Childhood executive functions and ADHD symptoms predict psychopathology symptoms in emerging adults with and without ADHD: a 10-year longitudinal study

Abstract

Deficits in executive functions (EFs) are theorized to play an important role in causing functional impairment and associated psychopathology in individuals with ADHD. The objective of this study was to examine the role of EFs and ADHD symptoms as longitudinal predictors of psychopathology symptoms in individuals with ADHD and typically developing individuals. We assessed individuals with and without ADHD (N = 135) with neuropsychological tests of EFs and scales of ADHD symptoms and psychopathology symptoms at baseline (T1; Mage = 11.59, 57.8% boys), 2-year follow-up (T2; Mage = 13.63, 97% retention), and 10-year follow-up (Mage = 21.18, 75% retention). Baseline EFs predicted psychopathology symptoms at the 2- and the 10-year follow-up, explaining 17% and 12% of the variance, respectively. Baseline EFs predicted both internalizing and externalizing symptoms, and the predictive value of EFs on psychopathology symptoms at 10-year follow-up was accounted for by cognitive flexibility. Baseline ADHD symptoms were a significant predictor of all symptom domains at all time points. Thus, childhood EFs, in particular cognitive flexibility, can predict psychopathology symptoms in emerging adulthood beyond the effect of ADHD symptoms. This supports dominating theories of ADHD stating that executive dysfunction contributes to the observed phenotype, including associated psychopathology symptoms, and suggests that EFs are important targets of interventional efforts.

Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study

“…Thus, it is interesting that EF, as measured with neuropsychological tests, did not predict QoL or functional impairments in this study. We have previously found, in the same sample, that neuropsychological tests of EF at baseline predicted psychopathology symptoms, including internalizing difficulties, at the 10-year follow-up (Orm, Andersen, et al, 2022). Thus, there is a possibility that EF affects QoL and functional impairments indirectly via its effect on internalizing difficulties, which are related to lower QoL and functional impairments (Haugan et al, 2021; Zhang et al, 2021).…”

“…For EF, we computed a composite score based on the four neuropsychological tests. This composite score was computed following the procedure described by Orm et al (2022). We converted test raw scores into Z -scores and then added the Z -scores into a composite score where higher scores indicate more EF deficits.…”

“…EF has previously been shown to be related to QoL and functional impairments among individuals with ADHD (Holst & Thorell, 2020; Stern et al, 2017; Zhang et al, 2021). Impaired EF is likely to influence QoL and everyday functioning negatively through its effect on psychosocial domains such as education, work, social relationships, and psychopathology symptoms (Orm, Andersen, et al, 2022; Owens & Hinshaw, 2016; Tamm et al, 2021). Meta-analytic evidence indicates that individuals with ADHD display a broad impairment in EF rather than a single domain impairment (Pievsky & McGrath, 2018).…”

“…Meta-analytic evidence indicates that individuals with ADHD display a broad impairment in EF rather than a single domain impairment (Pievsky & McGrath, 2018). Previous studies have shown that composite measures may have better clinical utility and predictive power over more circumscribed measures (Øie et al, 2021; Orm et al, 2022; Owens & Hinshaw, 2016; Romer & Pizzagalli, 2021; Suchy & Brothers, 2022). Furthermore, in childhood and adolescence, EF is best conceptualized as an unidimensional construct (Karr et al, 2018), which provides further support for the use of composite scores.…”

Construction of Meta-Thinking Educational Program Based on Mental-Brain Simulation (MTMBS) and Evaluating its Effectiveness on Executive Functions, Emotion Regulation, and Impulsivity in Children With ADHD: A Resting-State Functional MRI Study

“…Brocki et al (2010) and Bohlin et al (2012) studies showed that executive function at age 5 significantly predicts ADHD symptoms at age 7 (Fan & Wang, 2022). In addition, recent studies have shown that childhood executive functions are predictive later psychopathological symptoms in adolescents and emerging adults with ADHD (Meza et al, 2021; Miller et al, 2012; Orm et al, 2022; Owens & Hinshaw, 2016). Most children and adolescents with ADHD suffer from impairments in executive functions, particularly in the field of behavior inhibition, self-regulation, and selective attention, and the apparent symptoms of this disorder are due to deficiency in these three components (Crisci et al, 2021; Fay-Stammbach et al, 2014; Willcutt et al, 2005).…”