Meta-Analysis of Executive Function in Children With Cerebral Palsy: an Investigation of Challenges to Measurement...

Executive function (EF) has been increasingly identified as an area of difficulty in children with cerebral palsy (CP), but the exact nature of deficit remains elusive as accurate assessment of abilities is limited due to the physical and speeded task requirements of many standardised assessment tools. With the aim of estimating the magnitude of EF impairment and evaluating the validity of EF assessments, the current meta-analysis examined the impacts from CP characteristics, assessment task features, and study design factors through adopting a comprehensive Cattell-Horn-Carroll cognitive ability taxonomy to ensure coverage of available assessments of EF and related subdomains. PsycINFO, Medline, Web of Science, and CINAHL were searched to identify peer-reviewed studies that compared children with CP with neurotypical controls up to April 2025. A total of 43 studies with 448 effect sizes based on the EF and related cognitive task performance of 1240 participants with CP and 1554 neurotypical children were included. A large effect size for reduced performance across EF and related cognitive measures was identified in children with CP (Hedges' g = -.85) and effect sizes differed across EF and related ability subdomains, with greater effect sizes observed for processing speed, long-term memory, and visual-spatial skills. Measurement validity was impacted differentially by EF and related subdomain, type of outcome measure, and level of motor impairment. Timed measures were associated with larger effect sizes, and measures that accommodated motor difficulties showed smaller effects, highlighting the potential for non-EF factors to confound the validity of EF and related ability assessments. Aligning participant capability with assessment demand will benefit accurate evaluation of cognitive function and guide targeted interventions for people with CP.