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Attention and executive delays in early childhood: a meta-analysis of neurodevelopmental conditions
Dabin Lee1,2, Kelsie A Boulton1,2, Carter Sun1,2
1Clinic for Autism and Neurodevelopmental (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.
Insights
Children with neurodevelopmental conditions show attention and executive function delays, particularly by preschool age. Early detection and intervention are crucial for improving developmental trajectories.
Area of Science:
- Developmental Neuroscience
- Cognitive Psychology
- Pediatric Neurology
Background:
- Attention and executive functions are critical for cognitive development.
- Neurodevelopmental conditions can impact these cognitive domains early in life.
- Understanding the developmental trajectory of these delays is essential for timely intervention.
Purpose of the Study:
- To evaluate attention and executive function performance in children with neurodevelopmental conditions (0-5 years) compared to neurotypical peers.
- To identify the developmental timing and characteristics of these cognitive delays.
- To explore potential neurobiological underpinnings of observed delays.
Main Methods:
- Systematic review and meta-analysis of studies comparing attention/executive function in children (0-5 years) with or at risk for neurodevelopmental conditions versus controls.
- Inclusion of 111 studies with 12,292 participants, searching MEDLINE, EMBASE, and PsycINFO databases.
- Meta-regressions analyzed moderating effects of age, sex, diagnosis, and measure type; qualitative analysis of brain development in 5 studies.
Main Results:
- Children with neurodevelopmental conditions exhibited small attention delays (g=0.36) and moderate executive function delays (g=0.64).
- Delays were not evident in the first year but emerged as small to moderate in toddlerhood and moderate by preschool.
- Delays were largely transdiagnostic, with some diagnosis-specific effects and moderation by assessment method (informant, performance, physiological).
Conclusions:
- Neurodevelopmental conditions are associated with significant delays in attention and executive function, particularly in later early childhood.
- Brain development divergence in medial prefrontal regions may underlie these cognitive delays.
- Attention and executive function assessments hold potential for early detection and intervention in neurodevelopmental conditions.
Abstract:
The objective of this review was to evaluate attention and executive function performance in children with neurodevelopmental conditions across the first 5 years of life, compared to neurotypical peers. MEDLINE, EMBASE, and PsycINFO databases were searched until June 30, 2023, and studies comparing attention or executive function between children with (or at risk for) neurodevelopmental conditions and neurotypical (or low risk) peers, 0 to 5 years old, were included. Of the 4338 studies identified, 111 studies with 12292 participants were included in the meta-analysis. The qualitative analysis of brain development included 5 studies. Primary outcomes were the standardised mean difference (Hedges' g) in attention and executive function between groups. Meta-regressions examined moderating effects of age, biological sex, diagnosis, and measure type. Children with neurodevelopmental conditions showed small delays in attention (n = 49 studies, k = 251 outcomes, g = 0.36, 95% CI 0.23-0.48, p < 0.001) and moderate delays in executive function (n = 64 studies, k = 368 outcomes, g = 0.64,95% CI 0.53-0.76, p < 0.001). Attention and executive function delays could not be identified in the first year (equivalence tests, p < 0.001), small to moderate delays were found in toddlerhood and moderate delays by preschool. Delays identified were largely transdiagnostic, although there was some evidence of diagnosis-specific delays for attention and moderation by measure type (informant rating vs performance-based vs physiological). Qualitative analysis described how delays were underpinned by a divergence of brain development in medial prefrontal regions. These findings highlight the potential of using attention and executive measures to detect delay and to intervene in neurodevelopmental conditions early in life.
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