeholders (caregivers and clinicians) for autistic youth designed to measure everyday behavioral inflexibility (BI). We characterized anxiety in a large sample of autistic (N = 145) and non-autistic youth (N = 91), ages 3 to 17 years, using the Parent Rated Anxiety Scale for Autism Spectrum Disorder (PRAS-ASD). Further, we sought to understand how BI, measured via the Behavioral Inflexibility Scale (BIS), predicted anxiety compared to other variables known to increase anxiety in youth (chronological age, IQ, autism diagnosis, assigned sex at birth). Autistic youth had higher parent-related anxiety and BI compared to non-autistic youth. BI was the strongest predictor of anxiety scores, irrespective of diagnosis. Overall, our findings highlight the importance of BI to the understanding of anxiety in autistic youth.

The Impact of Executive Dysfunction on Anxiety in Hearing-Impaired College Students: Smartphone Addiction as a Mediator and Academic Procrastination as a Moderator

Purpose

Hearing-impaired college students often rely on smartphones for information exchange and social interaction due to their hearing limitations, which may increase their risk of smartphone addiction. This study aims to explore the impact of executive dysfunction on anxiety levels in hearing-impaired college students, investigating smartphone addiction as a mediator and academic procrastination as a moderator.

Methods

We conducted a questionnaire survey using the Executive Function Scale, the Anxiety Scale, the Smartphone Addiction Scale, and the Academic Procrastination Scale. The survey included 609 hearing-impaired college students from three universities in Jiangsu, Hunan, and Heilongjiang Provinces, China.

Results

After controlling for age, executive dysfunction was found to significantly predict higher anxiety levels in hearing-impaired college students. Additionally, smartphone addiction partially mediated the relationship between executive dysfunction and anxiety. Academic procrastination further moderated the relationship between smartphone addiction and anxiety.

Conclusion

This study enhances the understanding of the complex interactions between executive dysfunction, smartphone addiction, and academic procrastination in contributing to anxiety among hearing-impaired college students. The findings offer valuable insights for developing strategies to promote the mental health of this population.

The Tower of London task in children and adolescents with neuropsychiatric disorders

The Tower of London, Drexel Version, Second Edition (TOL-DX) is purported to measure multiple aspects of executive functions, although it also possesses inherent non-executive demands. Such complexity makes it useful in detecting impairment but difficult in interpreting the neurocognitive cause of impairment, particularly in children. This study investigated the developmental, neurocognitive, and symptom correlates of the TOL-DX in children and adolescents with neuropsychiatric disorders. Two-hundred and thirty-three children and adolescents (7-21 years old) completed the TOL-DX during a neuropsychological evaluation as part of clinical care within a children's psychiatric hospital. Pearson correlation, regression models, and receiver operating characteristic curve (ROC) analyses examined the association among variables. Visuospatial and executive functions (EF) were most consistently related to total moves, execution time, and violations. TOL-DX variables were associated with attention in younger participants and EF in older participants. No TOL-DX scores were related to parent-reported symptoms. The TOL-DX possesses inherent visuospatial and attention/executive demands in children and adolescents which are difficult to differentiate, differ by age group, and not associated to clinical symptoms. Taken together, the TOL-DX is complex to interpret, but psychometrically sound and sensitive to neurocognitive impairment in children and adolescents with transdiagnostic neuropsychiatric disorders.

Correlation research on physical activity and executive function in female college students with subclinical depression

Researchers have found that there may be a correlation between physical activity, executive function, and depression for college students with depression. However, there is limited information available regarding the relationship and interaction between subclinical depression, physical activity, and executive function among college students with subclinical depression. The purpose of this study is to assess the correlation and interaction between subclinical depression, physical activity, and executive function in female college students with subclinical depression. The ActiGraph GT3X was utilized to measure physical activity time, and the colour-word Stroop task was employed to evaluate the executive function of the participants. The findings revealed that female college students with subclinical depression had a significantly lower time for moderate-intensity physical activity compared to healthy female college students. Additionally, the subclinical depression group took significantly longer to complete the colour-word Stroop task compared to the healthy group of female college students. The results of correlation and mediation analyses suggest a negative correlation between BDI-II scores and physical activity time and executive function in female college students with subclinical depression. Moreover, executive function appears to play a partial mediating role in the relationship between physical activity and subclinical depression.

Quadratic associations between cardiovascular stress reactivity and development of cool and hot executive functions in adolescents

Stress affects executive functions and exploring the association between stress-induced physiological reactivity and executive functions could highlight the potential mechanism of the stress-cognitive function link. Our study examined the linear and nonlinear associations between cardiovascular stress reactivity and cool and hot executive functions among adolescents. In November 2021 (T1), 273 Chinese adolescents between 11 and 14 (Mage = 12.93, SDage = 0.79) underwent a speech task during which their cardiovascular data were recorded, and they completed a Flanker task and an Emotional Stroop task. In May 2023 (T2), 253 adolescents again completed the Flanker and Emotional Stroop tasks. Cool and hot executive functions were assessed using the intra-individual reaction time variability of the Flanker task and Emotional Stroop task, respectively. Results showed that cardiovascular stress reactivity was positively linearly associated with cool executive functions at T1 and quadratically (inverted U-shaped) associated with cool executive functions at T1 and hot executive functions at T1 and T2. These findings suggest that compared to very high and very low cardiovascular reactivity, moderate to high cardiovascular reactivity to a structured social challenge is associated with better cool and hot executive functions.

Childhood stress, gender, and cognitive control: Midline theta power

The emergence of psychiatric symptoms is a common consequence of childhood stress exposure. However, there are a dearth of reliable clinical hallmarks or physiological biomarkers to predict post-trauma symptom emergence. The objective of this study was to examine if childhood stressors and stress-related symptoms are associated with altered midline theta power (MTP) during cognitive control demands, and how these associations interact with gender and early adversity. N = 53 children (ages 9-13 years old) from a longitudinal study of children maltreated during early childhood and non-maltreated children participated in this study. EEG recorded neural activity during a Zoo-Themed Go/No-Go task. Stress-related symptoms, recent stressful events, and other adversity experiences were identified. MTP was analyzed with clinical variables in a series of follow-up analyses. The number of stressors in the past six months was negatively correlated with MTP in those with low preschool adversity, but not in those with high preschool adversity. MTP was higher in girls than in boys, and the associations of MTP with stressors and symptoms were moderated by gender. MTP was negatively associated with stressors in the past six months in girls, while in boys, MTP was associated with stress-related symptoms. Childhood stressful events were associated with reduced MTP during cognitive control demands, and this was finding was moderated by gender and early life adversity. These preliminary findings suggest that boys and girls may process stressful experiences in distinct ways, and preschool adversity may potentially blunt the interaction between current stress and neural dynamics. However, ongoing investigation is needed.

Improvement of anxiety in ADHD following goal-focused cognitive remediation: a randomized controlled trial

Introduction

Despite the high prevalence and detrimental consequences of cognitive and executive dysfunction in ADHD, the evidence base of cognitive remediation in the adult ADHD population is sparse. Executive problems can increase both anxiety and depression in ADHD. Thcus, it is important to develop treatment options for adults with ADHD, aiming to improve goal-directed behavior and mood. Goal Management Training (GMT) is an intervention that has received empirical support in improving executive functions and mood in normal aging and for various neurological and psychiatric conditions. The present randomized controlled trial investigated the effects of a goal-focused intervention combining 1) group-based GMT incorporating psychoeducation about ADHD and 2) guidance in implementing individual goals for coping with executive problems in everyday life, compared to treatment as usual (TAU). The primary outcome was perceived executive functioning in everyday life. Secondary outcomes included psychological well-being (anxiety, depression, and coping with ADHD symptoms).

Methods

We recruited 81 adult participants with a verified ADHD diagnosis (Mage   = 31 years). Inclusion was based upon the presence of executive functioning complaints. The participants were randomly assigned to either the intervention or TAU. The intervention group (n = 41) received 16 hours of GMT and psychoeducation, in addition to 4 individual sessions focusing on formulating goals. The goals were assessed in 6 bi-weekly phone calls in the first three months following the group sessions. Participants in the TAU group (n = 40) received standard, individually-adapted follow-up in an outpatient psychiatric health care setting. All participants were assessed at baseline, post-intervention, and at 8-month follow-up (main measurement time point).

Results

Significant improvements in everyday executive functioning, psychological wellbeing, and symptoms of ADHD from baseline to 8-month follow-up were reported in both groups. The intervention group reported a significantly higher reduction in symptoms of anxiety compared to TAU. Conclusions. Our findings provide support for considering cognitive remediation as a treatment option for patients with ADHD.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04638283?term=NCT04638283&rank=1, identifier: NCT04638283.

Reduced volume of the left cerebellar lobule VIIb and its increased connectivity within the cerebellum predict more general psychopathology one year later via worse cognitive flexibility in children

Predicting the risk for general psychopathology (the p factor) requires the examination of multiple factors ranging from brain to cognitive skills. While an increasing number of findings have reported the roles of the cerebral cortex and executive functions, it is much less clear whether and how the cerebellum and cognitive flexibility (a core component of executive function) may be associated with the risk for general psychopathology. Based on the data from more than 400 children aged 6-12 in the Children School Functions and Brain Development (CBD) Project, this study examined whether the left cerebellar lobule VIIb and its connectivity within the cerebellum may prospectively predict the risk for general psychopathology one year later and whether cognitive flexibility may mediate such predictions in school-age children. The reduced gray matter volume in the left cerebellar lobule VIIb and the increased connectivity of this region to the left cerebellar lobule VI prospectively predicted the risk for general psychopathology and was partially mediated by worse cognitive flexibility. Deficits in cognitive flexibility may play an important role in linking cerebellar structure and function to the risk for general psychopathology.

How Self-Regulation and Executive Functions Deficits Affect Quality of Life of Children/Adolescents with Emotional Regulation Disorders

BACKGROUND

Deficits in self-regulation and executive functions (EFs) frequently characterize children/adolescents with emotional regulation disorders and restrict their daily function and quality of life (QOL). These deficits are mainly manifested by neuropsychological measures in laboratory settings. This study aimed to compare self-regulation and EFs by ecological measures to reflect the implications in daily life between children with emotional regulation disorders and healthy controls and examine the relations between self-regulation, EFs and QOL in the study group.

METHODS

the participants were 49 children aged 8-18: 25 children/adolescents with emotional regulation disorders and 24 healthy children. The parents completed a socio-demographic questionnaire, the Child Behavior Checklist (CBCL), the Behavior Rating Inventory of Executive Functions (BRIEF) and the Pediatric Quality of Life Inventory (Peds-QL).

RESULTS

The study group had greater self-regulation difficulties (internalization and externalization problems), executive dysfunctions (EFdys) (including metacognition difficulties) and a lower QOL. Their internalization and externalization problems correlated with reduced EFs and QOL. Internalization predicted the physical and emotional QOLs, while metacognition predicted social and school-related QOLs.

CONCLUSIONS

Deficits in self-regulation and EFs are prevalent in children/adolescents with emotional disorders and restrict their daily function and QOL. Therefore, they should be routinely evaluated by ecological instruments to reflect daily restrictions.

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

Background

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

Methods

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

Results

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

Conclusion

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

Clinical trial registration

www.ClinicalTrials.gov, identifier NCT03167307.

Exposure to conflicting COVID-19 information in undergraduates: Implications for pandemic-related information-seeking and concern, attention, and cognitive workload

Objectives: To examine college students' conflicting COVID-19 information exposure, information-seeking, concern, and cognitive functioning. Participants: 179 undergraduates were recruited in March-April 2020, and 220 in September 2020 (Samples 1 and 2, respectively). Methods: Students completed the Attention Network Test, NASA Task Load Index, and COVID-related questions. Results: In Sample 1, exposure to conflicting information predicted poorer attentional performance and greater COVID-related information-seeking and concern; concern was correlated with workload. In Sample 2, conflicting information was associated with information-seeking. In Sample 1, but not Sample 2, cognitive effects of conflicting information were mediated by information-seeking and virus-related concern. Conclusions: Conflicting COVID-19 information may undermine students' cognitive functions, bearing implications for health, academic performance, and stress. Strategies for countering these effects include enhancing the clarity of institutional messaging, and tailoring course curricula and offering workshops to students, faculty, administrators, and counseling staff to augment students' capacity to comprehend and utilize COVID-related communications.

Childhood trauma and internalizing and externalizing behavior problems among adolescents: Role of executive function and life events stress

INTRODUCTION

Exposure to childhood trauma is found to increase internalizing and externalizing behavior problems in adolescents, however, the potential mechanism of this link remains underexplored. This study investigated the associations between childhood trauma and internalizing and externalizing behavior problems among adolescents, and tested the mediating role of executive function and the moderating role of life events stress in this relationship.

METHODS

Questionnaire data were collected from 952 junior students in Northwest China. Participants ranged in age from 11 to 15 years old (M = 12.88 years, SD = 0.72; 53% females). SPSS 26.0 was used to analyze the relationship between variables and examine the mediation model and the moderated mediation model.

RESULTS

Childhood trauma was positively associated with internalizing and externalizing behavior problems among adolescents. In addition, executive function partially mediated the relations between childhood trauma and internalizing and externalizing behavior problems. Life events stress was observed to moderate the relations between childhood trauma and executive function, as well as executive function and internalizing and externalizing behavior problems, but the effect sizes were relatively small.

CONCLUSIONS

These findings underscore the role of executive function and life events stress in the association between childhood trauma and behavioral problems among adolescents.

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

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

Developmental competencies, temperament, parenting practices and psychosocial adversities in children with internalising disorders - A pilot study

Research on the aetiology of internalising disorders has focussed on biological and environmental factors, however, the role of developmental competencies that a child acquires has not been explored much. The current report aimed to understand the association among the developmental competencies, temperament, parenting practices and psychosocial adversities in internalising disorders. The sample consisted of 30 children and adolescents with internalising disorders belonging to the age group of six to 18, and one of their parents. All the participants were assessed for functional impairment, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events and family environment using standardised tools. The findings revealed that positive parenting shares a negative relationship with functional impairment(ρ=-0.62; p <.001). On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. In conclusion, the current study indicates that children with internalising disorders differ from control groups in specific developmental competences. These findings have specific implications for intervention and research in the area of internalising disorders in children and adolescents.

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

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

Longitudinal relations between impaired executive function and symptoms of psychiatric disorders in childhood

BACKGROUND

Malfunctioning of executive functions correlates with psychopathology in children. However, the directionality, the extent to which the relation varies for various disorders, and whether prospective relations afford causal interpretations are not known.

METHODS

A community sample of Norwegian children (n = 874) was studied biennially from the age of 6 to 14 years. Executive functions were assessed using the Behavior Rating Inventory of Executive Function Teacher-report and symptoms of psychopathology were assessed using the Preschool Age Psychiatric Assessment (age 6; parents) and Child and Adolescent Psychiatric Assessment (ages 8-14; children and parents). Prospective reciprocal relations were examined using a random intercept cross-lagged panel model that adjusts for all unobserved time-invariant confounders.

RESULTS

Even when time-invariant confounders were accounted for, reduced executive functions predicted increased symptoms of depressive disorders, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) 2 years later, even when previous changes in these symptoms were adjusted for. The level of prediction (B = .83, 95% CI [.37, 1.3]) was not different for different disorders or ages. Conversely, reduced executive functions were predicted by increased symptoms of all disorders (B = .01, 95% CI [.01, .02]).

CONCLUSIONS

Reduced executive functioning may be involved in the etiology of depression, anxiety, ADHD, and ODD/CD to an equal extent. Moreover, increased depression, anxiety, ADHD, and ODD/CD may negatively impact executive functioning.

Exploring the relationship between suicide vulnerability, impulsivity and executive functioning during COVID-19: A longitudinal analysis

Public health emergencies increase the presence and severity of multiple suicide risk factors and thus may increase suicide vulnerability. Understanding how suicide risk factors interact throughout the course of a global pandemic can inform how to help the most vulnerable groups in society. The aims of the research were to explore the associations between, and changes in, suicide vulnerability, COVID-related stress, worry, rumination, executive functioning and impulsivity across the first 6 weeks of UK lockdown (1st April – May 17, 2020). 418 adults in the UK completed an online survey at three time points during the first lockdown (Time 1 (April 1–5th), Time 2 (April 15–19th April), Time 3 (May 13–17th). Impulsivity and executive functioning remained stable across the first six weeks of UK lockdown. COVID-related stress, worry, and rumination decreased throughout the 6 weeks. Suicide vulnerability was associated with greater impulsivity and poorer executive functioning. Sub-group analysis revealed individuals vulnerable to suicide reported worse COVID-related stress, poorer executive function and greater impulsivity than individuals who reported no suicide vulnerability. Individuals vulnerable to suicide appear to have experienced poorer executive functioning, greater impulsivity and COVID-related stress in the initial phase of the COVID-19 pandemic.

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

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

Targeting cognitive control to reduce anxiety in very young children: A proof of concept study

OBJECTIVE

Underdeveloped cognitive control (CC)-the capacity to flexibly adjust to changing environments-may predispose some children to early onset anxiety disorders and represents a promising intervention target. The current study established and pilot-tested "Camp Kidpower"-a novel group-based, interactive CC training intervention-and assessed its impacts on behavioral and neurophysiological indices of CC among preschool children with elevated anxiety symptoms.

METHODS

Forty-four anxious children (4-6 years) were enrolled in Camp Kidpower, delivered in four sessions over 10 days. Before and after camp, children's capacity for CC was measured using well-validated, non-trained behavioral tasks and error-related negativity (ERN). Child anxiety symptoms were measured by parent report on the Spence Preschool Anxiety Scale.

RESULTS

Thirty-two children completed the study, as defined by completion of pre- and follow-up assessments and at least three camp sessions. From baseline to after camp, performance on behavioral tests of CC improved, ERN amplitude increased, and anxiety symptoms decreased.

CONCLUSION

Results provide initial evidence that play-based cognitive training targeted to behavioral and brain markers of CC reduces anxiety in preschoolers.

Effect of trait anxiety on cognitive flexibility: Evidence from event-related potentials and resting-state EEG

Individuals with anxiety often exhibit cognitive flexibility impairment; however, the neural underpinnings of this cognitive impairment remain unclear. In this study, 45 participants were instructed to complete a task-switching assessment of shifting function by EEG technology, and 200 participants were included in microstate analysis to study why cognitive flexibility is impaired and the neuromechanism. Behaviorally, a positive correlation between trait anxiety scores and set shifting cost was found. At the EEG level, there was a positive correlation between trait anxiety scores and frontal P2 peaks under the shifting condition, which was related to the activation of the stimulus-response associations by attention. Furthermore, microstate analysis was used to analyze EEG functional networks, and TA scores had significant positive correlations with the Occurrence of class D and the Contribution of class D, which was related to the dorsal attention network. These results provided direct neuroelectrophysiological evidence that trait anxiety impairs cognitive flexibility when shifting is required.

Study of Positive and Negative Affect and Neurocognitive Functioning in Adolescents

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

Psychometric properties and clinical utility of the executive function inventory for children and adolescents: a large multistage populational study including children with ADHD

Executive functions (EF) are a set of high order mental abilities that regulate cognition, emotions, and behavior. This study aims to report the construction and validation of a rating scale instrument for EF in children and adolescents aged from 5 to 18 years (EFICA), as well as to report the results of a comparison between children with ADHD and their peers without it. Thus, we conducted a population-based cross-sectional study relying on a sample composed of 3,284 typical children and adolescents accessed to study the psychometric properties of the parents' inventory (EFICA-P) and the teacher's inventory (EFICA-T) within a Structural Equation Modeling framework (SEM). Exploratory and confirmatory analyses were fitted, as well as the Cronbach's alpha and the McDonald's omega reliability indices. The known-groups method was carried out by independent Welch t-tests between untreated ADHD children and their peers. We concluded that the parents' inventory is composed of three dimensions (Cool Index 1, Cool Index 2, and Hot Index): χ² (1,649) = 4,607.852 p < .01, CFI = .965, TLI .963, RMSEA = .053, whereas the teachers´ inventory is composed of two dimensions (Cool Index and Hot Index): χ² (1,273) = 5,158.240, p < .01, CFI = .991, TLI = .991, RMSEA = .077. The internal consistency of both inventories was >.9. Significant differences between the ADHD groups were found in all domains accessed. These findings indicate that both inventories have a high degree of validity regarding their internal structures, as well as supporting their clinical utility.

Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: A serial two-mediator model

BACKGROUND

Adult attention-deficit/hyperactivity disorder (ADHD) is associated with impaired executive function (EF), depressive/anxiety symptoms, and poor quality of life (QoL). In this study, we aimed to investigate correlations among these variables and to build a simple or serial mediation model for exploring the mechanisms between adult ADHD and QoL.

METHODS

This was a cross-sectional study. The sample included 223 participants with ADHD and 54 healthy volunteers. Participants were required to complete the following scales: ADHD Rating Scale (ADHD-RS), Brief Version of the World Health Organization Quality of Life Scale (WHOQOL-BREF), Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS). Correlations among EF, depressive/anxiety symptoms and QoL were analyzed using Pearson correlation. The simple and serial mediation models were analyzed using PROCESS (version 3.3).

RESULTS

The correlations between EF and QoL, depressive/anxiety symptoms and QoL, and depressive/anxiety symptoms and EF were statistically significant. In ADHD adults with comorbidities, the correlation coefficients were between -0.19 and -0.47, -0.20 and -0.62, 0.28 and 0.50, respectively. In simple mediation models, EF and depressive/anxiety symptoms were significant mediators respectively between ADHD and QoL, respectively. In a serial two-mediator model, ADHD could affect QoL indirectly via EF and then via depressive/anxiety symptoms significantly.

LIMITATIONS

The average age was young, the degree of education was high, and only self-reported scales were relied on.

CONCLUSIONS

There is a mutual effect between EF and emotional symptoms. This was the first study to build a serial two-mediator model between ADHD and QoL, suggesting the importance of EF and depressive/anxiety symptoms.

Executive Functions and Theory of Mind Skills of Sexually Abused Female Adolescents and Their Externalizing and the Internalizing Behavioral Problems

Sexually abused children (SAC) often experience acute and chronic adverse psychological and physiological effects later in life. This study aims to evaluate psychiatric diagnoses, Executive Functions (EF) and Theory of Mind (ToM) skills deficiencies in sexually abused female adolescents and examine the relation of these deficiencies with externalizing and internalizing behavioral problems. The patient group comprised 42 female adolescents aged 14-18 years (mean = 16.42, standard deviation = 1.01). The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version, Dokuz Eylül ToM Index and Reading the Mind in the Eyes test were applied. The Behavior Rating Inventory of Executive Function, Strengths and Difficulties Questionnaire, and Kiddo-KINDL were completed by the participants and their families. A total of 57.2% (n = 24) were classified as SAC with internalizing behavior problems (SAC+I), whereas 66.7% (n = 28) comprised the SAC with externalizing behavior problems (SAC+A) subgroup. SAC+I showed deficits in EF and TOM. Some EF skills were found to be statistically weaker in SAC+A. There was no difference between SAC+A and SAC-A in the TOM tests. The results highlight the need to explore whether these deficiencies are due to psychiatric diseases or whether those who have disabilities in this field carry a higher risk of psychiatric disorder.

A preliminary investigation of childhood anxiety/depressive symptomatology and working memory across multiple units of analysis

This exploratory study examined multiple units of working memory (WM) analysis in a transdiagnostic, treatment-seeking, pediatric sample. This included a) an electroencephalography marker of WM (coupling of theta and gamma oscillations [i.e., theta-gamma coupling] in frontal brain regions), b) WM test performance, and c) parent-reported WM symptoms. A composite score combining each of these units of analysis correlated with self-reported depressive and anxiety symptoms, with only theta-gamma coupling independently predicted anxiety/depressive symptoms. Results confirm prior findings on the association between WM and anxiety/depression, although the majority of this variance was explained by frontal theta-gamma coupling during WM demands.

Examining the Factor Structure and Incremental Validity of the Barkley Deficits in Executive Functioning Scale - Short Form in a Community Sample

The Barkley Deficits in Executive Functioning Scale - Short Form (BDEFS-SF; Barkley, 2011) was developed to assess deficits in five facets of executive functioning. Theoretical assumptions surrounding the BDEFS-SF presume that executive dysfunction is an overarching construct that consists of five domain-specific factors (i.e., a hierarchical model; Barkley, 2011). Prior research has supported a correlated five-factor model, but the tenability of hierarchical or bifactor models of the BDEFS-SF have not yet been tested. In the present study (N = 1,120 community adults), confirmatory factor analysis was used to compare four theoretically relevant models of the BDEFS-SF (i.e., one-factor, correlated five-factor, hierarchical, and bifactor models). The bifactor model provided the best fit to the data. However, the general factor accounted for the overwhelming majority of variance in BDEFS-SF scores and none of the domain-specific factors exhibited adequate construct replicability or factor determinancy. Further, the general factor accounted for the overhelming majority of variance in criterion variables (i.e., executive attention and health anxiety); the Organization and Emotion factors accounted for a small amount of unique variance in executive attention and the Emotion factor accounted for a small amount of unique variance in health anxiety. Taken together, study findings suggest that the BDEFS-SF has a strong general factor and independent use of the domain-specific factors is contraindicated.

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

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

Internalising symptoms in Developmental Coordination Disorder: The indirect effect of everyday executive function

BACKGROUND

Individuals with Developmental Coordination Disorder (DCD) report elevated executive function (EF) difficulties and internalising symptoms. Previous research suggests EF is important for wellbeing, yet no research has examined its role in internalising symptoms in DCD.

AIMS

To explore an indirect relationship between DCD and internalising symptoms, through everyday EF difficulties.

METHOD AND PROCEDURES

Thirty-two children with a DCD diagnosis and 51 typically-developing children (ages 8-15) participated. A cross-sectional survey was conducted to collect parent-reported EF and self-reported internalising symptoms.

OUTCOMES AND RESULTS

Internalising symptoms and everyday EF difficulties were significantly higher in the DCD group. A bias-corrected, bootstrapped mediation analysis identified an indirect effect of everyday EF difficulties on the relationship between DCD diagnosis and internalising symptoms.

CONCLUSIONS AND IMPLICATIONS

This supports previous research indicating that individuals with DCD experience greater levels of internalising symptoms and EF difficulties than peers. It is the first to suggest an indirect effect of everyday EF difficulties in the pathway between DCD and internalising symptoms. This highlights hypotheses for future research into the role of EFs in understanding mental health in DCD. It suggests benefits from increased awareness, routine screening, and intervention for mental health and EF in people with poor motor skills.

Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

BACKGROUND

The present study examined the effectiveness of a transdiagnostic prevention programme, Super Skills for Life (SSL), among children and adolescents with emotional problems in residential care institutions (RCIs) in the low- and middle-income country of Mauritius using a randomised waitlist-controlled trial (RCT). SSL is based on the principles of cognitive behavioural therapy, behavioural activation, social skills training, and uses video-feedback and cognitive preparation as part of the treatment.

METHODS

The RCT involved 100 children and adolescents aged 9 to 14 years, from six RCIs, randomly allocated to either an SSL intervention group (IG) or a waitlist-control (WLC) group. A set of questionnaires measuring internalising and externalising problems, emotion regulation and self-esteem, and experimental tasks measuring attentional bias and inhibitory control, were completed at baseline, post-intervention and 3-month follow-up. Participants also completed a 2-min video speech task during the first and final sessions of the SSL intervention.

RESULTS

Children and adolescents in the IG showed significant improvements in internalising symptoms (e.g. anxiety and depression), externalising symptoms (e.g. conduct problems and hyperactivity), and inhibitory control, and an increase in adaptive (except putting into perspective strategy) and decrease in maladaptive emotion regulation strategies, at both post-intervention and follow-up. These findings were not replicated among children in the WLC.

LIMITATIONS

The small sample size and lack of an active control group were the major limitations of this study.

CONCLUSIONS

This study provides evidence for the effectiveness of a transdiagnostic prevention programme for emotional problems in RCIs in a low- and middle-income country.

Executive functioning moderates neural reward processing in youth

Although executive functioning has traditionally been studied in "cool" settings removed from emotional contexts, it is highly relevant in "hot" emotionally salient settings such as reward processing. Furthermore, brain structures related to "cool" executive functioning and "hot" reward-related processes develop simultaneously, yet little is known about how executive functioning modulates neural processes related to reward processing during adolescence, a period of time when these systems are still developing. The present study examined how performance on "cool" behavioral executive functioning measures moderates neural reward processing. Youths (N = 43, M_age = 13.74 years, SD = 1.81 years) completed a child-friendly monetary incentive delay task during fMRI acquisition that captures neural responses to reward anticipation and to reward receipt and omission. Performance on inhibitory control and cognitive flexibility measures, captured outside the scanner, was used to predict brain activation and seed-based connectivity (ventral striatum and amygdala). Across analyses, we found that executive functioning moderated youths' neural responses during both reward anticipation and performance feedback, predominantly with respect to amygdala connectivity with prefrontal/frontal and temporal structures, supporting previous theoretical models of brain development during adolescence. Overall, youths with worse executive functioning had more pronounced differences in neural activation and connectivity between task conditions compared with youths with better executive functioning. This study contributes to elucidating the relationship between "cool" and "hot" processes and our findings demonstrate that simple executive functioning skills moderate more complex processes that involve incorporation of numerous skills in an emotionally salient context, such as reward processing.

Individual differences in affective flexibility predict future anxiety and worry

Deficits in cognitive flexibility have been associated with anxiety and worry, however few studies have assessed cognitive flexibility in the context of emotional stimuli (i.e. affective flexibility). The present study (n = 79) investigated whether individual differences in affective flexibility predict levels of trait anxiety and worry over a period of seven weeks. Affective flexibility was measured using a task-switching paradigm. Results showed that less efficient shifting of attention towards affective aspects of positive stimuli predicted higher anxiety over time. Additionally, more efficient shifting of attention away from affective towards non-affective aspects of negative stimuli predicted higher anxiety and worry over time. This latter finding may be understood by considering theoretical models and empirical evidence associating avoidance of negative information with increased anxiety. The effects were small and require replication in larger, representative samples, but they are an initial indication that anxiety may not be associated with general impairments in cognitive flexibility. Instead, our study emphasises the importance of breaking down cognitive flexibility into different components to investigate more nuanced relationships.

Predicting Late Adolescent Anxiety From Early Adolescent Environmental Stress Exposure: Cognitive Control as Mediator

Early exposure to stressful life events is associated with greater risk of chronic diseases and mental health problems, including anxiety. However, there is significant variation in how individuals respond to environmental adversity, perhaps due to individual differences in processing and regulating emotional information. Differences in cognitive control - processes necessary for implementing goal directed behavior - have been linked to both stress exposure and anxiety, but the directionality of these links is unclear. The present study investigated the longitudinal pathway of environmental stress exposure during early adolescence on later adolescent anxiety, and the possible mediating mechanism of cognitive control. Participants were 674 Mexican-origin adolescents (meanage = 10.8 years, 50% male) enrolled in the California Families Project, an ongoing longitudinal study of Mexican-origin families. In the current analysis, we examined self-reports of environmental stressors at age 14 (Time 1), cognitive control at age 16 (Time 2), and anxiety at age 18 (Time 3). Structural equation modeling revealed that environmental stressors (Time 1) had both direct and indirect effects on later anxiety (Time 3) through their effects on cognitive control (Time 2), even when accounting for prior levels of anxiety (Time 2). Cognitive control accounted for 18% of the association between environmental stressors and adolescent anxiety: an increase in stressors decreased cognitive control (β = -0.20, p < 0.001), however, cognitive control buffers against anxiety (β = -0.10, p = 0.004). These findings deepen our understanding of the mechanisms underlying the development of anxiety and highlight the importance of cognitive control as a potential protective factor.

Measurement of executive functioning with the National Institute of Health Toolbox and the association to anxiety/depressive symptomatology in childhood/adolescence

INTRODUCTION

Despite preliminary research, there remain inconsistent findings with regard to the role of executive functioning (EF) deficits in childhood anxiety and depression. This report examined the association of The National Institute of Health (NIH) Toolbox to clinical neuropsychological measures and to childhood, anxiety/depressive symptomatology. Methods: One-hundred eight children and adolescents completed the three EF measures from the NIH Toolbox (List Sorting Working Memory Test [LSWMT], Dimensional Change Card Sorting Test [DCCST], and Flanker Test of Attention and Inhibition [Flanker]) in an outpatient neuropsychology program. These tests were compared to established measures of EF in terms of linear correlations and detection of impairment. Heaton's Global Deficit Score (GDS) was utilized to calculate impairment. The Toolbox-EF measures were paired with parent-reported EF symptoms (Behavior Rating Inventory of Executive Function [BRIEF2]) to identify the role of EF in childhood anxiety/depressive symptomatology.

RESULTS

Toolbox-EF measures displayed medium sized correlations with their clinically comparable counterparts, and generally did not differ in their detection of impairment. Toolbox-GDS was associated with depression diagnosis and clinically significant child-reported anxiety and depressive symptoms. Together, Toolbox/BRIEF2 accounted for 26.8-30.9% of elevated depressive symptom variance, but only 13.2-14% of elevated anxiety symptom variance. Further, EF impairment was associated with depression across self report, parent report, and clinical diagnosis.

DISCUSSION

The NIH Toolbox-EF measures display comparable psychometric properties to clinically available EF measures in a pediatric (primarily psychiatric) neuropsychology setting. The Toolbox appears to display an appropriate ability to detect EF deficits secondary to self-reported depression in childhood.

Associations of Early Socio-familial Stress with Maladaptive and Adaptive Functioning in Middle Childhood: Roles of Executive Control and Foundational Cognitive Abilities

This study examined whether cognitive processes in preschool, conceptualized as a unitary construct of executive control (EC) as well as foundational cognitive abilities (FCA), predict both maladaptive and adaptive functioning in middle childhood and mediate associations between early childhood socio-familial stress and those functional outcomes. Performance-based, multidimensional, and age-appropriate measures of EC and FCA were collected in a laboratory setting from 313 preschool-age children at age 5, along with questionnaire data from children and their parents on three dimensions of early socio-familial stress and parent smoking. Parent, teacher, and child self-report data on 285 of these children were obtained when they were in grade 3 or 4. Middle childhood data were used to create indices of maladaptive and adaptive functioning. A bi-factor structural equation modeling analysis captured distinct dimensions of preschool EC and FCA and was used to test the hypothesized pathways. EC had a statistically significant negative association with later maladaptive functioning. FCA, but not EC, served as a mediator in links between each type of family stressor and both maladaptive and adaptive functioning in middle childhood. Results suggest that EC may play a role in predicting maladaptation, whereas early childhood FCA may operate as an intervening variable in pathways from early family stressors to subsequent maladaptation as well as adaptation. Findings point to the need to address FCA by reducing early family stressors. Early interventions that enhance cognitive abilities may help reduce maladaptive and promote adaptive functioning later in childhood, thereby potentially preventing, in turn, later behavioral problems.

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

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

Disrupted intrinsic functional connectivity of the cognitive control network underlies disease severity and executive dysfunction in first-episode, treatment-naive adolescent depression

BACKGROUND

Previous neuroimaging studies have showed that imbalanced functional integration of distributed large-scale brain networks is associated with pathophysiological characteristics of major depressive disorder (MDD). However, the association between network integrative disturbances and clinical features and cognitive functions remains largely unclear in adolescent MDD. This study investigated the neural correlates of abnormal functional connectivity networks with clinical and cognitive characteristics in adolescent MDD.

METHODS

Twenty-eight first-episode, treatment-naive adolescents with MDD and 24 well-matched healthy controls (HCs) underwent functional magnetic resonance imaging (fMRI) and a battery of cognitive tests. A seed-based functional connectivity (FC) approach was used to depict connectivity patterns of the cognitive control network (CCN), affective network (AN) and default mode network (DMN), whose between-group differences were correlated with clinical variables and cognitive functions in the patients.

RESULTS

Compared with the HCs, the MDD patients exhibited impaired executive functions. The FC analysis revealed lower CCN FC with the temporal, parietal and frontal regions and the limbic system, higher AN FC with the temporal and occipital regions and the cerebellum, and lower DMN FC with the cerebellum and insula. Interestingly, the decreased CCN FC was related to disease severity (with the inferior frontal gyrus) and executive dysfunctions (with the middle cingulate gyrus and supramarginal gyrus) in the patients.

LIMITATIONS

The main limitations were the relatively small sample size and suboptimal imaging parameters.

CONCLUSION

Functional alteration of CCN during the developmentally sensitive period may be important in the neurobiology of adolescent MDD.

A Meta-Analysis of Relationships between Measures of Wisconsin Card Sorting and Intelligence

The Wisconsin Card Sorting Test (WCST) represents a widely utilized neuropsychological assessment technique for executive function. This meta-analysis examined the discriminant validity of the WCST for the assessment of mental shifting, considered as an essential subcomponent of executive functioning, against traditional psychometric intelligence tests. A systematic search was conducted, resulting in 72 neuropsychological samples for the meta-analysis of relationships between WCST scores and a variety of intelligence quotient (IQ) domains. The study revealed low to medium-sized correlations with IQ domains across all WCST scores that could be investigated. Verbal/crystallized IQ and performance/fluid IQ were indistinguishably associated with WCST scores. To conclude, the WCST assesses cognitive functions that might be partially separable from common conceptualizations of intelligence. More vigorous initiatives to validate putative indicators of executive function against intelligence are required.

Neurocognitive Predictors of Clinical Improvement in Selective Serotonin Reuptake Inhibitor-Treated Adolescents with Major Depressive Disorder

OBJECTIVES

Numerous studies have suggested cognitive deficits as consistently associated with adolescent depression. No study to date, however, has assessed neurocognitive predictors of selective serotonin reuptake inhibitor (SSRI) treatment response in adolescents with depression. This study examined neurocognitive tasks at baseline as predictors of clinical improvement with SSRI treatment (fluoxetine) at week 6 and 12 in an adolescent population.

METHODS

Adolescents with depression were recruited from a child and adolescent psychiatry outpatient clinic at a university medical center. Twenty-four adolescents (mean age 14.8 years) with Major Depressive Disorder completed tasks of the Cambridge Neuropsychological Test Automated Battery, including visual memory, executive functioning, sustained attention, and impulsivity. Depression severity, measured by the Children's Depression Rating Scale-Revised (CDRS-R), was assessed at week 6 and 12 and clinical improvement was defined as percentage (%) change in CDRS-R from baseline.

RESULTS

Clinical improvement is noted at both week 6 (mean % change in CDRS-R [M] = 46.8, standard deviation [SD] = 51.9) and week 12 (M = 87.9, SD = 57.2). Results reveal that less difficulty in sustained attention (p = 0.02), lower impulsivity (p = 0.00), and better planning (p = 0.04) at baseline were predictors of greater clinical improvement at week 6. Lower impulsivity at baseline remained significantly predictive of clinical improvement at week 12 (p = 0.01).

CONCLUSION

Neurocognitive assessments could potentially help identify a subset of depressed adolescents who may not respond to conventional SSRI treatment and who may be better candidates for alternative or augmentation treatments.

Depression and neurocognitive dysfunction in pediatric and young adult chronic kidney disease

BACKGROUND

Depression affects 7-35% of children with chronic kidney disease (CKD), and in adults with CKD, the presence of depression links to poorer medical outcomes, social functioning difficulties, and neurocognitive impairments. The relationship between depression and neurocognitive function in youth with CKD is unclear. We sought to identify factors associated with depression in youth with CKD and to determine whether depression affects neurocognitive performance.

METHODS

We conducted cross-sectional analyses in 71 CKD and 64 control participants aged 8 to 25 years who completed depression inventories and neurocognitive assessments as part of the Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with CKD Study. In the CKD group, multivariable logistic regression analysis determined associations between clinical and demographic factors and depression. In the full study cohort, multivariable linear regression analyses, including an interaction term between CKD status and depression evaluated the effect of depression on 11 neurocognitive outcome domains.

RESULTS

Obesity significantly associated with depression in the CKD group (OR 10.25, P = 0.01). In adjusted analyses, depressed youth with CKD scored worse than non-depressed CKD participants by 0.6-1.0 standard deviations in 5 neurocognitive domains: attention, visual memory, visual-spatial, visual working memory, and problem solving.

CONCLUSIONS

CKD youth with obesity are more likely to be depressed, and those who are depressed exhibit worse neurocognitive performance. Depression may represent a therapeutic target to improve neurocognitive performance in youth with CKD.

Parental Demandingness and Executive Functioning in Predicting Anxiety among Children in a Longitudinal Community Study

Theoretical models and empirical studies of anxiety have predominately focused on the main effects of various predictors such as executive functioning deficits on anxiety. This study examined the moderating role of parental demandingness in the relationship between executive functioning deficits and anxiety in children. Ninety children (46.67% female) aged from 9 to 14 years completed several executive functioning tasks and a measure of anxiety. Parental demandingness was rated based on an observation of parent-child interactions. The children completed the anxiety measure again at one-year follow-up. The results showed that parental demandingness significantly moderated the prospective relationship between executive functioning deficits and anxiety, such that the association between executive functioning deficits and anxiety in children was weaker when parental demandingness was lower. These findings suggest that low parental demandingness may serve as a protective factor that buffers the detrimental effects of executive functioning deficits on anxiety.

Self-Regulation in Early and Middle Childhood as a Precursor to Social Adjustment Among Low-Income, Ethnic Minority Children

Although existing research has shed much light on the development of ethnic minority children, many studies focus on maladjustment, such as behavioral problems, without also speaking to positive experiences in children's lives, such as friendship. An aspect of development that predicts both positive and negative outcomes for children is self-regulation. The present study investigates precursors and sequelae of self-regulation in middle childhood among low-income, ethnic minority children. The four self-regulatory constructs examined in the current study include low-level executive function (EF; e.g., working memory), high-level EF (e.g., planning), effortful control (EC; e.g., delay of gratification), and impulsivity (e.g., does not think before doing). EC in preschool was related to high-level EF and impulsivity in elementary school. High-level EF explained positive and negative aspects of social development during middle childhood. Additionally, self-regulation during elementary school played a mediating role between EC in preschool and social development in middle childhood.