IMPORTANCEMany studies have demonstrated an association between early-life adversity (ELA) and executive functioning in children and adolescents. However, the aggregate magnitude of this association is unknown in the context of threat and deprivation types of adversity and various executive functioning domains.OBJECTIVE To test the hypothesis that experiences of deprivation are more strongly associated with reduced executive functioning compared with experiences of threat during childhood and adolescence.DATA SOURCES Embase, ERIC, MEDLINE, and PsycInfo databases were searched from inception to December 31, 2020. Both forward and reverse snowball citation searches were performed to identify additional articles.STUDY SELECTION Articles were selected for inclusion if they (1) had a child and/or adolescent sample, (2) included measures of ELA, (3) measured executive functioning, (4) evaluated the association between adversity and executive functioning, (5) were published in a peer-reviewed journal, and (6) were published in the English language. No temporal or geographic limits were set. A 2-reviewer, blinded screening process was conducted.DATA EXTRACTION AND SYNTHESIS PRISMA guidelines were used to guide data extraction and article diagnostics (for heterogeneity, small study bias, and p-hacking). Article quality was assessed, and data extraction was performed by multiple independent observers. A 3-level meta-analytic model with a restricted maximum likelihood method was used. Moderator analyses were conducted to explore heterogeneity. MAIN OUTCOMES AND MEASURESPrimary outcomes included measures of the 3 domains of executive functioning: cognitive flexibility, inhibitory control, and working memory.RESULTS A total of 91 articles were included, representing 82 unique cohorts and 31 188 unique individuals. Deprivation, compared with threat, was associated with significantly lower inhibitory control (F 1,90 = 5.69; P = .02) and working memory (F 1,54 = 5.78; P = .02). No significant difference was observed for cognitive flexibility (F 1,36 = 2.38; P = .12). The pooled effect size of the association of inhibitory control with deprivation was stronger (Hedges g = −0.43; 95% CI, −0.57 to −0.29) compared with threat (Hedges g = −0.27; 95% CI, −0.46 to −0.08). The pooled effect size of the association of working memory with deprivation was stronger (Hedges g = −0.54; 95% CI, −0.75 to −0.33) compared with threat (Hedges g = −0.28; 95% CI, −0.51 to −0.05).CONCLUSIONS AND RELEVANCE Experiences of both threat and deprivation in childhood and adolescence were associated with reduced executive functioning, but the association was stronger for exposure to deprivation. Efforts to address the consequences of ELA for development should consider the associations between specific dimensions of adversity and specific developmental outcomes.

Recovery from cardiovascular surgical procedures can be problematic for the frail elderly due to developmental considerations and the way that post-operative education is delivered in hospitals. In this short communication paper, we outline the physical and developmental considerations of this cohort as well as the standard delivery of post-operative education. As an alternative, we introduce online gaming and explore considerations for the design of this intervention related to post-operative, frail elderly cardiovascular surgical patients. Specific strategies and/or techniques for addressing each of these influences are presented.

Recovery from cardiovascular surgical procedures can be problematic for the frail elderly due to developmental considerations and the way that post-operative education is delivered in hospitals. In this short communication paper, we outline the physical and developmental considerations of this cohort as well as the standard delivery of post-operative education. As an alternative, we introduce online gaming and explore considerations for the design of this intervention related to post-operative, frail elderly cardiovascular surgical patients. Specific strategies and/or techniques for addressing each of these influences are presented.

As the population living with congenital heart disease ages, health promotion interventions have become more important. The uptake and maintenance of health-promoting behaviours and social support for the congenital heart disease population not only have the potential to extend a person's life expectancy, but also enhance quality of life and overall health and wellbeing. Using a gold-standard approach, such as a randomised controlled trial (RCT), to evaluate the effectiveness of such an intervention does not address heterogeneity among individuals, while the results obtained from RCTs tend to not be generalised to the larger population of interest. The Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework provides an alternative evaluative approach to examining the effectiveness of online gaming interventions, and has the capacity to address the unique needs of the congenital heart disease population.