A-164: "Age-Related Differences in Performance-Based Executive Functioning: Evidence From a Diagnosis-Adjusted Neuropsychological Sample"

Abstract

Objective: Standard developmental models assume executive dysfunction increases over time due to divergence from normative expectations. This may overlook compensatory strategies that reduce measurement sensitivity in adults. This study examined age-related differences in executive functioning (EF) impairment while adjusting for diagnosis. It was hypothesized that pediatric cases would demonstrate higher impairment rates than adults. Method/Data Selection: Archival data (N = 791) included pediatric (< 18 years; n = 480) and adult (≥18 years; n = 311) cases, predominantly attention-deficit/hyperactivity disorder (ADHD; pediatric = 94.0%, adult = 89.4%), with approximately 24% demonstrating comorbid or standalone autism spectrum disorder diagnoses (ASD). EF domains included attention variability and response consistency (Continuous Performance Test indices), sustained attention, cognitive flexibility, verbal fluency, and perseverative responding. Impairment was defined using clinical cutoffs. Logistic regression models evaluated age-group differences while adjusting for ADHD, ASD, mood/anxiety, learning/language, intellectual disability, and neurologic conditions. Results/Data Synthesis: Pediatric cases demonstrated higher relative impairment on Continuous Performance Test variability (19.0% vs. 9.4%; OR = 0.48 [0.29, 0.77]), hit reaction time standard deviation (19.9% vs. 10.8%; OR = 0.55 [0.34, 0.88]), detectability (16.2% vs. 9.7%; OR = 0.73 [0.52, 0.99]), and perseveration (68.5% vs. 59.0%; OR = 0.62 [0.44, 0.87]). No differences were observed for sustained attention or cognitive flexibility. Adults demonstrated higher impairment on semantic fluency (11.0% vs. 4.1%; OR = 2.31 [1.33, 4.02]). Conclusions: Findings support the hypothesis suggesting reduced adult impairment, which may reflect compensatory processes rather than resolution of executive dysfunction. Results highlight need for considering developmental adaptation when interpreting performance-based EF measures across the lifespan.