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Cracking under pressure: Cognitive load influences performance in youth with NF1
Johanna Nielsen1, Jonathan Payne2, Allison Payne3
1Children's National Hospitalhttps://ror.org/03wa2q724, Rockville, MD, USA.
Journal of the International Neuropsychological Society : JINS
|December 1, 2025
Summary
Children with neurofibromatosis type 1 (NF1) show significant executive function (EF) deficits, especially under high cognitive load. These EF impairments are linked to real-world executive dysfunction.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Cognitive Psychology
Background:
- Neurofibromatosis type 1 (NF1) is a genetic disorder associated with cognitive impairments, including executive function (EF) deficits.
- Previous research indicates EF challenges in youth with NF1, but the impact of cognitive load remains underexplored.
Purpose of the Study:
- To investigate how increased cognitive load affects executive function performance in children with NF1 compared to typically developing children.
- To determine if laboratory-based EF deficits in NF1 correlate with parent-reported executive dysfunction.
Main Methods:
- A prospective, multicenter study involving 42 children with NF1 (ages 7-18) and 42 age/sex-matched controls.
- Neuropsychological assessments measured intellect and executive functioning, including tasks of executive control (TEC) assessing inhibitory control and working memory.
- Multivariate analyses examined group differences and task effects, with supplementary analyses exploring associations between TEC and BRIEF (Behavior Rating Inventory of Executive Function) scores.
Main Results:
- Both groups experienced performance declines with increased inhibitory demand, but children with NF1 showed significantly lower accuracy and consistency, especially under higher cognitive load.
- While controls maintained or improved performance with increased working memory demand, children with NF1 exhibited decrements.
- Significant group-by-cognitive load interactions were found, and poorer TEC performance in NF1 was associated with higher parent-reported executive dysfunction.
Conclusions:
- Children with NF1 exhibit unique, multidimensional executive function decrements under increased cognitive load, differing from typically developing peers.
- These cognitive overload vulnerabilities are clinically significant and impact daily functioning.
- Interventions targeting working memory and inhibitory control may mitigate cognitive overload and improve outcomes for children with NF1.
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