Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function-Adult version in healthy adults and application to attention-deficit/hyperactivity disorder

Profile of Executive Functioning and Lifetime History of Acquired Brain Injury in Young Adults Experiencing Homelessness: A Pilot Study

(1) Background: Housing instability is a public health issue in both developed and developing countries. This exploratory pilot study examines executive functioning (EF) and the history of acquired brain injury (ABI) in youth and young adults experiencing homelessness (YYEH). (2) Methods: Twenty-three YYEH (ages 18-25; 48% male) were recruited from a drop-in center in Central Ohio. The Ohio State University TBI Identification Method (OSU TBI-ID+ABI) was used to screen for exposure to ABI. Outcomes were measured using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) and the NIH Toolbox Cognitive Battery. (3) Results: Eighty-seven percent of participants reported a lifetime history of ABI, including traumatic brain injury or hypoxic-anoxic brain injury. Overall, participants did not present with elevated EF scores on outcome measures. Those with multiple lifetime ABIs (n = 16) had significantly higher scores than those with a single ABI (n = 4), representing poorer EF, on shift, self-monitor, task monitor, and the Global Executive Composite of the BRIEF-A. There was no evidence of significant differences between participants on outcome measures based on injury mechanism. (4) Conclusions: In this pilot sample, those with multiple reported ABIs demonstrated decreased EF performance, and these differences were noted in specific areas of EF. To ensure YYEH have access to services, resource support and intervention providers should consider the cognitive profiles of the youth they serve.

Occupational Therapy Practice in Adult Rehabilitation of Persistent Postconcussion Symptoms: A Scoping Review

IMPORTANCE

The role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS) following mild traumatic brain injury is an emerging practice area. Research that contributes to growing knowledge and understanding of the profession's role may increase the recognition and visibility of occupational therapy in concussion rehabilitation programs.

OBJECTIVE

To identify and categorize (using World Health Organization International Classification of Functioning, Disability and Health [WHO ICF] One-Level Classification domains) existing literature that describes occupational therapy practice (including assessments and interventions) in the rehabilitation of adults with PPCS.

DATA SOURCES

Five scientific databases (MEDLINE, Embase, Emcare, PsycINFO, and CINAHL Complete) and gray literature were searched.

STUDY SELECTION AND DATA COLLECTION

Eligibility criteria included publications between 2013 and 2023, written in English, and within the peer-reviewed literature or on specified web domains (.gov, .edu, or .org).

FINDINGS

Nineteen publications from 16 sources met eligibility criteria, consisting of quantitative studies (n = 6); case studies, series, or reports (n = 3); qualitative studies (n = 2); systematic or scoping literature reviews (n = 2); and gray literature sources (n = 3). The United States was the origin for many sources (n = 10). Assessments and interventions reported were heterogenous, mapping across 27 of the 30 WHO ICF One-Level Classifications.

CONCLUSIONS AND RELEVANCE

Evidence to inform occupational therapy practice in adult PPCS rehabilitation is limited; however, some useful information about the assessments and interventions used by occupational therapists was found. At a time when considerable advancements in concussion rehabilitation are occurring, further research on evidence-informed occupational therapy practice is required. Plain-Language Summary: This study reviewed existing evidence about the role of occupational therapy in the rehabilitation of adults with persistent postconcussion symptoms (PPCS). It identifies and methodically documents a range of occupational therapy assessments and interventions described in the literature that may be used by occupational therapists within concussion rehabilitation programs or research. The study also categorizes these by using an internationally recognized taxonomy, the World Health Organization's International Classification of Functioning, Disability and Health. The review offers a novel synthesis of published evidence to guide occupational therapy practice and inform resource allocation in concussion rehabilitation. It also highlights the need for further research about the role of occupational therapy-including both high-quality evidence of current approaches and identification of future practice opportunities-in the rehabilitation of adults experiencing PPCS following brain injury.

Predicting emotional consequences of disorganization among adults with neurodevelopmental disorders: a structural equation model

PURPOSE

Previous studies exhibited differences in sensory processing, motor coordination, metacognitive executive functions (EF-MI), and sleep quality among adults with neurodevelopmental disorders (NDD). This study aims to find relationships between those abilities and organization-in-time, focusing on emotional responses after decreased organization abilities.

MATERIALS AND METHODS

This is a secondary data analysis of a larger sample from three previous studies conducted in one laboratory. Data were collected from 290 adults; 149 with NDD and 141 sex- and age- (20-50 years) matched controls completed the Adolescent/Adult Sensory Profile, Adult Developmental Coordination Disorder, Adults Behavioral Rating Inventory of Executive Functions, Mini Sleep, and Time Organization and Participation questionnaires. Structural equation model (SEM) analysed relationships and variable prediction.

RESULTS

Significant between-group differences were found for all variables; SEM indicated similar paths in both groups. Sensory processing affected EF-MI and sleep quality and significantly correlated with motor coordination, affecting EF-MI; EF-MI affected organization-in-time. Sleep quality significantly affected organization-in-time, affecting emotional responses.

CONCLUSIONS

Sensory, motor, EF, and sleep differences were associated with decreased organization-in-time abilities of adults with NDD, adversely affecting their emotional well-being. Early detection of such differences and targeted interventions may improve daily functioning and life quality and prevent negative emotional implications.

Negative impact of self-reported executive problems in patients with functional/dissociative seizures: Results from a prospective long-term observational study

OBJECTIVE

Functional/dissociative seizures (FDS) are common and pose a considerable burden on both individual patients and healthcare systems. Cognitive complaints are frequent in patients with FDS. Previous studies on cognitive function in patients with FDS have yielded mixed results. We investigated executive function and its impact on long-term outcome in a prospective sample of patients with FDS.

METHODS

Thirty-three inpatients (age range: 16-62 years) who had been admitted to the National Centre for Epilepsy in Norway with FDS underwent neuropsychological assessment for both tested and self-reported executive function, using the Behavior Rating Inventory of Executive Function, at baseline. Participants were evaluated for their medical status at a mean of 5.5 years (SD 2.4, range 1.9-10.9 years) after inclusion. To determine potential predictors of achieving cessation of FDS by time of follow-up a multivariate logistic regression analysis was conducted.

RESULTS

At follow-up, 14/33 (42 %) of the participants were FDS-free. Self-reported, but not tested, executive dysfunction was an independent risk factor for ongoing FDS at follow-up.

CONCLUSION

Our findings indicate an association between greater self-reported executive problems and poorer long term outcomes in patients with FDS. Screening for executive dysfunction with a self-report questionnaire may yield relevant information that could be used to guide psychological interventions.

A Functional Magnetic Resonance Imaging Investigation of Hot and Cool Executive Functions in Reward and Competition

Social and environmental influences are important for learning. However, the influence of reward and competition during social learning is less understood. The literature suggests that the ventromedial prefrontal cortex is implicated in hot executive functioning (EF), while the dorsolateral prefrontal cortex is related to cool EF. In addition, reward processing deficits are associated with atypical connectivity between the nucleus accumbens and the dorsofrontal regions. Here, we used functional magnetic resonance imaging (fMRI) to determine the role of hot and cool EF in reward processing and their relationship to performance under social competition. We adapted a reward-based n-back task to examine the neural correlates of hot and cool EF and the reward influence on performance during competition. A total of 29 healthy adults showed cortical activation associated with individual differences in EF abilities during fMRI scans. Hot and cool EF activated distinct networks in the right insula, hippocampus, left caudate nucleus, and superior parietal gyrus during the no-competition task, while they differentially activated the right precuneus and caudate nucleus in the competition condition. Further analysis revealed correlations between the Hot-Cool network and reward sensitivity and risk-taking behaviour. The findings provided further insights into the neural basis of hot and cool EF engagement in the socio-emotional regulation for learning.

Executive and adaptive function impacts long-term outcomes for adults with maple syrup urine disease

Successful transition to independent adulthood requires intact executive and adaptive function. These neurocognitive domains are frequently impaired in inherited metabolic disorders (IMD), despite optimal management. For many IMDs, the impact of executive and adaptive dysfunction on long-term outcomes remains undefined. Standardized assessments linking neurocognitive status with functional outcomes are needed to improve prognostication and tailor support for affected emerging adults. Maple syrup urine disease (MSUD), a relatively prevalent IMD, is primarily diagnosed in the first week of life through newborn screening. Despite early intervention, executive and adaptive dysfunction persist. We designed a remote, interactive battery of neurocognitive and functional assessments for adults (≥21 years) with MSUD to correlate neurocognition and long-term outcomes. Participants were selectively recruited for racial, ethnic, socio-economic, and geographic diversity. Assessments completed by 28 adults with MSUD (82% diagnosed after symptom onset, 25% from minority communities) show a wide range in educational attainment, employment, and residence. Executive and adaptive function were significantly impaired in adults with MSUD compared to controls. Executive and adaptive deficits correlated negatively with educational attainment, employment, and obtaining skills needed for adult-oriented healthcare or independent living. Clinical history did not predict functional outcomes, but neurocognitive assessments suggest the benefits of pre-symptomatic diagnosis. Independent adulthood is attainable for individuals with MSUD. Routine assessment of neurocognition and interventions targeting executive and adaptive function may improve long-term functional outcomes in IMD.

Psilocybin-assisted neurofeedback for the improvement of executive functions: a randomized semi-naturalistic-lab feasibility study

Executive function deficits, common in psychiatric disorders, hinder daily activities and may be linked to diminished neural plasticity, affecting treatment and training responsiveness. In this pioneering study, we evaluated the feasibility and preliminary efficacy of psilocybin-assisted frontal-midline theta neurofeedback (NF), a neuromodulation technique leveraging neuroplasticity, to improve executive functions (EFs). Thirty-seven eligible participants were randomized into an experimental group (n = 18) and a passive control group (n = 19). The experimental group underwent three microdose sessions and then three psilocybin-assisted NF sessions, without requiring psychological support, demonstrating the approach's feasibility. NF learning showed a statistical trend for increases in frontal-midline theta from session to session with a large effect size and non-significant but medium effect size dynamical changes within sessions. Placebo effects were consistent across groups, with no tasks-based EF improvements, but significant self-reported gains in daily EFs-working memory, shifting, monitoring and inhibition-showing medium and high effect sizes. The experimental group's significant gains in their key training goals underscored the approach's external relevance. A thorough study with regular sessions and an active control group is crucial to evaluate EFs improvement and their specificity in future. Psilocybin-enhanced NF could offer significant, lasting benefits across diagnoses, improving daily functioning. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Safety and Efficacy of Ashwagandha Root Extract on Cognition, Energy and Mood Problems in Adults: Prospective, Randomized, Placebo-Controlled Study

This prospective, randomized, placebo-controlled study assessed the effects of Ashwagandha root extract (ARE) on cognition, energy, and mood in adults with self-reported cognitive and energy problems. Healthy subjects aged 30-75 years were randomized to receive ashwagandha (Withania somnifera) root extract (ARE) 600 mg/day (n = 60)/identical placebo (n = 60) orally for 8 weeks. Cognitive function was assessed at baseline and week 8 using a Computerized Mental Performance Assessment System (COMPASS). Secondary outcomes were Profile of Mood States Abbreviated Version (POMS-A), Mental Fatigue Scale (MFS) and Behavior Rating Inventory of Executive Function-Adult (BRIEF-A) for effects on mood, mental fatigue and executive function, respectively, assessed at baseline, week 4 and 8. Greater improvement (p < .05) from baseline scores were seen with ARE as against placebo for COMPASS items episodic memory, working memory and accuracy of attention. ARE also improved the POMS-A, MFS and BRIEF-A scores from baseline suggesting an improvement in mood, vigor, and an increase in the executive functioning respectively with ARE. The herb was well tolerated and had a good patient compliance with no serious adverse events reported in either of the groups. This study suggests that a dose of 600 mg a day can improve cognition, energy, and mood in adults with self-reported cognitive and energy problems.

Maternal Sleep Quality and Executive Function are Associated with Perceptions of Infant Sleep

OBJECTIVES

This study examined the associations among maternal sleep quality, executive function, and perceptions of infant sleep in a sample of families recruited from human service and public health systems.

METHODS

Seventy-three mothers of infants 5-14 months old were included in the study. Mothers racially and ethnically identified as American Indian/Alaskan Native (4.1%), Asian (4.1%), Black/African American (12.3%), Latina (23.3%), more than one race (12.3%), Pacific Islander (1.4%), and White (42.5%). Mothers completed questionnaires assessing their own sleep (Pittsburgh Sleep Quality Index) and executive function (Behavior Rating Inventory of Executive Function) as well as their perceptions about their infant's sleep (Brief Infant Sleep Questionnaire).

RESULTS

Results of the path analysis indicated significant direct effects among maternal sleep quality, executive function, and perceptions of infant sleep. Significant indirect effects were found such that poor maternal sleep quality was linked to poorer perceptions of infant sleep through maternal executive dysfunction, adjusting for infant sleep patterns, infant age, and maternal race and ethnicity.

CONCLUSIONS

The current study highlights the potential role of maternal behavioral and cognitive factors in shaping mothers' perceptions about infant sleep. These findings support the need for health professionals and researchers to consider maternal sleep quality and executive function when addressing mothers' concerns about infant sleep.

A brief mindfulness-based intervention for stress, pain, emotion and attention regulation in military service members with mild traumatic brain injury

AIM

The primary aim of this study was to conduct an open pilot clinical trial of a brief mindfulness-based intervention for persistent postconcussion symptoms that occur after mild traumatic brain injury in military service members. For many service members, operational tempo and other time constraints may prevent them from completing a standard mindfulness-based stress reduction course. Thus, this study sought to examine the effectiveness of a five-session intervention called mindfulness-based stress, pain, emotion, and attention regulation (MSPEAR).

METHODS

Participants were active duty service members with a history of mild traumatic brain injury (TBI) and persisting postconcussion symptoms, all of whom were recruited from an outpatient TBI rehabilitation program at a military treatment facility. Of the 38 service members that were initially enrolled, 25 completed the 5-session MSPEAR intervention, and 20 returned for a 5-week follow-up evaluation. Questionnaires assessing perceived stress, positive affect, pain interference and catastrophizing, sleep disturbances, perceived behavioral and attention regulation, self-efficacy and satisfaction with life were administered at preintervention, postintervention, and at 5-week follow-up intervals. Neuropsychological testing at preintervention and 5-week follow-up included performance validity measures, attention, working memory, and executive function measures. T-tests were run to compare for questionnaire measures at preintervention (Time 1) to postintervention (Time 2). Repeated analysis of variances were conducted to compare questionnaire and neuropsychological measures at Time 1, Time 2, and at Time 3 which is the 5-week follow-up.

RESULTS

Improvements in perceived stress, positive affect, behavioral regulation, metacognition, sleep disturbance, self-efficacy, and satisfaction with life were found immediately after the MSPEAR intervention and were maintained at the 5-week follow-up. Magnification and helplessness aspects of pain catastrophizing improved when comparing preintervention to the 5-week follow-up. Pain interference was not significantly different across study assessment times. Neuropsychological testing revealed improvements in sustained attention, working memory, cognitive flexibility, and inhibitory control when comparing preintervention to the 5-week follow-up assessment.

CONCLUSIONS

The MSPEAR intervention appears to show promise as a brief and effective therapy for specific postconcussion symptoms after mild traumatic brain injury in military service members. Each of the components of MSPEAR including stress, pain catastrophizing, emotion and attention regulation showed improvements in this study, and bears further investigation in a larger scale, preferably randomized controlled trial in those active duty military service members who experience persisting symptoms after a mild traumatic brain injury.

Parental executive functions and motivations unveil variations in young children's screen media use

BACKGROUND

The increased screen media use among children aged 3 to 5, particularly in the post-COVID era, is concerning. Despite several organizations' recommendation of a one-hour screen limit for young children, actual usage often exceeds this guideline.

OBJECTIVE

This study explored the influence of parental characteristics such as self-efficacy, motivation, socioeconomic status, and cognitive abilities on children's screen time habits.

METHODS

Employing a feature selection model, 251 caregivers answered an online survey, presenting data from themselves and on-screen usage for 126 girls and 125 boys. We found that the caregiver's executive functions, including cognitive flexibility, initiation, task monitoring, and material organization, significantly impact children's screen time.

RESULTS

Our analysis highlighted the vital role of caregivers' self-efficacy in moderating children's screen usage. Family net income, children's age and gender, and motivations related to children's desires and behavioral control were also significant contributors to usage patterns.

CONCLUSION

This study offers insights into interventions and effective parenting strategies in the digital age, highlighting the importance of addressing socio-demographic factors in understanding this complex issue.

Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study

BACKGROUND

The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation.

METHODS

N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates.

RESULTS

The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five.

CONCLUSIONS

Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.

Measuring cognitive flexibility: A brief review of neuropsychological, self-report, and neuroscientific approaches

Cognitive flexibility involves dynamic processes that allow adaptation of our thinking and behavior in response to changing contextual demands. Despite a large consensus about its beneficial effects, cognitive flexibility is still poorly understood. In this mini review, we examined the main conceptualizations and approaches for assessing cognitive flexibility: (1) neuropsychological tasks, (2) self-report questionnaires, and (3) neuroscientific approaches. The reviewed evidence shows that the definition and assessment of cognitive flexibility are not unified within the field and suggests that a more consensual and consistent conceptualization and operationalization of this important concept is needed. We propose that an integrative behavior-brain-context approach can help advance our understanding of cognitive flexibility.

Clinical and Neuropathological Correlates of Substance Use in American Football Players

Background

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy more frequently found in deceased former football players. CTE has heterogeneous clinical presentations with multifactorial causes. Previous literature has shown substance use (alcohol/drug) can contribute to Alzheimer's disease and related tauopathies pathologically and clinically.

Objective

To examine the association between substance use and clinical and neuropathological endpoints of CTE.

Methods

Our sample included 429 deceased male football players. CTE was neuropathologically diagnosed. Informant interviews assessed features of substance use and history of treatment for substance use to define indicators: history of substance use treatment (yes vs no, primary variable), alcohol severity, and drug severity. Outcomes included scales that were completed by informants to assess cognition (Cognitive Difficulties Scale, BRIEF-A Metacognition Index), mood (Geriatric Depression Scale-15), behavioral regulation (BRIEF-A Behavioral Regulation Index, Barratt Impulsiveness Scale-11), functional ability (Functional Activities Questionnaire), as well as CTE status and cumulative p-tau burden. Regression models tested associations between substance use indicators and outcomes.

Results

Of the 429 football players (mean age = 62.07), 313 (73%) had autopsy confirmed CTE and 100 (23%) had substance use treatment history. Substance use treatment and alcohol/drug severity were associated with measures of behavioral regulation (FDR-p-values<0.05, ΔR2 = 0.04-0.18) and depression (FDR-p-values<0.05, ΔR2 = 0.02-0.05). Substance use indicators had minimal associations with cognitive scales, whereas p-tau burden was associated with all cognitive scales (p-values <0.05). Substance use treatment had no associations with neuropathological endpoints (FDR-p-values>0.05).

Conclusions

Among deceased football players, substance use was common and associated with clinical symptoms.

BRIEF-A: Factor structure and measurement invariance across self-report and informant forms

OBJECTIVE

This study analyzes the psychometric properties of the two forms (self-report and informant) of the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) in a sample of healthy Portuguese adults.

METHOD

The participants were 608 adults, 304 of whom answered the self-report form (ages 18-59; 137 male and 167 female) and 304 who answered the informant form (ages 18-70; 110 male and 194 female).

RESULTS

The internal consistency for the indexes and the Global Executive Composite was very good (≥.90), whereas for the scales they were either acceptable (between .70 and .80) or good (≥.80), except for the Inhibit scale in both forms. Confirmatory factor analysis was used to test seven competing factor models for each of the forms. The original two-factor model (Behavioral Regulation and Metacognition Indexes) showed a slightly better model fit than the three-factor model (Behavioral Regulation, Emotional Regulation, and Metacognition Indexes) in both forms. The multiple-group analysis of the two-correlated-factor model across forms was supported (configural, metric, and partial scalar invariance).

CONCLUSIONS

Overall, the BRIEF-A showed adequate psychometric properties, suggesting that it is a useful instrument to assess everyday executive functioning in healthy Portuguese adults.

The combined value of executive functions and self-regulated learning to predict differences in study success among higher education students

Introduction

Self-regulated learning (SRL) has traditionally been associated with study success in higher education. In contrast, study success is still rarely associated with executive functions (EF), while it is known from neuropsychological practice that EF can influence overall functioning and performance. However some studies have shown relationships between EF and study success, but this has mainly been investigated in school children and adolescents. EF refer to higher-order cognitive processes to regulate cognition, behavior, and emotion in service of adaptive and goal-directed behaviors. SRL is a dynamic process in which learners activate and maintain cognitions, affects, and behaviors to achieve personal learning goals. This study explores the added value of including EF and SRL to predict study success (i.e., the obtained credits).

Methods

In this study, we collected data from 315 first-year psychology students of a University of Applied Sciences in the Netherlands who completed questionnaires related to both EF (BRIEF) and SRL (MSLQ) two months after the start of the academic year. Credit points were obtained at the end of that first academic year. We used Structural Equation Modeling to test whether EF and SRL together explain more variance in study success than either concept alone.

Results

EF explains 19.8% of the variance, SRL 22.9%, and in line with our hypothesis, EF and SRL combined explain 39.8% of the variance in obtained credits.

Discussion

These results indicate that focusing on EF and SRL could lead to a better understanding of how higher education students learn successfully. This might be the objective of further investigation.

Neuropsychological Differences Between Surgery Interns and Age-Matched Adults

OBJECTIVE

The purpose of this study was to assess how neuropsychological factors differ between general surgery interns and normative data from age-matched adults in the general population.

DESIGN

Participants completed a comprehensive neuropsychological assessment battery. Neuropsychological factors assessed included: executive function (Behavioral Rating Inventory of Executive Function, BRIEF), working memory (Wechsler Adult Intelligence Scale, or WAIS, digit span), psychomotor speed (WAIS coding, Trails A and B), selective attention (D2 Test of Attention), and problem solving (Tower of London, TOL). Data for all measures was compared to previously published normative data for age-matched, healthy adults in the general population using one-sample t-tests.

SETTING

This study was completed at Indiana University School of Medicine in Indianapolis, IN, which is a large academic healthcare training institution.

PARTICIPANTS

Postgraduate year 1 general surgery residents (PGY1s) voluntarily participated in this study.

RESULTS

Twenty-six general surgery PGY1s completed all measures. We found that PGY1s had significantly better behavioral inhibition, working memory, selective attention, problem solving, and psychomotor speed than their counterparts in the general population (Table 1). Conversely, we found that PGY1s had significantly lower cognitive flexibility (p = 0.02) and ability to monitor task progress (p = 0.006) than the general population.

CONCLUSIONS

The results from this study indicate that there are several neuropsychological factors that may help explain the high achievement of general surgery PGY1s. Assessment of these factors could aid general surgery programs in the selection and training of high-caliber residents. However, there are indicators that PGY1s struggle from cognitive inflexibility and task monitoring compared to the general population. These skills are needed to manage the complex and dynamic nature of surgical performance, so educators should consider methods to enhance junior residents' development of these characteristics.

The Relations Between an Inventory-Based Measure of Executive Function and Impulsivity Factors in Alcohol- and Cannabis-Relevant Outcomes

OBJECTIVE

While the lack of relation between performance- and inventory-based executive function (EF) measures is well documented, there remains ambiguity between self-report EFs and closely related constructs (e.g., impulsivity) assessed via the same method. The degree of convergence between purported EF measures with similar yet distinct constructs contain important theoretical implications for available EF assessment strategies and their construct validity. A newer measure of EF, the Behavior Regulation Inventory of Executive Functions-Adult (BRIEF-A), allows for more direct comparisons to self-reported measures of impulsivity, such as the commonly used Urgency, Planning, Perseverance, Sensation Seeking-Positive Urgency (UPPS-P) assessment.

METHOD

The present study used factor analysis and hierarchical regression to explore the associations between the BRIEF-A and UPPS-P, using alcohol and cannabis consumption across various outcomes (i.e., quantity-frequency and consequences) as an external criterion. Participants were 339 undergraduate students (Mage = 19.35; Female = 63%) from a large southwestern university.

RESULTS

The BRIEF-A and UPPS-P demonstrated strong correlations at both higher- and lower order facets. While the BRIEF-A was a significant correlate to many substance use outcomes, these relations were generally weaker than those seen with the UPPS-P. Hierarchical regression suggested limited contributions of the BRIEF-A over and above the UPPS-P.

CONCLUSIONS

Overall, this study suggested substantial overlap between impulsigenic factors and EFs when measured by self-report, and limited utility of EF measures to account for unique variance with substance use outcomes in this sample.

Executive functioning as a moderator of flossing behaviour among young adults: a temporal self-regulation theory perspective

Background

Flossing among young adults is often infrequent and barriers not completely understood. One explanation concerns the capacity for executive functioning (EF) during the self-regulation of behaviour.

Methods

Using Temporal Self-Regulation Theory (TST) as a framework to explore EF, young adults from Norwegian universities completed a survey that measured monthly flossing frequency, flossing-related intentions and behavioural prepotency (BP), and EF using the Behaviour Rating Inventory of Executive Function - Adult Version (BRIEF-A).

Results

Data from 362 participants were analysed. The TST-model explained a substantial proportion of variance in monthly flossing (R2 = 0.74), and flossing was associated directly with intention and BP, and interactions between intention and both BP and global-EF. Sub-domains of EF were explored using the same model, revealing that behavioural regulation processes, specifically those related to emotional control and shifting between tasks, offered better fit. Simple slopes revealed that moderation effects were only present at lower levels of BP.

Conclusion

EF plays a role in moderating the translation of intentions into flossing behaviour. Specifically, emotional control and task-shifting appear to be influential, and this influence increases when habitual and environmental support (i.e. BP) is reduced. Overcoming EF-barriers may represent a key step in establishing flossing behaviours.

Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors

PURPOSE

Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls.

METHODS

A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity.

RESULTS

We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho >  - 0.29, p < .05). Distress did not correlate with salience network connectivity.

CONCLUSION

These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes.

IMPLICATIONS FOR CANCER SURVIVORS

Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.

Characteristics of Sluggish Cognitive Tempo among adults with ADHD: objective neurocognitive measures align with self-report of executive function

Introduction

Sluggish Cognitive Tempo (SCT) is a syndrome characterized by cognitive hypo-arousal that often appears as daytime sleepiness or drowsiness, mental fogginess, being easily confused, having difficulty with holding and manipulating information in working memory, and being forgetful. Although it frequently co-travels with attention-deficit/hyperactivity disorder (ADHD) or other conditions and confers significantly greater impairment, there are few studies examining SCT among adults with ADHD. Understanding what features SCT confers in association with ADHD, distinct from other conditions associating with ADHD, is critically important to confirm if SCT is a distinct syndrome that requires special assessment methods and special, distinct treatment efforts to reduce its impact. This study describes the clinical and neuropsychological features of SCT in a sample of adults with well-defined ADHD, and examines the relationship of SCT with other measures of ADHD, neurocognition, executive function (EF), and impairment.

Methods

A sample of n = 106 adults with ADHD, ages 18-57 years, was assessed for SCT using the Barkley SCT scale. Adults with (SCT+) and without (SCT-) SCT received a comprehensive clinical assessment battery, and neuropsychological testing. Clinical and neuropsychological variables were examined for their associations with SCT. The variables were treated with Principal Axis Factoring with Promax with Kaiser Normalization to elucidate latent constructs and determine performance profiles associated with SCT among people with ADHD.

Results

EF Deficits and emotional dyscontrol (ED) symptoms significantly differentiated adults with ADHD and SCT whether measured via self or clinician report. Additionally, significantly greater impairment via both clinician and participant report was seen in the SCT + versus SCT - cohorts. SCT was also associated with a significantly distinct profile on the neuropsychological battery, characterized by a pattern of slower latencies and cognitive strategy choices across CANTAB and WAIS subtests, that reveals difficulty with increased cognitive load, which primarily accounted for the higher level of impairment in the SCT group.

Discussion

The convergence of clinical ratings and neurocognitive measures of EF deficits is consistent with the conclusion that SCT represents a distinct subgroup of adults with ADHD.

Executive functions scale for university students: UEF-1

Introduction

Executive functions are a set of mental abilities that allow human beings to consciously regulate their behavior and, in a university setting, will have a significant impact on student success during professional training.

Objective

To develop a scale to assess executive functions in a university setting.

Method

Using a sample of 1,373 university students from Chile (663) and Ecuador (710) between 17 and 33 years old (M_age = 20.53, SD = 2.34). A study was carried out to analyze the psychometric properties of the instrument using a reliability and validity analysis for a scale that assesses executive functions: conscious monitoring of responsibilities, supervisory attentional system, conscious regulation of behavior, verification of behavior to learn, decision making, conscious regulation of emotions, and management of elements to solve tasks.

Results

Adequate internal consistency parameters were found between α = 0.71 and 0.85. The seven executive functions proposed on the scale correlated proportionally between r = 0.42 and 0.62. In the confirmatory factor analysis, good fit indices were obtained in the model of the seven executive functions x²₍₄₁₃₎ = 1649.14, p = <0.001, CFI = 0.91, SRMR = 0.04 and RMSEA = 0.04.

Discussion

The research carried out reaches its conclusion stating that the scale that was developed has the psychometric properties to assess executive functions in the Latin American setting. The results regarding previous research and the contribution made in the line of research of executive functions are discussed.

Viloxazine extended-release capsules for the treatment of attention-deficit/ hyperactivity disorder in adult patients

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with symptoms that may persist in up to 90% of adults diagnosed during childhood and continue to cause significant impairment throughout the lifespan. In the United States (US), amphetamine and methylphenidate formulations have been available to treat ADHD for several decades. Only one nonstimulant, atomoxetine, was available for the treatment of ADHD in adults until recently. In April 2022, a second nonstimulant, viloxazine extended-release (VLX-ER), became available in the US for the treatment of adult ADHD. Efficacy was previously established in placebo-controlled trials in children and adolescents.

AREAS COVERED

VLX-ER is a norepinephrine reuptake inhibitor with serotonin activity. The efficacy in adults, adverse event profile, pharmacokinetics, drug-drug interactions, and metabolism of VLX-ER are reviewed.

EXPERT OPINION

Despite the availability of effective pharmacological treatments for ADHD, many patients discontinue treatment in less than 1 year. Stimulants are effective in more than 80% of patients; however, some may have difficulty tolerating them. Although there were no head-to-head studies, the effect size of VLX-ER in an adult efficacy trial was lower than has been shown for stimulants. Nevertheless, the approval of VLX-ER adds another effective ADHD treatment option for adults.

Assessment of Self-Reported Executive Function in Patients with Irritable Bowel Syndrome Using a Machine-Learning Framework

Introduction: Irritable bowel syndrome (IBS) is characterized as a disorder of the gut-brain interaction (DGBI). Here, we explored the presence of problems related to executive function (EF) in patients with IBS and tested the relative importance of cognitive features involved in EF. Methods: A total of 44 patients with IBS and 22 healthy controls (HCs) completed the Behavior Rating Inventory of Executive Function (BRIEF-A), used to identify nine EF features. The PyCaret 3.0 machine-learning library in Python was used to explore the data, generate a robust model to classify patients with IBS versus HCs and identify the relative importance of the EF features in this model. The robustness of the model was evaluated by training the model on a subset of data and testing it on the unseen, hold-out dataset. Results: The explorative analysis showed that patients with IBS reported significantly more severe EF problems than the HC group on measures of working memory function, initiation, cognitive flexibility and emotional control. Impairment at a level in need of clinical attention was found in up to 40% on some of these scales. When the nine EF features were used as input to a collection of different binary classifiers, the Extreme Gradient Boosting algorithm (XGBoost) showed superior performance. The working memory subscale was consistently selected with the strongest importance in this model, followed by planning and emotional control. The goodness of the machine-learning model was confirmed in an unseen dataset by correctly classifying 85% of the IBS patients. Conclusions: The results showed the presence of EF-related problems in patients with IBS, with a substantial impact of problems related to working memory function. These results suggest that EF should be part of an assessment procedure when a patient presents other symptoms of IBS and that working memory function should be considered a target when treating patients with the disorder. Further studies should include measures of EF as part of the symptom cluster characterizing patients with IBS and other DGBIs.

Eye Gaze Patterns during Reasoning Provide Insights Regarding Individual Differences in Underlying Cognitive Abilities

Sequences of eye movements during performance of a reasoning task has provided insights into the strategies individuals use to solve that specific task; however, prior studies have not examined whether eye gaze metrics reflect cognitive abilities in a way that transcends a specific task. Thus, our study aimed to explore the relationship between eye movement sequences and other behavioral measures. Here, we present two studies that related different eye gaze metrics in a matrix reasoning task with performance on a different test of fluid reasoning and tests of planning, working memory, and cognitive flexibility. Additionally, we related gaze metrics to self-reported executive functioning in daily life, as measured by BRIEF-A. To perform this, we classified the participants' eye gaze in each item of the matrices test using an algorithm and then used LASSO regression models with the cognitive abilities as the dependent variable to select eye-tracking metrics to predict it. Overall, specific and distinct eye gaze metrics predicted 57% variance in the fluid reasoning scores; 17% variance in the planning scores; and 18% variance in the working memory scores. Taken together, these results support the hypothesis that the selected eye-tracking metrics reflect cognitive abilities that transcend specific tasks.

Performance on Cognitive Screening Tests and Long-Term Substance Use Outcomes in Patients with Polysubstance Use Disorder

INTRODUCTION

Cognitive impairments among patients with substance use disorders are prevalent and associated with adverse treatment outcomes. However, knowledge of the predictive value of broad cognitive screening instruments on long-term treatment outcomes is limited. The present study aimed to examine the predictive value of measures from the Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and the Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) on self-reported long-term substance use and abstinence in patients with polysubstance use disorders (pSUD).

METHODS

A cohort (N = 164) of patients with pSUD who started a new treatment sequence in the Stavanger University Hospital catchment area were recruited and followed prospectively for 5 years. Participants completed neurocognitive testing with the MoCA®, WASI, and BRIEF-A at inclusion and were categorized as cognitively impaired or non-impaired according to recommended cut-off values. The sum score of the items from the Drug Use Disorders Identification Test Consumption scale (DUDIT-C) was used as a measure of substance use outcome 1 and 5 years after inclusion. We defined substance abstinence (DUDIT-C = 0) and heavy substance use (DUDIT-C ≥7) to determine whether cognitive impairments measured by the respective instruments were associated with and could predict abstinence and heavy substance use 1 and 5 years after baseline.

RESULTS

At the 1-year follow-up, 54% of the total sample reported total abstinence from substances. Conversely, 31% presented heavy substance use. At 5 years, 64% of the total sample reported abstinence from substances, while 25% presented heavy substance use. The results showed a statistically significant association between cognitive impairment defined from MoCA® and higher continuous scores on DUDIT-C at 1-year follow-up. There were no differences in substance abstinence or heavy substance use between patients with and without cognitive impairment at the 1- and 5-year follow-ups. Furthermore, cognitive impairment did not explain substance abstinence or heavy substance use at the 1- and 5-year follow-ups.

CONCLUSION

Generally, individuals with pSUD may be burdened and lack psychosocial resources to such an extent that cognitive functioning plays a subordinate role in long-term recovery. The present study suggests that results on screening tools assessing broad cognitive domains at treatment initiation have limited clinical value in predicting long-term substance use outcomes. There is a need to establish clinically viable instruments to assess cognitive functions with well-established clinical and ecological validity in the SUD population.

Interhemispheric transfer time and concussion in adolescents: A longitudinal study using response time and event-related potential measures

Introduction

Concussion in children and adolescents is a public health concern with higher concussion incidence than adults and increased susceptibility to axonal injury. The corpus callosum is a vulnerable location of concussion-related white matter damage that can be associated with short- and long-term effects of concussion. Interhemispheric transfer time (IHTT) of visual information across the corpus callosum can be used as a direct measure of corpus callosum functioning that may be impacted by adolescent concussion with slower IHTT relative to matched controls. Longitudinal studies and studies testing physiological measures of IHTT following concussion in adolescents are lacking.

Methods

We used the N1 and P1 components of the scalp-recorded brain event-related potential (ERP) to measure IHTT in 20 adolescents (ages 12–19 years old) with confirmed concussion and 16 neurologically-healthy control participants within 3 weeks of concussion (subacute stage) and approximately 10 months after injury (longitudinal).

Results

Separate two-group (concussion, control) by two-time (3 weeks, 10 months) repeated measures ANOVAs on difference response times and IHTT latencies of the P1 and N1 components showed no significant differences by group (ps ≥ 0.25) nor by time (ps ≥ 0.64), with no significant interactions (ps ≥ 0.15).

Discussion

Results from the current sample suggest that measures of IHTT may not be strongly influenced at 3 weeks or longitudinally following adolescent concussion using the current IHTT paradigm.

Executive Functions as Measured by the Dog Executive Function Scale (DEFS) over the Lifespan of Dogs

Executive Functions (EFs) are needed for effortful self-regulation of behaviour and are known to change over the lifespan in humans. In domestic dogs, EFs can be assessed through behavioural rating scales, such as the Dog Executive Function Scale (DEFS). The primary aim of this study was to investigate whether the DEFS, developed initially using a sample of adult dogs, can be used in juvenile (<1 year) and senior (>8 years) dogs. Confirmatory factor analysis of a juvenile and senior dog sample led to good model fit indices, indicating that juvenile and senior dogs' EF structure follows the same functional organisation as found in the DEFS. The secondary aim was to analyse the lifespan development of EFs. Analysis of subscale scores revealed multifaceted relationships with age for four subscales. Working Memory and Attention Towards Owner showed the u-shaped curve traditionally associated with the lifespan development of EFs. Forms of inhibition showed complex associations with age, i.e., Delay Inhibition declined in aging and Motor Regulation increased during aging. Training history and Working Status influenced performance independent of age. More highly trained dogs and working dogs exhibited higher EF skills. Training history appeared more important for EF in non-working dogs than working dogs, perhaps because all working dogs receive a high level of training.

FMR1 CGG Repeats and Stress Influence Self-Reported Cognitive Functioning in Mothers

Variation in the FMR1 gene may affect aspects of cognition, such as executive function and memory. Environmental factors, such as stress, may also negatively impact cognitive functioning. Participants included 1,053 mothers of children with and without developmental disabilities. Participants completed self-report measures of executive function, memory, and stress (i.e., life events, parenting status), and provided DNA to determine CGG repeat length (ranging from 7 to 192 CGGs). Stress exposure significantly predicted greater self-reported difficulties in executive function and the likelihood of memory problems. Cubic CGG effects independently predicted executive function and memory difficulties, suggesting effects of both genetic variation and environmental stress exposure on cognitive functioning.

Cognitive Strategies: Moderating the Relationship between Executive Functions and Daily Functioning

Whereas prior studies have addressed relationships between cognitive strategies and learning and achievement, very few dealt with their connection to daily functioning. This study examines the moderation effect of the frequency of compensatory cognitive strategy use within that relationship among university students. A sample of 336 students (18-36 years; 180 women, 156 men) answered the Dysexecutive Questionnaire (DEX; executive function components), Time Organization and Participation Scale (TOPS; daily functioning), and Compensatory Cognitive Strategies Scale (CCSS; strategy use). The results showed significant correlations between the DEX and TOPS for three CCSS levels (-1.0, -1.0 to 1.0, and 1.0 SD from average); the higher the frequency of cognitive strategy use, the stronger the association between the DEX and TOPS. The findings suggest that more frequently use of cognitive strategies can strengthen efficient daily functioning.

Connecting residual depressive symptoms to self-reported executive functioning: A network analytical approach

Persisting executive functioning (EF) impairments following remission from depression form an important source of disability in daily life. However, little is known regarding how specific aspects of EF relate to residual depressive symptomatology. Using network analysis, the current study investigates unique associations between cognitive-, affective-, and somatic depressive symptoms (Beck Depression Inventory 2nd edition, BDI-II) and self-reported EF (Behavior Rating Inventory of Executive Function - Adult version, BRIEF-A) in a sample of 161 remitted depressed individuals. We identified three clusters of closely connected nodes, corresponding with the Metacognition- and Behavioral Regulation Index of the BRIEF-A, and one cluster consisting of cognitive, affective-, and somatic depressive symptomatology. Among the clusters consisting of EF domains, working memory and shifting difficulties emerged as bridging nodes. Depressive cognition most strongly connected the cluster of depressive symptoms with the EF clusters. Depressive symptom dimensions demonstrated both shared and unique associations with EF domains. Each depressive symptom dimension was directly related to emotional control impairments. In addition, multiple associations were observed between depressive symptomatology and complaints at the level of working memory, shifting, and planning/organizing. Depressive affect was uniquely related to difficulties initiating activity. The current findings provide insights into the relationship between perceived difficulties in EF and residual depressive symptomatology. EF domains were differentially related to depressive symptom dimensions, suggesting the need for further research into the role of EF following remission from depression.

Protocol for a cluster randomised crossover pilot trial of Goal Management Training+ (GMT+) for methamphetamine use disorder

Background

Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes. However, current treatments for MUD do not directly address cognition. We recently modified Goal Management Training (now Goal Management Training⁺; GMT⁺), a group-based intervention originally designed to improve executive functions after brain injury, to enhance suitability for MUD. Here, we describe the rationale and design of a trial which aims to determine the acceptability and feasibility of GMT⁺ during residential rehabilitation for MUD, and its impact on executive functions and clinical outcomes.

Methods

We used a cluster randomised crossover design: participants are randomised at the cluster level to receive either GMT⁺ or psychoeducation-control (Brain Health Workshop; BHW). GMT⁺ is delivered in four 90-min weekly sessions and includes a between-session journal with 10-min daily activities. The program targets attention, impulse control, goal-setting, and decision-making. BHW is a health-oriented intervention that delivers information about the brain and promotes healthy exercise, diet, and sleep. It is matched to GMT⁺ on program format, length, and time with therapists. We will recruit forty-eight participants with MUD from residential treatment services. Our primary outcomes are acceptability, feasibility, and self-reported executive functioning. Secondary outcomes include craving, quality of life and cognitive performance. Outcome assessments are performed at baseline, post-interventions, 4-week follow-up, and 12-week follow-up.

Conclusions

This study will provide GMT⁺ feasibility and acceptability data and will indicate initial efficacy on executive functions and clinical outcomes in residential treatment for MUD. Information from this pilot trial will inform a powered RCT.

Self-reported executive function problems in adults born very low birthweight

BACKGROUND

Executive function difficulties are common among children born very preterm and/or very low birthweight (<1500 g; VLBW), but little is known about whether they persist into adulthood.

OBJECTIVES

Examine the nature and pattern of self-reported executive functioning at 23 and 28 years of age using data from a national cohort study of adults born VLBW and a comparison group of same-age full-term (FT) born adults. Also examined were associations between executive function difficulties and socio-economic outcomes.

METHODS

All infants born VLBW in New Zealand during 1986 were prospectively included in an audit of retinopathy of prematurity (n = 413), with 250 (77% of survivors) followed to median age 28 years. A comparison group of FT adults was also recruited at age 23 and followed to 28 years (n = 100). Across both adult assessments, executive functioning was assessed using the Behaviour Rating Inventory of Executive Function-Adult Version (BRIEF-A) and analysed with semi-parametric models to examine the effects of age and group on executive function.

RESULTS

At 23 and 28 years, VLBW adults had increased risk of executive function impairment compared with FT adults in behaviour regulation (relative risk [CI] 2.37, 95% confidence interval (CI)1.27, 4.45), meta-cognition (RR 6.03, 95% CI 2.18, 16.78) and global functioning (RR 3.20, 95% CI 1.40, 7.28). Impaired global executive functioning was associated with lower socio-economic status (regression estimate [b] = -0.43, 95% CI -0.59, -0.27) and a reduced likelihood of home ownership by age 28 years (RR 0.98, 95% CI 0.96, 1.00), even after controlling for sex, ethnicity and parental socio-economic backgrounds for both groups.

CONCLUSION(S)

VLBW-born adults continue to experience more executive function difficulties in their everyday life relative to term controls at age 28 years. These difficulties were negatively associated with their socio-economic opportunities as young adults.

Do outcomes from a behavioral weight loss intervention differ in Alabama versus Colorado?

Background

There are well-established regional differences in obesity prevalence in the United States but relatively little is known about why or whether success in weight loss differs regionally.

Objective

The objective of this study was to determine whether changes in body weight, engagement in physical activity (PA), and psychosocial factors differed in Alabama (AL) versus Colorado (CO) in response to a 16-week behavioral weight loss program.

Design

This is an ancillary study to a weight loss intervention being conducted simultaneously in AL and CO with identical intervention content and delivery in 70 participants (n = 31 AL and n = 39 CO). Body weight, objective (accelerometry) PA, and responses to psychosocial questionnaires (reward-based eating, stress, social support) were collected at baseline and at Week 16.

Results

There were no differences in percent weight loss between states (AL: 10.98%; CO: 11.675%, p = 0.70), and weights at Week 16 were not different for participants in AL and CO (AL: 101.54 ± 4.39 kg, CO: 100.42 ± 3.67 kg, p = 0.84). Accelerometry-derived step count, stepping time, and activity score were all greater at Week 16 for participants in AL compared to participants in CO. Hedonic eating scores were more favorable for participants in AL at baseline (AL: 24.08 ± 2.42; CO: 34.99 ± 2.12, p = 0.0023) and at Week 16 (AL: 18.62 ± 2.70; CO: 29.11 ± 2.19, p = 0.0023). Finally, participants in AL presented more favorable social support scores at Week 16 compared to participants in CO.

Conclusions

Weight loss did not differ between states, suggesting that factors contributing to higher obesity rates in some regions of the United States may not be barriers to weight loss. Further, participants in AL experienced greater improvements in some factors associated with weight maintenance, indicating the need to study regional differences in weight loss maintenance. National Clinical Trial 03832933.

Validation of the executive function strategy awareness and use questionnaire (SAUQ) in a university student population

Objective: The aim of the study is to design and evaluate the Strategy Awareness and Use Questionnaire to estimate students' awareness and use of strategies that optimize control of attention and/or compensate for stress on an executive system due to environmental and/or neurobiological influences. Participants: One hundred and forty-eight undergraduate and graduate students from various disciplines at an urban Canadian university campus participated in the Spring 2019 semester. Methods: An item analysis was conducted that included an assessment of dimensionality and item trimming. Results: Findings from an exploratory factor analysis suggest a seven-factor solution is optimal; Comprehension Monitoring, Planning/Organization, Self-Reward, Self-Regulation, Organization with Mobile Phone Technology, Regulating Technology, and Organization of Materials. Conclusion: This measure is likely to benefit students, as well as counselors and coaches interested in improving EF strategy use among students in a university population.

Inhibitory control within the context of early life poverty and implications for outcomes

Early life poverty confers risk for unfavorable outcomes including lower academic achievement, behavioral difficulties, and neurodevelopmental disorders. Disruptions in inhibitory control (IC) have been posed as one mechanism to explain the relationship between early life poverty and deleterious outcomes. There is robust research to suggest that early life poverty is associated with development of poorer IC. Further, poorer IC in children is related to decreased academic achievement and social competence, and increased externalizing and internalizing behavior. There is some parent-report evidence to suggest that IC is a mediator of the relationship between poverty and externalizing behaviors, as well as some limited evidence to suggest that IC is a mediator between poverty and academic achievement. Future work should aim to determine whether early life poverty's relation to IC could be explained by verbal ability which is thought to be central to the development of effective IC. In addition, future neuroimaging work should utilize IC fMRI tasks to identify key neural mechanisms that might contribute to a relationship between early life poverty and IC.

Behavior Rating Inventory of Executive Function - adult version (BRIEF-A) in Iranian University students: Factor structure and relationship to depressive symptom severity

Major depressive disorder is the most common psychiatric illness in Iran, and depression is common among university students in the country. The presence of depression is frequently associated with problems in executive functioning. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life in clinical and non-clinical populations. Currently, there is limited empirical validation of the measure for use in Iran. This study evaluated the psychometric properties of a Persian-language BRIEF-A in a sample of Iranian university students (n = 300). The factor structure of the BRIEF-A was examined via a confirmatory factor analysis. We also evaluated whether BRIEF-A scores differed among university students varying in severity of depressive symptoms (Minimal, Mild, Moderate, Severe) as measured by the Beck Depression Inventory - II. Results indicated that a two-factor model structure best fit the data for the BRIEF-A. Acceptable internal consistency was also observed. Furthermore, poorer subjective executive functioning was endorsed by the three depressive subgroups relative to the Minimal symptoms group. Together, these findings support a two-factor model for the Persian translation of the BRIEF-A, and indicate that more severe depressive symptoms in Iranian university students is associated with worse subjective executive functioning.

Relationships between executive functions and sensory patterns among adults with specific learning disabilities as reflected in their daily functioning

Adults with specific learning disabilities (e.g., dyslexia, dysgraphia, and dyscalculia) reveal limitations in daily functioning in various life domains. Following previous evidence of deficient executive functions and unique sensory patterns in this population, this study examined how relationships between these two domains are expressed in daily functioning. Participants included 55 adults with specific learning disabilities and 55 controls matched by age, gender, socioeconomic status, and education. Participants completed a sociodemographic questionnaire, the Behavioral Rating Inventory of Executive Functions-adult version, and the Adolescent/Adult Sensory Profile. Results indicated significant relationships between executive functions (per the Behavioral Rating Inventory of Executive Functions-adult version) and sensory patterns (per the Adolescent/Adult Sensory Profile) as reflected in daily functioning. The low sensory registration pattern predicted 12% to 16% of the variance in the behavioral regulation index, metacognitive index, and general executive composite scores and was a significant predictor of specific executive function abilities. Results indicated that the difficulties of adults with specific learning disabilities in using executive function abilities efficiently might be tied to a high sensory threshold and passive self-regulation strategies. A deeper understanding of this population's sensory-executive mechanisms may improve evaluation and intervention processes. This understanding can consequently increase executive abilities for improved daily functioning and life satisfaction.

Efficacy of cognitive behavioural therapy in medicated adults with attention-deficit/hyperactivity disorder in multiple dimensions: a randomised controlled trial

The study aimed to evaluate the efficacy of group cognitive behavioural therapy (CBT) in medicated adults with attention-deficit/hyperactivity disorder (ADHD) with a multidimensional evaluation and follow-up to week 36. Ninety-eight adult ADHD were randomly allocated to the CBT combined with medication (CBT + M) group or the medication (M) only group. The primary endpoint was the ADHD-Rating Scale (ADHD-RS). Secondary endpoints included emotional symptoms, self-esteem, automatic thoughts, quality of life (QoL), and executive function (EF). The outcome measures were obtained at baseline (T1), after the 12-week CBT treatment (T2), and at two follow-up time points (week 24, T3, and week 36, T4). Compared to the M-only group, the patients in the CBT + M group showed an overall significantly greater reduction from baseline in ADHD core symptoms (ADHD-RS total score at T3, and inattention subscale at T2 and T3), depression and anxiety symptoms (T2-T4), state anxiety (T2 and T3) and trait anxiety (T2), automatic thoughts questionnaire at T3, and QoL (physical domain, psychological domain, and social domain, most significant at T3 and weakened at T4). These findings further confirmed the efficacy of CBT on multiple dimensions and verified improvements in automatic thinking in adult ADHD. The superiority of the combination treatment mainly manifested in reduced inattention, emotional symptoms, and maladaptive thoughts and improved QoL. Trial registration number ChiCTR1900021705 (March-05-2019).

Fish oil supplementation may improve attention, working memory and attention-deficit/hyperactivity disorder symptoms in adults with autism spectrum disorder: a randomised crossover trial

Marine n-3 fatty acids (n-3LCPUFA) have shown neurocognitive benefits in children with attention-deficit/hyperactivity disorder (ADHD), but few trials have examined effects in adults with autism spectrum disorder (ASD). We explored, if n-3LCPUFA affect cognitive functions in adults with ASD, and if effects are modified by comorbid ADHD. In a 2 × 4 week crossover study, twenty-six participants were randomised to sequence of supplementation with fish oil (FO, 5·2 g/d n-3PUFA) and safflower oil (SO). At baseline and after each period, we measured primary outcomes: attention (d2-test) and spatial working memory (Corsi test) and secondary outcomes: flexibility (Stroop word-colour test), ADHD symptoms (Conners scales), executive functions (Behavioural Inventory of Executive Function) and social behaviour (Social Responsiveness Scale). The dropout rate was 15 %. Compliance was 94 % and correlated with whole-blood n-3LCPUFA. Corsi scores improved by ∼0·3 × sd (P = 0·032) after FO v. SO, and the odds for d2 errors were 30 % lower (P = 0·016), which was supported by improved Conners scores of attention (P = 0·023). Improvement in Conners ADHD symptom score was limited to participants with ADHD (-3·5(-6·0; -1·0), n 10 v. -0·2(-2·5;2·2), n 11 without ADHD, Pinteraction = 0·096), who also improved their behavioural regulation index by 0·3 × sd after FO (Pinteraction = 0·016). Participants without ADHD gained most in d2 test performance (OR = 0·4(0·2;0·7) v. 0·9(0·6;1·3) in those with ADHD, Pinteraction = 0·002), but their executive function score was exacerbated after FO (5·9(0·0,11·8), Pinteraction = 0·039). Our results did not show any effects on ASD symptoms, but suggest that FO may improve attention and working memory in adults with ASD and ameliorate ADHD symptoms in those with comorbid ADHD.

Subjective cognition in adults with common psychiatric classifications; a systematic review

The aim is to assess whether instruments developed to measure subjective cognitive complaints (SCCs) and in neurology and aging can reliably be used in ADHD and other common psychiatric classifications. MEDLINE, PsycINFO, CINAHL and EMBASE+EMBASE CLASSIC were searched for relevant work on SCCs in psychiatric classifications (ADHD, autism, mood disorders, schizophrenia) in two phases: 1 identify instruments, 2 relevant studies. 35 studies with varying study quality were included. SCCs are most commonly studied in ADHD and mood disorders, but are found in all psychiatric classifications. SCCs show inconsistent and low associations to objective cognition across disorders, but higher and consistent relations are found with behavioral outcomes. SCCs are not qualitatively different for ADHD compared to other psychiatric classifications, and should thus not be seen as analogous to well validated measures of objective cognition. However, SCCs do reflect suffering, behavioral difficulties and problems experienced by across those with psychiatric problems in daily life.

Examining the Item-Level Factor Structure of the Behavior Rating Inventory of Executive Function-Adult Version Within a Traumatic Brain Injury Sample

OBJECTIVE

To conduct the first item-level exploration of scale and index structure of the self-report Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) in traumatic brain injury (TBI).

DESIGN

This was an observational cross-sectional study design using secondary data. We conducted exploratory factor analyses (EFA) to explore the index structure and scale structure of the BRIEF-A. We conducted EFA with all 70 items of the BRIEF-A to examine the index structure. Based on the finding of index structure, we conducted EFA on the 30 items of the Behavioral Regulation Index (BRI) and the 40 items of the Metacognitive Index (MI).

SETTING

Data were collected through 5 studies in outpatient and community settings in the southeast United States.

PARTICIPANTS

Individuals (N=338) aged 18-89 years with a history of mild to severe TBI who were able to speak English fluently.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The BRIEF-A.

RESULTS

The 2-factor structure aligned with the BRIEF-A manual at the index level. Scale structure for the MI (40 items) resulted in 1 factor, whereas the BRI (30 items) could be represented by either a 2- or 3-factor structure. The 2-factor structure of the BRI is more parsimonious and matched other factor analyses derived from the sum of scale items.

CONCLUSIONS

We confirmed the manual designated index structure (BRI and MI) of the BRIEF-A but took precautions against using the 9 scales. Instead, we recommend using the 2 designated index scores and 2 newly identified composite scores representing Behavioral Control Trait and Emotional Control Trait.

A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial Assessing the Efficacy and Safety of Viloxazine Extended-Release Capsules in Adults with Attention-Deficit/Hyperactivity Disorder

BACKGROUND AND OBJECTIVE

Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder that typically begins in childhood and often persists into adulthood. Recent phase III trials have demonstrated the efficacy and safety of viloxazine extended-release capsules (viloxazine ER; Qelbree^®) in pediatrics (6-17 years of age). The aim of this study was to evaluate the efficacy and safety of viloxazine ER in adults with attention-deficit/hyperactivity disorder.

METHODS

This was a phase III, randomized, double-blind, placebo-controlled, two-arm trial in adults (18-65 years of age) with attention-deficit/hyperactivity disorder. Eligible subjects were randomized 1:1 to viloxazine ER (flexible dose of 200-600 mg/day) or matched placebo. The primary efficacy endpoint was the change from baseline at end of study (week 6) in the Adult ADHD Investigator Symptom Rating Scale (AISRS) total score. The key secondary endpoint was the change from baseline at end of study in the Clinical Global Impressions-Severity of Illness (CGI-S) score. Additional secondary outcome measures included the AISRS Inattention and Hyperactivity/Impulsivity subscales, the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A), the Generalized Anxiety Disorder-7 Item (GAD-7), and the Clinical Global Impressions-Improvement (CGI-I); each was analyzed at end of study. Responder rates on CGI scales and the AISRS were also assessed.

RESULTS

A total of 374 subjects were randomized. At end of study, the mean viloxazine ER dose was 504 mg. The reduction in the change from baseline at end of study AISRS total score (least-square means ± standard error) was significantly greater in subjects treated with viloxazine ER (-15.5 ± 0.91) compared with placebo (-11.7 ± 0.90), p = 0.0040. The reduction in the CGI-S score was also significantly greater in subjects treated with viloxazine ER (-1.4 ± 0.10) compared with placebo (-1.0 ± 0.10), p = 0.0023. The viloxazine ER group demonstrated significantly greater improvements in the AISRS Inattention (p = 0.0015) and Hyperactivity/Impulsivity (p = 0.0380) subscales, the CGI-I (p = 0.0076), and the BRIEF-A Global Executive Composite (p = 0.0468) and Metacognition Index (p = 0.0100). Analysis of categorical secondary endpoints revealed that the viloxazine ER group had a significantly higher AISRS 30% response rate compared with placebo (p = 0.0395); all other comparisons were not significant. Many treatment effects (including the primary and key secondary endpoints) were significant by week 2. The most common treatment-related adverse events that occurred in ≥5% of subjects receiving viloxazine ER were insomnia (14.8%), fatigue (11.6%), nausea (10.1%), decreased appetite (10.1%), dry mouth (9.0%), and headache (9.0%). Viloxazine ER was well tolerated, with a 9.0% discontinuation rate due to adverse events compared with 4.9% in the placebo group.

CONCLUSIONS

Treatment with viloxazine ER resulted in a statistically significant improvement in primary and key secondary endpoints, indicating improvements in attention-deficit/hyperactivity disorder symptomology, executive function, and overall clinical illness severity in adults. Viloxazine ER was well tolerated at the tested doses in adults with attention-deficit/hyperactivity disorder.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT04016779.

Respondents of health survey powered by the innovative NURO app exhibit correlations between exercise frequencies and diet habits, and between stress levels and sleep wellness

Nurosene's NURO app (nurosene.com) is an innovative smartphone application that gathers and analyzes active self-report metrics from users, empowering them with data-driven health machine intelligence. We present the data collected and analyzed from the initial round of participants who responded to a 12-question survey on their life-style and health status. Exploratory results using a variational autoencoder (VAE) suggested that much of the variability of the 12 dimensional data could be accounted for by two approximately uncorrelated latent variables: one pertaining to stress and sleep, and the other pertaining to exercise and diet. Subsequent modeling of the data using exploratory and confirmatory factor analyses (EFAs and CFAs) found that optimal data fits consisted of four factors, namely exercise, diet, stress, and sleep. Covariance values were high between exercise and diet, and between stress and sleep, but much lower between other pairings of non-identical factors. Both EFAs and CFAs provided extra contexts to and quantified the more preliminary VAE observations. Overall, our results significantly reduce the apparent complexity of the response data. This reduction allows for more efficient future stratification and analyses of participants based on simpler latent variables. Our discovery of novel relationships between stress and sleep, and between exercise and diet suggests the possibility of applying predictive analytics in future efforts.

Subjective executive dysfunction in patients with primary brain tumors and their informants: relationships with neurocognitive, psychological, and daily functioning

OBJECTIVE

We assessed agreement between patient- and informant-report on the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A) in patients with primary brain tumors (PBT) and differences on BRIEF-A in neurocognitive (intact v. impaired), psychological (asymptomatic v. distressed), and functional (independent v. dependent) categories using both patient- and informant-report.

METHOD

PBT patients (n = 102) completed neuropsychological evaluations including the BRIEF-A, clinical interview, neurocognitive tests, and mood questionnaires. Correlations between the BRIEF-A and Informant (n = 39) were conducted. Differences in patient and informant BRIEF-A indices were investigated across five classifications: neurocognitive functioning, psychological functioning, medication management, appointment management, and finance management.

RESULTS

Patient and informant BRIEF were correlated. There was no difference on BRIEF-A or Informant indices for intact v. impaired neurocognitive status. Higher BRIEF-A and Informant indices were observed among psychologically distressed v. asymptomatic patients. Results showed higher BRIEF indices among those requiring assistance with medication, appointments, and finances.

CONCLUSIONS

Patients and informants agreed in their reports of executive function (EF). These reports, while not different in neurocognitive classification, were different in psychological functioning and in those needing assistance with instrumental activities of daily living (IADL). Patient- and informant-reported EF may provide important data regarding psychological and IADL functioning in this population.

Cross-Sectional Characterization of Local Brain Network Connectivity Pre and Post Breast Cancer Treatment and Distinct Association With Subjective Cognitive and Psychological Function

Objective: We aimed to characterize local brain network connectivity in long-term breast cancer survivors compared to newly diagnosed patients. Methods: Functional magnetic resonance imaging (fMRI) and subjective cognitive and psychological function data were obtained from a group of 76 newly diagnosed, pre-treatment female patients with breast cancer (mean age 57 ± 7 years) and a separate group of 80, post-treatment, female breast cancer survivors (mean age 58 ± 8; mean time since treatment 44 ± 43 months). The network-based statistic (NBS) was used to compare connectivity of local brain edges between groups. Hubs were defined as nodes with connectivity indices one standard deviation or more above network mean and were further classified as provincial (higher intra-subnetwork connectivity) or connector (higher inter-subnetwork connectivity) using the participation coefficient. We determined the hub status of nodes encompassing significantly different edges and correlated the centralities of edges with behavioral measures. Results: The post-treatment group demonstrated significantly lower subjective cognitive function (W = 3,856, p = 0.004) but there were no group differences in psychological distress (W = 2,866, p = 0.627). NBS indicated significantly altered connectivity (p < 0.042, corrected) in the post-treatment group compared to the pre-treatment group largely in temporal, frontal-temporal and temporal-parietal areas. The majority of the regions projecting these connections (78%) met criteria for hub status and significantly less of these hubs were connectors in the post-treatment group (z = 1.85, p = 0.031). Subjective cognitive function and psychological distress were correlated with largely non-overlapping edges in the post-treatment group (p < 0.05). Conclusion: Widespread functional network alterations are evident in long-term survivors of breast cancer compared to newly diagnosed patients. We also demonstrated that there are both overlapping and unique brain network signatures for subjective cognitive function vs. psychological distress.