Age-varying associations between parent-reported executive function and internalizing/externalizing problems in
Dan Liu1, Xiaoli Zong1,2, Pamela L Wolters3
1Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, USA.
Insights
Executive function (EF) difficulties in children with neurofibromatosis type 1 (NF1) are consistently linked to internalizing and externalizing symptoms across all ages. These associations highlight EF as a potential intervention target for behavioral issues in NF1.
Area of Science:
- Neuroscience
- Child Psychology
- Genetics
Background:
- Neurofibromatosis type 1 (NF1) is a genetic disorder often associated with neurodevelopmental challenges.
- Executive function (EF) difficulties are common in children with NF1 but understudied in relation to psychiatric symptoms.
- Internalizing and externalizing symptoms are prevalent behavioral concerns in pediatric populations.
Purpose of the Study:
- To investigate age-specific associations between parent-reported executive function (EF) difficulties and internalizing/externalizing symptoms in children with NF1.
- To explore potential moderating effects of sex and parental education on these associations.
Main Methods:
- Cross-sectional analysis of 1,049 observations from 803 children with NF1 (ages 3-18).
- Parental ratings of EF difficulties (Behavior Rating Inventory of Executive Function) and behavioral symptoms (Child Behavior Checklist, Behavior Assessment System for Children).
- Time-varying effect modeling to assess age-specific associations and moderation by sex and parental education.
Main Results:
- Poorer EF functioning across all domains was associated with increased internalizing and externalizing symptoms from ages 3 to 18.
- Associations remained largely consistent across age, sex, and parental education subgroups.
- Specific EF difficulties showed age-related patterns: emotional control/cognitive flexibility with internalizing symptoms in adolescence; inhibitory control with externalizing symptoms in childhood; stronger EF-internalizing links in early adolescent males.
Conclusions:
- Parent-reported EF difficulties are robustly associated with internalizing and externalizing problems in children with NF1 throughout development.
- These findings underscore the importance of addressing EF deficits in managing behavioral symptoms in NF1.
- Further research, including longitudinal and experimental studies, is recommended to clarify causality and explore EF-targeted interventions.
Objectives:
This study examined age-specific associations between parent-reported executive function (EF) difficulties and internalizing/externalizing symptoms in children with neurofibromatosis type 1 (NF1), a genetic condition underrepresented in psychiatric research.
Methods:
Cross-sectional data of 1,049 observations from 803 children with NF1 (Mage = 10.58 years, SD = 3.84, range = 3-18; 47.5% female; 67.5% from higher-education households; 36.6% with familial NF1) across nine U.S. and Australian institutions were integrated. Parents rated EF difficulties using the Behavior Rating Inventory of Executive Function and internalizing/externalizing symptoms using the Child Behavior Checklist and the Behavior Assessment System for Children. Time-varying effect modeling estimated age-specific associations between EF and internalizing/externalizing symptoms and tested moderation by sex and parental education.
Results:
Poorer functioning in all EF domains was associated with greater internalizing and externalizing symptoms from ages 3 to 18. The associations were largely consistent across ages as well as sex and parental education subgroups with a few differences: (1) emotional control and cognitive flexibility problems were more strongly associated with internalizing symptoms during middle and late adolescence; (2) inhibitory control was more strongly linked to externalizing symptoms in childhood; (3) stronger associations between EF and internalizing symptoms were observed among males in early adolescence.
Conclusions:
Parental complaints of EF difficulties are robustly linked to internalizing and externalizing problems from early childhood to late adolescence in children with NF1. Further longitudinal and experimental studies are needed to determine the directionality of these associations and whether EF represents a viable target for intervention.
