Results from a new study suggest that childhood executive dysfunction has a long-term impact on psychopathology in emerging adulthood. The findings, published in Research on Child and Adolescent Psychopathology, suggest that interventions that target executive function in children may lead to improved outcomes in adulthood.
People with Attention-Deficit/Hyperactivity Disorder (ADHD) experience difficulty paying attention and may exhibit impulsivity and overactivity. ADHD is often accompanied by psychopathology symptoms that can impair daily functioning, like performance in school, success on the job, and quality of life.
It has been suggested that these psychopathology symptoms may be partly caused by deficits in executive function, which play a central role in ADHD. Executive function describes a set of effortful cognitive processes that help regulate other cognitive processes, behavior, and emotions. The three main executive functions are working memory, response inhibition, and cognitive flexibility.
“Difficulties with executive functions, that is cognitive processes related to the regulation of our behaviors, emotions, and thoughts, have long been assumed to be central to the development of ADHD but little research has examined whether difficulties with executive functions also contribute to co-occurring symptoms, such as symptoms of conduct problems, anxiety, and depression, in individuals with ADHD, in the short- and long-term,” said study author Stian Orm, a PhD candidate at the University of Oslo.
“The co-occurring symptoms may be more bothersome for individuals with ADHD and their close ones than ADHD per se, so understanding how these symptoms develop is important. In our team, we have followed individuals with ADHD over a 10-year period, from childhood to emerging adulthood, to identify childhood factors that can predict outcomes later in life.”
“We hope that the knowledge resulting from this can help us to improve clinical care for children with ADHD and their families and can help us to target treatment towards areas of importance for functioning later in life.”
Orm and his colleagues conducted a study to explore the extent that executive function and ADHD symptoms might predict psychopathology over time. To do this, they conducted a longitudinal study among individuals with and without ADHD.
At the start of the study, the sample included 85 children with ADHD and 50 typically-developing children, all of whom were between the ages of 8 and 17. The children were invited to participate in two follow-up studies, one 2 years after baseline and the other 10 years after baseline. About 97% of the sample was retained at the 2-year mark and 75% at the 10-year mark.
The three studies included measures of internalizing psychopathology symptoms (inner-focused symptoms like anxiety, sadness, and withdrawal) and externalizing psychopathology symptoms (outer-focused symptoms like overactivity, aggression, and impulsivity). As measures of executive function, the study included tests of working memory, response inhibition, and cognitive flexibility. At baseline and at the 2-year follow-up, the studies also included a parent-rated measure of ADHD symptoms.
For their analysis, the researchers calculated a composite score that considered all measures of executive function. The findings revealed that executive function at baseline significantly predicted total psychopathology symptoms at both the 2-year and 10-year follow-ups. This was after accounting for ADHD symptoms and was also true for both externalizing and internalizing symptoms. At the 10-year follow-up, one particular executive function — cognitive flexibility — accounted for this effect.
“Children with ADHD that have more difficulties with executive functions are at higher risk of co-occurring symptoms of anxiety, depression, and conduct problems later in life,” Orm told PsyPost. “This means that we should pay attention to this risk in children with ADHD and more severe difficulties with executive functions, and, if possible, initiate preventive efforts. Our findings suggest that difficulties with executive functions are not only involved in the development of ADHD but also the co-occurring symptoms commonly observed among individuals with ADHD.”
Importantly, the opposite direction was not found to be significant — childhood psychopathology symptoms did not significantly predict concurrent or later executive function.
These findings suggest that executive function during childhood can predict psychopathology in adulthood, over and above ADHD symptoms. While past studies have focused on female samples, these results show that this effect extends to boys as well.
“We were surprised to find that difficulties with executive functions were a better predictor of later (at the 2- and 10-year follow-up) than concurrent (at baseline) co-occurring symptoms,” Orm said. “At baseline, the effect of executive functions disappeared when controlling for ADHD symptoms. We think this is because in the short run, ADHD symptoms and co-occurring symptoms are closely related but in the long run, these symptoms are fluctuating while executive functions remain more stable, and thus, in the long run, executive functions are more stable predictors of who’s going to develop co-occurring symptoms such as depression or conduct problems.”
According to the study authors, these results highlight the importance of executive function and its long-term influence on psychopathology. Future studies may help illuminate the pathways through which executive dysfunction leads to psychopathology. One possibility is that executive dysfunction impairs academic and occupational success, and the failure to meet these life outcomes increases a young adult’s risk of psychopathology. The authors suggest that interventions that target executive function in children may help prevent psychopathology in later years.
“An important caveat to our findings is the observational nature of our study,” Orm said. “Based on our study design, we can conclude that early difficulties with executive functions predict later co-occurring symptoms, but we cannot be certain that this relationship is causal, that difficulties with executive functions cause co-occurring symptoms later in life.”
“To provide evidence of a causal relationship, we need experimental studies that for example look at how improving executive functions in children with ADHD affects the development of later co-occurring symptoms. We also need more studies examining the processes through which executive functions affect the development of co-occurring symptoms.”
“In the article, we discuss that difficulties with executive functions may contribute to later co-occurring symptoms because difficulties with executive functions interfere with academic achievements and school functioning, can create difficulties in social relationships, and hamper independent living in emerging adulthood. However, this needs to be further studied.”
The study, “Childhood executive functions and ADHD symptoms predict psychopathology symptoms in emerging adults with and without ADHD: a 10-year longitudinal study”, was authored by Stian Orm, Per Normann Andersen, Martin Hersch Teicher, Ingrid Nesdal Fossum, Merete Glenne Øie, and Erik Winther Skogli.