Examining patterns of executive functioning across dimensions of psychopathology.

BACKGROUND AND OBJECTIVES: The current study examined relationships between psychopathology and individual domains of executive functioning (EF) amongst adults. While previous studies have examined these relationships using diagnostic groups, we compared factor structures of both dimensional psychopathology and EF and used an approach to better isolate EF-specific task variance within each domain. METHODS: This study analyzed the data of 722 individuals between the ages of 18-59 years, who took part in the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses were used to derive a three-factor model of EF (i.e., inhibition, shifting, and fluency) proposed by Karr et al. (2019) with scores primarily from the Delis-Kaplan Executive Function System (D-KEFS), as well as a three-factor model of psychopathology (i.e., internalizing, externalizing, and thought disorder symptoms) from the Adult Self-Report (ASR) and Peter's et al. Delusions Inventory (PDI). These models were compared using structural equation modeling. RESULTS: Results demonstrated an adequate fit for both model structures and indicated that internalizing and externalizing psychopathology had positive and negative relationships with different factors of EF, while thought disorder traits were not related to EF. LIMITATIONS: This study examines pathological traits within a non-clinical sample that excluded individuals with severe mental illness. Additionally, analyses were limited by the availability of certain variables, and potential shared method variance within factors. CONCLUSIONS: Patterns of associations with EF were unique to all three aspects of dimensional psychopathology. When examined together, different dimensions of psychopathology were related to both better and worse EF performance.

The Influence of Processing Speed, Attention, and Inhibition on Texas Functional Living Scale Performance.

OBJECTIVE: Attention, inhibition, and processing speed are related to functional decline among older adults. This study attempts to clarify the relationships between these cognitive factors and adaptive functioning. METHOD: We examined relationships between attention, inhibition, and processing speed, with scores on the Texas Functional Living Scale (TFLS), a performance-based measure of daily functioning, in a mixed clinical sample of 530 older adults who were referred for an outpatient neuropsychological evaluation. RESULTS: The current study used a confirmatory factor analysis (CFA) to derive a three-factor cognitive model consisting of attention, inhibition, and processing speed. Results from a hierarchical regression, which included factor scores from the CFA, revealed that processing speed was the only significant predictor of TFLS performance when all three cognitive factors were included within a single model. CONCLUSION: These results highlight the influence of processing speed as an important indicator of functional decline among a clinical population of older adults.

Normative and Maladaptive Personality Traits and Self-Reported Executive Functioning.

Research on self-reported executive functioning (EF) and personality has largely focused on normative personality traits. While previous research has demonstrated that maladaptive personality traits are associated with performance-based EF, the literature examining the relationship between these traits and self-reported EF is limited. The current study examined the relationship between multiple domains of self-reported EF (Barkley Deficits in Executive Functioning Scale) and both normative (The International Personality Item Pool-NEO-120 Item [IPIP-120]) and maladaptive (Personality Inventory for DSM-5-Short Form [PID-5-SF]) personality traits in an undergraduate student sample (n = 354). Similar to past research, relationships were largest across EF domains for both measures related to neuroticism (i.e., IPIP-120 neuroticism and PID-5-SF negative affectivity) and conscientiousness (i.e., IPIP-120 conscientiousness and PID-5-SF disinhibition). Normative personality traits generally accounted for greater variance in EF when examined alone and were also generally associated with greater incremental validity when compared with maladaptive personality traits. However, multiple regression analyses indicated that maladaptive personality traits added unique predictive variance above and beyond normative personality traits in their association with multiple domains of EF. These results highlight the utility of assessing both normative and maladaptive personality traits as well as multiple domains of EF to more fully understand the relationship between personality and EF.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting.

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS. The current study examined the relationship between both the RBANS and NAB Judgment performance as predictors of LOS among 63 individuals diagnosed with schizophrenia spectrum disorders undergoing competency restoration treatment. Additionally, sensitivity analyses were used to determine cutoff scores for individuals requiring additional competency services. Results indicated that the NAB Judgment subtest was more predictive of LOS than the RBANS Total Index Score. Additionally, a raw score of ≤9 on NAB Judgment was indicative of increased LOS. These results highlight the utility of the NAB Judgment subtest within a forensic inpatient setting.

Evaluating the construct validity of the King-Devick test in a psychological outpatient clinical sample.

The King-Devick test (K-D) has demonstrated sensitivity as a screener measure of ocular motor and cognitive problems. Despite its empirical support in the assessment of patients with certain injuries and disorders (e.g., concussion, reading disorders), less is known about the construct validity of the K-D. This study examined this topic in an outpatient, diagnostically heterogeneous clinical sample. A total of 70 individuals seen for an outpatient psychoeducational evaluation completed the K-D in addition to measures of intellectual abilities, speeded reading ability, simple and sustained attention, and executive functioning. Pearson correlation coefficients revealed that poorer K-D performance was associated with poorer processing speed, speeded reading ability and response time to target stimuli (r = .26-.31, p < .05). K-D performance was unrelated to other intellectual abilities, other aspects of attention, or executive functioning (all p > .05). Results suggest that the K-D demonstrates good convergent and discriminant validity in a heterogeneous outpatient clinical sample including individuals with attention-deficit hyperactivity disorder, specific learning disorders, and a number of different depressive and anxiety disorders. Findings support its wider use as a measure of reading ability and processing speed in clinical contexts.

Relationships between multiple dimensions of executive functioning and resting-state networks in adults.

The current study sought to examine the functional connectivity of resting state networks (RSNs) as they relate to the individual domains of executive functioning (EF). Based on the Unity and Diversity model (Miyake et al., 2000), EF performance was captured using a three-factor model proposed by Karr et al. (2018), which includes inhibition, shifting, and fluency. Publicly available data was used from the Nathan Kline Institute -Rockland project was used. Of the 722 participants who completed the Delis-Kaplan Executive Function System (D-KEFS), which was used to measure EF performance, 269 of these individuals completed resting state fMRI scans. First, a confirmatory factory analysis replicated Karr et al. (2018) revealing three components: inhibition, shifting and fluency. Next, RSNs were identified across the sample using an Independent Components Analysis (ICA) and was compared to previously established intrinsic connectivity networks (Laird et al., 2011). Finally, dual regression was used to analyze the relationships between the functional connectivity of RSNs and EF performance, which indicated that RSNs were differentially associated with inhibition and shifting. Better inhibition was related to increased connectivity between the left striatum and the attentional control network. Better shifting performance was related to increased connectivity between the pre- and postcentral gyri and the speech and sensorimotor network. These results highlight individual differences within these RSNs that are unique to the literature, as non-EF confounds are mitigated within the current measurements of EF performance.

Examining the factor structure of the Rey auditory verbal learning test in individuals across the life span.

Objective: Previous studies analyzing the factor structure of the Rey Auditory Verbal Learning Test (RAVLT) have been limited in the number of scores included in the analysis. Often, they lacked inclusion of process scores that have been shown to add predictive value in identifying future cognitive decline. Therefore, the goal of the current study was to determine the factor structure of the RAVLT utilizing factor scores including serial position effects, repetitions, and intrusion errors, and to examine if the factor structure for older adults is similar to that found in the entire lifespan sample.Method: Exploratory factor analysis (EFA) was conducted on 718 participants (age 16-85 years) from the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses (CFA) of a reduced model of the EFA was conducted on the entire sample and an older (ages 55-85 years; n = 265) and a younger (less than 55 years of age; n = 453) subsample.Results: EFA indicated three factors: Memory, Attention/Learning, and Inaccurate Memory (i.e., repetitions and intrusions). CFA of a reduced model indicated adequate fit in the entire sample and older subsample, and good fit in the younger subsample.Conclusion: The present study examined the factor structure of the RAVLT in a large lifespan sample utilizing a larger set of RAVLT scores than have been examined in prior studies, including total scores and process scores. The same factors were identified in the entire lifespan sample and the younger and older adult subsamples, although similar to previous studies, measures of model fit were less robust in the older adult subsample. These results provide additional support for the error scores (e.g., intrusions and repetitions) as separable from other aspects of learning and memory.

The effects of childhood inattention and anxiety on executive functioning: inhibition, updating, and shifting.

Although anxiety and attention-deficit/hyperactivity disorder (ADHD) symptoms are highly comorbid, research has generally examined the executive functioning (EF) deficits associated with each of these symptoms independently. The purpose of this study was to examine the unique and interactive effects of anxiety and ADHD symptoms (first respectively, then collectively) on multiple dimensions of EF (i.e., inhibition, updating, and shifting, respectively). A sample of 142 youth from the community (age range 8-17 years; Mage = 11.87 ± 2.94 years) completed the Delis-Kaplan Executive Function System and dimensional measures of anxiety, inattention, and hyperactivity/impulsivity. It was hypothesized that anxiety would moderate the effect of ADHD symptomatology on EF. Multiple regression models examined anxiety and ADHD symptom domains as predictors of EF. When examining ADHD symptom domains separately, anxiety moderated the relationship between inattention and both updating and shifting; the association between hyperactivity/impulsivity and updating was also moderated by anxiety. Within the full model including both ADHD symptom domains, results indicated that anxiety moderated the relationship between inattention and shifting. Analyses of ADHD symptoms in separate and combined models demonstrated a similar pattern: Increased inattention was associated with worse EF and when anxiety was a significant moderator, and increased ADHD symptoms were associated with worse EF only for those with high levels of anxiety. These results highlight the utility of including anxiety in studies examining the relationship between ADHD and EF. EF is related to multiple aspects of daily functioning (e.g., academic achievement), and EF deficits are often targeted in interventions for ADHD.

Utility of a novel simulator paradigm in the assessment of driving ability in individuals with and without attention-deficit hyperactivity disorder.

This study aimed to evaluate the utility of a novel, more cost-effective driving simulator, Assetto Corsa (AC), in detecting differences in driving performance between individuals with and without ADHD. Driving simulators are a useful means of assessing driving performance in those with attention-deficit hyperactivity disorder (ADHD); however, they are frequently expensive and thus unavailable to many researchers. A total of 87 participants (16 with ADHD, 71 without) completed an AC driving simulator task. They also completed computerized measures of attention and executive functioning and a questionnaire assessing self-reported driving behaviors and anger, ADHD and related symptoms, and mind wandering. Relative to those without ADHD, participants with ADHD reached higher average ground speeds and more greatly utilized the throttle. They also applied higher maximum pressure to the throttle and brake pedals. Within the full sample, greater mind wandering was associated with average and maximum throttle pressure and maximum ground speed. Findings confirm prior works indicative of a deleterious effect of ADHD diagnosis on simulator performance and may be attributed to a combination of impulsivity and mind wandering.

A multi-study examination of performance validity in undergraduate research participants.

Objective: Performance validity testing is a necessary practice when conducting research with undergraduate students, especially when participants are minimally incentivized to provide adequate effort. However, the failure rate on performance validity measures in undergraduate samples has been debated with studies of different measures and cutoffs reporting results ranging from 2.3 to 55.6%. Method: The current study examined multiple studies to investigate failures on performance validity measures in undergraduate students, and how these rates are influenced by liberal and conservative cutoffs. Failure rates were calculated using standalone performance validity tests (PVTs) and embedded validity indices (EVIs) from eight studies conducted at two universities with over one thousand participants. Results: Results indicated that failure rates in standalone PVTs were up to four times greater when using liberal versus conservative cutoffs. EVI rates varied for conservative versus liberal cutoffs with some measures showing almost no difference and others showing 10 times greater failure rates. Conclusions: Findings provide further descriptive data on the base rate of validity test failure in undergraduate student samples and suggest that EVIs might be more sensitive to alterations made in cutoff scores than standalone PVTs. Overall, these results highlight the variability in failure rates across different measures and cutoffs that researchers might employ in any individual study.

The association of anxiety, depression, and worry symptoms on cognitive performance in older adults.

Emerging research suggests that a relationship exists between the cognitive aspects of anxiety (e.g. worry) and cognitive decline in older adults. The current study examined the association between anxiety, depressive, and worry symptoms on cognitive performance. Participants were 156 older adults enrolled in the Nathan Kline Institute-Rockland Sample Study (NKI-RS).  Hierarchical linear regression analysis was used to determine the unique associations of anxiety, depressive, and worry symptoms on cognitive performance as measured by the Penn Computerized Neurocognitive Battery (Penn CNB), the Delis-Kaplan Executive Function System (D-KEFS), and the Rey Auditory Verbal Learning Test (RAVLT). Worry symptoms were a significant predictor of Penn CNB social cognition, complex cognition, executive function, and episodic memory performance as well as RAVLT immediate and short-delay recall, but not of D-KEFS performance or RAVLT long-delay recall. In contrast, anxiety and depressive symptoms had few unique associations with cognitive performance. Given that worry symptoms have a negative impact on many aspects of neurocognitive performance, they may have utility in predicting and preventing cognitive decline in older adults.

The Compensatory ADHD Behaviors Scale (CABS): Development and Initial Validation.

Several measures are available that assess inattention, hyperactivity/impulsivity, and executive functioning deficits. Treatments for adults with attention-deficit/hyperactivity disorder (ADHD) and skill-based academic interventions focus on improving compensatory strategies to ameliorate functional impairment; however, no measure exists that examines the compensatory behaviors adults utilize to compensate for the functional deficits associated with inattention and hyperactivity/impulsivity. The current study aimed to determine the psychometric properties of the Compensatory ADHD Behaviors Scale (CABS). Five-hundred participants (Mage= 36.83, SD = 11.57) completed measures of ADHD symptomatology, executive functioning, functional impairment, mood disorder symptoms, and the CABS. Analyses revealed that scales assessing both use and effectiveness of compensatory behaviors subscales had similar factor structures, reflecting present- and future-oriented behaviors. The present-, but not future-oriented, behaviors significantly related to ADHD symptomatology, executive dysfunction, and functional impairment; effectiveness of present-oriented compensatory behaviors demonstrated incremental validity in predicting impairment. Compensatory strategies may be a useful variable to measure when examining functional impairment associated with inattention and hyperactivity/impulsivity. The current study provides preliminary evidence of the ability of CABS to validly measure various strategies associated with (clinical and subclinical) ADHD symptomatology, executive functioning, and overall impairment.

Parsing the neural correlates of anxious apprehension and anxious arousal in the grey-matter of healthy youth.

Neuroscientific and psychological research posits that there are two transdiagnostic facets of anxiety: anxious arousal and anxious apprehension. Though these two facets of anxiety are distinct, they are often subsumed into one domain (e.g., trait anxiety). The primary goal of the current study was to delineate the relationship between anxious arousal and cortical thickness versus the relationship between anxious apprehension and cortical thickness in a sample of typically functioning youth. The secondary aim was to determine where in the brain cortical thickness significantly correlated with both components of anxiety. Results indicated that the right anterior insula has a stronger relationship to anxious arousal, whereas the dorsolateral prefrontal cortex and left anterior insula were found to correlate with both anxious arousal and apprehension. We also observed volumetric differences in the amygdala and hippocampus between anxious arousal and anxious apprehension. Whereas anxious arousal, but not apprehension, predicted left amygdala volume, anxious apprehension, but not arousal, predicted right hippocampal volume. These findings demonstrated that there are both differences and similarities in the neural regions that contribute to independent facets of anxiety. Results are discussed in terms of previous findings from the affective and developmental cognitive neurosciences.

Does prior administration of the RBANS influence performance on subsequent neuropsychological testing?

The objective of this study was to determine whether administration of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) prior to other neuropsychological testing improves performance on subsequent measures due to practice effects. Participants completed the RBANS and related neuropsychological measures of the same cognitive domain in one of two counterbalanced orders. A MANOVA and follow-up independent t-tests were used to examine whether or not completing one set of measures prior to the other was associated with score differences. Prior administration of the RBANS did not impact performance on subsequent testing. However, a significant effect of test order administration was found such that the group administered the RBANS second performed worse on RBANS delayed memory measures. This finding was likely due to proactive interference, given that items from initially administered memory measures presented as intrusions on subsequently administered memory measures. Current results indicate that the practice of administering the RBANS as a screener prior to administration of additional tests will not impact performance on the subsequent tests. Although practice effects were not found, clinicians and researchers administering memory measures with similar designs (e.g., verbal list-learning tasks) within a single testing session should be aware of the potential of interference effects.

Further validation of booklet category test subscales for learning, set loss, and memory in a mixed clinical sample.

Although it has long been proposed that performance on the Booklet Category Test (BCT) relies on a number of different cognitive abilities, including executive functioning, perceptual reasoning, and memory, only a single total error score is typically derived and interpreted in clinical practice. BCT subscales based on factor analyses of subtest errors or designed specifically to measure specific cognitive domains have been proposed to better assess the multidimensional abilities underlying BCT performance. The aim of this study was to independently replicate and extend previous findings regarding the validity of these subscales. A mixed clinical sample of 137 patients completed the BCT and a number of additional measures used to assess neuropsychological domains of selective attention, various aspects of executive functioning, intellectual functioning, and memory. Correlation and regression analyses were used to explore the convergent and discriminant validity of each subscale. Subscales varied in the number and magnitude of their significant correlations with scores derived from traditional measures. In general, findings supported the convergent validity of BCT category learning, set loss, and memory subscales. However, findings regarding discriminant validity were more variable across subscales. Results provide additional support for the multidimensional nature of the BCT and the validity of derived subscales to measure specific aspects of cognitive functioning beyond what is measured by a total errors score. The recently proposed subscales examined in the current study appear to be worthy of further investigation by clinicians and researchers to determine their clinical utility.

Eliciting affect via immersive virtual reality: a tool for adolescent risk reduction.

OBJECTIVE: A virtual reality environment (VRE) was designed to expose participants to substance use and sexual risk-taking cues to examine the utility of VR in eliciting adolescent physiological arousal. METHODS: 42 adolescents (55% male) with a mean age of 14.54 years (SD = 1.13) participated. Physiological arousal was examined through heart rate (HR), respiratory sinus arrhythmia (RSA), and self-reported somatic arousal. A within-subject design (neutral VRE, VR party, and neutral VRE) was utilized to examine changes in arousal. RESULTS: The VR party demonstrated an increase in physiological arousal relative to a neutral VRE. Examination of individual segments of the party (e.g., orientation, substance use, and sexual risk) demonstrated that HR was significantly elevated across all segments, whereas only the orientation and sexual risk segments demonstrated significant impact on RSA. CONCLUSIONS: This study provides preliminary evidence that VREs can be used to generate physiological arousal in response to substance use and sexual risk cues.