Executive Functioning in Adolescent Depressive Disorders.

Executive Functioning in Adolescent Depressive Disorders. 

Link to article:

http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=8&sid=bf1f871c-b662-4da2-a50e-176a7ff6618a%40sessionmgr103

In this study, the authors set out to pursue three hypotheses.  They were:

1)   Adolescent inpatients with depressive disorders that were not self-diagnosed would display lower performance on measures of executive functioning than the other inpatient and outpatient groups where depression was self-diagnosed.

2)   Regardless of depressive presentation, the inpatient groups would display lower performance on measures of executive functioning when compared to an outpatient group.

3)   Within those expressed inpatient adolescents, elevated self-reported depressive symptoms would be associated with worse performance on measures of executive functioning.

The researchers used several tools to assess executive functioning across 5 different categories.  The 5 different categories of executive functioning studied were:

1)   Problem Solving/Planning

2)   Cognitive Flexibility/Set Shifting

3)   Response Inhibition/Interference control

4)   Fluency

5)   Working Memory/Simple Attention.

The assessment tools that they used were:

1)   For Problem Solving/Planning the researchers used a test called the WCST, or the Wisconsin Card Sorting Test, and the ROCF, or the Rey Osterreith Complex Figure (used to directly assess planning)

2)   For Set Shifting/Cognitive Flexibility the researchers used the Trail Making test, or TMT.  There are two portions for this test, TMT A and TMT B.

3)   For Response Inhibition/Interference Control the researchers used a verbal test called The Stroop Test.  An example of the hardest portion of this test presents a set of names of colors, written in a different color.  For example the word RED would be written in blue ink.  The participant is required to say the color of the ink, not the word, as quickly as they can.  An additional test used to assess problem Solving/Planning is called the WCST FMS.

4)   For Fluency, a test called Controlled Oral Word Association, or COWAT was used.  Of note, the COWAT is normally used as a language measure.  For the purposes of this study however, it was used to assess verbal fluency.

5)   For Working Memory/Simple Attention, a test called The Wide Range Assessment of Memory and Learning, or WRAML was used.  Specifically, they used a subtest of the WRAML called WRAML Sentence Repetition.

Furthermore, the researchers used separate tests to diagnose Self-Reported Anxiety/Depressive symptoms.  The tests that they used were:

1)   The Childhood Depression Inventory (CDI).  Of note, the CDI can be and was used to diagnose children and adolescents age 7-17.

2)   The Revised Children’s Manifest Anxiety Scale-2^nd edition, or RCMAS-2)

When Comparing the tests, the researchers compared the results of their various tests using Turkey’s Honestly Significant Difference test (HSD).

The researcher’s first hypothesis was only “partially supported, as there were no identified differences between the depressive disorder groups and the inpatient control group.”  These findings were reported to be similar to the findings of relevant literature.  Of note, the researchers speculate that the correlations between executive functioning and depression may increase with severity of depression. Furthermore, specific areas of executive function may be more vulnerable to impairment with depression (working memory and cognitive flexibility).  This makes the practice of identifying the different domains of executive functioning important.

The researcher’s second hypothesis was “generally supported”, in that most inpatient groups displayed lower executive functioning abilities than the outpatient groups.

            Hypothesis number three was not supported, leading the researchers to believe that executive functioning impairments caused by depression are dependent on the state that the depressed person is in.  For example, if they were not in an anxietal, depressed state when they took the tests, the results may have been affected. 

Holler, K., Kavanaugh, B., Cook, N.E., (2014). Executive Functioning in Adolescent Depressive Disorders. http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=8&sid=bf1f871c-b662-4da2-a50e-176a7ff6618a%40sessionmgr103