Executive control and dimensions of problem behaviors in preschool children

The experiences of occupational therapists supporting children with self-regulation needs: A qualitative descriptive study

INTRODUCTION

Occupational therapists support children with self-regulation needs to engage in meaningful occupations at home, school, and in the community. However, little is known about how Australian practitioners perceive their role working with children with self-regulation needs in the Australian healthcare context. Therefore, we explored the contemporary practice experiences of Australian occupational therapists working with children 4-12 years referred for self-regulation support, to better understand elements constituting efficacious service delivery to enhance occupational engagement.

METHODS

A qualitative descriptive design, underpinned by constructivism and relativism, was implemented to address the research aim. Occupational therapists were recruited online to participate in audio-recorded focus groups and interviews. The audio recordings were anonymised, transcribed verbatim, and analysed through reflexive thematic analysis.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers were involved in the study design or analysis.

FINDINGS

Four themes were generated, encapsulating the experience of 13 occupational therapists working with children with self-regulation needs: (1) navigating the complexities of self-regulation, (2) intervening to support the child and surrounding systems, (3) bringing the occupational therapy perspective to the self-regulation puzzle, and (4) working within an evolving practice context. Themes 1-3 describe specific processes that all occurred within the context of Theme 4. Overall, participants detailed successful practice to support children with self-regulation needs to participate in meaningful occupations that required person-centredness, collaboration, coaching, and adaptability of therapists responding to different stakeholder demands.

CONCLUSION

Self-regulation is a complex area of practice, and occupational therapists have a key role in supporting occupational engagement by balancing the child's needs with those of family, other stakeholders, and funding bodies. Findings support occupational therapists and decision-makers advocating for the unique role of occupational therapy in supporting self-regulation in childhood as part of a collaborative, multi-disciplinary approach. Specific consideration must also be given to ways that current funding schemes in Australia enable occupational therapy services for children with self-regulation needs.

PLAIN LANGUAGE SUMMARY

Controlling emotions and behaviours is sometimes called 'self-regulation'. Some children find this hard and need help from an occupational therapist, who knows a lot about the body and the systems within it. A lot of occupational therapists in Australia help children with their self-regulation. There is not much known about how these therapists see their role in working with these children. We wanted to understand what it is like for occupational therapists who help children, between 4 and 12 years old, with their self-regulation. We interviewed 13 occupational therapists from across Australia and analysed what they said. The data showed four main points: (1) understanding the challenges of self-regulation, (2) helping the child and their environment, (3) using an occupational therapy approach to solve self-regulation issues, and (4) working in a changing practice environment. The therapists described how important it is to focus on the child, work together with many people like caregivers and teachers, and being flexible. They talked about how they balance the needs of the child, family, and funding bodies, which could sometimes be tricky. The study shows the things that therapists are doing when working with children who need help with their self-regulation and the things that therapists find hard working in this space. The results of the study can be used by people who advocate for services that help children and by people who make decisions about Australia's healthcare. One way the study can be used is to think about how current funding schemes do or do not allow different people and professions to work together to support children's self-regulation. Even though there were some limitations, such as a low response rate due to the stress of the COVID-19 pandemic, we did interview therapists from different parts of Australia who work in different settings to each other.

Effects of 12-week aerobic exercise with different frequencies on executive function in preschool children: a cluster randomized controlled trial

OBJECTIVE

To explore the effects of a 12-week aerobic exercise program with different frequencies on executive functions (EFs) in preschool children.

METHOD

Four kindergartens, comprising 126 preschool children in Shanghai, were enrolled in this 12-week cluster randomized controlled trial with a 12-week follow-up period. Kindergartens were allocated to high-frequency (three times a week) or low-frequency (once a week) exercise groups using stratified block randomization. Three core sub-EFs, including inhibition, working memory, and cognitive flexibility, were assessed at baseline, post-intervention, and the 12-week follow-up.

RESULTS

Compared to baseline, both groups showed significant improvements in inhibition and working memory after the intervention and at the 12-week follow-up. However, only the high-frequency exercise group demonstrated a significant improvement in cognitive flexibility after the follow-up period. Nonetheless, there were no significant differences in the core sub-functions of EFs between the two groups at the end of the intervention or the follow-up periods.

CONCLUSION

A 12-week aerobic exercise of three times a week was insufficient to significantly improve EFs in preschool children compared to once a week. Future studies are needed to examine the dose-response relationship of aerobic exercise on EFs and to verify the effects of different exercise modalities on EFs in preschool children.

Intimate Partner Violence and Child and Adolescent Cognitive Development: A Systematic Review

Intimate partner violence (IPV) is a public health and human rights issue, with millions of children affected worldwide. While several reviews have explored the emotional-behavioural functioning of children exposed to IPV, this review aimed to examine the relationship between children's exposure to IPV and their cognitive development, and to identify associated factors such as aspects of parenting. The databases MEDLINE, PsycInfo, EMBASE, Family and Society Studies Worldwide, CINAHL, and ERIC were searched using key words related to IPV, such as domestic, family, partner, interparental, spousal, marital, violence, abuse, aggression, assault, combined with key words related to cognitive functioning, such as neuropsychological, executive, intelligence, learning, memory, and key words related to children and adolescents. A total of 38 studies met the criteria for review which included reporting an estimate of the relationship between IPV and cognition using direct assessments of cognitive functioning. Approximately 70% of studies found a relationship between IPV and poorer cognitive functioning, with general IQ the most frequently assessed domain of functioning, followed by verbal abilities and academic skills. Most studies assessed skills during early childhood, with fewer studies assessing children during middle childhood and adolescence. Results were consistent across cognitive domains and developmental stages. In terms of factors associated with IPV and cognition, a range of demographic, individual, and family factors were included, with several studies exploring mediating and moderating mechanisms. The findings suggest that IPV in childhood is associated with poorer cognitive skills across a range of domains. Implications for policy, practice and research are discussed.

ADHD and ASD symptoms in young males with fragile X syndrome: associations with early trajectories of inhibitory control

Inhibitory control (IC), the ability to suppress inappropriate responses, emerges late in the first year of life and improves across typical development, concurrent with brain maturation. The development of IC is critical to various social-emotional and behavioral functions, with IC difficulties being linked to numerous neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Fragile X syndrome (FXS) is a single-gene disorder characterized by IC difficulties, and elevated rates of ADHD and ASD, making it a useful model for understanding the early development and consequences of IC. In this longitudinal study, we characterized IC trajectories across multiple time points between 16 and 71 months of age in young males with FXS (n = 79) relative to neurotypical (NT) controls (n=49). To explore the association between behavioral outcomes and IC, we identified a subsample of 50 children with longitudinal IC data and an outcome assessment for ADHD and ASD symptoms at age 5 (FXS: n = 26, NT: n = 24). Results indicated that, compared to their NT peers, young males with FXS exhibit differences in IC as early as 24 months, with group differences increasing through age 5. Additionally, we determined that lower IC levels at 24 months were associated with later ADHD symptoms and a decreasing slope in IC over time was associated with later ASD symptoms in male children with FXS. These findings help refine early developmental phenotypes of FXS and highlight IC as a potential target for early detection and intervention of ASD and ADHD symptoms in male children with FXS.

The Relationship Between Executive Functions and Externalizing and Internalizing Behaviors in Mexican Preschoolers

Executive functions allow the regulation of behavior and emotions. This study aimed to analyze the association of executive functions with externalizing and internalizing behaviors in 30 Mexican preschoolers with typical development (age M = 53.63 months; SD = 7.83 months; 40% girls) from homes of middle-low socioeconomic status. Behavioral and cognitive measures were used to assess executive functions and analyzed them using robust statistical methods. We found that executive functions are related to externalizing and internalizing behaviors at the behavioral level. Only Forward Digit Span predicts attentional problems. Individual differences in children's cognitive development in a Mexican context were adressed, and they have clinical and educational implications.

Executive functions are important for academic achievement, but emotional intelligence too

Finding predictors of academic achievement has caught the interest of many educational researchers in the last decades. Two of the variables that have received considerable attention are emotional intelligence (EI) and executive functions (EF). However, only a few studies have considered their influence in the primary school stage. The aim of this study is to identify which EI components and specific EF are most related to academic achievement and to explore if these relationships vary among subjects. The sample comprised of 180 students between 8-11 years old. We administered the BarOn EI Inventory, tasks of EF and tests of mathematic and linguistic competences. The results showed that EF are better predictors of school performance than EI. Inhibition and working memory were the EF most associated with achievement while adaptability emerged as the EI dimension most linked to it. This study suggests that EI and EF should be consciously developed in classrooms.

Early Risk of Tobacco Smoke Exposure and Preschoolers' Hot and Cool Inhibitory Control: Promotive and Protective Roles of Maternal Positivity in Early Mother-child Interaction

Early tobacco smoke exposure (TSE) in utero and/or during the first years after birth poses threats to the development of child executive functioning and self-regulation skills, including inhibitory control. Efforts are still needed to examine under what conditions such effects may occur and thus identify modifiable intervention targets. In addition, a distinction between cool and hot inhibitory control is also important to obtain greater nuance in such links. The cool inhibitory control refers to children's suppression of prepotent automatic responses to a distracting stimulus in solving arbitrary and decontextualized problems, whereas the hot inhibitory control refers to children's control of impulse in motivationally and emotionally high-stake situations. Using data derived from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, we examined the links between early risk of TSE and preschoolers' hot and cool inhibitory control and tested the potential promotive/protective roles of maternal positivity in early mother-child interactions. Results indicate that early risk of TSE was negatively linked to child cool inhibitory control when maternal positivity was low, but this link was nonsignificant when maternal positivity was high (i.e., the protective role of maternal positivity). The link between early risk of TSE and child later hot inhibitory control was not moderated by maternal positivity; instead, early risk of TSE and maternal positivity were negatively and positively associated with child hot inhibitory control above and beyond each other, respectively (i.e., the promotive role of maternal positivity). Accordingly, building a tobacco-free environment during pregnancy and infancy likely yields long-term benefits for child self-regulation development. Improving early mothering may offset the negative link between early TSE and child cool inhibitory control and also facilitate child hot inhibitory control even in the face of early TSE.

Reference production in Mandarin–English bilingual preschoolers: Linguistic, input, and cognitive factors

Reference in extended discourse is vulnerable to delayed acquisition in early childhood. Although recent research has increasingly focused on effects of linguistic, input, and cognitive factors on reference production, these studies are limited in number and the results are mixed. The present study provides insight into bilingual reference production by investigating how production of referring expressions in the two languages of preschool bilingual children may be influenced by structural similarities and differences between the languages, frequency of referring expressions in maternal input, amount of exposure to each of the languages, and working memory capacity. Using two stories in the Multilingual Assessment Instrument for Narratives (MAIN), we examined character introduction and re-introduction in oral narratives of 4–6-year-old Singaporean bilingual children acquiring Mandarin Chinese and English (n = 21), and in child-directed speech of the mothers (n = 17). The children’s language exposure, executive function, and general bilingual proficiency were also recorded or directly tested through structured interviews with the parents or standardized assessments with the children. Data collection was conducted remotely in real time over a video-conferencing platform, supplemented by on-site audio recording to ensure sound quality. Results showed prolonged development in the production of felicitous REs for first mentions and over-reliance on overt marking of definiteness in our bilingual children. Mixed modeling revealed that frequency of felicitous REs in the input predicted children’s production of felicitous REs across languages and discourse functions, with a modulating effect of working memory. Overall, our findings are consistent with previous ones in that reference production is vulnerable in early Mandarin-English bilinguals in a multilingual society. This study also presents novel evidence that structural frequency in the input interacts with working memory in shaping patterns of reference production in bilingual children.

Latent Class Analysis Reveals Distinct Groups Based on Executive Function and Socioemotional Traits, Developmental Conditions, and Stuttering: A Population Study

A growing body of research has reported associations between weaker Executive Functions (EF), the set capacities that are needed to manage and allocate one's cognitive resources during cognitively challenging activities and various neurodevelopmental conditions, including stuttering. The majority of this research has been based on variable-centered approaches, which have the potential to obscure within-population heterogeneity. Person-centered analyses are essential to understanding multifactorial disorders where relationships between indicators have been elusive, such as stuttering. The current study addressed gaps in the literature by using latent class analysis (LCA), a person-centered approach, to identify homogenous subgroups within the National Health Interview Survey (2004-2018) publicly available data set. Using this exploratory approach, we examined the hypothesis that there exist distinct classes (or subgroups) of children based on parent reports of EF, Socioemotional (SE) traits, developmental atypicality, and stuttering. Our analyses revealed distinct subgroups with substantially different likelihoods of parent-reported stuttering behaviors and developmental atypicality. For children with both EF and SE difficulties, the likelihood of parental report of stuttering and atypical development was even higher, in fact this likelihood (of stuttering and not-typically developing) was highest among all subgroups. In contrast, children without difficulties were the least likely to be reported with stuttering or not-typically developing. Our findings are consistent with theoretical frameworks for stuttering, which cite EF as a crucial component in the disorder. Additionally, our findings suggest within-population heterogeneity among children with EF difficulties and, specifically, EF and SE heterogeneity among children who stutter.

Basketball training frequency is associated with executive functions in boys aged 6 to 8 years

This study investigates the relationship between the frequency of basketball training and executive functions (inhibitory control, working memory, and cognitive flexibility) in boys aged 6 to 8. A total of 40 boys recruited from a local after-school basketball training club were divided into a low-frequency group (once a week) and a high-frequency group (at least twice a week). An additional 20 age-matched boys recruited from a local elementary school were considered as the control group (no training experience). All subjects conducted the Stop-signal task, the N-back task, and the switching task at rest. The mean reaction time and accuracy data obtained from each task were used in statistical analysis. There was no significant group difference in either the accuracy or reaction time of inhibitory control. Meanwhile, no significant difference was found in the reaction time of working memory across groups. However, the high-frequency group exhibited significantly higher accuracy (93.00 ± 4.31%) with regard to working memory than the low-frequency group (85.4 ± 6.04%, P < 0.001) and the control group (83.73 ± 7.70%, P < 0.001), respectively. A positive correlation was also found between the accuracy of working memory and groups. Furthermore, in comparison with the control group, the high-frequency group exhibited significantly higher cognitive flexibility accuracy (91.93 ± 7.40% vs. 85.70 ± 9.75%, P = 0.004) and shorter reaction time (934.24 ± 213.02 ms vs. 1,122.06 ± 299.14 ms, P < 0.001). There was also a positive correlation between the accuracy of cognitive flexibility and groups. These findings suggest that regular basketball training, especially with higher frequency, is beneficial to working memory and cognitive flexibilityin boys aged 6 to 8.

The relationship between executive functioning and attention deficit hyperactivity disorder in young children: A cross-lagged study

Early childhood is a critical period for cognitive development and the emergence of attention deficit hyperactivity disorder. Therefore, many researchers have explored the relationship between executive function and attention deficit hyperactivity disorder (ADHD) in young children. However, the findings have been inconsistent. This study used a cross-lagged survey to clarify the interaction between executive function and ADHD in early childhood as well as explore the trends of the same. Data were collected using questionnaires distributed to 376 parents of children aged 4–6 years in October 2018 (Time 1) and June 2019 (Time 2), with components including the Child Executive Functioning Scale (Parent Version) and Child Difficulty and Strengths Scale (Parent Version), and the mean age of the children surveyed at Time 1 was 58.96 ± 11.94 months. Results indicate that executive function and attention deficit hyperactivity disorder were stable, with significant positive and secondary positive correlations between executive function and attention deficit hyperactivity disorder. The cross-lagged regression analysis showed that the inhibition of executive function components at Time 1 predicted the attention deficit hyperactivity disorder at Time 2. Finally, the cross-lagged regression analysis showed that attention deficit hyperactivity disorder at Time 1 significantly predicted the inhibition at Time 2. There was a strong relationship between inhibition and attention deficit hyperactivity disorder in the sample, with some reciprocal causality. The findings indicate the urgent need for early screening and intervention in cognitive and behavioral disorders.

Identifying Children With Self-Regulation Problems

Abstract. The Preschool Self-Regulation Questionnaire (Questionario di Valutazione dell’Autoregolazione [QUVA-p]) is a teacher-completed screening tool for assessing child dysregulation at preschool age. This study presents the psychometric properties of the questionnaire, which was investigated in a sample of 413 preschoolers. We tested for construct validity, measurement invariance across gender, subscale internal consistency, subscale convergent validity with executive control tasks (working memory, inhibitory control, and cognitive flexibility), and power to detect child differences in executive control. Results show that the factorial structure of the QUVA-p is in line with Nigg’s theoretical model of self-regulation and the subscales have good reliability. Measurement invariance is maintained across gender; the instrument reveals small but significant associations with executive control tasks, and it could be useful to detect child differences in executive control.

Preschoolers’ Attitudes, School Motivation, and Executive Functions in the Context of Various Types of Kindergarten

European policy has seen a number of changes and innovations in the field of early childhood preschool education over the last decade, which have been reflected in various forms in the policies of individual EU countries. Within the Czech preschool policy, certain innovations and approaches have been implemented in the field of early children education, such as the introduction of compulsory preschool education before entering primary school from 2017, emphasis on inclusive education, equal conditions in education and enabling state-supported diversity in the education concepts of kindergartens. The aim of our study was to assess the influence of various preschool education systems in the Czech Republic in the context of psychological variables reflecting selected children’s outcomes which may contribute to future school achievement. The monitored variables were the attitudes, motivations and executive functions of children in the last year of preschool education. A comparison was made between the traditional preschool education program and the so-called alternative types of preschool education, such as Montessori, Waldorf and religious schools. The total sample was divided into four subgroups, namely a group of children attending traditional kindergartens (731, 84.9%), religious (65, 7.5%), Montessori (35, 4.1%), and Waldorf (30, 3.5%) kindergartens. To determine empirical data, the following research methods were used: Attitude Questionnaire, School Performance Motivation Scale, and Behavior Rating Inventory of Executive Function (BRIEF). The results of our survey show the fact that the type of kindergarten attended has a significant effect on the child’s level of school performance motivation, attitudes toward school as well as executive functions. Significant differences were found between the different types of kindergartens attended in the monitored variables.

Assessment of Preschool-age Executive Functions: A Systematic Review

Executive functions (EF) are higher-order cognitive processes present in the prefrontal cortex, and are fundamental in planning, executing, and monitoring goal-oriented behaviors. Evaluating EF in early stages of child development is essential for identifying any cognitive alterations in young children, given that it allows for early intervention and minimizes future complications. Additionally, it contributes to a better understanding of this construct in this age bracket, as well as its operational model. Study of EF has recently been the focus of multiple researcher; however, there is still a serious lack of instruments and measurements validated towards children's age bracket. This systematic review's main goal is to evaluate instruments and/or tasks that serve to evaluate and analyze EF and/or their components between the ages of 36 and 72 months. Forty-nine studies were analyzed, containing multiple tasks and tools oriented towards EF and their constituent components. Results indicate the existence of various tasks that grade the different components independently from one another; nevertheless, they also confirm the lack of any global measurement instrument or method. Therefore, this systematic review presents itself as an important contribution in the study of EF, not only stressing the importance of further investing into constructing and validating new and better tools for evaluating the construct, but also the study of operating models of executive functioning, especially in an age bracket where comprehending it is notoriously difficult.

Socioeconomic Status, Urbanization and Executive Functions Development: Differences Between Urban and Rural Children

Abstract Socioeconomic Status (SES) has been linked to the development of Executive Functions (EF) usually by means of parental education and family income. Living conditions related to urbanization characteristics are rarely considered. This cross-sectional study investigated the performance in EF tasks of 99 Brazilian children aged 6 to 8 years residing in rural and urban regions. Results showed that children who lived in the rural area performed better than those who lived in the industrial city in the working memory and inhibitory tasks. Social interactions and urbanization conditions, such as parent occupations and social stratification, may explain these differences. Therefore, urbanization conditions of locations where families live should be considered in future studies concerning the influences of SES in EF development.

Sleep during infancy, inhibitory control and working memory in toddlers: findings from the FinnBrain cohort study

Background

Sleep difficulties are associated with impaired executive functions (EFs) in school-aged children. However, much less is known about how sleep during infancy relates to EF in infants and toddlers. The aim of this study was to investigate whether parent-reported sleep patterns at 6 and 12 months were associated with their inhibitory control (IC) and working memory (WM) performances at 30 months.

Methods

This study included children whose parents filled in a sleep questionnaire at 6 or 12 months and who participated in the development assessment at 30 months (initial available sample at 30 months; N = 472). The final sample comprised (a) 359 infants with IC task and sleep questionnaire at 6 months and 322 toddlers at 12 months and (b) 364 infants with WM task and sleep questionnaire at 6 months and 327 toddlers at 12 months. Nighttime, daytime and total sleep duration, frequency of night awakenings, time awake at night, and proportion of daytime sleep were assessed at 6 and 12 months using the Brief Infant Sleep Questionnaire. IC at 30 months was measured using a modified version of the Snack Delay task, and WM was measured at 30 months using the Spin the Pots task. Further, children were divided into three groups (i.e., “poor sleepers”, “intermediate sleepers”, and “good sleepers”) based on percentile cut-offs (i.e., <10th, 10th–90th and > 90th percentiles) to obtain a comprehensive understanding of the direction and nature of the associations between sleep and EF in early childhood.

Results

Our results showed an inverted U-shaped association between proportion of daytime sleep at 12 months and IC at 30 months, indicating that average proportions of daytime sleep were longitudinally associated with better IC performance. Furthermore, a linear relation between time awake at night at 12 months and WM at 30 months was found, with more time awake at night associating with worse WM.

Conclusions

Our findings support the hypothesis that sleep disruption in early childhood is associated with the development of later EF and suggest that various sleep difficulties at 12 months distinctively affect WM and IC in toddlers, possibly in a nonlinear manner.

Effects of Cognitive Training and Exergaming in Pediatric Cancer Survivors-A Randomized Clinical Trial

Supplemental digital content is available in the text.

Purpose

Although most pediatric cancer patients survive, those who undergo anticancer treatments like chemotherapy and/or radiotherapy are at a high risk for late effects, such as cognitive deficits. To counteract these deficits, feasible and effective interventions are needed. The aim of this study was to compare the effects of working memory training, exergaming, and a wait-list control condition on cognitive functions in pediatric cancer survivors.

Methods

In a parallel-group randomized trial, 69 pediatric cancer survivors aged 7–16 yr (mean = 11.35, SD = 3.53) were randomly assigned to 8-wk working memory training, exergaming, or a wait-list control group. Each training course consisted of three 45-min training sessions per week. The primary outcome comprised the core executive functions (visual working memory, inhibition, switching), and the secondary outcomes included other cognitive domains (intelligence, planning, memory, attention, processing speed), motor abilities, and parent rating on their children’s executive functions. Assessments were conducted both before and immediately after the interventions, and at 3-month follow-up.

Results

Linear mixed models revealed that participants in the working memory training group showed a linear improvement in visual working memory after training and at follow-up compared with the control group. No other intervention effects of either type of training could be detected.

Conclusion

This study presents evidence that working memory training improves visual working memory in pediatric cancer survivors. Results show that near-transfer, but no far-transfer effects can be expected from working memory training. Multiple-component interventions tailored to fit the individual’s cognitive profile are needed to best support cognitive development after cancer and its treatment.

The dimensionality of early executive functions in young preschoolers: Comparing unidimensional versus bidimensional models and their ecological validity

The study analyses the dimensionality of executive functions (EF) and its relationship with behavior in typically developing 3- and 4-year-old children. In study 1, confirmatory factor analysis (CFA) was used to investigate the validity of a one-factor model in 117 preschoolers. Since this model was not confirmed, a two-factor model was identified through exploratory factor analysis. In study 2, the validity of the new two-factor versus one-factor model was tested on a new sample of 128 children through a series of CFAs. The relationship between the models and specific behavioral aspects of the children was investigated. The results suggest that a bidimensional structure showed a better fit to the data and more ecological validity than a unitary structure.

Associations between stuttering, comorbid conditions and executive function in children: a population-based study

Background

The aim of this study was to investigate the relationship between executive function (EF), stuttering, and comorbidity by examining children who stutter (CWS) and children who do not stutter (CWNS) with and without comorbid conditions. Data from the National Health Interview Survey were used to examine behavioral manifestations of EF, such as inattention and self-regulation, in CWS and CWNS.

Methods

The sample included 2258 CWS (girls = 638, boys = 1620), and 117,725 CWNS (girls = 57,512; boys = 60,213). EF, and the presence of stuttering and comorbid conditions were based on parent report. Descriptive statistics were used to describe the distribution of stuttering and comorbidity across group and sex. Regression analyses were to determine the effects of stuttering and comorbidity on EF, and the relationship between EF and socioemotional competence.

Results

Results point to weaker EF in CWS compared to CWNS. Also, having comorbid conditions was also associated with weaker EF. CWS with comorbidity showed the weakest EF compared to CWNS with and without comorbidity, and CWS without comorbidity. Children with stronger EF showed higher socioemotional competence. A majority (60.32%) of CWS had at least one other comorbid condition in addition to stuttering. Boys who stutter were more likely to have comorbid conditions compared to girls who stutter.

Conclusion

Present findings suggest that comorbidity is a common feature in CWS. Stuttering and comorbid conditions negatively impact EF.

Temperament in preschool children with sickle cell anaemia

AIMS

Few studies have investigated the potential impact of sickle cell anaemia (SCA) on temperament. The aim of the current study was to investigate temperament in preschool children with SCA and to establish the reliability of the Children's Behaviour Questionnaire (CBQ) in this population.

METHODS

The CBQ, a parent-report measure of temperament, was completed by parents of 21 preschool children with SCA and a control group of parents of typically developing children, matched for age, ethnicity and socioeconomic status.

RESULTS

A significant difference between groups was identified for the dimension of negative affectivity only, with specific differences observed in the discomfort subdomain. Patients with a greater number of hospital admissions in the previous year were reported to have higher levels of discomfort.

CONCLUSIONS

Preschool children with SCA are reported to have higher rates of negative affectivity, particularly discomfort. Future research is required to investigate the potential influence of dysregulated negative emotions and discomfort on disease management and quality of life throughout childhood.

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

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

The Association Between Persistence and Change in Early Childhood Behavioural Problems and Preschool Cognitive Outcomes

The link between behavioural and cognitive difficulties is well established. However, research is limited on whether persistence and change in behavioural difficulties relates to cognitive outcomes, particularly during preschool. We used a large New Zealand birth cohort to investigate how persistence and change in serious behavioural problems from ages 2 to 4.5 years related to measures of cognitive delay at 4.5 years (n = 5885). Using the Strengths and Difficulties total problems score at each time point, children were categorised as showing no difficulties, improved behaviour, concurrent difficulties, and persistent difficulties. Cognitive measures assessed included receptive language, early literacy ability, and executive control. Our results showed that children with concurrent and persistent behavioural difficulties were at a greater risk of showing delays within specific cognitive domains relative to children with no difficulties and were also more likely to show comorbid delays across multiple cognitive domains.

Research Review: Do parent ratings of infant negative emotionality and self-regulation predict psychopathology in childhood and adolescence? A systematic review and meta-analysis of prospective longitudinal studies

BACKGROUND

Identifying low-cost and easy to implement measures of infant markers of later psychopathology may improve targeting of early intervention for prevention. Because of their early manifestation, relative stability and overlap with constructs central to affect-based dimensions of child and adolescent psychopathology, negative emotionality and self-regulation have been the focus of this research. We conducted a meta-analysis of longitudinal studies examining the prospective association between infant temperament measured with parent ratings and child/adolescent psychopathology.

METHODS

A systematic literature search for prospective longitudinal studies, which included measures of questionnaire-assessed infant temperament (negative emotionality, self-regulation, behavioural inhibition, surgency/extraversion, activity level) and symptoms of child or adolescent mental health (externalising, internalising) and neurodevelopmental problems (attention deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]), was conducted. Standardised estimates of association were calculated and pooled in meta-analyses.

RESULTS

Twenty-five studies (n = 28,425) met inclusion criteria. Small associations were seen between psychopathology aggregated across all domains and infant negative emotionality (r = .15; p < .001) and self-regulation (r = -.19; p = .007). Effects were also significant but weaker for behavioural inhibition (r = .10; p = .027) and activity level (r = .08; p = .016). Surgency/extraversion was not significantly associated with psychopathology in general (r = -.04; p = .094); however, it was negatively associated with ASD (r = -.10, p = .015). Significant correlations were observed with some outcomes isomorphic with predictors, internalising problems and behavioural inhibition (r = .10; p = .013), ADHD symptoms and activity level (r = .19; p = .009).

CONCLUSION

Questionnaire-based assessments of infant negative emotionality may have transdiagnostic potential to contribute to a risk index of later childhood psychopathology. Behavioural inhibition, surgency/extraversion and activity ratings may provide more specific predictive power. More data from prospective studies are required before the potential of self-regulation and surgency/extraversion can be properly gauged.

The effects of chronic physical activity interventions on executive functions in children aged 3-7 years: A meta-analysis

OBJECTIVES

To use a quantitative approach to examine the effects of chronic physical activity (PA) interventions on executive functions (EFs) in children aged 3-7 years.

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and the China National Knowledge Infrastructure were searched from their inception to December 2019. Intervention studies with a control group that examined the effects of chronic PA interventions on EFs among children aged 3-7 years were included in this meta-analysis. Lastly, subgroup analyses were conducted to examine the potential modifying effects of chronic PA intervention's characteristics and study quality.

RESULTS

A total of 10 studies were included in this meta-analysis with a total of 716 participants. The fixed-effects model was used to estimate the pooled effect sizes since heterogeneity across included studies was not significant. The summary effects revealed that chronic PA interventions have a small but positive effects on participants' overall EFs [standardized mean difference (SMD) = 0.35, 95% CI: 0.20-0.50] as well as inhibition (SMD = 0.37, 95% CI: 0.12-0.62) and working memory (SMD = 0.24, 95% CI: 0.02-0.46) domains and a moderate effect on the cognitive flexibility domain (SMD = 0.66, 95% CI: 0.28-1.05). Lastly, the pooled effect was not significantly modified by intervention duration, session length, or frequency.

CONCLUSIONS

Chronic PA interventions, especially PA plus cognitive challenges interventions, may be a promising way to promote the development of multiple aspects of EFs in children aged 3-7 years.

Prenatal lead exposure and childhood executive function and behavioral difficulties in project viva

BACKGROUND

Lead is an established neurotoxicant and early life exposure to lead is associated with detrimental impacts on IQ and several neurobehavioral domains. Less is known, however, about effects of prenatal lead exposure below 5 μg/dL on executive function and on social, emotional and self-regulatory behaviors in childhood.

OBJECTIVES

To examine the association between prenatal lead exposure and childhood executive function and social, emotional and self-regulatory behaviors.

METHODS

We included 1006 mother-child pairs from the Project Viva prospective pre-birth cohort. We measured prenatal maternal lead in second-trimester erythrocytes. In mid-childhood (median 7.7 years), parents and teachers rated executive function related behaviors using the Behavior Rating Inventory of Executive Function (BRIEF) and behavioral difficulties using the Strengths and Difficulties Questionnaire (SDQ). We used multivariable linear regression models adjusted for maternal, paternal, and child characteristics and metal co-exposures.

RESULTS

Mean maternal erythrocyte lead concentration was 1.2 μg/dL (interquartile range [IQR] 0.8-1.5 μg /dL), equivalent to approximately 0.4 μg/dL in whole blood. In adjusted models, associations with parent and teacher-rated scales were largely null, although effect estimates were consistently positive, suggesting worse scores with increasing lead levels. For an IQR increase in lead, BRIEF Global Executive Composite (GEC) was 0.73 (95% CI: -0.06, 1.52) points higher for parent-rated scores and 0.42 (95% CI: -0.39, 1.23) points higher for teacher-rated scores. Associations were strongest for parent-rated BRIEF plan/organize (β = 0.85; 95% CI: 0.12, 1.59) and shift (β = 0.88; 95% CI: 0.01, 1.75) subscales, as well as the SDQ emotional problems subscale (β = 0.18; 95% CI: 0.03, 0.33).

DISCUSSION

In this cohort with lead levels commonly experienced by U.S. women, there were few statistically significant associations with childhood executive function and behavior. However, there was a trend of worse neurobehavioral scores with increasing prenatal lead concentrations, in particular for childhood emotional problems and capacity to plan/organize and shift. Our results highlight the importance of continuing efforts to eliminate lead exposure in the general population.

Common mechanisms of executive attention underlie executive function and effortful control in children

Executive Function (EF) and Effortful Control (EC) have traditionally been viewed as distinct constructs related to cognition and temperament during development. More recently, EF and EC have been implicated in top-down self-regulation - the goal-directed control of cognition, emotion, and behavior. We propose that executive attention, a limited-capacity attentional resource subserving goal-directed cognition and behavior, is the common cognitive mechanism underlying the self-regulatory capacities captured by EF and EC. We addressed three related questions: (a) Do behavioral ratings of EF and EC represent the same self-regulation construct? (b) Is this self-regulation construct explained by a common executive attention factor as measured by performance on cognitive tasks? and (c) Does the executive attention factor explain additional variance in attention deficit hyperactivity disorder (ADHD) problems to behavioral ratings of self-regulation? Measures of performance on complex span, general intelligence, and response inhibition tasks were obtained from 136 preadolescent children (M = 11 years, 10 months, SD = 8 months), along with self- and parent-reported EC, and parent-reported EF, and ADHD problems. Results from structural equation modeling demonstrated that behavioral ratings of EF and EC measured the same self-regulation construct. Cognitive tasks measured a common executive attention factor that significantly explained 30% of the variance in behavioral ratings of self-regulation. Executive attention failed to significantly explain additional variance in ADHD problems beyond that explained by behavioral ratings of self-regulation. These findings raise questions about the utility of task-based cognitive measures in research and clinical assessment of self-regulation and psychopathology in developmental samples.

Art of Learning - An Art-Based Intervention Aimed at Improving Children's Executive Functions

Executive functions (EFs) can be conceptualized as a mean of behavioral self-regulation, and difficulties with EFs may adversely affect school success, social function, and cognitive and psychological development. Research about EFs and how they are affected by various educational and psychosocial factors is sparse. EFs are of great importance to understand how children can handle the challenges that they meet at various stages of development. There has been an increased focus on programs aimed at improving EFs, either as a primary outcome, or as a supplemental result of a specific activity. In this randomized controlled study, 66 children (31 girls, mean age 7:1 years) were given an arts and culture rich intervention (Art of Learning) aimed at improving EFs. EFs were assessed with the Behavior Rating Inventory of Executive Functioning-teacher version (BRIEF-teacher form) before, immediately after, and 6 months after intervention. Outcome in the intervention group was compared to children from two schools serving as controls (n = 37, 18 girls, mean age 7:3 years). In addition, teachers from intervention schools were also interviewed both individually and in focus groups. The results reveal that both groups improved their EFs, as measured with BRIEF, over time on the global executive composite (GEC) score, the metacognition index, and on behavioral regulation index (BRI). However, the intervention group displayed a significantly greater improvement than the control group on GEC and BRI. The teacher interviews reveal positive effects for the children when it comes to several aspects: collaboration, conflict management, inclusion, vocabulary, and confidence. These factors are regarded as important for EFs development and academic outcome. The results support the notion of best training transfer effects for tasks addressing global executive functioning and specifically behavioral regulation skills (BRI).

Der längsschnittliche Zusammenhang zwischen vorschulischen Selbstregulationsfähigkeiten und akademischen Kompetenzen in der Grundschule

Zusammenfassung. Die Vorhersagekraft selbstregulatorischer Fähigkeiten für die Entwicklung früher akademischer Kompetenzen wurde vielfach hervorgehoben. Allerdings bestehen häufig variierenden Definitionen von Selbstregulation, die mit verschiedenen Operationalisierungsvarianten einhergehen. Das Ziel dieses systematischen Reviews ist es, unter Berücksichtigung der verschiedenen Definitionen, eine Übersicht der Ergebnisse zur Vorhersagekraft vorschulischer Selbstregulationsfähigkeiten auf die akademischen Kompetenzen in der Grundschule zu erstellen. Eine systematische Literaturrecherche in den bibliografischen Fachdatenbanken Web of Science, PsycINFO und Psyndex ergab 1.509 Studien, von denen 22 Studien die weiteren Einschlusskriterien erfüllt haben. Trotz unterschiedlicher Erhebungsmethoden und Definitionen unterstützen die Studienergebnisse übereinstimmend die bedeutende Rolle vorschulischer Selbstregulationsfähigkeiten für die Entwicklung mathematischer Kompetenzen und Lese- und Schreibfähigkeiten in den frühen Grundschuljahren. Insbesondere kognitive Aspekte der Selbstregulation scheinen im Zusammenhang mit der Schulleistungsfähigkeit von Kindern zu stehen. Implikationen für frühe Trainingsmaßnahmen und die Übertragbarkeit der Erkenntnisse der vorwiegend internationalen Studien auf das deutsche Bildungssystem werden diskutiert.

Associations between parenting behavior and executive function among preschool-aged children born very preterm

The objective of the current study was to determine whether three domains of observed parenting behavior were associated with executive function in preschool-aged children born very preterm (<30 completed weeks' gestation). Executive function of 41 preschool-aged (3.5 to 4.5 years) children was assessed using a standardized protocol (gift delay) and by parent-report (Behavior Rating Inventory of Executive Function-Preschool, BRIEF-P). Observational protocols were used to determine parental sensitivity, harsh intrusiveness, and dyadic mutuality in a semi-structured play task. Parental sensitivity and mutuality were rated as higher, and harsh intrusiveness was rated as lower for children high in executive function on the gift delay task. Similarly, correlations between the three parenting scales and the BRIEF-P Global Executive Composite t-score were in the expected direction though not always statistically significant. Findings suggest that very preterm children who experienced sensitive parenting and were rated as having greater mutuality in their interactions with their caregivers scored higher on executive function tasks. These findings add to the growing literature on the key role that sensitive parenting and mutually responsive, harmonious interactions between caregivers and children may play in the development of executive function in very preterm children.

Executive Control and Adolescent Health: Toward A Conceptual Framework

Executive control is a set of cognitive abilities that may impact a variety of adolescent health behaviors and outcomes; however, research on executive control as a contributor to the physical health of youth is relatively limited. Therefore, the current article explores the possible role of executive control in adolescent health by reviewing relevant literature and proposing a conceptual framework to guide future research in this area. The development of executive control from preschool through adolescence is described, with particular attention to executive control in the unique health context of adolescence. A new conceptual model is proposed, focusing on how executive control may play a critical role in supporting health in adolescence and beyond through the mechanisms of attentional, behavioral, and emotional control. Literature exploring associations between youth executive control and key health behaviors (including diet, physical activity, sleep and substance use) is reviewed. Researchers and clinicians are encouraged to consider executive control as an important cross-cutting contributor to health during adolescence and beyond and to incorporate this construct into longitudinal studies of health.

Commonality between executive functioning and effortful control related to adjustment

This study examined the association between executive functioning (EF) and effortful control (EC), and tested whether cognitive control as the commonality of EF and EC, predicted competence and internalizing and externalizing symptomatology in children (N = 218, 6-8 years) and adolescents (N = 157, 13-14 years). Confirmatory factor analyses suggested cognitive control-inhibitory control and attentional control-as a significant overlap between EF and EC. Structural equation modeling analyses indicated that the cognitive control latent factor was associated with competence and internalizing and externalizing symptomatology among children and externalizing symptomatology among adolescents. The results provide evidence that inhibitory control and attentional control are the commonality between EF and EC and highlight that they are linked with positive and negative adjustment outcomes.

Preschool Executive Control and Internalizing Symptoms in Elementary School

Depression and anxiety are prevalent and impairing forms of psychopathology in children and adolescents. Deficits in early executive control (EC) may contribute to the development of these problems, but longitudinal studies with rigorous measurement across key developmental periods are limited. The current study examines EC in preschool as a predictor of subsequent depression and anxiety symptoms in elementary school in a community sample (N = 280). Child participants completed a battery of nine developmentally-appropriate tasks designed to measure major aspects of EC at age 5 years, 3 months. Children later participated in an elementary school follow-up phase, during which they completed validated norm-referenced self-report questionnaires of depression and anxiety symptoms in fourth grade. Results indicate that poorer preschool EC was significantly associated with both greater depression and anxiety symptoms in elementary school, controlling for baseline depression and anxiety symptoms in preschool and other relevant variables. These findings suggest that poor EC may be an important risk factor for the development of internalizing psychopathology in childhood. Given emerging evidence for the modifiability of EC, particularly in preschool, EC promotion interventions may hold promise as a potential target in psychopathology prevention.

Preschool executive control and sleep problems in early adolescence

OBJECTIVE

Although numerous studies have documented the effects of sleep loss on executive control (EC) and related abilities, research examining the impact of early EC on subsequent sleep problems is lacking. Therefore, the current study reports on a longitudinal investigation of EC in preschool as a predictor of sleep-wake problems and daytime sleepiness in early adolescence.

PARTICIPANTS

The participants were 141 children (48.6% female) recruited from the community for a longitudinal study spanning preschool through early adolescence, with an oversampling for high sociodemographic risk (34.1% based on eligibility for public medical insurance, free or reduced lunch status, or family income-to-needs below the federal poverty line).

METHODS

Participants completed a battery of developmentally appropriate tasks assessing major aspects of EC (working memory, inhibitory control, flexible shifting) during a laboratory visit at age 4 years, 6 months. Participants also completed a follow-up session in early adolescence (between ages 11 years and 13.5 years; mean age = 11.82 years, SD = .62 years), during which they completed self-report measures of sleep-wake problems and daytime sleepiness.

RESULTS

Structural equation modeling results indicate that preschool EC (represented by a single latent construct) significantly negatively predicted both sleep-wake problems and daytime sleepiness in early adolescence, with poorer EC predicting greater subsequent sleep problems.

CONCLUSIONS

Poorer EC abilities during the critical period of preschool may be a risk factor for later sleep problems in adolescence. Given that EC appears to be modifiable, early interventions to promote EC development may help prevent subsequent sleep problems and promote long-term health trajectories.

The unity and diversity of executive functions: A systematic review and re-analysis of latent variable studies

Confirmatory factor analysis (CFA) has been frequently applied to executive function measurement since first used to identify a three-factor model of inhibition, updating, and shifting; however, subsequent CFAs have supported inconsistent models across the life span, ranging from unidimensional to nested-factor models (i.e., bifactor without inhibition). This systematic review summarized CFAs on performance-based tests of executive functions and reanalyzed summary data to identify best-fitting models. Eligible CFAs involved 46 samples (N = 9,756). The most frequently accepted models varied by age (i.e., preschool = one/two-factor; school-age = three-factor; adolescent/adult = three/nested-factor; older adult = two/three-factor), and most often included updating/working memory, inhibition, and shifting factors. A bootstrap reanalysis simulated 5,000 samples from 21 correlation matrices (11 child/adolescent; 10 adult) from studies including the three most common factors, fitting seven competing models. Model results were summarized as the mean percent accepted (i.e., average rate at which models converged and met fit thresholds: CFI ≥ .90/RMSEA ≤ .08) and mean percent selected (i.e., average rate at which a model showed superior fit to other models: ΔCFI ≥ .005/.010/ΔRMSEA ≤ -.010/-.015). No model consistently converged and met fit criteria in all samples. Among adult samples, the nested-factor was accepted (41-42%) and selected (8-30%) most often. Among child/adolescent samples, the unidimensional model was accepted (32-36%) and selected (21-53%) most often, with some support for two-factor models without a differentiated shifting factor. Results show some evidence for greater unidimensionality of executive function among child/adolescent samples and both unity and diversity among adult samples. However, low rates of model acceptance/selection suggest possible bias toward the publication of well-fitting but potentially nonreplicable models with underpowered samples. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Hyperactivity precedes conduct problems in preschool children: a longitudinal study

BACKGROUND

Externalising problems are among the most common symptoms of mental health problems in preschool children.

AIMS

To investigate the development of externalising problems in preschool children over time, and the way in which conduct problems are linked to hyperactivity problems.

METHOD

In this longitudinal study, 195 preschool children were included. Latent growth modelling of conduct problems was carried out, with gender and hyperactivity at year 1 as time-invariant predictors.

RESULTS

Hyperactivity was a significant predictor for the intercept and slope of conduct problems. Children with more hyperactivity at year 1 had more conduct problems and a slower reduction in conduct problems. Gender was a significant predictor for the slope of conduct problems.

CONCLUSIONS

Children with more initial hyperactivity have less of a reduction in conduct problems over time. It is important to consider the role of hyperactivity in studies of the development of conduct problems.

DECLARATION OF INTEREST

None.

A classroom intervention to improve executive functions in late primary school children: Too 'old' for improvements?

BACKGROUND

Given the strong relationship between executive functions and academic achievement, there has been great interest in improving executive functions. School-based group interventions targeting executive functions revealed encouraging results in preschoolers and young school children; however, there is a paucity of studies in older primary school children (age 10-12). This is surprising considering that deficits in executive function performance can often be observed in this age group.

AIMS

Therefore, the aim of this study was to examine whether an innovative customized school-based group intervention could improve core executive functions (updating, inhibition, and shifting) in the age group concerned.

SAMPLE

In total, 118 ten- to twelve-year-old school children were recruited from eight participating classes.

METHODS

They were randomly assigned to one of two-six-week conditions of either a cognitive games group comprising of card and board games training executive functions (experimental group) or a wait-list control group (regular school lessons). In the cognitive games group, the class teachers held a 30-min training session twice a week. ANCOVAs (using pre-test values as covariate) were used to compare executive function performance between groups.

RESULTS

Results revealed that the cognitive games group improved specific executive functions (updating and shifting) compared to the control group. These findings indicate that a school-based group intervention can improve executive functions, even in 'older' primary school children.

CONCLUSION

This study provides empirical evidence for the effectiveness of a classroom-based cognitive training in older primary school children and is of practical relevance for educators.

Executive function assessment in New Zealand 2-year olds born at risk of neonatal hypoglycemia

A growing number of babies are born with perinatal risk factors that may impair later development. These children are often assessed at 2 years to help predict outcome and direct support services. Executive function is an important predictor of academic achievement and behavior, but there are limited assessments of executive function in 2-year-olds and few have been tested in at-risk populations. Therefore, we developed a battery of four age-appropriate tasks to assess executive function in 2-year-olds. At 24 months’ corrected age 368 children completed tasks assessing attention, inhibition, working memory and cognitive flexibility. Scores on different tasks were weakly correlated, suggesting that they measured separate aspects of executive function, with combined scores for this cohort approximating a normal distribution. Significantly more boys (67%) than girls (57%) were unable to inhibit their behavior on the Snack Delay Task and girls (M = 3.24, SD = 2.4) had higher mean scores than boys (M = 2.7, SD = 2.7) on the Ducks and Buckets Reverse Categorization Task of working memory. Performance was significantly affected by family socioeconomic status. Mean scores were lower on all four individual tasks and on the global score of overall performance in children from a low household income (<$40,000) compared to those from medium ($40,001-$70,000) and high income households (>$70,001). Maternal education was only associated with scores on the working memory task and the global score; and a measure of neighborhood deprivation was only associated with scores on the two inhibitory tasks and the global score. Our findings confirm the feasibility of assessing executive function in 2-year-olds, and its ability to discriminate effects of socioeconomic status, a common confounder in child development research. Further development and standardization of this test battery comparing at-risk children with a normative population would provide a much-needed measure of executive function in early childhood.

Child Executive Control as a Moderator of the Longitudinal Association Between Sleep Problems and Subsequent Attention-Deficit/Hyperactivity Disorder Symptoms

Objective

To examine the longitudinal associations among sleep, executive control (EC), and attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood.

Methods

In this longitudinal study (N = 271), parents answered questions about sleep problems when children were 3 years old, children completed a comprehensive EC task battery at 4.5 years, and teachers completed standardized measures of child ADHD symptoms in 4th grade.

Results

Latent moderated structural equation models demonstrated that sleep problems at 3 years and EC deficits at 4.5 years were associated with ADHD symptoms in 4th grade. EC moderated the relationship between sleep problems and hyperactivity/impulsivity, such that children with both sleep problems and poor EC were particularly at risk for hyperactivity/impulsivity.

Conclusions

Sleep problems and EC deficits early in development were associated with increased risk for ADHD symptoms in elementary school. Early assessment and intervention to promote healthy sleep and EC development may be helpful in ADHD prevention.