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. 2022 Oct 20:13:1022700.
doi: 10.3389/fpsyg.2022.1022700. eCollection 2022.

Associations between executive functioning, challenging behavior, and quality of life in children and adolescents with and without neurodevelopmental conditions

Thomas W Frazier  1 , Ethan Crowley  1 , Andy Shih  2 , Vijay Vasudevan  2 , Arun Karpur  2 , Mirko Uljarevic  3 , Ru Ying Cai  4
Affiliations

Associations between executive functioning, challenging behavior, and quality of life in children and adolescents with and without neurodevelopmental conditions

Thomas W Frazier et al. Front Psychol. .

Abstract

The present study sought to clarify the impact of executive and social functioning on challenging behavior and the downstream influence of challenging behavior on quality of life and functioning in a large transdiagnostic sample. Understanding these relationships is crucial for developing and designing tailored intervention strategies. In a cross-sectional study, parent informants of 2,004 children completed measures of executive and social functioning, challenging behavior, child and family quality of life, and reported on functional impacts of challenging behavior. Using structural (path) modeling, analyses evaluated the associations between executive and social functioning, including emotion regulation and risk avoidance, with overall and specific types of challenging behavior. Structural models also examined the influence of challenging behavior on child and family quality of life, including measures of the immediate and extended environment, and functional impacts on the parent/child as well as interactions with the medical/legal systems. Finally, mediational models explored the direct and indirect effects of executive and social functioning on quality of life and impact measures via challenging behavior. Results indicated that executive functioning accounts for substantial variance (R 2 = 0.47) in challenging behavior. In turn, challenging behavior accounts for substantial variance in child and family quality of life (R 2 = 0.36) and parent/child impacts (R 2 = 0.31). Exploratory mediational models identified direct effects from executive and social functioning measures on quality of life and functional impacts and indirect effects for executive functioning via challenging behavior. These findings support the development of new intervention strategies and suggest the need to measure executive functioning when assessing and tailoring the treatment of challenging behavior in clinical practice.

Keywords: challenging behavior; developmental disability; executive function; functional impact; quality of life; social skills.

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Conflict of interest statement

Beyond the scope of this research, TF has received funding or research support from, acted as a consultant to, received travel support from, and/or received a speaker’s honorarium from the PTEN Research Foundation, SYNGAP Research Fund, Malan Syndrome Foundation, ADNP Kids Research Foundation, Quadrant Biosciences, Autism Speaks, Impel NeuroPharma, F. Hoffmann-La Roche AG Pharmaceuticals, the Cole Family Research Fund, Simons Foundation, Ingalls Foundation, Forest Laboratories, Ecoeos, IntegraGen, Kugona LLC, Shire Development, Bristol-Myers Squibb, Roche Pharma, MaraBio, National Institutes of Health, and the Brain and Behavior Research Foundation and has an investor stake in Autism EYES LLC and iSCAN-R. EC received research support funding from Autism Speaks. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Executive and social functioning measures as predictors of challenging behavior. The model is just identified. Correlations among executive functioning subscales ranged from 0.40 to 0.76. Correlations among social functioning (SSDS) subscales ranged from |0.29| to |0.74|. The correlations between executive and social functioning subscales ranged from |0.07| to |0.63|. The pattern of residual correlations was consistent with the observed bivariate correlations among these subscales (see Supplementary material 6).
Figure 2
Figure 2
Challenging behavior subscales as predictors of child and family quality of life, work/school, and medical/legal functional impacts. The model is just identified. For each challenging behavior subscale, standardized parameters are listed in order starting with CFQL-2, Parent and Child Impacts, and Medical and Legal Impacts. Correlations among challenging behavior subscales ranged from 0.39 to 0.76. Correlations among the CFQL-2 and impact subscales were (CFQL-2 with parent/child impacts r = −0.41; CFQL-2 with medical/legal impacts r = −0.09; parent/child impacts with medical/legal impacts r = 0.22). The pattern of residual correlations was consistent with the observed bivariate correlations among these subscales (see Supplementary material 6). Gray boxes are challenging behavior scales serving as predictors, while red boxes are quality of life and impact outcome variables.
Figure 3
Figure 3
Mediational model estimating direct effects of executive and social functioning on quality of life and functional impacts as well as indirect effects via challenging behavior. The model is just identified. Branching arrows represent direct effects from social and executive functioning to child and family quality of life and functional impact measures. Red font designates indirect effects from social or executive functioning to parent and child impacts (A), child and family quality of life (B), or medical and legal impacts (C). Residual correlations were as follows: social functioning with executive functioning r = 0.38; CFQL-2 with Parent and Child Impacts r = −0.26; CFQL-2 with Medical and Legal Impacts r = −0.08; Parent and Child Impacts with Medical and Legal Impacts r = 0.26.
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References

    1. Aldao A., Gee D. G., De Los Reyes A., Seager I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: current and future directions. Dev. Psychopathol. 28, 927–946. doi: 10.1017/S0954579416000638, PMID: - DOI - PubMed
    1. Alduncin N., Huffman L. C., Feldman H. M., Loe I. M. (2014). Executive function is associated with social competence in preschool-aged children born preterm or full term. Early Hum. Dev. 90, 299–306. doi: 10.1016/j.earlhumdev.2014.02.011, PMID: - DOI - PMC - PubMed
    1. Anderson P. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychol. 8, 71–82. doi: 10.1076/chin.8.2.71.8724 - DOI - PubMed
    1. Baiden P., Stewart S. L., Fallon B. (2017). The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Child Abuse Negl. 69, 163–176. doi: 10.1016/j.chiabu.2017.04.011, PMID: - DOI - PubMed
    1. Beck K. B., Conner C. M., Breitenfeldt K. E., Northrup J. B., White S. W., Mazefsky C. A. (2020). Assessment and treatment of emotion regulation impairment in autism Spectrum disorder across the life span: current state of the science and future directions. Child Adolesc. Psychiatr. Clin. N. Am. 29, 527–542. doi: 10.1016/j.chc.2020.02.003, PMID: - DOI - PMC - PubMed

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