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Executive functions assessment in very preterm children at school age: A pilot study about a clinical and
Marion Décaillet1,2,3, Solange Denervaud2, Cléo Huguenin-Virchaux1,3
1Clinic of Neonatology, Department of Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
Very preterm children show subtle executive function (EF) difficulties, impacting self-regulation. A brief Flanker task shows promise in identifying these EF challenges in neurodevelopmental assessments.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatric Neuropsychology
Background:
- Very preterm (VPT) infants face increased risks of long-term neurodevelopmental impairments, particularly in executive functions (EFs) like inhibition, shifting, and working memory.
- Traditional comprehensive tests for EFs are time-consuming, limiting their use in routine pediatric assessments.
- EFs are crucial for self-regulatory abilities and goal-directed behaviors, essential for academic and social success.
Purpose of the Study:
- To evaluate the efficacy of a brief, child-friendly Flanker task in measuring executive functions in very preterm (VPT) children aged 8-10 years.
- To compare the performance of VPT children with full-term children on the Flanker task and standardized clinical tests.
- To explore the potential of the Flanker task as a sensitive screening tool for subtle EF deficits in VPT populations.
Main Methods:
- Thirty-one VPT children (8-10 years) underwent assessment using the Flanker task, alongside standardized clinical tests (WISC-V, BRIEF, NEPSY, CPT-3).
- Performance on the Flanker task was analyzed for measures of inhibition, shifting, and working memory.
- Statistical correlations were examined between Flanker task scores and results from clinical assessments.
Main Results:
- VPT children generally performed within norms on most clinical tests but showed slower reaction times and more omission errors on the CPT-3, suggesting potential inattentiveness.
- The Flanker task revealed poorer global EF performance and lower accuracy in VPT children compared to full-term peers.
- Some Flanker task scores showed correlations with standardized clinical tests, indicating potential validity, though not resistant to multiple comparisons correction.
Conclusions:
- The child-friendly Flanker task demonstrated sensitivity in detecting executive function differences between VPT and full-term children.
- Despite generally normal intelligence, VPT children exhibit subtle executive function challenges that this task can help identify.
- The Flanker task shows promise as a time-efficient screening tool for neuropsychological assessments in VPT populations, warranting further validation in larger studies.
Abstract:
While the survival rate of very preterm (VPT) infants has increased in the last decades, they are still at risk of developing long-term neurodevelopmental impairments, especially regarding self-regulatory abilities, and goal-directed behaviors. These skills rely on executive functions (EFs), an umbrella term encompassing the core capacities for inhibition, shifting, and working memory. Existing comprehensive tests are time-consuming and therefore not suitable for all pediatric neuropsychological assessments. The Flanker task is an experimental computer game having the advantage to last less than ten minutes while giving multiple EFs measures. Here, we tested the potency of this task in thirty-one VPT children aged 8-10 years during their clinical assessment. First, we found that VPT children performed in the norm for most clinical tests (i.e., WISC-V, BRIEF, and NEPSY) except for the CPT-3 where they were slower with more omission errors, which could indicate inattentiveness. Second, some Flanker task scores were correlated with standardized clinical testing without resisting to multiple comparisons correction. Finally, compared to full-term children, VPT children showed poorer performance in global EFs measure and lower accuracy in the Flanker task. These findings suggest that this child-friendly version of the Flanker task demonstrated a reasonable sensitivity in capturing EFs with good discrimination between VPT and term children despite VPT children's mild difficulties. It may represent a promising tool for neuropsychological assessments and be suitable as a screening test, providing further validating larger studies. Moreover, while VPT schoolchildren globally display normal intelligence, subtle difficulties that seem to relate to EFs are observed.
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