Testing the Stability and Validity of an Executive Dysfunction Classification Using Task-Based Assessment in Children and Adolescents

It is unclear if pediatric executive dysfunction assessed only with cognitive tasks predicts clinically relevant outcomes independently of psychiatric diagnoses. This study tested the stability and validity of a task-based classification of executive function. A total of 2,207 individuals (6–17 year...

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Published in:	Journal of the American Academy of Child and Adolescent Psychiatry Vol. 60; no. 12; pp. 1501 - 1512
Main Authors:	Manfro, Arthur Gus, Pine, Daniel S., Polanczyk, Guilherme Vanoni, Santoro, Marcos, Smoller, Jordan Wassertheil, Koenen, Karestan, Mari, Jair, Pan, Pedro Mario, Zugman, André, Schäfer, Julia Luiza, Belangero, Sintia, Gosmann, Natan Pereira, Simioni, André Rafael, Hoexter, Marcelo Queiroz, Miguel, Euripedes Constantino, Gadelha, Ary, Rohde, Luis Augusto, Salum, Giovanni Abrahão
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-12-2021 Elsevier BV
Subjects:	Adolescent Age Age composition Attention Deficit Disorder with Hyperactivity - diagnosis Attention Deficit Disorder with Hyperactivity - genetics Attention deficit hyperactivity disorder Brain Brain research Brain structure Brazil Cell Adhesion Molecules - genetics Child Children & youth Classification Cognition & reasoning Cognitive ability Cognitive Dysfunction - diagnosis Cognitive tasks Cognitive Tests Cohort analysis Cohort Studies Definitions Educational attainment Executive Function Families & family life Family (Sociological Unit) Functional impairment Gene polymorphism genetics High risk Humans Hyperactivity Intelligence Intelligence Quotient Intelligence tests Interviews Latent class analysis Measurement Techniques Memory Mental disorders neuroimage Neuropsychological Tests Neuropsychology Pediatrics Psychiatry Psychopathology research domain criteria Response inhibition Schizophrenia Short term memory Social classes Socioeconomic factors Socioeconomic Status Test Results Thinking Skills Validity Youth Brazil neuropsychology neuroimage genetics research domain criteria executive function
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Summary:	It is unclear if pediatric executive dysfunction assessed only with cognitive tasks predicts clinically relevant outcomes independently of psychiatric diagnoses. This study tested the stability and validity of a task-based classification of executive function. A total of 2,207 individuals (6–17 years old) from the Brazilian High-Risk Cohort Study participated in this study (1,930 at baseline, 1,532 at follow-up). Executive function was measured using tests of working memory and inhibitory control. Dichotomized age- and sex-standardized performances were used as input in latent class analysis and receiver operating curves to create an executive dysfunction classification (EDC). The study tested EDC’s stability over time, association with symptoms, functional impairment, a polymorphism in the CADM2 gene, polygenic risk scores (PRS), and brain structure. Analyses covaried for age, sex, social class, IQ, and psychiatric diagnoses. EDC at baseline predicted itself at follow-up (odds ratio [OR] = 5.11; 95% CI 3.41–7.64). Participants in the EDC reported symptoms spanning several domains of psychopathology and exhibited impairment in multiple settings, including more adverse school events (OR = 2.530; 95% CI 1.838–3.483). Children in the EDC presented higher attention-deficit/hyperactivity disorder and lower educational attainment PRS at baseline; higher schizophrenia PRS at follow-up; and lower chances of presenting a polymorphism in a gene previously linked to high performance in executive function (CADM2 gene). They also exhibited smaller intracranial volumes and smaller bilateral cortical surface areas in several brain regions. Task-based executive dysfunction is associated with several validators, independently of psychiatric diagnoses and intelligence. Further refinement of task-based assessments might generate clinically useful tools.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Supervision: Rohde, Salum Formal analysis: Manfro, Santoro, Gosmann, Simioni, Salum Project administration: Mari, Pan, Schäfer, Miguel, Gadelha, Rohde, Salum Data curation: Santoro, Zugman, Belangero, Simioni, Hoexter Funding acquisition: Rohde, Salum Writing–ereview and editing: Manfro, Pine, Polanczyk, Santoro, Smoller, Koenen, Mari, Pan, Zugman, Schäfer, Belangero, Gosmann, Hoexter, Miguel, Gadelha, Rohde, Salum Conceptualization: Manfro, Salum Writing–eoriginal draft: Manfro Investigation: Manfro, Pine Author Contributions
ISSN:	0890-8567 1527-5418
DOI:	10.1016/j.jaac.2020.11.016