Executive functioning profiles from the BRIEF across pediatric medical disorders: Age and diagnosis factors

Abstract

Objective To compare Executive Functioning (EF) profiles across several pediatric medical conditions and explored the influence of age of diagnosis and evaluation. Methods This was a retrospective, cross sectional study of 734 children ages 5-18 across five medical groups [brain tumor, leukemia (ALL), epilepsy (EPI), Neurofibromatosis Type 1 (NF1), and Ornithine Transcarbamylase Deficiency (OTC-D)], ADHD controls, and matched healthy controls. We compared groups across the subscales of a parent completed Behavior Rating Inventory of Executive Functioning (BRIEF) using MANOVA. Separate MANOVAs were conducted to look at age factors. Results The ADHD group differed from all other groups and had the highest level of reported EF problems. The NF1 and OTC-D groups differed significantly from the healthy comparison group for overall EF problems, while the EPI and cancer groups did not. Working Memory was the most elevated subscale across medical groups, followed by Plan/Organize. Children with medical disorders were two to four times as likely as healthy controls to have clinically significant problems in several EF domains. There was a main effect for age at diagnosis and age at evaluation.. Conclusions A subset of children with medical disorders were found to have parent reported EF difficulties, with particular vulnerability noted in working memory and organizational/planning skills. This has relevance for the development of interventions that may be helpful across disorders. Children with particular diagnoses and earlier age of diagnosis and evaluation had greater reported EF problems.

Self-Reported Executive Dysfunction, Fatigue, and Psychological and Emotional Symptoms in Physically Well-Functioning Long-Term Survivors of Pediatric Brain Tumor

“…Notably, there were no significantly higher rates of reported problems with behavioral inhibition, i.e., an important hot EF aspect, either in the adolescent or in the young adult PBT survivor group. This is in line with previous findings noting that PBT survivors are less likely to demonstrate clinically significant problems with behavioral inhibition, even compared to healthy controls (Brinkman, Li, et al, 2016;Krivitzky et al, 2016).…”

“…This raises concern about the appropriateness of these norms in a Norwegian setting, and indicates that mean scores from a matched Norwegian sample of healthy controls are a more suitable basis for comparisons, both in clinical and research settings. Altogether, the present findings are in line with the PBT literature, consistently demonstrating impaired functioning in these neurocognitive/EF domains, not only in survivors treated with CRT and chemotherapy, but also after surgery only (Edelstein et al, 2011;King et al, 2019;Krivitzky, Walsh, Fisher, & Berl, 2016;Moberget et al, 2015;Palmer, 2008;Rey-Casserly & Diver, 2019;Rønning et al, 2005;Wolfe et al, 2012) .…”

“…Although the opposite pattern has generally been found in pediatric populations (i.e., parents reporting higher rates of problems in various domains compared to their child, especially for subjective symptoms) (Brinkman, Li, et al, 2016;Jurbergs et al, 2008;Lund et al, 2011;Sung et al, 2008), for the EF domain specifically, there are a few studies that are in line with the findings from this study. For example, studies have demonstrated low levels of parental endorsement of EF problems in survivors of PBT, even in the presence of performance-based findings of executive dysfunction (Krivitzky et al, 2016;Wochos, Semerjian, & Walsh, 2014). In comparison, teacher reports have been found to be more in accordance with performance-based data (Wochos et al, 2014).…”

Systematic Review and Meta-analysis of Executive Functions in Preschool and School-Age Children With Neurofibromatosis Type 1

“…These data provide an additional argument for considering that EF disorders are the source of several learning disabilities in children with NF1. Contrasting these data with other clinical contexts (e.g., Krivitsky, Walsh, Fisher, & Berl, 2016), for which executive impairment seems to be a core feature of cognitive phenotype, seems to be important to improve our knowledge of executive dysfunction in pediatric medical conditions.…”

Investigation of the Clinical Utility of the BRIEF2 in Youth With and Without Intellectual Disability

“…The measure's revision, the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) (Gioia, Isquith, Guy, & Kenworthy, 2015), has been found to discriminate children with and without Attention-Deficit/ Hyperactivity Disorder (ADHD), as well as among subtypes of ADHD; while children with ADHD consistently exhibited higher clinical scale scores than those without ADHD, the most significant scale elevation was found on the Working Memory scale for the inattentive type, the Inhibit scale for the hyperactive/impulsive type, and both scales for the combined type (Jacobson, Pritchard, Koriakin, Jones, & Mahone, 2016). While such profile analyses of clinical populations indicate generally higher index and scaled scores than in nonclinical populations (Krivitzky, Walsh, Fisher, & Berl, 2016), the BRIEF/ BRIEF2 appears helpful in capturing distinct EF features associated with specific neurodevelopmental disorders (Gioia et al, 2015, page 6-8).…”