Evaluation of executive functioning in people with intellectual disabilities

Everyday Executive Functioning Profiles in Adults with Down Syndrome

Research on everyday executive functions in individuals with Down Syndrome (DS) has focused mostly on children and adolescents. The current study examined everyday executive functions in DS adults. 27 DS adults (aged 22.00 to 42.00 years) were tested using the Behaviour Rating Inventory of Executive Function-Adult Informant Version (BRIEF-A). Findings revealed that DS adults exhibited greater impairments in Global Executive Composite (GEC), Working Memory, Plan/Organise, Task-Monitor and the Metacognition Index (MI) relative to typically developing adults in the normative sample. Substantial variabilities were found in all everyday executive function abilities among DS adults. Findings highlight the importance of making comprehensive assessments of everyday executive functions in DS individuals in order to identify problem areas and plan individualised support programmes.

Neuropsychological assessment of aggressive offenders: a Delphi consensus study

Objective

This study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression.

Methods

An international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability.

Results

The panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed.

Conclusions

This research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify.

Active music making and leisure activities for people with intellectual disabilities: A cluster randomized pilot study

AIM

A pilot cluster randomized controlled trial was performed to evaluate the effects of a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, challenging behaviour and three components of executive functions (inhibitory control, cognitive flexibility and visual working memory) of adults with intellectual disabilities (ID).

METHOD

Twenty-nine participants living in four residential facilities for people with ID were randomized into a music or a leisure activities group intervention. Sixteen weekly sessions of one hour were performed with six to eight participants per group. Measurements were carried out at baseline, post-intervention and 11 weeks follow- up. Results were analysed with linear mixed models.

RESULTS

The leisure activities group intervention improved more than the music group intervention on internalizing behaviour overall and on inhibitory control at post-intervention. However, further analyses showed that this improvement was only significant in one of the two leisure activities facilities.

CONCLUSION

A leisure activities group intervention seems a promising intervention to improve internalizing behaviour and inhibitory control of younger adults with mild ID. Implications for the delivery of leisure activities group interventions and especially music group interventions are discussed.

WHAT THIS PAPER ADDS

Involvement in leisure activities of people with ID is associated with better well-being, an improvement in social skills and a reduction in emotional and behavioural problems. Active music making, as a specific form of leisure activities, seems to improve well-being, social acceptance and challenging behaviour (CB) as well. Moreover, in different (non-clinical) groups a significant effect of active music making has been found on self-esteem and executive functioning (EF). So far, little attention has been paid to the possible positive effects of active music making on adults with ID. In the current paper, a randomized controlled trial (RCT) was conducted to compare the post-intervention and follow-up measurements with baseline measurements between a music group intervention and a leisure activities group intervention on well-being, self-esteem, social acceptance, CB and EF in adults with ID. Multilevel models were used to detect possible intervention effects of 16 weekly sessions. Overall, inhibitory control and internalizing behaviour improved more amongst the participants of the leisure activities group than amongst the participants of the music group. This was mainly the case for younger participants who had mild ID. These effects are discussed and recommendations regarding the improvement of a music intervention for people with ID are presented.

Cognitive dysfunction and psychopathology: a cohort study of adults with intellectual developmental disorder

BACKGROUND

Cognitive impairment of intellectual developmental disorders (IDD) is determined by several different combinations of specific cognitive alterations. People with IDD present a rate of mental health problems that is up to 4 times higher than that of the general population. Despite this, the relationship between specific cognitive dysfunctions and co-occurring mental disorders has not been adequately studied. The aim of the present paper is to investigate the association between specific cognitive dysfunctions and specific psychiatric symptoms and syndromes in people with IDD.

METHODS

One hundred and twenty adults with mild to moderate IDD living in residential facilities underwent a clinical and instrumental assessment for specific cognitive and psychopathological features.

RESULTS

Participants with IDD and ASD have significantly lower scores compared to those without respect to who has not the diagnosis on the Processing Speed Index (PSI) and Perceptual Reasoning Index (PRI) on the WAIS-IV and higher time scores on the TMT A. Moreover, there is a significant association between years of hospitalisation and TMT B and TMT B A time scores; the longer a participant with IDD was hospitalised, the worse their performance on the TMT. Although not statistically significant, many psychopathological clusters showed substantial cognitive profiles.

CONCLUSIONS

Although further research is needed, neuropsychological and IQ tests scores seem to be differently associated to various psychopathological conditions co-occurring with IDD, and with ASD especially. Cognitive assessment seems to support diagnosis and treatment of psychopathological co-occurrences in persons with IDD, also in consideration of indirect implications including a better knowledge of the patient's characteristics beyond IQ deficit.

The Association between Executive Function and Performing Instrumental Daily Activities in People with Intellectual Disabilities

Institutionalized individuals with intellectual disabilities have few opportunities to participate in instrumental activities of daily living (IADLs), which probably affects higher cognitive functions, or vice versa. The objectives of this study were to evaluate the possible difference in the ability to perform IADLs and executive functioning between individuals with and without intellectual disabilities and to determine if executive functions are associated with the performance of IADLs in people with intellectual disabilities. This was a multi-center cross-sectional study, conducted between July 2019 and May 2020. Participants with intellectual disabilities were recruited from four centers for people with intellectual disabilities. Adults without these disabilities were gathered from several community centers. The sample consisted of 90 individuals with moderate intellectual disabilities and 79 individuals with no intellectual disability. Executive functions were evaluated using the Wechsler Adult Intelligence Scale-WAIS-IV, the INECO Frontal Screening test, the Semantic Verbal Fluency Test, and the Behavioural Assessment of the Dysexecutive Syndrome-BADS-Scale. The performance of the IADLs was assessed by the Lawton and Brody Scale. The results showed that the higher the function in instrumental activities, the lower the impairment of executive functions. Executive functions accounted for 81% of the total variance in the ability to perform the IADLs. In conclusion, individuals with moderate intellectual disabilities demonstrated limitations in executing the IADLs, which were partially associated with low performance in executive functions. This information could help in the development of evidence-based intervention programs and facilitate the formulation of appropriate support strategies to enhance participation in these activities.

Characteristics of shifting ability in children with mild intellectual disabilities: an experimental study with a task-switching paradigm

BACKGROUND

Shifting enables flexible switch between tasks or mental sets. It is a component of the executive function that plays critical roles in human behaviour control. However, shifting ability in individuals with intellectual disability (ID) has not been well clarified because of the use of intellectually demanding tasks in previous studies. The present study invented a novel shifting task with minimal intellectual demands and aimed to clarify the characteristics of shifting in adolescents with ID.

METHODS

Adolescents with ID (n = 21) and chronological-age-matched (n = 10) and mental-age-matched controls (n = 33) performed a novel shifting task with simple rule switching (i.e. change in direction). Analyses focused on the switch cost or the increase in the reaction time associated with rule switching.

RESULTS

Two subtypes of adolescents with ID were found with respect to the switch cost: one that lacks it and another with an increased switch cost. The lack of a switch cost was unique to the subgroup adolescents with ID and was not indicated in the control group.

CONCLUSIONS

The present study indicated that shifting in adolescents with ID does not depend solely on their intellectual function and is highly heterogeneous. This finding further implies that executive functions, including shifting, must be evaluated separately from their intellectual functions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Assessing Children's Executive Function: BADS-C Validity

OBJECTIVES

To investigate the external and ecological validity of a standardized test of children's executive functioning (EF), the Behavioral Assessment of the Dysexecutive Syndrome for Children (BADS-C).

BACKGROUND

There are few standardized measures for assessing executive functions in children, and the evidence for the validity of most measures is currently limited.

METHOD

A normative sample of 256 children and adolescents from age 8-16 years completed the BADS-C, and a parent or teacher completed rating scales of the child's everyday problems related to EF (Children's version of the Dysexecutive Questionnaire; DEX-C) and Strengths and Difficulties Questionnaire (SDQ), a commonly used measure of emotional, social, cognitive, and behavioral problems.

RESULTS

Exploratory factor analyses yielded a two-factor structure to the BADS-C, indicative of monitoring and abstract reasoning processes, and a three-factor structure to the DEX-C, reflecting behavioral, and cognitive components of the dysexecutive syndrome as well as emotional responsiveness. Regression analyses showed significant relationships between BADS-C scores and everyday functioning as reported on the DEX and SDQ. Furthermore, there were significant differences in BADS-C scores between those children in the upper and lower quartiles on the SDQ.

CONCLUSION

Results provide tentative evidence of BADS-C and DEX-C construct, convergent and predictive validity.

Executive Functions and Attention Processes in Adolescents and Young Adults with Intellectual Disability

(1) Background: We made a comprehensive evaluation of executive functions (EFs) and attention processes in a group of adolescents and young adults with mild intellectual disability (ID). (2) Methods: 27 adolescents and young adults (14 females and 13 males) with ID, aged between 15.1 and 23 years (M = 17.4; SD = 2.04), were compared to a control group free of cognitive problems and individually matched for gender and age. (3) Results: As for EFs, individuals with ID were severely impaired on all subtests of the Behavioral Assessment of Dysexecutive Syndrome (BADS) battery. However, we also found appreciable individual differences, with eight individuals (approximately 30%) scoring within normal limits. On the attention tests, individuals with ID were not generally slower but presented specific deficits only on some attention tests (i.e., Choice Reaction Times, Color Naming and Color–Word Interference, and Shifting of Attention for Verbal and for Visual Targets).The role of a global factor (i.e., cognitive speed) was modest in contributing to the group differences; i.e., when present, group differences were selectively associated with specific task manipulations, not global differences in cognitive speed. (4) Conclusions: The study confirmed large group differences in EFs; deficits in attentional processing were more specific and occurred primarily in tasks taxing the selective dimension of attention, with performance on intensive tasks almost entirely spared.

Cognitive abilities and life experience in everyday planning in adolescents with intellectual disabilities: Support for the difference model

BACKGROUND

The literature on planning ability in individuals with intellectual disability (ID) provides no clarity on whether their ability matches their mental age (MA) or not. Perhaps can planning experience explain the mixed results. The current study investigated to what extent cognitive abilities and life experience can explain everyday planning ability in individuals with ID and to what extent results from everyday planning tasks support the developmental or the difference model of ID.

METHOD

Planning tests, cognitive ability tasks and a self-rated life experience form were administered to 71 adolescents with ID and 62 children with a typical development matched on MA.

RESULTS

Adolescents with ID exhibited planning ability according to their MA. Regression analyses showed that the predictors of planning differed between the groups. The cognitive measures could predict planning in both groups, but life experience only contributed positively to planning in the MA group, whereas chronological age was negatively correlated with successful planning in the ID group.

CONCLUSIONS AND DISCUSSION

The results support the difference model of ID. When matched on MA, the individuals with ID will solve the planning task in a qualitatively different manner. Additionally, the participants with ID could not utilise their life experience when solving the planning task, contrary to the MA group. Practitioners should be aware that individuals with ID might need more everyday planning training throughout adolescence. To support adolescents with ID, practitioners may focus on supporting the individual's cognitive abilities rather than relying on their prior knowledge.

Intelligence and specific cognitive functions in intellectual disability: implications for assessment and classification

PURPOSE OF REVIEW

Current diagnostic criteria for intellectual disability categorize ability as measured by IQ tests. However, this does not suit the new conceptualization of intellectual disability, which refers to a range of neuropsychiatric syndromes that have in common early onset, cognitive impairments, and consequent deficits in learning and adaptive functioning. A literature review was undertaken on the concept of intelligence and whether it encompasses a range of specific cognitive functions to solve problems, which might be better reported as a profile, instead of an IQ, with implications for diagnosis and classification of intellectual disability.

RECENT FINDINGS

Data support a model of intelligence consisting of distinct but related processes. Persons with intellectual disability with the same IQ level have different cognitive profiles, based on varying factors involved in aetiopathogenesis. Limitations of functioning and many biopsychological factors associated with intellectual disability are more highly correlated with impairments of specific cognitive functions than with overall IQ.

SUMMARY

The current model of intelligence, based on IQ, is of limited utility for intellectual disability, given the wide range and variability of cognitive functions and adaptive capacities. Assessing level of individual impairment in executive and specific cognitive functions may be a more useful alternative. This has considerable implications for the revision of the International Classification of Diseases and for the cultural attitude towards intellectual disability in general.

The Key Search Subtest of the Behavioural Assessment of the Dysexecutive Syndrome in Children (BADS-C) Instrument Reveals Impaired Planning Without External Constraints in Children With Neurofibromatosis Type 1

Studies of executive function and its relationship with brain T2-weighted hyperintensities in children with neurofibromatosis type 1 (NF1) have yielded inconsistent results. We examined 16 children with NF1 aged 8 to 15 years, of normal intelligence, and compared their findings to those of 16 siblings and 16 typically developing children using the Behavioural Assessment of the Dysexecutive Syndrome in Children (BADS-C). NF1 patients had an adequate overall score at BADS-C, but showed significantly lower performance than typical peers in the Key Search subtest. This is a task that must be solved without any given rules, in which subjects must devise a strategy and an efficient search pattern transferable to other similar real situations. The Key Search scores were not correlated with number and signal characteristics of T2-weighted hyperintensities. Planning without external indications is impaired in children with NF1 because they have to rely entirely on self-organization and monitoring; this study provides information for remediation programs designed to improve functioning in daily life.

The Role of Executive Control and Readiness to Change in Problematic Drinkers with Mild to Borderline Intellectual Disability

BACKGROUND

Problematic alcohol use is associated with neuropsychological consequences, including cognitive biases. The goal of the study was to explore the moderating role of executive control and readiness to change on the relationship between alcohol use and cognitive biases in light and problematic drinkers with and without mild to borderline intellectual disability (MBID).

METHOD

Participants (N = 112) performed the visual dot probe task to measure the strength of the cognitive biases. Executive control was measured using two computerised tasks for working memory capacity (Corsi block-tapping task) and inhibitory control (Go/No-go task). Readiness to change was measured using the Readiness to Change Questionnaire.

RESULTS

No cognitive biases or executive dysfunctions were found in problematic drinkers. Working memory capacity and inhibitory control were impaired among individuals with MBID, irrespective of severity of alcohol use-related problems. Executive control and readiness to change did not moderate the relationship between alcohol use and cognitive biases.

CONCLUSION

The results fail to support the dual-process models of addiction, but results need to be treated with caution given the problematic psychometric qualities of the visual dot probe task. Implementing a neurocognitive assessment and protocols in the treatment of substance use disorders seems premature.

Tobacco and Alcohol Use in People With Mild/Moderate Intellectual Disabilities: Giving Voice to Their Health Promotion Needs

BACKGROUND

Concerns have been raised about the use/misuse of tobacco and alcohol by people with mild/moderate intellectual disabilities. Aiming to address an identified gap in the current evidence base, this study sought to gain an understanding of the tobacco- and alcohol-related health promotion needs of this client group.

METHODS

Informed by the principles of social cognitive theory, data were collected using focus group and telephone interviews. Participants were 16 people with intellectual disabilities, two family carers and 15 health and social care professionals. Data were analysed using the Framework approach.

FINDINGS

Four themes were described: being like others; social and emotional influences; understandings, misunderstandings and learning from experience; and choices and challenges. Reasons for smoking and drinking alcohol echoed those of the general population; however, health promotion needs were more complex (e.g. linked to problems with consequential thinking; low levels of self-efficacy).

CONCLUSION

This article provides insight into the tobacco- and alcohol-related health promotion needs of people with intellectual disabilities. There is a need for integrated service provision that addresses both personal and environmental influences on behaviour.

A Novel Analog Reasoning Paradigm: New Insights in Intellectually Disabled Patients

Background

Intellectual Disability (ID) is characterized by deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, and learning. As new avenues are emerging for treatment of genetically determined ID (such as Down’s syndrome or Fragile X syndrome), it is necessary to identify objective reliable and sensitive outcome measures for use in clinical trials.

Objective

We developed a novel visual analogical reasoning paradigm, inspired by the Progressive Raven’s Matrices, but appropriate for Intellectually Disabled patients. This new paradigm assesses reasoning and inhibition abilities in ID patients.

Methods

We performed behavioural analyses for this task (with a reaction time and error rate analysis, Study 1) in 96 healthy controls (adults and typically developed children older than 4) and 41 genetically determined ID patients (Fragile X syndrome, Down syndrome and ARX mutated patients). In order to establish and quantify the cognitive strategies used to solve the task, we also performed an eye-tracking analysis (Study 2).

Results

Down syndrome, ARX and Fragile X patients were significantly slower and made significantly more errors than chronological age-matched healthy controls. The effect of inhibition on error rate was greater than the matrix complexity effect in ID patients, opposite to findings in adult healthy controls. Interestingly, ID patients were more impaired by inhibition than mental age-matched healthy controls, but not by the matrix complexity. Eye-tracking analysis made it possible to identify the strategy used by the participants to solve the task. Adult healthy controls used a matrix-based strategy, whereas ID patients used a response-based strategy. Furthermore, etiologic-specific reasoning differences were evidenced between ID patients groups.

Conclusion

We suggest that this paradigm, appropriate for ID patients and developmental populations as well as adult healthy controls, provides an objective and quantitative assessment of visual analogical reasoning and cognitive inhibition, enabling testing for the effect of pharmacological or behavioural intervention in these specific populations.

Latent profiles of executive functioning in healthy young adults: evidence of individual differences in hemispheric asymmetry

Two competing theoretical models of individual differences in executive functioning (EF) were examined: the Prefrontal Convexity Model and the Hemispheric Asymmetry Model. Neurologically healthy individuals (N = 315; mean age 20.8) completed a modified switching task (MST) and the Attention Network Test (ANT) in a single testing session. Data analysis was conducted in two phases. In the first phase (model identification), latent profile analysis was applied to MST variables measuring the abilities to form, switch, and maintain mental sets under conditions designed to tax left or right hemisphere resources. In the second phase (model validation), participant clusters obtained from the first phase were compared on the ANT. The Model Identification phase yielded a 3-profile solution consistent with the Hemispheric Asymmetry Model. Profile 1 (N = 203) was characterized by average EF performances. Profile 2 (N = 43) revealed a set maintenance weakness under non-verbal conditions. Profile 3 (N = 38) demonstrated weaknesses in cognitive flexibility combined with poor executive performances under verbal conditions. The Model Validation phase confirmed group differences. Profile 1 demonstrated average EF performances. Profile 2 demonstrated distractibility and decreased alertness, consistent with a right hemisphere weakness. Profile 3 demonstrated cognitive rigidity in the absence of external cues, consistent with a left hemisphere weakness. Individual differences in EF appear to follow a Hemispheric Asymmetry Model of EF among neurologically healthy adults. Investigating the relationship between hemispherically mediated executive functions and other individual difference factors known to confer health risk or resilience could inform numerous disciplines within the field of psychology.

Characterising the Profile of Everyday Executive Functioning and Relation to IQ in Adults with Williams Syndrome: Is the BRIEF Adult Version a Valid Rating Scale?

Although there is evidence of a distinct profile of executive dysfunction in Williams syndrome (WS), a rare genetically based neurodevelopmental disorder, the utility of informant reports of everyday executive function (EF) impairments and their relation to intelligence is not yet clear. Here we aimed to evaluate the functional impact of executive dysfunction in adults with WS and to establish the validity of child and adult versions of the most commonly used rating scale for EF assessment, the Behaviour Rating Inventory of Executive Function (BRIEF). We were also interested in whether distinct components of everyday EF relate to intelligence in WS. Parent report child (BRIEF-C) and adult (BRIEF-A) ratings were collected on 20 adults with WS (aged 18.5 to 53 years), with a mean IQ of 60.95 (SD = 17.67). Neuropsychological measures of EF included: The Shape School Test (Espy, 2007); select subdomains of EF from the Woodcock-Johnson III Tests of Cognitive Abilities, Australian Adaptation (WJ III COG); and select subdomains from the Vineland Adaptive Behaviour Scales, Second Edition—Parent Survey (Vineland-II). Results showed that the BRIEF-A, but not the BRIEF-C, was the most highly correlated with neuropsychological measures of EF, suggesting that it was a valid measure of the profile of EF impairments in adults with WS. The profile of everyday EF dysfunction revealed relative impairments in monitoring, working memory, planning and organisation in WS. In addition, both neuropsychological and rating scale measures showed an association between the shifting component of EF and intelligence. These findings indicate that the BRIEF-A is a valid measure of the multidimensional nature of real-world impairments in EF, and highlight its utility as a less labor intensive and low-cost screening tool for measuring specific EF impairments that could become the focus of targeted intervention in adults with WS.

Executive functioning in individuals with intellectual disabilities and autism spectrum disorders

BACKGROUND

Executive functioning (EF) is important for adequate behavioural functioning and crucial for explaining symptoms of autism spectrum disorders (ASD) in individuals with normal intelligence, but is scarcely studied in individuals with ASD and intellectual disabilities (ID). We therefore study EF in an ID population by comparing performances on three frequently studied executive functions (shifting, inhibition and updating) between individuals with ASD and individuals without ASD. When studying ID populations, one should be aware of Spearman's Law of Diminishing Returns (SLODR), as it questions the possibility of measuring separate cognitive functions in ID populations.

METHODS

Six EF tasks were administered to 50 individuals with mild to borderline ID, of which half was diagnosed with ASD. In order to investigate the distinctness of the three executive functions in this ID sample, the results on the six EF tasks were subjected to principal components analysis (PCA). Subsequently, a multivariate analysis of variance (MANOVA) was performed to assess differences between the ASD and non-ASD group on shifting, inhibition and updating.

RESULTS

The PCA revealed the hypothesised EF trichotomy. MANOVA analysis showed no significant group differences on EF-performance.

CONCLUSIONS

Three separate executive functions were measured in this ID population, but despite much evidence that individuals with ASD display more behavioural problems and the proven relevance of EF in behavioural functioning, no significant group difference was found on shifting, inhibition or updating. After this first effort to achieve more insight into EF of individuals with ASD and ID the relation between behavioural problems and EF will require further study.

Is there a relationship between executive functions and academic success in children with neurofibromatosis type 1?

The present study aimed to compare the executive function (EF) of children with neurofibromatosis type 1 (NF1) to those of typically developing children and to investigate whether those abilities could predict the child's academic success in terms of academic skills and enablers. Twenty-nine children with NF1 and 27 age-and-gender-matched controls (aged 8-16 years) were examined with two tests to measure EF in an ecologically valid manner: the Behavioural Assessment of the Dysexecutive Syndrome in Children (BADS-C) and the parent questionnaire for the Behavior Rating Inventory of Executive Function (BRIEF). In order to evaluate academic success we used the Academic Competence Evaluation Scales (ACES). The performance of the NF1 group was significantly lower on the Water and Key search subtest of the BADS-C and on four scales of the BRIEF: initiate; working memory; plan/organise and organisation of materials. Significant correlations and predictive models via regression analysis were generated for: BADS-C, BRIEF and ACES scores. Based on these findings, children with NF1 have executive dysfunction that partially accounts for their difficulties in academic achievements.

Behavioral Assessment of the Dysexecutive Syndrome for Children: an examination of clinical utility for children with attention-deficit hyperactivity disorder (ADHD)

The present study evaluated the utility of the Behavioral Assessment of Dysexecutive Syndrome for Children for discerning differences in executive functioning between attention-deficit hyperactivity disorder (ADHD) children and normal controls and examined its associations with real-life executive function as rated by parent reports on the Dysexecutive Questionnaire for Children. Sixty-three children diagnosed with ADHD and 60 normal healthy peers were recruited for this study. All participants completed the Behavioral Assessment of Dysexecutive Syndrome for Children, while their parents completed the Dysexecutive Questionnaire for Children. Results revealed that the ADHD group exhibited significantly poorer performance than the controls on 3 subtests of the Behavioral Assessment of Dysexecutive Syndrome for Children (ie, Playing Cards Test, Water Test, and Zoo Map Test 2), as well as on the total Dysexecutive Questionnaire for Children. Significant correlation was found between the total Dysexecutive Questionnaire for Children and the 6-Part Test. Findings suggested that some subtests of the Behavioral Assessment of Dysexecutive Syndrome for Children were particularly useful for detecting real-life executive dysfunction in ADHD. Yet, further studies are needed to provide extended validity data.

Inhibition deficits in individuals with intellectual disability: a meta-regression analysis

BACKGROUND

Individuals with intellectual disabilities (ID) are characterised by inhibition deficits; however, the magnitude of these deficits is still subject to debate. This meta-analytic study therefore has two aims: first to assess the magnitude of inhibition deficits in ID, and second to investigate inhibition type, age, IQ and the presence/absence of comorbid problems as potential moderators of effect sizes.

METHOD

Twenty-eight effect sizes comparing ID and age matched normal controls on inhibition tasks were included in a random effects meta-regression. Moderators were age, IQ, inhibition type and presence/absence of comorbid disorder.

RESULTS

The analysis showed a medium to large inhibition deficit in ID. Inhibition type significantly moderated effect size, whereas age and comorbid disorder did not. IQ significantly moderated effect size indicating increasing effect size with decreasing IQ, but only in studies that included a sample of ID participants with mean IQ > 70. The analysis indicated comparable deficits in behavioural inhibition and interference control, but no significant deficits in cognitive inhibition and motivational inhibition.

CONCLUSIONS

These results indicate that ID is characterised by a medium to large inhibition deficit in individuals with ID. ID seems not to be characterised by deficits in cognitive and motivational inhibition, which might indicate that distinct processes underlie distinct inhibition capacities.

Executive control in long-term abstinent alcoholics with mild to borderline intellectual disability: the relationship with IQ and severity of alcohol use-related problems

Deficits in executive control might be related to alcohol abuse in individuals with mild to borderline intellectual disability (MBID). The goal of the present study was to test the relationship between executive control (i.e., working memory capacity, inhibitory control and delay discounting), IQ and chronic alcohol use. Participants (N=40) were divided into four groups based on IQ and severity of alcohol use-related problems (heavy and light drinkers with and without MBID). They were all admitted to a psychiatric treatment facility and long-term abstinent at the time of testing. Contrary to the expectations, executive control was not consistently impaired among individuals with MBID. Results showed that working memory capacity did seem to be impaired, whereas inhibitory control and delay discounting did not. Moreover, there were no differences between heavy and light drinkers on any of the parameters and having a dual diagnosis (heavy drinkers with MBID) did not result in additive negative effects on executive control. It is suggested that alcohol-related cognitive impairment is temporary and decreases over time after cessation of drinking.

Conceptual abilities of children with mild intellectual disability: analysis of wisconsin card sorting test performance

BACKGROUND

The ability to generate and flexibly change concepts is of great importance for the development of academic and adaptive skills. This paper analyses the conceptual reasoning ability of children with mild intellectual disability (MID) by their achievements on the Wisconsin Card Sorting Test (WCST).

METHOD

The sample consisted of 95 children with MID aged between 10 years and 13 years 11 months. The following variables from the WCST were analysed: number of categories completed, initial conceptualisation, total number of errors, non-perseverative errors, perseverative errors, number of perseverative responses, and failures to maintain set.

RESULTS

The observed WCST predictive variables account for 79% of the variability in the number of categories completed (p < .000). The total number of errors was the most significant predictor of performance on the WCST.

CONCLUSION

We can conclude that there is a significant progress of conceptual abilities between the age of 13 years to 13 years 11 months, compared to other assessed age groups. The results of our research suggests that the development of mental set flexibility is the basis of progress in conceptual abilities, thus intervention programs should offer specially designed activities that vary in their attentional demands, content, conceptual patterns, and actions required.

Practices Changes in the Child Protection System to Address the Needs of Parents With Cognitive Disabilities

Parents with cognitive disabilities (PCD) are over-represented in the child protection system. However, the current state of the child protection system is not well prepared for working with them. Biases that exist against their parenting, the need for accommodations in assessment and intervention practices, and specific training in staff and cross systems barriers need to be addressed. This paper argues for changes that will ensure such parents are more effectively served and that child protection staff and contract providers are better equipped to work with them. Specific changes are discussed in assessment and intervention practices. These changes will require human capacity building and organizational restructuring. Although empirically based behavioral approaches with PCD will be emphasized, recent empirical work suggests that social information processing and neurocognitive problems occur in PCD. Approaches to working with such problems are emerging and must also be considered and integrated into a blueprint for change.

Practical aspects of a visual aid to decision making

BACKGROUND

Previous research has demonstrated that people with mild intellectual disabilities (ID) have difficulty in 'weighing up' information, defined as integrating disparate items of information in order to reach a decision. However, this problem could be overcome by the use of a visual aid to decision making. In an earlier study, participants were taught to translate information about the pros and cons of different choices into a single evaluative dimension, by manipulating green (good) and red (bad) bars of varying lengths (corresponding to the value ascribed). Use of the visual calculator increased the consistency of performance (and decreased impulsive responding) in a temporal discounting task, and increased the amount of information that participants provided to justify their decisions in scenario-based financial decision-making tasks.

METHODS

The present study examined some practical aspects of visual calculator training, using a pen-and-paper version of two temporal discounting tasks. Participants with mild ID were tested, individually and in a group setting, before and after training in the group setting, and 2 months later.

RESULTS

(i) The visual aid improved temporal discounting performance using pen-and-paper presentation in a group setting as effectively as previously demonstrated using computer-based individual presentation. (ii) Following withdrawal of the aid, improvements in temporal discounting performance were maintained at 1 day post training, but lost following a 2-month hiatus; however, participants showed perfect retention, over 2 months, of how to use the aid. (iii) In addition to decreasing impulsivity in a hypothetical task, as previously demonstrated, use of the visual calculator also increased the ability of impulsive participants to wait in real time.

CONCLUSION

The results suggest that the visual calculator has practical applicability to support decision making by people with mild ID in community settings.

Executive dysfunctions among boys with Attention Deficit Hyperactivity Disorder (ADHD): performance-based test and parents report

Difficulty in executive functions (EF) is a core symptom of ADHD. Yet, the EF assessments are still in controversy. It is still unclear whether the everyday implementation of EF can be assessed under laboratory conditions. Therefore, the purposes of the present study are: (a) to examine EF among boys with ADHD both in everyday behavior (as reported by parents) and in a performance-based test. (b) To examine correlations between the two tests. Both the Behavior Assessment of Dysexecutive Functions for Children (BADS-C) and the Behavior Rating Inventory of Executive Functions (BRIEF) were independently applied to 25 boys aged 8-11 years with ADHD and 25 age-matched typical boys. Results of the two assessments were compared between the two groups to indicate differences in EF. Correlations between the two assessments for all participants were evaluated. Overall, significant differences in EF were found between the two groups on both assessments. Significant correlations were found between BADS-C and BRIEF, specifically in metacognition but not in behavioral regulation. Findings indicate that poor EF manifests itself in everyday behavior. These difficulties are found in metacognitive and behavioral regulation components. Nevertheless, applying a valid ecological assessment of behavior regulation merits future research.

A visual aid to decision-making for people with intellectual disabilities

Previous studies have shown that people with mild intellectual disabilities have difficulty in 'weighing-up' information, defined as integrating information from two different sources for the purpose of reaching a decision. This was demonstrated in two very different procedures, temporal discounting and a scenario-based financial decision-making task. In the present study, both tasks were presented to 24 participants who attended day services for people with learning disabilities (mean Full-Scale IQ = 59.8), half of whom were trained to use a visual aid to support decision-making. Performance of control participants did not change over repeated testing, but use of the visual aid substantially improved the quality of decision-making on both tasks: temporal discounting performance became more orderly, and participants were able to provide more information to justify their decisions in the financial decision-making task. The visual aid also substantially improved participants' ability to justify decisions they made about their own lives. We suggest that, while the visual aid was designed and evaluated as a means of increasing the quality of reasoning that supports a decision, it may also have potential as an aid to therapeutic interventions aimed at encouraging wiser decision-making.

Evaluation of the ability of people with intellectual disabilities to 'weigh up' information in two tests of financial reasoning

BACKGROUND

An assessment of mental capacity includes an evaluation of the ability to 'weigh up' information, but how to do this is uncertain. We have previously used a laboratory decision-making task, temporal discounting, which involves a trade-off between the value and the delay of expected rewards. Participants with intellectual disabilities (ID) showed very little evidence of 'weighing up' of information: only a third of participants showed consistent temporal discounting performance, and when present, consistent performance was usually impulsive; and the ability to perform consistently was more strongly related to executive functioning than to IQ. The aim of the present study was to replicate these observations and extend them to a more realistic financial decision-making task.

METHODS

We administered a temporal discounting task and a financial decision-making task, as well as tests of executive functioning and IQ, to 20 participants who attended day services for people with learning disabilities (mean Full-Scale IQ = 59), and to 10 staff members.

RESULTS

Performance in both decision-making tasks was related more strongly to executive functioning than to IQ. In both tasks, decisions by service users were made largely on the basis of a single item of information: there was very little evidence in either task that information from two sources was being 'weighed'.

CONCLUSIONS

The results suggest that difficulty in 'weighing up' information may be a general problem for people with ID, pointing to a need for psycho-educational remediation strategies to address this issue. The importance of executive functioning in decision-making by people with ID is not recognized in the legal test for mental capacity, which in practice includes a possibly irrelevant IQ criterion.

Performance in temporal discounting tasks by people with intellectual disabilities reveals difficulties in decision-making and impulse control

The subjective value of rewards declines as a function of the delay to receive them (temporal discounting). Three temporal discounting tasks that assessed preferences between small amounts of money (10 pence) over short delays (60 s), moderate amounts of money (10 pound) over moderate delays (2 weeks), and large amounts of money (1000 pound) over long delays (12 months) were presented to people with intellectual disabilities (Full-Scale IQ < 70) and to a comparison group (ns = 20 for each group). Measures of IQ, financial knowledge, memory, and executive functioning were also obtained. Only a third of the service users were able to perform the temporal discounting tasks consistently, and they tended to respond impulsively. The proportion of participants responding consistently increased following training. Both the initial performance and the effect of training were related to executive functioning but not IQ.