Is executive dysfunction a risk marker or consequence of psychopathology? A test of executive function as a prospective predictor and outcome of general psychopathology in the adolescent brain cognitive development study®

Abstract

A general psychopathology ('p') factor captures shared variation across mental disorders. One hypothesis is that poor executive function (EF) contributes to p. Although EF is related to p concurrently, it is unclear whether EF predicts or is a consequence of p. For the first time, we examined prospective relations between EF and p in 9845 preadolescents (aged 9-12) from the Adolescent Brain Cognitive Development Study® longitudinally over two years. We identified higher-order factor models of psychopathology at baseline and one- and two-year follow-up waves. Consistent with previous research, a cross-sectional inverse relationship between EF and p emerged. Using residualized-change models, baseline EF prospectively predicted p factor scores two years later, controlling for prior p, sex, age, race/ethnicity, parental education, and family income. Baseline p factor scores also prospectively predicted change in EF two years later. Tests of specificity revealed that bi-directional prospective relations between EF and p were largely generalizable across externalizing, internalizing, neurodevelopmental, somatization, and detachment symptoms. EF consistently predicted change in externalizing and neurodevelopmental symptoms. These novel results suggest that executive dysfunction is both a risk marker and consequence of general psychopathology. EF may be a promising transdiagnostic intervention target to prevent the onset and maintenance of psychopathology.

Keywords: Executive function; General psychopathology; Longitudinal; Risk factor; Transdiagnostic; p Factor.

Fig. 1

Higher-Order Model of the Structure of Psychopathology. Note. The higher-order structure of psychopathology is shown with a higher-order p factor and five lower-order factors (Michelini et al., 2019). This model was tested at each of the three waves. Example CBCL items loading on the lower-order factors are shown in bullets (loadings >0.6). EXT = Externalizing; INT = Internalizing; ND = Neurodevelopmental; SOMAT = Somatization; DETACH = Detachment.

Fig. 2

One-Factor Model of Executive Function. Note. Model fit statistics and standardized loadings are shown of a baseline one-factor model of executive function (EF) with loadings from the Flanker, List Sorting Working Memory, Dimensional Change Card Sort, and Pattern Comparison Processing Speed tests. X²=chi-square; df = degrees of freedom; CFI = Comparative Fit Index; TLI = Tucker Lewis Index; RMSEA = Root Mean Square Error of Approximation; CI = confidence interval.