Executive function (EF) supports goal-directed behavior, yet little is known about how different scoring algorithms influence the measurement of executive function performance in pediatric Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. We compared four algorithms: Accuracy, Speed, Rate Corrected Score (RCS), and Linear Integrated Speed-Accuracy Score (LISAS) in 51 children with ADHD (23.5% female; Mage = 12.9, SDage = 2.8) and 102 matched controls (23.5% female; Mage = 12.8, SDage = 3.1) using the NIH Toolbox Dimensional Change Card Sort (DCCS) and Flanker Inhibitory Control and Attention (Flanker) tests. Results showed that while RCS and Speed demonstrated high internal consistency across tasks, Accuracy and LISAS indices were less reliable, particularly during cognitive flexibility trials in the ADHD group. Children with ADHD exhibited lower Accuracy and higher switching costs on the DCCS, whereas no group differences were observed on the Flanker task. Group differences in cognitive flexibility were detected by accuracy-based metrics but remained obscured by scores based on speed alone. Findings suggest that integrated methods, particularly accuracy-dominant metrics like RCS, may offer reliable, clinically sensitive alternatives to single-metric scores. Their utility depends on task demands, emphasizing that relying solely on response speed may underestimate cognitive flexibility deficits in ADHD.
Craniopharyngioma is a rare pediatric brain tumor that is often treated with surgical resection and radiation therapy, all of which can have significant impacts on cognitive abilities. The objectives of the current study were to characterize the neurocognitive functioning of pediatric patients that have been treated for craniopharyngioma and examine the impact of medical, demographic, and treatment variables on neurocognitive outcomes. We completed retrospective chart reviews to collect medical, demographic, and neurocognitive data for 27 patients that were treated for craniopharyngioma and underwent follow-up neuropsychological evaluation. Bivariate correlations revealed that preoperative hydrocephalus was associated with worse performance in IQ, working memory, verbal fluency, learning memory, recall memory, and memory recognition. Patients with hydrocephalus did significantly worse than those without hydrocephalus in almost all cognitive domains. Those who underwent surgical resection via the endoscopic endonasal approach (vs. craniotomy) did significantly worse on recall memory and processing speed. No significant correlations or differences were observed between neurocognitive outcomes and age at treatment, extent of surgical resection, time elapsed since surgery, new hypothalamic injuries, new endocrinopathies, or radiation treatment history. These data suggest hydrocephalus is a key predictor of neurocognitive outcomes among patients treated for craniopharyngioma, with surgery factors also contributing to outcomes. Larger studies are needed to understand the individual risk factors for cognitive impacts within this patient population.
Cognitive Disengagement Syndrome (CDS) is characterized by symptoms such as daydreaming, slowed behavior, and mental confusion, but remains understudied outside of ADHD populations. CDS has recently emerged as a potential transdiagnostic construct, yet most investigations have been limited to ADHD samples. To further clarify the clinical profile of CDS, research is needed in pediatric mood disorder populations and comorbid presentations. This study examined predictors of caregiver-reported CDS symptoms in a racially and socioeconomically diverse sample of treatment-seeking outpatient youth (N = 697), with attention to psychiatric diagnoses (ADHD and mood disorders), youth demographics, caregiver education, and number of other psychiatric diagnoses. A 5-item CBCL-based CDS index demonstrated acceptable psychometric performance and was used to capture youth CDS levels. Hierarchical regression revealed that mood disorder diagnosis was the strongest and most unique predictor of elevated CDS symptoms, followed by ADHD diagnosis, with the comorbid group (ADHD+Mood) showing the highest CDS levels. Clinical and structural factors, including mood and ADHD diagnoses, number of other psychiatric diagnoses, Black racial identity, lower caregiver education, and older age, each independently predicted CDS severity. These findings support CDS as a clinically meaningful construct extending beyond ADHD and underscore the importance of contextually informed, transdiagnostic assessment. Implications are discussed through a developmental psychopathology framework, emphasizing equifinality.
This research aims to examine the roles of students diagnosed with attention deficit hyperactivity disorder (ADHD) who perform above their peers in Turkish language skills in the peer-supported teaching process. The research was carried out in four private education institutions operating in the Turkish Republic of Northern Cyprus. A total of 20 peer instructors from each school, including 5 students who showed high performance in Turkish language skills and were clinically diagnosed with ADHD, participated in the study. Each peer instructor guided 5 students who needed support in Turkish reading, vocabulary, and reading comprehension; thus, a total of 80 students constituted the research application group. Peer tutors participated in structured Turkish instruction activities held two days a week for eight weeks. Reading fluency, vocabulary teaching, text comprehension studies and interactive language activities were used in the teaching process. A mixed-method design was adopted in the research. The findings revealed that students who received peer support showed significant improvement in Turkish reading accuracy, vocabulary and reading comprehension scores. Effect sizes were recalculated using the corrected formula (Cohen's d = M_diff / SD_pooled), yielding medium-to-large effects (d = 0.65-0.82) consistent with educational intervention norms. In addition, significant progress was observed in the communication skills, leadership characteristics, self-efficacy perceptions and social interaction levels of students with ADHD who took on the role of instructors. In conclusion, the research reveals that peer-assisted Turkish teaching models that leverage the strengths of students with ADHD are an effective and inclusive educational approach that supports both academic success and social-emotional development.
In recent decades, the use of digital technologies has become ubiquitous in children's lives, raising debates about their potential effects on cognitive development. Among the most studied domains are executive functions (EF); however, empirical evidence on this relationship remains mixed, partly due to the prevailing tendency to assess technology use through unidimensional indicators. Current research recommends adopting methods that capture the complexity of technology use, such as person-centered approaches. The present study aimed to identify profiles of technology use among Argentine children aged 9 to 12 years and to examine their differences in EF. Based on measures of recreational screen time (self- and parent-reported), frequency of social and recreational use, and symptoms of problematic use, a latent profile analysis was conducted with a sample of 223 participants. Four distinct profiles were identified: low, moderate - social, moderate - recreational, and high-problematic use. Male gender and lower socioeconomic status were associated with a higher likelihood of belonging to the high-problematic profile. No significant differences were found in EF performance. These findings highlight the heterogeneity of children's digital habits and challenge deterministic perspectives on technology use among younger generations.
There is limited understanding of modifiable factors influencing health-related quality of life (HRQoL) among children living with type 1 diabetes (T1D). Executive function skills may be a relevant factor because they underpin the ability to successfully orchestrate T1D self-management. We examined the association between executive functioning and HRQoL among 10-17 year old children living with T1D for more than six months. Caregivers and children (n = 41) completed assessments to measure the child's executive function skills and child and caregiver HRQoL. Linear regression models estimated adjusted betas and 95% confidence intervals (CI) for associations between child executive functioning and child and caregiver HRQoL. In adjusted models, worse executive functioning skills were associated with worse HRQoL. This pattern was consistent across caregiver and child report of the child's executive functioning, caregiver and child report of the child's HRQoL, and caregiver report of their own HRQoL. Further investigation is needed to understand how executive functioning and HRQoL are related in this population, as well as whether educating families on the role of executive functioning in diabetes self-management could improve HRQoL within the family ecosystem.
Stuttering is increasingly recognized as a neurodevelopmental condition extending beyond speech-motor disruptions to include socio-emotional and social-cognitive processes. This study examined emotion regulation, empathy, and theory of mind (ToM) in children who stutter (CWS) compared to typically developing peers. Eighty school-aged children (41 CWS, 39 children who do not stutter [CWNS]) were assessed using the Emotion Regulation Checklist (ERC), Bryant Index of Empathy (BIE), and Reading the Mind in the Eyes Test - Child Version (RMET-C). CWS demonstrated significantly greater emotion regulation difficulties (higher Lability/Negativity and total ERC scores; all p < 0.001), lower empathy (p < 0.001), and poorer ToM performance (p < 0.001) than CWNS. False Discovery Rate-corrected item-level analyses identified five RMET-C items on which CWS showed reduced accuracy, spanning affectively valenced states (worried, carefree, friendly) and cognitively complex mental states (thinking about something, certain). A sensitivity analysis excluding CWS with comorbid ADHD (n = 31) replicated all primary findings. Within the CWS group, female gender (p = 0.003) and higher maternal education (p = 0.001) predicted greater empathy, whereas psychiatric comorbidity predicted lower empathy (p = 0.022) and greater emotion regulation difficulties (p = 0.008). Stuttering severity was not associated with any socio-emotional outcome (all p > 0.05). These findings suggest that CWS experience significant socio-emotional and social-cognitive difficulties independent of disfluency severity. Multidimensional assessment and intervention addressing emotion regulation and social cognition alongside speech fluency may support optimal developmental outcomes.
The main goal of the study was to explore the effect of false information on decision-making in preschoolers. One-hundred-and-thirteen preschoolers (Mage = 48 months, SDage = 6 months) were given false information at different time points during a child-adapted Iowa Gambling task (IGT). Children were divided into three decision-making groups based on decision-making strategies in the early part of the game. Findings indicated a robust effect of false information on decision-making with children making significantly more disadvantageous choices following false information. Early explicit knowledge of the game moderated the effect of false information, suggesting that an initial correct belief has a protective effect on the impact of false information. Decision-making group membership moderated responses to false information, but the effect of false information was not persistent. Moreover, analysis of the trials following false information indicated that most children were correctly re-classified into their initial decision-making group. This finding indicates that there is a great deal of individual variability in children's responses to false information and that much of this variability can be attributed to initial decision-making strategies and early awareness of the game.
Difficulties in temporal processing (TP) are frequently reported in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), yet adolescents remain underexamined despite their critical role in executive maturation. This study investigated whether adolescents with ADHD exhibit domain-specific TP impairments and whether executive functions (EF) and ADHD symptom dimensions predict temporal performance. Fifty-four adolescents aged 12-18 years (27 ADHD, 27 controls) completed a Duration Discrimination Task, a Time Reproduction Task (1000-5000 ms), and a 53-second Time Estimation Task. EF was assessed via the Barkley Deficits in Executive Functioning Scale-Children and Adolescents (BDEFS-CA), and ADHD symptoms through the SNAP-IV. Adolescents with ADHD showed selective impairments in time reproduction, consistently under-reproducing 1000, 3000, 4000, and 5000 ms intervals compared to controls (p = .048-.001), whereas performance on the 2000 ms interval, discrimination thresholds, and the Time Estimation Task did not differ significantly between groups. Regression analyses indicated that higher executive dysfunction was significantly associated with elevated discrimination thresholds in the 100 ms task, even after accounting for covariates (p < .05). Furthermore, regardless of group or demographics, attention problems appeared to be linked with a tendency to underestimate durations in the 53-second task. These findings suggest that temporal processing deficits in ADHD may not be monolithic, but rather closely intertwined with specific attentional and executive control mechanisms. Consequently, the study underscores the potential value of incorporating temporal monitoring and organizational strategies into clinical interventions to better support the developmental trajectory of adolescents with ADHD.
Individuals prenatally exposed to alcohol experience elevated rates of adverse postnatal experiences, including neglect, abuse, and caregiver separation, which often co-occur. Identifying distinct adversity patterns may clarify their links to neurodevelopmental outcomes. Latent class analysis was conducted in a clinical sample with 811 youth with prenatal alcohol exposure (PAE; mean age 6.9 years, range 0-21) to identify distinct profiles of postnatal adversity. Class differences in neuropsychological functioning were examined using the Bolck, Croon, and Hagenaars method. A four-class solution demonstrated best fit AIC = 5121.272, BIC = 5266.918, aLRT = 55.874, p < .001. Classes reflected: 1) high probability of neglect and caregiver change with moderate probability of familial mental health challenges; 2) low familial mental health risk with moderate caregiver change; 3) high probability of familial trauma and neglect; and 4) high probability of all adverse experiences. Classes differed significantly in memory, executive functioning, and mental health domains (anxiety). Demographic differences included age, number of caregiver placements, and age of placement with long-term caregiver. Distinct adversity patterns in youth with PAE are linked to neurodevelopmental outcomes and demographic factors. Findings highlight the importance of early intervention, addressing familial mental health, and developing or adapting trauma-responsive supports for children with PAE.
Executive functioning plays a central role in adolescents' emotional and behavioral regulation, yet validated French-language measures remain limited. This study evaluated the psychometric properties of the French Teen Executive Functioning Inventory (TEXI) in a community sample of Canadian adolescents (N = 601). Factorial structure was examined using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). Convergent validity was assessed through associations with reward sensitivity, impulsivity, and internalizing symptoms. Results supported the expected two-factor structure, with ESEM providing the best model fit. Convergent validity analyses revealed theoretically coherent patterns: inhibition difficulties were strongly associated with reward sensitivity (β = .70, p < .001) and impulsivity (β = .55, p < .001), whereas working memory difficulties showed weaker and differentiated associations once internalizing symptoms were controlled. Overall, findings support the reliability and validity of the French TEXI and its usefulness for screening executive functioning difficulties in French-speaking adolescents.
While many adolescents receive insufficient sleep, the role of specific cognitive abilities as modifiable predictors of adolescent sleep remain equivocal. Executive control (EC) comprises cognitive processes important for self-regulation, but few studies have investigated associations between early EC performance and later sleep. This study examines longitudinal associations between preschool EC and adolescent sleep outcomes (average and intraindividual sleep duration, bedtime, waketime), with preschool negative affectivity (NA) as a possible moderator. Youth completed an EC task battery during preschool (age 5.25 years) and wore an actigraphy monitor to record sleep during adolescence (ages 14 to 18). Caregivers reported on child NA. Multilevel structural equation modeling with a Markov chain Monte Carlo (MCMC) procedure was used to examine EC, NA, and sleep associations. Preschool EC, represented by a latent factor, was significantly associated with adolescent average sleep duration, with better preschool EC significantly related to greater average sleep duration in adolescence. Preschool EC was also significantly associated with adolescent intraindividual variability in bedtimes, with better preschool EC related to more consistent night-to-night bedtimes. No significant interaction between preschool EC and NA was found. Given the ramifications of poor adolescent sleep across domains, findings suggest targeting early EC may support healthy sleep behaviors.
Child diversity has become an increasingly relevant topic in developmental science with significant methodological and applied implications. Clustering algorithms, a type of machine learning approach, offer accessible methods for exploring such diversity by identifying the latent data structure, which allows for the extraction of groups or profiles of subjects. Following a person-oriented approach, this study explores the cognitive profiles of a sample of 105 children coming from Unsatisfied Basic Needs homes in Argentina. An ensemble clustering method was applied to performance data from tests assessing attention, inhibitory control, working memory, planning, and fluid reasoning. Results delivered three specific clusters with statistically significant differences in cognitive accuracy and reaction time variables. Specifically, we found a "working memory low-performance group," a "generalized high-performance group," and a "generalized low-performance group." The individual characteristics of these clusters may potentially guide differentiated strategies for future interventions. In addition, the incorporation of diverse performance variables - such as accuracy and response times - can help uncover individual strengths and weaknesses that may inform the design of such interventions. This approach contributes to fostering more inclusive and diverse perspectives in developmental science, moving away from deficit-based interpretations of low or atypical performance and instead recognizing them as expressions of the potential diversity of developmental pathways.
The Early Years Toolbox (EYT) is a validated instrument for assessing early language, executive functioning (EF), self-regulation, and social development. However, normative data specific to Spanish-speaking preschoolers in Spain are lacking. This study aimed to develop age- and sex-specific normative reference values for EF in Spanish children aged 3-6 years, using the EYT battery. In this cross-sectional study, 567 Spanish preschoolers (49.2% female) were evaluated using four EYT tasks: Mr Ant (visual-spatial working memory), Not This (phonological working memory), Go/No-Go (inhibitory control), and Card Sorting (cognitive flexibility). Scores were organized by age group, and smoothed percentile curves were created using the LMS method, incorporating the L (λ), M (μ), and S (σ) parameters. Performance on all EF tasks increased with age, reflecting developmental differences throughout the preschool years. Girls outperformed boys in the Go/No-Go, Not This, and Card Sorting tasks. Percentile distributions indicated these age-related differences across EF domains, with the most noticeable changes seen in working memory and cognitive flexibility. Inhibitory control followed a more gradual pattern. Variability between individuals decreases with age, suggesting increased cognitive stability in older preschoolers. This study provides preliminary normative data illustrating the developmental trajectory of executive functioning in Spanish preschool-aged children. These benchmarks offer a culturally relevant reference for school-based EF assessments and enable meaningful cross-national comparisons.
This study aimed to examine the associations between cognitive disengagement syndrome (CDS), chronotype, and Attention-Deficit/ Hyperactivity Disorder (ADHD) symptomatology in children and adolescents, and to identify whether different ADHD presentations show distinct profiles in terms of CDS severity and chronotype preference. The sample included 99 children and adolescents aged 8 to 17 years, evenly divided into three groups: ADHD-inattentive presentation (ADHD-I; n = 33), ADHD-combined presentation (n = 33), and typically developing controls (TDC; n = 33). The assessment was conducted using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Turgay DSM-IV-Based Disruptive Disorders Rating Scale, Sluggish Cognitive Tempo Scale, Strength and Difficulties Questionnaire and Children's Chronotype Questionnaire were completed by mothers. There were significant group differences in CDS (F = 3.762, p = 0.027) and chronotype (F = 4.709, p = 0.011) scores. Post hoc analysis showed that the ADHD-I group had significantly higher eveningness scores compared to the TDCs (p = 0.014). CDS symptoms, particularly daytime sleepiness, were positively correlated with eveningness (r = 0.461, p < 0.01). Linear regression analysis revealed that inattention was significantly associated with eveningness chronotype (B = 0.20, p = 0.02), and CDS symptoms also emerged as a significant predictor (B = 0.20, p = 0.003). Daytime sleepiness partially mediated the association between inattention and eveningness symptoms (B = 0.09, p < 0.01), even after controlling for age and gender. The findings suggest that CDS symptoms, particularly daytime sleepiness, may play a contributory role in the association between inattention and eveningness chronotype in youth with ADHD. Incorporating chronotype and CDS features into clinical assessment may enhance understanding of attentional profiles and guide targeted behavioral or chronobiological interventions.
Pediatric Brain Tumor Survivors (PBTS) are at elevated risk of neurocognitive impairments. This study aims to assess the contribution of sociodemographic and family functioning variables on cognitive outcomes in PBTS in the context of medical factors. PBTS (n = 100; 47% female) were included in the study. They were on average 5.68 years old at diagnosis and were 6.25 years from diagnosis. Participant intelligence quotient (IQ) was measured using the full-scale IQ of the WISC-IV and WISC-V, and executive function using the BRIEF2 Global Executive Composite. Sociocontextual variables included: parental education, parental employment, and family functioning (measured via the Family Assessment Device). Medical factors considered included: child age at diagnosis, sex, time since diagnosis, tumor location, radiation field, chemotherapy and the Neurological Predictor Scale (NPS). Multivariable models were fit separately for the association between sociocontextual variables and the four neurocognitive outcomes adjusting for medical factors. Having two employed parents (betas ranged from 14.79 to 15.63 for WISC outcomes) and higher parental education (betas ranged from 11.98 to 14.72 for WISC outcomes) were significantly associated with better neurocognitive outcomes in PBTS. Better family functioning was associated with higher total IQ (betas ranged from -0.80 to -0.82). Associations were consistent in magnitude and direction when adjusted for medical factors. Findings shed light on the impact of sociocontextual variables on neurocognitive outcomes in PBTS, emphasizing a need for a more holistic, family-centered approach to survivorship care.
Children with attention difficulties are more susceptible to problematic media use (PMU). However, little consideration has been given to whether the risk of PMU varies based on the nature of attentional difficulties, namely whether children diagnosed with ADHD or difficulties that co-occur with early neurological risk are differentially related to PMU. The Problematic Media Use Measure (PMUM) was examined in three samples of parents with children aged 6-18: Community (N = 386), ADHD (N = 66) and early neurological risk (N = 65) samples, using a mixed-methods approach. Parents were given questionnaires to assess PMU and screen media use and impact, followed by semi-structured interviews with a subset of parents in the ADHD sample. Group comparisons used an age- and sex-matched subset (n = 36/group). Parents in the ADHD group reported higher PMU and more stress related to screen media use compared to both the Early Neurological Risk and Community groups. Parents in the ADHD group also reported significantly more negative and fewer positive impacts of screen media for their children compared to the Community group. Higher PMU was associated with older age in the Early Neurological Risk group (rs = .26, p = .04), and higher externalizing behavior in both clinical samples (ADHD, rs = .29, p = .02; neurological, rs = .56, p < .001). Thematic analysis of parent interviews yielded complementary themes, including unique challenges of screen use for children with ADHD. Clinical implications and future research directions are discussed.
This study examined the association between caregiver anxiety, ADHD symptom severity, and metacognitive awareness in children with attention-deficit/hyperactivity disorder (ADHD), and evaluated whether metacognitive awareness mediates the relationship between caregiver anxiety and ADHD symptom severity. This cross-sectional study included children aged 7-17 years diagnosed with ADHD and their primary caregivers. Caregiver anxiety was assessed using the Beck Anxiety Inventory (BAI). Children's ADHD symptom severity was evaluated with the Atilla Turgay Disruptive Behavior Disorders Rating Scale, metacognitive awareness with the Junior Metacognitive Awareness Inventory (Jr.MAI), and overall clinical severity with the Clinical Global Impression - Severity scale (CGI-S). Group comparisons were conducted based on caregiver anxiety severity, and correlation, multiple regression, and mediation analyses were performed. Children of caregivers with higher anxiety severity exhibited significantly greater total ADHD symptom severity, particularly in hyperactivity and oppositional defiant symptoms. Metacognitive awareness was negatively correlated with ADHD symptom severity. In regression analyses, metacognitive awareness and CGI-S independently predicted ADHD symptom severity, whereas caregiver anxiety severity did not remain a significant predictor. Mediation analyses indicated that metacognitive awareness did not significantly mediate the relationship between caregiver anxiety and ADHD symptom severity. Caregiver anxiety is associated with increased ADHD symptom severity, particularly behavioral dysregulation domains. Although metacognitive awareness does not function as a mediator, its inverse association with symptom severity highlights its potential protective role. These findings underscore the importance of addressing both caregiver mental health and children's metacognitive skills in comprehensive ADHD interventions.
Neuropsychological assessments such as the Continuous Performance Test (CPT) and the Conners' Continuous Auditory Test of Attention (CATA) are frequently used to evaluate visual and auditory attention in individuals suspected of having attention-deficit/hyperactivity disorder (ADHD). The Integrated Visual and Auditory Continuous Performance Test (IVA-2 CPT) is a computerized assessment tool designed to measure both visual and auditory attention, as well as response control, in individuals aged six years and older. This study aimed to evaluate the discriminant validity of the IVA-2 CPT in identifying ADHD in children. A total of 152 children diagnosed with ADHD and 72 control participants were recruited from Kaohsiung Chang Gung Memorial Hospital. All participants completed the IVA-2 CPT, CPT, and CATA. Receiver operating characteristic (ROC) curve analysis was performed, and the area under the curve (AUC) was used to assess discriminant validity. Children with ADHD performed significantly worse on the IVA-2 CPT, with lower scores on the Attention Quotient (FSAQ), the overall and component scores of the Response Control Quotient (FSRCQ), and the Comprehension Index. The IVA-2 CPT demonstrated good discriminative validity (AUC = 0.76-0.82), comparable to the CPT-3 (AUC = 0.70-0.77) and superior to the CATA (AUC = 0.61-0.67). The IVA-2 CPT shows good discriminant validity in identifying ADHD in children, and validity remained consistent across subgroups stratified by age (≥10 years and <10 years) and gender. It appears to be a promising and reliable tool for the comprehensive assessment of visual and auditory attention in clinical settings.
