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Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor

  • Gabriel C. Araujo (a1), Tanya N. Antonini (a2), Vicki Anderson (a3), Kathryn A. Vannatta (a4), Christina G. Salley (a5), Erin D. Bigler (a6), H. Gerry Taylor (a7), Cynthia Gerhardt (a4), Kenneth Rubin (a8), Maureen Dennis (a9), Warren Lo (a10), Mark T. Mackay (a11), Anne Gordon (a12), Christine Hajek Koterba (a13), Alison Gomes (a14), Mardee Greenham (a15) and Keith Owen Yeates (a16)...


Objectives: This study examined whether children with distinct brain disorders show different profiles of strengths and weaknesses in executive functions, and differ from children without brain disorder. Methods: Participants were children with traumatic brain injury (N=82; 8–13 years of age), arterial ischemic stroke (N=36; 6–16 years of age), and brain tumor (N=74; 9–18 years of age), each with a corresponding matched comparison group consisting of children with orthopedic injury (N=61), asthma (N=15), and classmates without medical illness (N=68), respectively. Shifting, inhibition, and working memory were assessed, respectively, using three Test of Everyday Attention: Children’s Version (TEA-Ch) subtests: Creature Counting, Walk-Don’t-Walk, and Code Transmission. Comparison groups did not differ in TEA-Ch performance and were merged into a single control group. Profile analysis was used to examine group differences in TEA-Ch subtest scaled scores after controlling for maternal education and age. Results: As a whole, children with brain disorder performed more poorly than controls on measures of executive function. Relative to controls, the three brain injury groups showed significantly different profiles of executive functions. Importantly, post hoc tests revealed that performance on TEA-Ch subtests differed among the brain disorder groups. Conclusions: Results suggest that different childhood brain disorders result in distinct patterns of executive function deficits that differ from children without brain disorder. Implications for clinical practice and future research are discussed. (JINS, 2017, 23, 529–538)


Corresponding author

Correspondence and reprint requests to: Gabriel C. Araujo, One Children’s Place, St. Louis, MO 63110. E-mail:


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Aarsen, F.K., Paquier, P.F., Arts, W.F., Van Veelen, M.L., Michiels, E., Lequin, M., & Catsman-Berrevoets, C.E. (2009). Cognitive deficits and predictors 3 years after diagnosis of a pilocytic astrocytoma in childhood. Journal of Clinical Oncology, 27(21), 35263532. doi: 10.1200/JCO.2008.19.6303
Alexander, G.E., DeLong, M.R., & Strick, P.L. (1986). Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annual Review of Neuroscience, 9, 357381. doi: 10.1146/
Alvarez, J.A., & Emory, E. (2006). Executive function and the frontal lobes: A meta analytic review. Neuropsychology Review, 16(1), 1742. doi: 10.1007/s11065-006-9002-x
Anderson, V., Fenwick, T., Manly, T., & Robertson, I. (1998). Attentional skills following traumatic brain injury in childhood: A componential analysis. Brain Injury, 12(11), 937949. doi: 10.1080/026990598121990
Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65. doi: 10.1037//0033-2909.121.1.65
Bayless, S., & Stevenson, J. (2007). Executive functions in school-age children born very prematurely. Early Human Development, 83, 247254. doi: 10.1016/j.earlhumdev.2006.05.021
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B (Methodological), 57, 289300. doi: 10.2307/2346101
Brocki, K.C., & Bohlin, G. (2004). Executive functions in children aged 6 to 13: A dimensional and developmental study. Developmental Neuropsychology, 26, 571593. doi: 10.1207/s15326942dn2602_3
Brocki, K., Fan, J., & Fossella, J. (2008). Placing neuroanatomical models of executive function in a developmental context. Annals of the New York Academy of Sciences, 1129, 246255. doi: 10.1196/annals.1417.025
Conklin, H.M., Ashford, J.M., Di Pinto, M., Vaughan, C.G., Gioia, G.A., Merchant, T.E., &Wu, S. (2013). Computerized assessment of cognitive late effects among adolescent brain tumor survivors. Journal of Neurooncology, 113(2), 333340. doi: 10.1007/s11060-013-1123-5
Conklin, H.M., Ashford, J.M., Howarth, R.A., Merchant, T.E., Ogg, R.J., Santana, V.M., & Xiong, X. (2012). Working memory performance among childhood brain tumor survivors. Journal of the International Neuropsychological Society, 18(6), 9961005. doi: 10.1017/S1355617712000793
Conklin, H.M., Ogg, R.J., Ashford, J.M., Scoggins, M.A., Zou, P., Clark, K.N.,& Zhang, H. (2015). Computerized cognitive training for amelioration of cognitive late effects among childhood cancer survivors: A randomized control trial. Journal of Clinical Oncology, 33, 38943902. doi: 10.1200/JCO.2015.61.6672
Corbett, B.A., Constantine, L.J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2), 210222. doi: 10.1016/j.psychres.2008.02.005
De Ruiter, M.A., Van Mourik, R., Schouten-Van Meeteran, A.Y., Grootenhuis, M.A., & Oosterlaan, J. (2013). Neurocognitive consequences of a paediatric brain tumour and its treatment: A meta‐analysis. Developmental Medicine & Child Neurology, 55(5), 408417. doi: 10.1111/dmcn.12020
Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science, 333, 959964. doi: 10.1126/science.1204529
Ewing-Cobbs, L., Prasad, M.R., Landry, S.H., Kramer, L., & DeLeon, R. (2004). Executive functions following traumatic brain injury in young children: A preliminary analysis. Developmental Neuropsychology, 26(1), 487512. doi: 10.1207/s15326942dn2601_7
Fisk, J.E., & Sharp, C.A. (2004). Age-related impairment in executive functioning: Updating, inhibition, shifting, and access. Journal of Clinical and Experimental Neuropsychology, 26, 874890. doi: 10.1080/13803390490510680
Fletcher, J.M., & Copeland, D.R. (1988). Neurobehavioral effects of central nervous system prophylactic treatment of cancer in children. Journal of Clinical and Experimental Neuropsychology, 10(4), 495537. doi: 10.1080/01688638808408255
Fournier-Vicente, S., Larigauderie, P., & Gaonac’h, D. (2008). More dissociations and interactions within central executive functioning: A comprehensive latent variable analysis. Acta Psychologica, 129, 3248. doi: 10.1016/j.actpsy.2008.04.004
Garnett, M.R., Blamire, A.M., Rajagopalan, B., Styles, P., & Cadoux-Hudson, T.A. (2000). Evidence for cellular damage in normal-appearing white matter correlates with injury severity in patients following traumatic brain injury: A magnetic resonance spectroscopy study. Brain, 123(7), 14031409. doi: 10.1093/brain/123.7.1403.
Gioia, G.A., Isquith, P.K., Kenworthy, L., & Barton, R.M. (2002). Profiles of everyday executive function in acquired and developmental disorders. Child Neuropsychology, 8, 121137. doi: 10.1076/chin.
Goldberg, M.C., Mostofsky, S.H., Cutting, L.E., Mahone, E.M., Astor, B.C., Denckla, M.B., & Landa, R.J. (2005). Subtle executive impairment in children with autism and children with ADHD. Journal of Autism and Developmental Disorders, 35, 279293. doi: 10.1007/s10803-005-3291-4
Grunewaldt, K.H., Lohaugen, G.C.C., Austeng, D., Brubakk, A., & Skranes, J. (2013). Working memory training improves cognitive function in VLBW preschoolers. Pediatrics, 131(3), 747754. doi: 10.1542/peds.2012-1965
Hajek, C.A., Yeates, K.O., Anderson, V., Mackay, M., Greenham, M., Alison Gomes, A., & Lo, W. (2014). Cognitive outcomes following arterial ischemic stroke in infants and children. Journal of Child Neurology, 29, 887894. doi: 10.1177/0883073813491828
Happé, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: Examining profiles across domains and ages. Brain and Cognition, 61, 2539. doi: 10.1016/j.bandc.2006.03.004
Hobson, P., & Leeds, L. (2001). Executive functioning in older people. Reviews in Clinical Gerontology, 11, 361372. doi: 10.1017/S0959259801011479
Iverson, G., & Lange, R.T. (2011). Mild traumatic brain injury. In M.R. Schoenberg & J.G. Scott (Eds.), The little black book of neuropsychology: A syndrome-based approach (pp. 697719). New York, NY: Springer.
Jacobs, R., Harvey, A.S., & Anderson, V. (2007). Executive function following focal frontal lobe lesions: Impact of timing of lesion on outcome. Cortex, 43, 792805. doi: 10.1016/S0010-9452(08)70507-0
Jurado, M.B., & Rosselli, M. (2007). The elusive nature of executive functions: A review of our current understanding. Neuropsychology Review, 17, 213233. doi: 10.1007/s1106 5-007-9040-z
Klingberg, T., Fernell, E., Olesen, P., Johnson, M., Gustaffson, P., Dahlstrom, K., & Westerberg, H. (2005). Computerized training of working memory in children with ADHD: A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 177186. doi: 10.1097/00004583-200502000-00010
Konrad, K., Gauggel, S., Manz, A., & Scholl, M. (2000). Inhibitory control in children with traumatic brain injury (TBI) and children with attention deficit/hyperactivity disorder (ADHD). Brain Injury, 14, 859875. doi: 10.1080/13803395.2011.562864
Kurowski, B.G., Wade, S.L., Kirkwood, M.W., Brown, T.M., Stancin, T., & Taylor, G. (2013). Online problem-solving therapy for executive dysfunction after child traumatic brain injury. Pediatrics, 132, e158e166. doi: 10.1542/peds.2012-4040
Law, N., Bouffet, E., Laughlin, S., Laperriere, N., Brière, M.E., Strother, D., & Dickson, J. (2011). Cerebello–thalamo–cerebral connections in pediatric brain tumor patients: Impact on working memory. Neuroimage, 56(4), 22382248. doi: 10.1016/j.neuroimage.2011.03.065
Leblanc, N., Chen, S., Swank, P.R., Ewing-Cobbs, L., Barnes, M., Dennis, M., & Schachar, R. (2005). Response inhibition after traumatic brain injury (TBI) in children: Impairment and recovery. Developmental Neuropsychology, 28, 829848. doi: 10.1207/s15326942dn2803_5
Levin, H.S., & Hanten, G. (2005). Executive functions after traumatic brain injury in children. Pediatric Neurology, 33, 7993. doi: 10.1016/j.pediatrneurol.2005.02.002
Lewis, S.J., Dove, A., Robbins, T.W., Barker, R.A., & Owen, A.M. (2004). Striatal contributions to working memory: A functional magnetic resonance imaging study in humans. European Journal of Neuroscience, 19, 755760. doi: 10.1111/j.1460-9568. 2004.03108.x
Lezak, M.D. (1983). Neuropsychological assessment (2nd ed.). New York: Oxford University Press.
Miller, E.K., & Cohen, J.D. (2001). An integrative theory of prefrontal cortex function. Annual Review of Neuroscience, 24, 167202.
Lieh-Lai, M.W., Theodorou, A.A., Sarnaik, A.P., Meert, K.L., Moylan, P.M., & Canady, A.I. (1992). Limitations in of the Glasgow Coma Scale in predicting outcome in children with traumatic brain injury. The Journal of Pediatrics, 120, 195199. doi: 10.1016/S0022-3476(05)80426-3
Mahone, E.M., Koth, C.W., Cutting, L., Singer, H.S., & Denckla, M.B. (2001). Executive function in fluency and recall measures among children with Tourette syndrome or ADHD. Journal of the International Neuropsychological Society, 7, 102111. doi: 10.1017/ S1355617701711101
Mangeot, S., Armstrong, K., Colvin, A.N., Yeates, K.O., & Taylor, H.G. (2002). Long-term executive function deficits in children with traumatic brain injuries: Assessment using the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology, 8, 271284. doi: 10.1076/chin.
Manly, T., Anderson, V., Nimmo-Smith, I., Turner, A., Watson, P., & Roberston, I.H. (2001). The differential assessment of children’s attention: The test of everyday attention for children (TEA-Ch), normative sample and ADHD performance. The Journal of Child Psychology and Psychiatry, 42(8), 10651081. doi: 10.1111/1469-7610.00806
Manly, T., Robertson, I.H., Anderson, V., & Nimmo-Smith, I. (1999). Test of Everyday Attention for Children (TEA–Ch). London: Harcourt Assessment.
McDonald, B.C., Flashman, L.A., & Saykin, A.J. (2002). Executive dysfunction following traumatic brain injury: Neural substrates and treatment strategies. Neurorehabilitation, 17(4), 333344.
McNett, M. (2007). A review of the predictive ability of Glasgow Coma Scale scores in head-injured patients. Journal of Nursing Neuroscience, 39, 6875. doi: 10.1001/jamasurg.2014.13
Middleton, F.A., & Strick, P.L. (2001). A revised neuroanatomy of frontal-subcortical circuits. In D.G. Lichter & J.L. Cummings (Eds.), Frontal-subcortical circuits in psychiatric and neurological disorders (pp. 4458). New York, NY: Guilford Publications.
Miller, E.K., & Cohen, J.D. (2001). An integrative theory of prefrontal cortex function. Annual review of neuroscience, 24(1), 167202. doi: 10.1146/annurev.neuro.24.1.167
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., & Wager, T.D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49100. doi: 10.1006/ cogp.1999.0734
Pennington, B.F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 5187. doi: 10.1111/ j.1469-7610.1996.tb01380.x
Power, T., Catroppa, C., Coleman, L., Ditchfield, M., & Anderson, V. (2007). Do lesion site and severity predict deficits in attentional control after preschool traumatic brain injury (TBI)? Brain Injury, 21, 279292. doi: 10.1080/02699050701253095
Salley, C.G., Hewitt, L.L., Patenaude, A.F., Vasey, M.W., Yeates, K.O., Gerhardt, C.A., & Vannatta, K. (2015). Temperament and social behavior in pediatric brain tumor survivors and comparison peers. Journal of Pediatric Psychology, 40(3), 297308. doi: 10.1093/jpepsy/jsu083
Sherer, M., Struchen, M.A., Yablon, S.A., Wang, Y., & Nick, T.G. (2008). Comparison of indices of traumatic brain injury severity: Glasgow Coma Scale, length of coma and post-traumatic amnesia. Journal of Neurology, Neurosurgery, and Psychiatry, 79, 678685. doi: 10.1136/jnnp.2006.111187
Slomine, B.S., Gerring, J.P., Grados, M.A., Vasa, R., Brady, K.D., Christensen, J.R., & Denckla, M.B. (2002). Performance on measures of ‘executive function’ following pediatric traumatic brain injury. Brain Injury, 16, 759772. doi: 10.1080/02699050210127286
Spiegler, B.J., Bouffet, E., Greenberg, M.L., Rutka, J.T., & Mabbott, D.J. (2004). Change in neurocognitive functioning after treatment with cranial radiation in childhood. Journal of Clinical Oncology, 22(4), 706713. doi: 10.1200/JCO.2004.05.186
Stuss, D.T., & Levine, B. (2002). Adult clinical neuropsychology: Lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401433. doi: 10.1146/annurev.psych.53.100901.135220
Taylor, H.G., & Alden, J. (1997). Age-related differences in outcomes following childhood brain insults: An introduction and overview. Journal of the International Neuropsychological Society, 3(6), 555567. doi: 10.1093/brain/awn293
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical scale. The Lancet, 304(7872), 8184. doi: 10.1016/S0140-6736(74)91639-0
van der Naalt, J., van Zomeren, A.H., Sluiter, W.J., & Minderhound, J.M. (1999). One year outcome in mild to moderate head injury: The predictive value of acute injury characteristics related to complaints and return to work. Journal of Neurology, Neurosurgery, and Psychiatry, 66, 207213. doi: 10.1136/jnnp.66.2.207
Verte, S., Geurts, H.M., Roeyers, H., Oosterlaan, J., & Sergeant, J.A. (2006). The relationship of working memory, inhibition, and response variability in child psychopathology. Journal of Neuroscience Methods, 151(1), 514. doi: 10.1016/j.jneumeth.2005.08.023
Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio, TX: Psychological Corporation.
Westmacott, R., Askalan, R., Macgregor, D., Anderson, P., & Deveber, G. (2010). Cognitive outcome following unilateral arterial ischaemic stroke in childhood: Effects of age at stroke and lesion location. Developmental Medicine & Child Neurology, 52(4), 386393. doi: 10.1111/j.1469-8749.2009.03403.x
Yeates, K.O., Bigler, E.D., Abildskov, T., Dennis, M., Gerhardt, C.A., Vannatta, K., & Taylor, H.G. (2014). Social competence in pediatric traumatic brain injury: From brain to behavior. Clinical Psychological Science, 2, 97107. doi: 10.1177/2167702613499734


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Profiles of Executive Function Across Children with Distinct Brain Disorders: Traumatic Brain Injury, Stroke, and Brain Tumor

  • Gabriel C. Araujo (a1), Tanya N. Antonini (a2), Vicki Anderson (a3), Kathryn A. Vannatta (a4), Christina G. Salley (a5), Erin D. Bigler (a6), H. Gerry Taylor (a7), Cynthia Gerhardt (a4), Kenneth Rubin (a8), Maureen Dennis (a9), Warren Lo (a10), Mark T. Mackay (a11), Anne Gordon (a12), Christine Hajek Koterba (a13), Alison Gomes (a14), Mardee Greenham (a15) and Keith Owen Yeates (a16)...


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