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Executive function deficits in high-functioning autistic individuals: relationship to theory of mind.

A group of high-functioning autistic individuals was compared to a clinical control group matched on VIQ, age, sex and SES. Significant group differences were found on executive function, theory of mind, emotion perception and verbal memory tests, but not on spatial or other control measures. Second-order theory of mind and executive function deficits were widespread among the autistic group, while first-order theory of mind deficits were found in only a subset of the sample. The relationship of executive function and theory of mind deficits to each other, and their primacy to autism, are discussed.

Adolescent↗

Executive functions in adolescents with schizotypal personality disorder.

Adolescents meeting diagnostic criteria for schizotypal personality disorder (SPD) are presumed to be at risk for developing schizophrenia in adulthood, making them an important group for exploring the developmental trajectory of the disease. Deficits in executive functioning have been documented in schizophrenia patients and adults with SPD. The present study examined executive functions in adolescents with SPD. It was predicted that the SPD group would score below comparison groups (normals and adolescents with other disorders) on measures of executive function, and that those with greater 'negative' signs of SPD would show more pronounced performance deficits. Analyses revealed that the performance of the SPD subjects was impaired relative to the other groups on the modified Wisconsin Card Sorting Test (MCST), but not on the Tower of London or the Controlled Oral Word Association Test. Consistent with prediction, regression analyses indicated that MCST deficits were associated with greater negative signs of SPD, but not positive signs.

Adolescent↗

Relationship between confabulation and measures of memory and executive function.

Confabulation has traditionally been attributed to a combination of memory impairment and executive dysfunction, but recent models propose that confabulation can result from executive dysfunction alone. One hundred and ten patients with diverse neurologic and psychiatric diagnoses were subdivided into high-, low-, and non-confabulator groups based upon the ratio of confabulations to total responses produced during story recall. Consistent with the combined deficit model, high-confabulators performed significantly worse than the low- and non-confabulators on measures of memory and measures of executive function that assess sustained attention, mental tracking, and set-shifting ability. However, there were no differences between groups on measures of problem-solving, concept formation, and verbal fluency, suggesting a dissociation in executive functions that contribute to confabulation.

Attention↗

Executive functions in preschool children born preterm: application of cognitive neuroscience paradigms.

Although children born preterm are at risk for neuropsychological impairments at school age and adolescence, including difficulties with visual motor integration, spatial/constructional skills, attention, arithmetic, and nonverbal executive functions, specific neuropsychological outcome has not been investigated adequately in preschoolers. Application of cognitive neuroscience tasks offers the opportunity to characterize early executive functions in young children born preterm. In a preliminary sample of 29 preschool children born preterm (M birth gestational age = 32.4 weeks), executive function outcome was compared to that of fullterm controls by contrasting performance on two prototypic delayed-response-type paradigms, Delayed Alternation and Spatial Reversal. Preschoolers born preterm correctly retrieved the reward on fewer trials on Delayed Alternation than did matched controls. Furthermore, preschool children born preterm used problem-solving strategies that included more perseverative errors than controls. These preliminary findings highlight the utility of cognitive neuroscience paradigms to understand neuropsychological outcome in preschool children born preterm and suggest areas of developmental vulnerability that may include dorsolateral prefrontal circuits.

Child, Preschool↗

Motor sequencing in Parkinson's disease: relationship to executive function and motor rigidity.

Parkinson's disease (PD) is a movement disorder that also affects central cognitive processing; however, the extent to which high-order cognitive processes disrupted by PD affect complex motor function is incompletely explicated. The present analysis provides an examination of the relative contributions of simple motor versus complex cognitive functions involving sequencing, problem solving, and overall cognitive status to complex motor movements involving sequencing and temporal ordering in PD. Motor sequencing performance was videotaped for quantitative scoring. Compared with an age-matched control group, the PD group was impaired on motor agility and motor sequencing tasks in addition to cognitive sequencing and set shifting tasks. Neither current cognitive functioning, age, disease duration, nor overall intellectual abilities accounted for the relationships between motor sequencing and cognitive sequencing abilities in PD. By contrast, both sequencing and nonsequencing executive functions predicted motor sequencing performance as well as or better than motor rigidity or overall cognitive status. These relationships were strongest for the most challenging motor sequencing task, fist-edge-palm, and did not apply to the least challenging task, which required simple alternations of hand movements. Unlike PD, controls showed correlations between motor sequencing tests and executive functioning only tapping nonsequencing abilities. Thus, despite the predominant motor feature of PD, executive functions, as assessed by sequencing and set formation, predicted motor sequencing performance as well as or better than simple motor performance. The results further suggest that the more complex the motor sequencing task, the more susceptible it is to influence from generalized cognitive sequencing ability.

Adult↗

Spatial working memory span, delayed response and executive function in schizophrenia.

This study investigated the spatial working memory span (SWMS) as well as the immediate memory span of schizophrenic patients, and examined the contribution of each span to the patients' executive function deficit in the visuospatial domain. SWMS measured the visuospatial working memory capacity that simultaneously processes and stores visuospatial information. Immediate memory span was measured with the spatial span (SS), a variant of Corsi's block-tapping test. A total of 16 patients diagnosed with schizophrenia and 16 normal control subjects participated in the study. SWMS, as well as the forward and backward SS, was significantly reduced in schizophrenia. The SWMS deficit observed in this study and previous findings of deficit in verbal working memory spans suggest that impairment in working memory capacity in schizophrenia is general, and not limited to the verbal domain. Executive function as assessed with the self-ordered pointing task (SOPT) was also impaired in the patients, which is consistent with clinical observations of self-monitoring impairment in schizophrenia. SWMS was able to account for the performance on the SOPT, but its contribution in the patients' impairment did not reach statistical significance. Backward span deficit explained this executive function impairment. SWMS was effective in explaining schizophrenic patients' impaired performance on the spatial delayed response, a prefrontal function task. Implications of the relations observed between the spans and the prefrontal function tasks are discussed.

Adult↗

Platelet monoamine oxidase activity in alcoholism subtypes: relationship to personality traits and executive functions.

AIMS: The purpose of the present study was to compare alcoholic subtypes (type 1 versus type 2) with regard to platelet monoamine oxidase (MAO) activity. A possible relationship between enzyme activity, personality traits and executive functions was also investigated. METHODS: Seventeen type 1 and 16 type 2 in-patient male chronic alcoholic patients and 17 healthy male volunteers were included in the study. The personality traits were investigated by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Executive functions were assessed by the Wisconsin Card Sorting Test (WCST). RESULTS: When compared to the healthy subjects, platelet MAO activity was reduced in both alcoholic groups. The enzyme activity of the type 2 group was significantly lower than that of type 1 patients. Both groups of alcoholic patients also displayed impairment in executive functions. The comparison of the MMPI-2 scores of the study groups revealed that type 2 alcoholics had more severe psychopathology. CONCLUSIONS: The results support previous evidence suggesting that platelet MAO activity is a useful biochemical measure for the subtyping of alcoholics.

Adult↗

ADHD outside the laboratory: boys' executive function performance on tasks in videogame play and on a visit to the zoo.

One current theory of attention-deficit/hyperactivity disorder (ADHD) proposes that a primary deficit in behavioral inhibition gives rise to secondary deficits in 4 executive functions and motor control. To date, empirical support for this model is based primarily on laboratory-based cognitive methods. This study assessed behavioral inhibition and executive functioning in children with ADHD in 2 real-life contexts: videogames (motor-skill target game, cognitively demanding adventure game) and an outing at the zoo (route tasks). Participants were a community sample of 57 boys diagnosed with ADHD (20 inattentive, 37 combined type) and 57 normally developing control boys, matched individually for age and nonverbal IQ. Operationally defined measures of behavioral inhibition and specific executive functions were derived from these activities and assessed under contrasting conditions of low or high working memory and distractor loads. There were no group differences in basic motor skills on the target game, nor in terms of the ability to inhibit a prepotent or ongoing response in the adventure videogame. However, boys with ADHD exhibited more self-talk, more effortful response preparation, and completed fewer challenges in the latter videogame. Also, they manifested inhibition deficits in terms of interference control during the route task at the zoo and took longer to complete the tasks. Typically, these differences were greatest under conditions of high working memory and distractor loads. Findings from this study suggest that cognitive difficulties in ADHD may be context dependent and that ADHD is associated with deficits in some but not all aspects of behavioral inhibition.

Analysis of Variance↗

Executive function in abstinent MDMA ('ecstasy') users.

BACKGROUND: Methylenedioxymethamphetamine (MDMA, or 'Ecstasy') is a growingly popular recreational drug of abuse that is known to damage brain serotonergic neurons in animals and possibly humans. Few functional consequences of MDMA-induced serotonin neurotoxicity have been identified, either in animals or humans. This study sought to determine whether individuals with a history of MDMA use showed evidence of executive dysfunction. MATERIAL AND METHODS: Two groups of young individuals were compared: 24 abstinent MDMA users who had taken MDMA at least once and 24 controls who had never taken MDMA. Each MDMA user completed a questionnaire regarding the characteristics of their MDMA use and all participants completed a questionnaire regarding other recreational drug experience. The Behavioural Assessment of the Dysexecutive Syndrome (BADS) was used to measure executive function in all participants. RESULTS: Evidence of impairment was found on two subtests of the BADS and in terms of a Total Profile Score. In addition, several significant product moment correlations were found suggesting that increases in MDMA consumption may relate to more pronounced impairment in executive function. CONCLUSIONS: Accordingly, MDMA use may be associated with deficits in executive function.

Adolescent↗

Executive function in Parkinson's disease and subcortical disorders.

Changes in cognitive function that accompany the progression of subcortical disorders such as Parkinson's disease are often overlooked in the early stages because of a "context of discovery" that accompanies the diagnostic progress. This article discusses the nature of that context, a subcortical cognitive profile, and the contribution of executive function failure to that profile. The utility of using brief assessments of executive function and other measures, such as a brief screen for apathy, are shown with Parkinson's disease patients. Several suggestions are provided for means by which clinicians can help patients, caregivers, and families adjust to patients' impairments in executive function.

AIDS Dementia Complex↗

The relationship between CVLT-C process scores and measures of executive functioning: lack of support among community-dwelling adolescents.

In an effort to characterize how a child goes about learning and recalling information, the developers of the California Verbal Learning Test for Children (CVLT-C) provided normative data related to both learning outcome and learning process. The present study examined the assertion that CVLT-C process indices relate to executive functioning in a sample of community-dwelling adolescents. Contrary to predictions, measures of executive functioning typically correlated poorly with measures of learning process, despite displaying significant correlations with measures of learning outcome. Although further research is recommended, these findings do not support the clinical interpretation of CVLT-C process indices as reflections of executive functioning.

Adolescent↗

Insight in schizophrenia: its relationship to measures of executive functions.

Lack of awareness of specific symptoms among persons with schizophrenia has not been adequately studied in the context of neuropsychological function. The purpose of this study is to investigate whether poor insight as measured by the Scale to Assess Unawareness of Mental Disorder is empirically related to performance measures having a known association with executive functions in a group of individuals with chronic schizophrenia. The results showed that unawareness and misattribution of negative symptoms are significantly associated with deficits in some aspects of executive functioning even after a test of general intelligence had been partialed from the analyses. We conclude that unawareness of negative symptoms is associated with executive functioning in individuals with chronic schizophrenia. Unawareness of other symptoms (i.e., positive symptoms) may reflect dysfunction in other types of neuropsychological processes, or it may reflect motivation to deceive oneself or others.

Adult↗

Impairment of executive function induced by hypertension in the rhesus monkey (Macaca mulatta).

The effects of chronic, untreated hypertension on executive function were investigated in a nonhuman primate model of hypertensive cerebrovascular disease. Executive function was assessed with the Conceptual Set-Shifting Task (CSST). a task adapted from the human Wisconsin Card Sorting Test (WCST). Like the WCST, the CSST requires abstraction of a stimulus set, followed by a series of set shifts. Performance on the CSST by 7 young adult monkeys (Macaca mulatta) with surgically induced hypertension was compared with that of 6 normotensive monkeys. The hypertensive group was significantly impaired relative to the normotensive group in abstraction and set shifting. Although the neural basis of this impairment is unclear, evidence from studies with humans and monkeys suggests that the prefrontal cortex may be the locus for this effect of hypertension.

Animals↗

Spatial reversal as a measure of executive functioning in children with autism.

The purpose of this experiment was to compare the executive functioning performance of children with autism with chronological- and verbal-matched controls in a spatial-reversal task. Three groups of children participated in this experiment. One group was identified as having autism (7 boys), the 2nd group contained 7 typically developing children (6 boys, 1 girl) who were matched to the 1st group based on their verbal performance, and the 3rd group contained 7 typically functioning children (6 boys, 1 girl) matched to the 1st group based on chronological age. Each group was given a spatial-reversal task containing 2 problems. In the 1st problem, children selected a toy on a particular side in a pair. In the 2nd problem, the contingencies were reversed such that children were to choose the toy on the opposite side. Children with autism generally performed worse than comparison groups as indicated by their overall higher rate of errors. However, these results must be qualified by considering the performance for each problem: Errors for the children with autism were infrequent during the 1st problem but increased in the 2nd, whereas errors for comparison children showed the opposite pattern. When these results from the spatial-reversal task were interpreted from the perspective of hypothesis-testing theory, the executive functioning deficiency of children with autism was found to involve the selection and testing of stereotypic response sets that were not likely to be revised or changed flexibly according to feedback from the environment or the demands of the task.

Autistic Disorder↗

Acquisition and short-term retention of inhaler techniques require intact executive function in elderly subjects.

BACKGROUND: patients with dementia are almost invariably unable to use any form of inhaler. Some elderly patients are unable to learn to use a metered dose inhaler or Turbohaler despite a normal abbreviated mental test score. Studies have shown that in many people this is due to unrecognised cognitive impairment and/or dyspraxia. The executive domains of cognition are particularly important in planning and sequencing; it might be expected therefore that disordered frontal (executive) function could be a predictor of poor inhaler technique in subjects with no overt features of dementia. OBJECTIVE: to explore the relationship between cognitive, and executive, function and the ability to acquire metered dose inhaler and Turbohaler technique in old age. DESIGN: a prospective randomised observational study with blinded evaluation. SUBJECTS: 30 inhaler-naive inpatients (21 female) with a mean age of 85 (range 75-94) and having a normal (8-10) abbreviated mental test score. METHODS: subjects received standardised metered dose inhaler and Turbohaler training and were scored on an analogue scale (for metered dose inhaler) or for competence (Turbohaler) the following day. The Mini-Mental State Examination and EXIT25 (for executive function) were performed by separate observers. RESULTS: significant correlation was found between the metered dose inhaler score and Mini-Mental State Examination (r 0.540, P<0.002) and EXIT25 (r -0.702, P<0.0001). Threshold effects emerged for the metered dose inhaler in that 18/19 with a competent score compared to 2/11 scored as incompetent had a Mini-Mental State Examination of >23 (P<0.01) and 19/19 compared to 0/11 had an EXIT25 of <15 (P<0.01). Similarly, for the Turbohaler 21/21 of the competent subjects had a Mini-Mental State Examination of >23 compared with 3/9 incompetent subjects (P<0.01), with 21/21 competent compared with 0/9 incompetent having an EXIT25 <15 (P<0.01). CONCLUSION: acquisition and short-term retention of metered dose inhaler and Turbohaler techniques is unlikely to be successful in frail elderly people who have an abnormal Mini-Mental State Examination and/or EXIT25 test. The latter test, when abnormal, is probably the superior predictor of inability to learn inhaler techniques.

Aged↗

Executive function and verbal working memory in adolescents with closed head injury (CHI).

The relationship between executive function (EF) and working memory (WM) was studied in eight adolescents with closed head injury (CHI) and eight controls, matched for age, gender and socioeconomic status (SES). A cognitive-linguistic test (Scales of Cognitive Ability for Traumatic Brain Injury, SCATBI) was used to group CHI participants by seventy. EF was tested with a measure of daily functioning (Pro-Ex) and WM was tested with a recognition memory task (RMT). When all subject test data were grouped, a positive linear correlation was found for the Pro-Ex and the RMT. A strong-to-moderate positive correlation was found for components of the EF measure and the RMT. Severity of injury influenced test performance for both the EF and WM measures, with a significance between group effects found on the RMT task. Results indicate a relationship between executive function and working memory, severity of injury and test performance and the need to assess EF of CHI adolescents with a measure of daily functioning.

Activities of Daily Living↗

Tests of executive functioning predict scores on the MacAndrew Alcoholism Scale.

1. Previous work reported that tests of executive functioning (EF) predict the risk of alcoholism in subject populations selected for a "high density" of a family history of alcoholism and/or the presence of sociopathic traits. The current experiment examined the ability of EF tests to predict the risk of alcoholism, as measured by the MacAndrew Alcoholism Scale (MAC), in outpatient subjects referred to a general neuropsychological testing service. 2. Sixty-eight male and female subjects referred for neuropsychological testing were assessed for their past drinking histories and administered the Wisconsin Card Sorting Test, the Wechsler Adult Intelligence Scale-Revised, the Trails (Part B) Test, and the MAC. Principal Components analysis (PCA) reduced the number of EF tests to two measures, including one that loaded on the WCST, and one that loaded on the Similarities, Picture Arrangement, and Trails tests. Multiple hierarchical regression first removed the variance from demographic variables, alcohol consumption, and verbal (i.e., Vocabulary) and non-verbal (i.e., Block Design) IQ, and then entered the executive functioning factors into the prediction of the MAC. 3. Seventy-six percent of the subjects were classified as either light, infrequent, or non-drinkers on the Quantity-Frequency-Variability scale. The factor derived from the WCST on PCA significantly added to the prediction of risk on the MAC (p = .0063), as did scores on Block Design (p = .033). Relatively more impaired scores on the WCST factor and Block Design were predictive of higher scores on the MAC. The other factors were not associated with MAC scores. 4. These results support the hypothesis that decrements in EF are associated with risk factors for alcoholism, even in populations where the density of alcoholic behaviors are not unusually high. When taken in conjunction with other findings, these results implicate EF test scores, and prefrontal brain functioning, in the neurobiology of the risk for alcoholism.

Adult↗

Executive functions in young children with autism.

The executive dysfunction hypothesis of autism has received support from most studies of older people with autism; however, studies of young children have produced mixed results. Two studies are presented that compare the performance of preschoolers with autism (mean = 51 months/4.3 years of age) to a control group matched on age, and verbal and nonverbal ability. The first study (n = 18 autism and 17 control) found no group differences in performance on 8 executive function tasks (A not B, Object Retrieval, A not B with Invisible Displacement, 3-Boxes Stationary and Scrambled, 6-Boxes Stationary and Scrambled, and Spatial Reversal), but did find that children with autism initiated fewer joint attention and social interaction behaviors. The second (longitudinal) study of a subset of the children (n = 13 autism and 11 control) from the first study found that neither groups' performance on Spatial Reversal changed significantly over the course of a year. The results of these studies pose a serious challenge to the executive dysfunction hypothesis of autism.

Attention↗