IN BRIEF

Different Patterns of Executive Function Deficits in Different Pediatric Brain Disorders

July 25, 2017
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Clinical implications include specialized testing for deficits in executive function as these may not be apparent at a routine exam.

A large group of researchers, including many from Nationwide Children’s Hospital, recently looked at whether children with different brain disorders show diverse patterns of strengths and weaknesses in executive functions.

Children with traumatic brain injuries (TBI), arterial ischemic stroke and brain tumors have all been shown to have deficits in executive function, but the groups have never been compared to one another.

In the recent study, researchers gathered data sets from different studies of cognitive function in children with these three brain disorders. They assessed three elements of executive function – task-shifting, response inhibition and working memory – using the Test of Everyday Attention: Children’s Version (TEA-Ch).

Overall, the children with brain disorders showed impairments on measures of executive function compared to healthy control children.

More importantly, there were different patterns and magnitudes of executive dysfunction among the three brain injury groups. For example, children with TBI have more trouble with switching from one task to another but fewer problems with response inhibition and working memory. The children with stroke are more severely impaired when it comes to response inhibition than they are in their ability to switch tasks or use their working memory. These, and other, differences suggest that different childhood brain disorders can be distinguished from each other by the severity and profile of their executive function deficits.

One possible explanation for the different patterns of executive dysfunction is disruption of the brain’s white matter, the connections between different brain regions. Future research, including neuroimaging data, will be important to bearing out this theory and determining how profiles of executive function relate to the size and location of lesions as well as white matter abnormalities.

The findings also have implications for clinical practice, says Warren Lo, pediatric neurologist at Nationwide Children’s Hospital, clinical professor of Pediatrics and Neurology at The Ohio State University College of Medicine and one of the study’s authors.

“It is important for health care providers and families that care for kids with these brain disorders to be aware that they can have executive function impairments that may not be apparent by simple physical examination,” says Dr. Lo.

“Specialized testing by neuropsychologists can reveal these deficits, and there are some cognitive and behavioral measures one can use to help with organization, working memory or impulse regulation.”

Rather than administering a single test and concluding that executive functions are globally intact or impaired, these results highlight the importance of examining different elements of executive function in children with brain disorders to identify areas of relative strength and weakness. Future work may also reveal how children with different profiles of executive function respond to different forms of remediation, providing clinicians with an enhanced understanding of how to best help each type of patient.

While all three of these brain disorders impact executive functions, they cause different patterns and magnitudes of deficits. Clinicians and parents should be aware of the potential for executive function impairment in children who have suffered these brain injuries and be prepared to parse out each patient’s particular strengths and weaknesses to help design the most effective recovery plan.

 

Reference:

Araujo GC, Antonini TN, Anderson V, Vannatta KA, Sailey CG, Bigler ED, Taylor HG, Gerhardt C, Rubin K, Dennis M, Lo W, Mackay MMT, Gordon A, Hajek Koterba C, Gomes A, Greenham M, Owen Yeates K. Profiles of executive function across children with distinct brain disorders: traumatic brain injury, stroke, and brain tumor. Journal of the International Neuropsychological Society. 2017 May 15;1-10.