Does executive functioning (EF) predict depression in clinic-referred adults?: EF tests vs. rating scales

Abstract

Background Deficits in executive functioning (EF) are implicated in neurobiological and cognitive-processing theories of depression. EF deficits are also associated with Attention-deficit/hyperactivity disorder (ADHD) in adults, who are also at increased risk for depressive disorders. Given debate about the ecological validity of laboratory measures of EF, we investigated the relationship between depression diagnoses and symptoms and EF as measured by both rating scales and tests in a sample of adults referred for evaluation of adult ADHD. Method Data from two groups of adults recruited from an ADHD specialty clinic were analyzed together: Adults diagnosed with ADHD (N=146) and a clinical control group of adults referred for adult ADHD assessment but not diagnosed with the disorder ADHD (N=97). EF was assessed using a rating scale of EF deficits in daily life and a battery of tests tapping various EF constructs. Depression was assessed using current and lifetime SCID diagnoses (major depression, dysthymia) and self-report symptom ratings. Results EF as assessed via rating scale predicted depression across measures even when controlling for current anxiety and impairment. Self-Management to Time and Self-Organization and Problem-Solving showed the most robust relationships. EF tests were weakly and inconsistently related to depression measures. Limitations Prospective studies are needed to rigorously evaluate EF problems as true risk factors for depressive onset. Conclusions EF problems in everyday life were important predictors of depression. Researchers and clinicians should consistently assess for the ADHD-depression comorbidity. Clinicians should consider incorporating strategies to address EF deficits when treating people with depression.

Brazilian Portuguese transcultural adaptation of Barkley Deficits in Executive Functioning Scale (BDEFS)

“…This absence of a strong correlation between ratings and tests reflects a lack of ecological validity of neuropsychological tests. Other studies using the BDEFS English Version have shown similar results [17][18][19][20]24,25 . For example, as found by Vasconcelos et al 26 the BIS 11 Brazilian Portuguese Version presents almost non-significant correlations with the Iowa Gambling Task, which support the theoretical and statistical difference between these types of neuropsychological methods.…”

“…Knouse 25 used the BDEFS successfully to examine the relationship of EF to understand and predict the mediation of self-regulation in academic performance. That study 19 also showed that the BDEFS could be used to predict depressive symptoms, especially using the self-management of time, self-organization, and problem-solving subscales, in a sample with symptoms of ADHD and depression. Future studies should address the relationship between the Brazilian adaptation of BDEFS and functional outcomes in a Brazilian context.…”

“…The respondents have to select the best option based in a four-point Likert type-scale to describe the frequency of certain behaviors and situations linked with impulsivity. The BIS-11 has three subscales: attentional impulsivity (items 6,5,9,11,20,24,26,28), motor impulsivity (items 2,3,4,16,17,19,21,22,23,25,30) and non-planning impulsivity (items 1,7,8,10,12,13,14,15,18,27,29). Furthermore, the BIS-11 has a total score ranges from 30 to 120 points.…”

“…In this context, Barkley created the Barkley Deficits in Executive Functioning Scale (BDEFS), which consists of a self-reported questionnaire that assesses different components of executive functioning related to daily-life impairments of psychiatric patients 16 . Since the publication of BDEFS, this scale has accumulated evidence of validity 17,18 , as well as utility in clinical practice for the assessment of psychiatric patients 19,20 . The present work presents the adaptation of the BDEFS to Brazilian Portuguese, and provides evidence of its reliability and construct validity in a non-clinical community sample of Brazilian adults.…”

Executive Functioning Mediates the Effect of Behavioral Problems on Depression in Mothers of Children With Developmental Disabilities

“…Similarly, executive functioning deficits have emerged as a risk factor for depressive symptoms in clinical and community samples (Feldman, Knouse, & Robinson, 2013; Knouse, Barkley, & Murphy, 2013; Wingo, Kalkut, Tuminello, Ascnape, & Han, 2013). Thus, negative impact of stress on executive functioning may be a plausible mediating mechanism linking stress exposure to levels of depression among maternal caregivers of adolescent or adult children with developmental disabilities.…”