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. 2022 Dec;50(12):1557-1572.
doi: 10.1007/s10802-022-00930-4. Epub 2022 Jul 15.

Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems

Kira L Williams  1 , Joni Holmes  1   2 , Francesca Farina  3   4 , Maria Vedechkina  1 ; CALM team; Marc P Bennett  5
Affiliations

Inconsistencies between Subjective Reports of Cognitive Difficulties and Performance on Cognitive Tests are Associated with Elevated Internalising and Externalising Symptoms in Children with Learning-related Problems

Kira L Williams et al. Res Child Adolesc Psychopathol. 2022 Dec.

Abstract

Children with learning difficulties are commonly assumed to have underlying cognitive deficits by health and educational professionals. However, not all children referred for psycho-educational assessment will be found to have deficits when their abilities are measured by performance on cognitive tasks. The primary aim of this study was to estimate the prevalence of this inconsistent cognitive profile (ICP) in a transdiagnostic sample of children referred by health and education service providers for problems related to attention, learning and memory (N = 715). A second aim was to explore whether elevated mental health problems were associated with ICPs. Findings suggest that approximately half of this sample could be characterised as having an ICP. Cognitive difficulties, whether identified by parent ratings or task performance, were associated with elevated internalising and externalising difficulties. Crucially, a larger discrepancy between a parent's actual ratings of a child's cognitive difficulties and the ratings that would be predicted based on the child's performance on cognitive tasks was associated greater internalising and externalising difficulties for measures of working memory, and greater externalising difficulties for measures of attention. These findings suggest that subjective cognitive difficulties occurring in the absence of any task-based performance deficits may be a functional problem arising from mental health problems.

Keywords: Externalising and internalising difficulties; Functional cognitive difficulties; Inattention; Working Memory (WM).

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Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Schematic overview of the steps and thresholds used to group participants as having a consistent cognitive profile (CCP) and inconsistent cognitive profile (ICP) and to determine the comparison group who did not meet the threshold for neither parent-reported or performance-based cognitive difficulties. These steps were taken for both attention and working memory separately, and final group numbers are reported
Fig. 2
Fig. 2
Residual plots for the continuous analysis for measures of attention. Residuals represent the difference between the actual parent-rated difficulties for each child and the parent-rated difficulties predicted by actual performance on a sustained attention task. (A) This figure indicates the regression line; values above this line (relatively more positive) indicate cases wherein parent report less severe inattention than would be predicted by performance. Values below this line (relatively more negative) indicate cases wherein parents report more severe inattention than would be predicted by performance. (B) The distribution of residual scores
Fig. 3
Fig. 3
Residual plots for the continuous analysis for measures of working memory. Residuals represent the difference between the actual parent-rated difficulties for each child and the parent-rated difficulties predicted by actual performance on a working memory task. (A) This figure indicates the regression line; values above this line (relatively more positive) indicate cases wherein parent report fewer WM difficulties than would be predicted by performance. Values below this line (relatively more negative) indicate cases wherein parents report more WM difficulties than would be predicted by performance. (B) The distribution of residual scores
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