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10 Performance between bilinguals and monolinguals: Anxiety as a moderating effect across executive functioning and processing speed in a multicultural cohort with ADHD symptoms
- Christopher Gonzalez, Demy Alfonso, Brian M Cerny, Karen S Basurto, John-Christopher A Finley, Gabriel P Ovsiew, Phoebe Ka Yin Tse, Zachary J Resch, Kyle J Jennette, Jason R Soble
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 425-426
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Objective:
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder commonly associated with relative impairments on processing speed, working memory, and/or executive functioning. Anxiety commonly co-occurs with ADHD and may also adversely affect these cognitive functions. Additionally, language status (i.e., monolingualism vs bilingualism) has been shown to affect select cognitive domains across an individual’s lifespan. Yet, few studies have examined the potential effects of the interaction between anxiety and language status on various cognitive domains among people with ADHD. Thus, the current study investigated the effects of the interaction of anxiety and language status on processing speed, working memory, and executive functioning among monolingual and bilingual individuals with ADHD.
Participants and Methods:The sample comprised of 407 consecutive adult patients diagnosed with ADHD. When asked about their language status, 67% reported to be monolingual (English). The Mean age of individuals was 27.93 (SD = 6.83), mean education of 15.8 years (SD = 2.10), 60% female, racially diverse with 49% Non-Hispanic White, 22% Non-Hispanic Black, 13% Hispanic/Latinx, 9% Asian/Pacific Islander, and 6% other race/ethnicity. Processing speed, working memory, and executive function were measured via the Wechsler Adult Intelligence Scale-Fourth Edition Processing Speed Index, Working Memory Index, and Trail Making Test B, respectively. Anxiety was measured via the Beck Anxiety Inventory (BAI). Three separate linear regression models examined the interaction between anxiety (moderator) and cognition (processing speed, working memory, and executive function) on language. Models included sex/gender and education as covariates with Processing Speed Index and Working Memory Index as the outcomes. Age, sex/gender, and education were used as covariates when Trail Making Test B was the outcome.
Results:Monolingual and bilingual patients differed in mean age (p < .05) but did not differ in level of anxiety, education, or sex/gender. Overall, anxiety was not associated with processing speed, working memory, and executive function. However, the interaction between anxiety and language status was significantly associated with processing speed (ß = -0.37, p < .05), and executive functioning (ß = 0.82, p < .05). No associations were found when anxiety was added as a moderator for the associations between language and working memory.
Conclusions:This study found that anxiety moderated the relationship between language status and select cognitive domains (i.e., processing speed and executive functioning) among individuals with ADHD. Specifically, anxiety had a greater association on processing speed and executive functioning performance for bilinguals rather than monolinguals. Future detailed studies are needed to better understand how anxiety modifies the relationship between language and cognitive performance outcomes over time amongst a linguistically diverse sample.
52 Internalizing Psychopathology is Highly Related to Subjective Cognitive Impairment and the Discrepancy Between Objective and Subjective Cognitive Impairment: A Preliminary Cross-Sectional Study.
- John-Christopher Finley, Andrea Cladek, Michael Brook
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 838-839
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Objective:
Eliciting perceived cognitive complaints is a routine part of a clinical neuropsychological evaluation, presumably because complaints are informative of underlying pathology. However, there is no strong empirical support that subjective cognitive impairment (SCI) is actually related to objective cognitive impairment as measured by neurocognitive tests. Instead, internalizing psychopathology is thought to predominately influence the endorsement of SCI. Specifically, individuals with greater symptoms of depression and anxiety, when accounting for comorbidities, have a higher disposition to overestimate their degree of cognitive impairment as compared to objective testing. Yet, there are few existing studies that have determined which factors influence both SCI and the discrepancy between subjective and objective cognitive impairment in general outpatient populations. The current study examined the relationship between subjective and objective cognitive impairment in a clinically diverse sample of outpatients. We additionally explored the associations between SCI and relevant intrapersonal factors including internalizing psychopathology, number of medical comorbidities, and demographics. Finally, we quantified the degree of discrepancy between subjective and objective impairment and examined this discrepancy in relation to the intrapersonal factors.
Participants and Methods:The sample comprised 142 adult women and men (age range 18–79 years) seen in an outpatient neuropsychology clinic for a diverse range of referral questions. Scores on the cognition portion of the WHO Disability Assessment Schedule (WHODAS 2.0) were used to index SCI. A composite score from 14 measures across various domains of cognitive functioning served as an objective measure of cognitive functioning. Internalizing psychopathology was measured via a standardized composite of scores from screening measures of anxiety and depression. Medical comorbidities were indexed by the number of different ICD diagnostic categories documented in patients' medical records. Demographics included age, sex, race, and years of formal education. Objective-subjective discrepancy scores were computed by saving standardized residuals from a linear regression of neurocognitive test performance on the WHODAS 2.0 scores.
Results:A hierarchical linear regression revealed that objective cognitive impairment was not significantly related to SCI (p > .05), explaining less than 2% of the variance in SCI ratings. Likewise, participants' demographics (age, sex, education, race) and number of comorbidities were not significantly related to their SCI ratings, explaining about 6% of the variance. However, participants' level of internalizing psychopathology was significantly associated with SCI (F[10, 131] = 4.99, p < .001), and explained approximately 20% of the variance in SCI ratings. Similarly, the degree of discrepancy between subjective and objective cognitive impairment was primarily influenced by internalizing psychopathology (F[9, 132] = 5.20, p < .001, R2 = 21%) and largely unrelated to demographics and number of comorbidities, which explained about 6% of the variance.
Conclusions:These findings are consistent with prior research suggesting that SCI may be more indicative of the extent of internalizing psychopathology rather than actual cognitive impairment. Taken together, these results illuminate potential treatment and diagnostic implications associated with assessing perceived cognitive complaints during a neuropsychological evaluation.