Data-Driven Profiles of Youth Executive Function and Their Longitudinal Associations With Externalizing Problems

Executive function (EF) deficits are observed in externalizing disorders. However, research has yet to explore the specificity of these associations for externalizing symptom dimensions and their potential utility in identifying subgroups of youth at risk for persistent problems. The current study leveraged unsupervised learning methods to investigate longitudinal associations between EF domains of inhibitory control and working memory and externalizing dimensions of hyperactivity, impulsivity, and aggression.

The study included 5,501 youths from the Adolescent Brain Cognitive Development Study who participated in the baseline through 3-year follow-up (T0-T3) assessments. Youth EF was assessed with the stop signal and emotional n-back tasks. Externalizing problems were captured with the Child Behavior Checklist (CBCL) and parent-report Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).

A 2-cluster k-means solution optimally fit the data at T0 and T2. At both time points, the largest cluster (T0: n = 2,927; T2: n = 3,089) was characterized by higher EF, whereas the smaller cluster (T0: n = 2,574; T2: n = 2,412) was characterized by lower EF. Temporal stability of group membership was moderate (Cohen's κ = 0.41). Membership in the lower EF group at both time points was significantly associated with greater CBCL attention problems concurrently (T0, T2) and longitudinally (T0-T3; qs < .05, rank biserial rs = 0.6-0.11) and was associated with a greater proportion of attention-deficit/hyperactivity disorder diagnoses at T1 (qs ≤ .001, odds ratios = 1.65-1.71). Associations were not observed for aggressive or rule-breaking behaviors.

These findings suggest multifaceted and specific cognitive performance deficits associated with youth attention problems that may inform tailoring and development of personalized treatment and cognitive interventions.

Study Preregistration: Data-Driven Profiles of Youth Executive Function and Their Longitudinal Associations With Externalizing Problems; https://doi.org/10.1016/j.jaac.2025.05.014 DIVERSITY & INCLUSION STATEMENT: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science.