Sadozai Ayesha K, Sun Carter, Demetriou Eleni A, Lampit Amit, Munro Martha, Perry Nina, Boulton Kelsie A, Guastella Adam J
Clinic for Autism and Neurodevelopment (CAN) Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Sydney, Australia.
Nat Hum Behav. 2024 Dec;8(12):2357-2366. doi: 10.1038/s41562-024-02000-9. Epub 2024 Oct 18.
Executive function (EF) delays are well documented in paediatric neurodevelopmental conditions (NDCs). There is no consensus about whether EF delay represents a transdiagnostic feature of NDCs. This systematic review and meta-analysis synthesized 180 studies reporting two or more NDC comparisons on EF, examined differences between NDCs, and the moderating effects of gender, age, publication year, DSM editions and assessment types. Studies using established EF measures across seven domains (attention, fluency, set-shifting, set-switching, response inhibition, planning and working memory) in participants under 18 were included. Summary effects were compared: (1) for all reported NDCs relative to control, (2) for each individual NDC relative to control and (3) between NDC groups. Results confirmed that EF delay was a transdiagnostic feature of neurodevelopmental delay, with a moderate effect size of delay across all NDCs (g = 0.56, 95% confidence interval (CI) 0.49-0.63) compared with control. This effect increased with comorbidities (g = 0.72, 95% CI 0.59-0.86), DSM-5 criteria and informant measures. Comparisons between NDCs revealed few differences: children with tic disorders (TD) showed smaller EF delays, children with attention-deficit/hyperactivity disorder (ADHD) showed larger delays in attention, response inhibition, planning and working memory compared with TD and specific learning disorders, while children with autism spectrum disorders showed greater delays on set-switching compared with ADHD. Findings support transdiagnostic models of neurodevelopment to further a developmentally sensitive science that can reveal how EF delays contribute to brain circuitry, symptom profiles and functioning, and ultimately support early interventions and outcomes for all children with NDCs.
执行功能（EF）延迟在儿科神经发育疾病（NDCs）中已有充分记录。关于EF延迟是否代表NDCs的跨诊断特征，目前尚无共识。这项系统评价和荟萃分析综合了180项报告了两种或更多NDCs在EF方面比较的研究，检查了NDCs之间的差异，以及性别、年龄、出版年份、《精神疾病诊断与统计手册》版本和评估类型的调节作用。纳入了对18岁以下参与者在七个领域（注意力、流畅性、定势转换、定势切换、反应抑制、计划和工作记忆）使用既定EF测量方法的研究。比较了汇总效应：（1）所有报告的NDCs相对于对照组；（2）每个单独的NDC相对于对照组；（3）NDC组之间。结果证实，EF延迟是神经发育延迟的跨诊断特征，与对照组相比，所有NDCs的延迟效应大小适中（g = 0.56，95%置信区间（CI）0.49 - 0.63）。这种效应随着合并症（g = 0.72，95% CI 0.59 - 0.86）、《精神疾病诊断与统计手册》第五版标准和 informant 测量而增加。NDCs之间的比较显示差异不大：抽动障碍（TD）儿童的EF延迟较小，注意缺陷/多动障碍（ADHD）儿童在注意力、反应抑制、计划和工作记忆方面的延迟比TD和特定学习障碍儿童更大，而自闭症谱系障碍儿童在定势切换方面的延迟比ADHD儿童更大。研究结果支持神经发育的跨诊断模型，以推动一门对发育敏感的科学发展，该科学可以揭示EF延迟如何影响脑回路、症状特征和功能，并最终支持所有NDCs儿童的早期干预和预后。
