Exploring neurocognitive features in adolescents and young adults with anorexia nervosa: Evidence from a longitudinal study.

OBJECTIVE: We aimed to evaluate longitudinal changes in set-shifting and central coherence in a predominantly adolescent cohort with anorexia nervosa (AN) and to explore whether these factors predict long-term eating disorder outcomes. METHOD: Ninety-two female patients with AN (mean age: 16.2, range: 13-21 years) completed neurocognitive tests (Rey Complex Figure Test, Adapted Version of the Wisconsin Card Sorting Test) before and after 12 months of psychotherapeutic treatment (n = 45 Maudsley AN Treatment, MANTRa; n = 47 standard psychotherapy; groups not randomised). Eating disorder severity was assessed at baseline, after 6, 12 and 18 months. RESULTS: Central coherence (indicated by an increase in the Rey Figure Style Index) and set-shifting (indicated by a reduction in the percentage of perseverative errors) significantly improved over the course of treatment, with similar outcomes across groups. Lower central coherence was associated with higher eating disorder severity. Individuals with lower baseline set-shifting ability tended to have worse eating disorder outcomes in the long-term. However, this trend did not reach statistical significance in a multilevel linear mixed model. CONCLUSIONS: Neurocognitive difficulties in adolescents and young adults with AN can improve after treatment. Interventions specifically addressing flexibility in thinking and behaviour may contribute to treatment success.

Cognitive flexibility and attention to detail in adolescents and adults with severe forms of anorexia nervosa.

OBJECTIVE: To determine if adolescents and adults diagnosed with anorexia nervosa differ in their levels of cognitive flexibility and attention to detail independently of potential confounds. METHOD: Sixty-two adolescents and 54 adults were assessed while receiving inpatient treatment and completed the following self-reports: Eating Disorders Examination Questionnaire, Maudsley Obsessive Compulsive Inventory and Hospital Anxiety and Depression scale. Performance-based evaluations included the Wisconsin Card Sorting Test Computerised Version, the Comprehensive Trail Making Test, the Brixton Spatial Anticipation Test, the Rey Complex Figure and the Group Embedded Figures Test. RESULTS: Comparisons of the adolescents and adults with anorexia nervosa revealed no significant differences for any of the neuropsychological test scores even after adjusting for potential confounding factors. Neither cognitive flexibility nor attention to detail were associated with level of eating disorder symptomatology, depression, anxiety or obsessive-compulsive symptomatology. Unlike age, illness duration was found weakly associated with perseverative errors Wisconsin Card Sorting Test and with the central coherence index of the Rey Complex Figure recall condition. CONCLUSIONS: Set-shifting and central coherence performance were independent of age, clinical symptoms severity and emotional status. Additional studies on the relationship between the duration of anorexia nervosa and neuropsychological difficulties are needed.

Randomized controlled trial of cognitive remediation therapy in adolescent inpatients with anorexia nervosa: Neuropsychological outcomes.

OBJECTIVE: Neuropsychological dysfunction exists in anorexia nervosa (AN). Cognitive Remediation Therapy (CRT), mainly evaluated in adults with AN, targets these impairments. METHODS: Adolescent inpatients (age = 11-17 years) with AN were randomized to 5 weeks of either 10 sessions of individually delivered CRT or non-specific cognitive-training (NSCT). Co-primary outcomes included cognitive domain 'flexibility' [composite score of Wisconsin Card Sorting Test (WSCT) and Trail Making Test (TMT-4)] and 'central coherence' [composite score of Central Coherence Index (CCI) and Group Embedded Figures Test (GEFT)] at end of treatment (FU1). Secondary outcomes included individual test scores and self-reported everyday-life flexibility at FU1 and at 6-months post-treatment (FU2). Independent sample t-tests, Pearson chi-square-tests and mixed models for repeated measures (MMRM) analyses were conducted. RESULTS: In 56 females (age = 15.1 ± 1.5 years), CRT was not superior to NSCT at FU1 regarding 'flexibility' (p = 0.768) or 'central coherence' (p = 0.354), nor at FU2 (p = 0.507; p = 0.624) (effect sizes = 0.02-0.26). Both groups improved over time in central coherence (CCI p = 0.001; GEFT p < 0.001), self-reported flexibility (p = 0.002) and WCST (p = 0.18), but not TMT-4 (p = 0.286). NSCT was superior to CRT regarding self-reported planning/organisation ability at FU1 (p < 0.001) and FU2 (p = 0.003). CONCLUSIONS: CRT was not superior to NSCT in adolescent inpatients with AN. More randomized controlled studies are needed.

Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD: We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS: People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION: Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.

OBJECTIVO: Esta revisión sistemática y metanálisis comparó las ineficiencias documentadas previamente en la coherencia central y el cambio de tareas entre personas con trastornos de la conducta alimentaria sin bajo peso (bulimia nervosa y trastorno por atracón) y personas con anorexia nerviosa. MÉTODO: Realizamos metanálisis de efectos aleatorios en 16 estudios (1112 participantes) para la coherencia central y 38 estudios (3505 participantes) para el cambio de tareas. Se utilizaron metarregresiones de efectos aleatorios para probar si los tamaños del efecto para las personas con trastornos alimentarios sin bajo peso eran significativamente diferentes de los tamaños del efecto para las personas con anorexia nerviosa. RESULTADOS: Las personas con anorexia nervosa (g de Hedge = −.53, IC del 95%: −.80, −.27, p <.001) y bulimia nervosa (g de Hedge = −.70, IC del 95%: −1.14, − 0,25, p = 0,002), pero no el trastorno por atracón, tenían una coherencia central significativamente más pobre que los controles sanos. De manera similar, las personas con anorexia nervosa (g de Hedge = −.38, IC del 95%: −.50, −.26, p <.001) y bulimia nervosa (g de Hedge = −.55, IC del 95%: −.81, −.29, p <.001), pero no el trastorno por atracón, tuvieron cambios de tareas significativamente más pobres que los controles sanos. Los tamaños del efecto para las personas con trastornos de la conducta alimentaria sin bajo peso no difirieron significativamente de los de las personas con anorexia nervosa. DISCUSIÓN: Nuestro metanálisis no tuvo el poder estadístico suficiente para emitir juicios definitivos sobre las personas con trastorno por atracón. Sin embargo, encontramos que las personas con bulimia nervosa claramente tienen coherencia central e ineficiencias de cambio de tareas que no difieren significativamente de las observadas en personas con anorexia nerviosa. Clínicamente, esto sugiere que las personas con bulimia nervosa podrían beneficiarse de enfoques complementarios para abordar estas ineficiencias, como la terapia de remediación cognitiva.

Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review.

BACKGROUND: Anorexia nervosa (AN) is a severe eating disorder, recognized by a relentless pursuit for thinness and extreme low body weight. The disorder is often accompanied by comorbid disorders such as anxiety and depression, and altered neuropsychological function in terms of poor set-shifting and reduced central coherence. The aim of this review was to evaluate whether neuropsychological impairments in AN are influenced by body mass index, anxiety or depression. METHOD: A systematic review approach was used, following the PRISMA guidelines for systematic reviews. Literature was identified via searches in PubMed, PsychInfo and Embase database, by using the search words [anorexia nervosa] AND [central coherence], and [anorexia nervosa] AND [set-shifting]. Studies were included if they were written in English, peer-reviewed, included individuals with AN, included tests measuring set-shifting and/or central coherence, investigated associations between set-shifting/central coherence with anxiety and/or depression and/or BMI. Risk of bias was assessed by using a critical appraisal checklist from the Joanna Briggs Institute. Results were summarized in a narrative synthesis. RESULTS: Although results are heterogeneous, the majority of studies report that neither body mass index (BMI), anxiety or depression is associated with altered central coherence and set-shifting in individuals with AN. CONCLUSIONS: Findings indicate that BMI, depression and anxiety does not influence neuropsychological function in AN, suggesting that it could be a characteristic of the disorder. A complete understanding of predisposing, precipitating and maintaining factors in AN needs to be addressed in future research. This could contribute to the development of better and more targeted treatment strategies.

The role of context in verbal humor processing in autism.

Difficulties in processing humor have been associated with individuals with autism. The current study investigated whether humor comprehension and appreciation could be augmented in children with autism by providing contextual support suggesting that humor was to be expected. A verbally presented riddle task was used in which participants were assessed for their subjective ratings and comprehension of the materials. They were also filmed to record any smiling or laughing. Both riddles and control stimuli were presented with supporting verbal context and also without it. The results showed that (a) the greater subjective appreciation of riddles than of control stimuli was dependent on the provision of context for the participants with autism and that (b) context statistically equated these ratings of riddles between participants with autism and matched typically developing controls. However, context had no effect on comprehension or affective response. The results of the current study demonstrate that children with autism are, even in the most conservative interpretation, able to use verbal context to recognize verbal humor. This lays the foundation of possible interventions based on training sensitivity to context.

The neural correlates of a central coherence task in young women with anorexia nervosa.

OBJECTIVE: Heightened detail-processing and low levels of central coherence are common in individuals with anorexia nervosa (AN) and predict poorer prognosis. However, it is unclear whether these processing styles predate the disorder or, rather, emerge during later stages of AN. The current study aimed to address this question by investigating central coherence, and the neural correlates of central coherence, in a sample of young women with AN with shorter duration of illness than previous studies recruiting adult samples. METHODS: We recruited 186 participants, including: 73 young women with AN, 45 young women weight-recovered from AN, and 68 age-matched controls. Participants completed the Embedded Figures Task during an fMRI scan. RESULTS: There were no significant differences between the participant groups in performance accuracy or reaction time. There were no other between-groups differences in neural response to the Embedded Figures Task. CONCLUSIONS: These findings contrast with evidence from older adults demonstrating differences in the neural underpinning of central coherence amongst participants with AN versus control participants. The current study adds to an increasing literature base demonstrating the resilience of neuropsychological traits and associated brain systems in the early stages of AN.

Exploring neuropsychological and socio-emotional task performance in anorexia nervosa: A cluster analytic approach.

OBJECTIVE: The aim of this study was to characterise heterogeneity in neuropsychological and socio-emotional task performance in young women with anorexia nervosa (AN) using hierarchical cluster analysis. Further, we aimed to test whether cognitive profiles were associated with differences in clinical variables (body mass index, illness duration and age at diagnosis), psychopathology (eating disorder, autistic symptoms, anxiety and depression) and functional impairment. METHOD: Set-shifting, central coherence and theory of mind abilities were measured in 118 women with acute or remitted AN. A hierarchical cluster analysis using Ward's method with a Euclidean distance measure was performed with the neuropsychological and socio-emotional variables. Differences between clusters were assessed using ANOVAs. RESULTS: Four clusters emerged, with significant differences in neuropsychological and socio-emotional task performance. There were no significant differences between clusters in clinical variables, psychopathology or functional impairment, however, these analyses lacked power due to small cluster sizes. CONCLUSIONS: Our results demonstrate significant heterogeneity in cognitive profiles in AN, supporting a more personalised approach to treatment. Studies in larger samples are required to establish whether these variables map onto clinically significant differences in aetiology, clinical presentation, comorbidity patterns and/or treatment responses.

Global and local visual processing in autism - a co-twin-control study.

BACKGROUND: Autism Spectrum Disorder (ASD) is associated with altered global and local visual processing. However, the nature of these alterations remains controversial, with contradictory findings and notions ranging from a reduced drive to integrate information into a coherent 'gestalt' ("weak central coherence" = WCC) to an enhanced perceptual functioning (EPF) in local processing. METHODS: This study assessed the association between autism and global/local visual processing, using a large sample of monozygotic (MZ) and dizygotic (DZ) twins (N = 290, 48% females, age = 8-31 years). The Fragmented Pictures Test (FPT) assessed global processing, whereas local processing was estimated with the Embedded Figures Test (EFT) and the Block Design Test (BDT). Autism was assessed both categorically (clinical diagnosis), and dimensionally (autistic traits). Associations between visual tasks and autism were estimated both across the cohort and within-twin pairs where all factors shared between twins are implicitly controlled. RESULTS: Clinical diagnosis and autistic traits predicted a need for more visual information for gestalt processing in the FPT across the cohort. For clinical diagnosis, this association remained within-pairs and at trend-level even within MZ twin pairs alone. ASD and higher autistic traits predicted lower EFT and BDT performance across the cohort, but these associations were lost within-pairs. CONCLUSIONS: In line with the WCC account, our findings indicate an association between autism and reduced global visual processing in children, adolescents and young adults (but no evidence for EPF). Observing a similar association within MZ twins suggests a non-shared environmental contribution.

Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis.

OBJECTIVE: Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD: Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS: Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION: A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.

OBJETIVO: La Anorexia Nerviosa (AN) está asociada con características neuropsicológicas como alteraciones en la coherencia central, flexibilidad cognitiva, y reconocimiento de emociones. Las mismas características también se manifiestan en los trastornos del espectro autista (TEA), y se ha sugerido que se asocian con una prolongación de la enfermedad de la AN. El propósito de este meta-análisis fue examinar si las características neuropsicológicas pronunciadas relacionadas al TEA están asociadas con la duración de la enfermedad en la AN. MÉTODOS: Se investigó en cuatro bases de datos (Medline, PsycINFO, Scopus, PubMed) para encontrar estudios elegibles. Los términos de búsqueda fueron 1) "anorexia nerviosa", y 2) "flexibilidad cognitiva" o "cambio de un tipo de información a otro (set shifting)" o "coherencia central" o "reconocimiento de emociones" o "teoría de la mente". La muestra final consistió en 53 estudios. La duración de la AN fue dividida en tres categorías para poder investigar las diferencias entre los grupos con una duración variable de la enfermedad. El meta-análisis fue realizado con Review Manager utilizando un modelo de efecto aleatorio. RESULTADOS: Los déficits en la coherencia central, flexibilidad cognitiva, y el reconocimiento de emociones fueron más pronunciados en los individuos con AN prolongada en comparación con aquellos con una menor duración de la enfermedad. DISCUSIÓN: Un curso prolongado de AN parece estar asociado con características neuropsicológicas subyacentes que también son distintivas de los TEA. Las alteraciones neuropsicológicas pueden llevar a una AN prolongada y la enfermedad prolongada puede contribuir al posterior "efecto de cicatriz neurológica", reforzando aún más estas alteraciones.

Contribution of executive functions to eating behaviours in obesity and eating disorders.

BACKGROUND: Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence. AIMS: The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity. METHOD: Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively. RESULTS: Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing. CONCLUSIONS: The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.

Weight and age do not account for a worse executive functioning among BED-obese patients.

PURPOSE: Research has demonstrated impaired executive functioning among Binge Eating Disorder (BED) patients that could be influenced by age and weight. We aim to compare decision-making, set-shifting and central coherence between BED-obese patients (BED-Ob), non-BED-obese patients (non-BED-Ob), and normal-weight healthy controls (NW-HC) without the influence of these variables. METHODS: Overall, 35 BED-Ob, 32 non-BED-Ob and 26 NW-HC participants completed the Iowa Gambling Task, the Trail Making Test and the Rey-Osterrieth Complex Figure Test. RESULTS: BED-Ob patients showed higher cognitive impairment compared to NW-HC on decision-making, set-shifting, visual attention and memory. CONCLUSIONS: BED-Ob patients have an impaired cognitive profile on decision-making, set-shifting, visual attention and memory but not impaired central coherence. As all groups were aged-matched and no significant differences between BED-Ob and non-BED-Ob participants were evident, our results demonstrate that this impairment is independent from weight/age, pointing out that it is BED itself to account for inefficiencies in cognitive functioning. LEVEL OF EVIDENCE: Level III, case-control study.

Second-generation long-acting injections anti-psychotics improve executive functions in patients with schizophrenia: a 12-month real-world study.

Background: The main purpose of this study was to assess possible modifications of cognitive performance among schizophrenia patients treated with long-acting injectable antipsychotics (LAIs) of second generation anti-psychotics (SGAs). Our hypothesis is that the shift from the oral formulation to the LAI formulation of SGAs drugs improves the cognitive performance. The secondary objective was to carry out a head to head comparison of two different SGA-LAI treatments [i.e., 1-month Paliperidone Palmitate (PP1M), monthly Aripiprazole (Ari-LAI)] in our study with an independent and real-world setting.Methods: The sample comprised 32 participants who were consecutively recruited over 12 months. Seventeen patients treated with Ari-LAI and 10 treated with PP1M completed psychopathological, neuropsychological and functional assessments. Group differences were explored through chi-squared and t-tests, as appropriate. GLM Repeated Measures were used to study variations of cognitive performance along 12 months and to test differences between drugs.Results: We found an effect of time on the outcomes investigated but this did not depend on the type of LAI used.Conclusions: In comparison with the previous oral treatment with SGAs, patients showed a significant improvement in neurocognitive function after 12 months of treatment with SGA-LAI. Furthermore, there were no differences between the SGA-LAI regimens.Key pointsThe main purpose of this study was to assess possible modification of cognitive performance of patients with Schizophrenia treated with second generation long-acting injectable antipsychotics (SGA-LAIs).The secondary objective was to carry out a head to head comparison of two different SGA-LAIs: Paliperidone Palmitate 1-Month (PP1M) and Aripiprazole Monthly (Ari-LAI).Patients showed a significant improvement in neurocognitive function after 12 months of treatment with SGA-LAI.There were no differences between the SGA-LAI regimens.From a practical point of view, switching to LAI formulation seems to produce further social and cognitive improvements in patients who had already benefitted from oral SGA therapy.

[Characteristics that Occupational Safety and Health Engineers Should Know Before Conducting Health and Safety Education for Workers with Developmental Disorders].

As a result of the amendment to the act on promotion of employment of persons with disabilities the statutory employment rate for handicapped people was raised from 2.0% to 2.2% in April 2018. By 2021, it will be raised again by 0.1% to 2.3%. The number of jobs for handicapped people has also been increasing recently, and it is predicted that the number of jobs for people with developmental disorders will also increase. From this perspective, it is predicted that occupational safety and health engineers, such as health officers, will have more opportunities to give safety and health education to workers with developmental disorders. People with developmental disorders have various characteristics that are different from those with an ordinary type of development, and occupational health and safety engineers need to understand their characteristics when providing education for them. This report summarizes the characteristics of people with developmental disorders that occupational safety and health engineers should know when educating them.

Disordered eating behaviours and autistic traits-Are there any associations in nonclinical populations? A systematic review.

OBJECTIVE: The objective of this study is to critically review existing literature concerning the possible association between autistic-like behaviours and problematic eating behaviours in nonclinical populations. METHOD: We performed a systematic literature search in three large databases. Studies were included if they assessed any association between a broad range of autistic-like behaviours and problematic eating behaviours in nonclinical samples. RESULTS: Sixteen eligible studies were found covering 3,595 participants in total, including five studies on children/adolescents (n = 685). All studies were cross-sectional, and thus, only concurrent associations could be evaluated. Several autistic-like behaviours were found to be associated with problematic eating behaviours, with the overall "autism spectrum quotient," deficiencies in set-shifting, and theory of mind showing the strongest associations. CONCLUSIONS: The existing literature indicates concurrent associations between specific autistic-like behaviours and problematic eating behaviours in nonclinical samples across ages. Large prospective longitudinal studies are needed for insight into the temporal order of these associations.

Cognitive remediation therapy in Mexico as a treatment for Anorexia Nervosa: A case study.

The purpose of this study was to conduct a preliminary evaluation of cognitive remediation therapy (CRT) as part of the treatment of a patient with anorexia nervosa (AN) from Mexico. The participant was a 21-year-old woman with a body mass index (BMI) of 14.7, who had suffered from the disorder for 10 years. Using a pre-post treatment design, changes were evaluated using four neuropsychological tests, two tests to measure the AN symptoms and two to measure psychological distress (depression and anxiety). BMI was also evaluated before and after the intervention. The results of the present study were similar to those reported for patients from English-speaking countries. The average percentage of favorable change in the different measures was higher than 30%, except for BMI, which increased by only 21%. The results suggest that the inclusion of CRT in AN treatment programs in Mexico is a potentially viable option.

Executive functioning and central coherence in anorexia nervosa: Pilot investigation of a neurocognitive endophenotype.

A neurocognitive profile characterized by problems in set shifting, executive functioning, and central coherence may pre-date and maintain anorexia nervosa (AN). To test this pattern as a possible endophenotype for AN, 10 youth with current AN, 14 healthy youth, and their biological parents, participated in a neuropsychological battery. Youth with AN demonstrated significantly weaker central coherence, related to enhanced detail-focused processing. Youth with AN and their parents demonstrated significantly greater psychopathology relative to controls, and youth-parent scores were significantly correlated. The study, limited by a small sample size, found little evidence supporting a neuropsychological endophenotype for AN. Identifying a neurocognitive profile for children and adolescents with AN has important implications for the treatment of young patients.

Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: A treatment trial.

Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whether individual and group CRT was a feasible, acceptable, and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age = 15.22, SD = 1.44) received 10 sessions of individual CRT, and 55 patients (mean age = 14.89, SD = 1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out, and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills, and large-sized improvements in motivation to recover. Group CRT had higher dropout (9.09%; n = 5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest that a randomised controlled trial for adolescents with AN is warranted.

Executive functioning and local-global visual processing: candidate endophenotypes for autism spectrum disorder?

BACKGROUND: Heterogeneity within autism spectrum disorder (ASD) hampers insight in the etiology and stimulates the search for endophenotypes. Endophenotypes should meet several criteria, the most important being the association with ASD and the higher occurrence rate in unaffected ASD relatives than in the general population. We evaluated these criteria for executive functioning (EF) and local-global (L-G) visual processing. METHODS: By administering an extensive cognitive battery which increases the validity of the measures, we examined which of the cognitive anomalies shown by ASD probands also occur in their unaffected relatives (n = 113) compared to typically developing (TD) controls (n = 100). Microarrays were performed, so we could exclude relatives from probands with a de novo mutation in a known ASD susceptibility copy number variant, thus increasing the probability that genetic risk variants are shared by the ASD relatives. An overview of studies investigating EF and L-G processing in ASD relatives was also provided. RESULTS: For EF, ASD relatives - like ASD probands - showed impairments in response inhibition, cognitive flexibility and generativity (specifically, ideational fluency), and EF impairments in daily life. For L-G visual processing, the ASD relatives showed no anomalies on the tasks, but they reported more attention to detail in daily life. Group differences were similar for siblings and for parents of ASD probands, and yielded larger effect sizes in a multiplex subsample. The group effect sizes for the comparison between ASD probands and TD individuals were generally larger than those of the ASD relatives compared to TD individuals. CONCLUSIONS: Impaired cognitive flexibility, ideational fluency and response inhibition are strong candidate endophenotypes for ASD. They could help to delineate etiologically more homogeneous subgroups, which is clinically important to allow assigning ASD probands to different, more targeted, interventions.

Weak central coherence in weight-restored adolescent anorexia nervosa: Characteristics and remediation.

OBJECTIVE: Weak central coherence (WCC) refers to a bias towards processing details (local processing) at the expense of paying attention to the bigger picture (global processing). Multiple studies reported WCC in adults with anorexia nervosa (AN). Evidence for WCC in adolescents with AN has been inconsistent. The current study characterizes WCC in weight-restored adolescents with AN (WR-AN) using a direct measure of WCC, and examines whether WCC can be remediated by increasing alertness level-a manipulation that was found useful in enhancing global processing in healthy individuals and clinical populations. METHODS: 40 adolescents (18 WR-AN and 22 healthy adolescents) performed a global/local processing task (Navon task). Auditory alerting cues that elevate alertness level were integrated into the task. RESULTS: Both groups processed global information faster than local information. However, compared with controls, adolescents with WR-AN were better at ignoring an irrelevant bigger picture while attending to details (smaller global interference) and had greater difficulty ignoring irrelevant details while attending to the bigger picture (larger local interference). These differences were attenuated when adolescents with WR-AN were under a state of high alertness. Additionally, the local interference effect was positively correlated with three independent self-report questionnaires assessing eating disorders symptomatology. DISCUSSION: This study suggests that abnormal interference by irrelevant global and local information is a central characteristic of WCC in adolescents with WR-AN that cannot be accounted for by enduring illness or malnourishment. Additionally, this study demonstrates that WCC can be temporarily remediated by encouraging a state of high alertness.