Figura. Diagrama de flujo de estudios incluidos en el análisis. TA: trastorno específico del aprendizaje; TDAH: trastorno por déficit de atención/hiperactividad; TEA: trastorno del espectro autista.
Tabla I. Variables descriptivas de los estudios analizados. |
||
Trastornos del neurodesarrollo |
Trastorno por déficit de atención/hiperactividad |
12 (44,4%) |
Trastorno del espectro autista |
16 (59,3%) |
|
Trastornos específico del aprendizaje |
3 (11,1%) |
|
Funciones ejecutivas: dimensiones evaluadas |
Inhibición |
18 (66,7%) |
Flexibilidad |
11 (40,7%) |
|
Memoria de trabajo/actualización |
11 (40,7%) |
Tabla II. Prueba U de Mann-Whitney (TDAH y dimensiones ejecutivas). |
|||||||
TDAH |
Rango |
U de |
W de |
Z |
Sig. asintótica (bilateral) |
Significación exacta |
|
Inhibición |
No |
13,9 |
88,5 |
208,5 |
–0,09 |
0,923 |
0,943 |
Sí |
14,13 |
||||||
Flexibilidad |
No |
17,00 |
45,0 |
123,0 |
–2,55 |
0,011 b |
0,028 a |
Sí |
10,25 |
||||||
Memoria de trabajo |
No |
12,53 |
68,0 |
188,0 |
–1,20 |
0,228 |
0,300 |
Sí |
15,83 |
||||||
TDAH: trastorno por déficit de atención/hiperactividad. a p < 0,05; b p < 0,001. |
Tabla III. Prueba U de Mann-Whitney (TEA y dimensiones ejecutivas). |
|||||||
TEA |
Rango |
U de |
W de |
Z |
Sig. asintótica (bilateral) |
Significación exacta |
|
Inhibición |
No |
15,05 |
76,5 |
212,5 |
–0,74 |
0,455 |
0,577 |
Sí |
13,28 |
||||||
Flexibilidad |
No |
9,23 |
35,5 |
101,5 |
–3,01 |
0,003 a |
0,008 b |
Sí |
17,28 |
||||||
Memoria de trabajo |
No |
15,45 |
72,0 |
208,0 |
–0,89 |
0,375 |
0,451 |
Sí |
13,00 |
||||||
TEA: trastorno del espectro autista. a p < 0,05; b p < 0,001. |
Tabla IV. Prueba U de Mann-Whitney (TA y dimensiones ejecutivas). |
|||||||
TA |
Rango |
U de |
W de |
Z |
Sig. asintótica (bilateral) |
Significación exacta |
|
Inhibición |
No |
14,13 |
33 |
39 |
–0,30 |
0,761 |
0,856 |
Sí |
13,00 |
||||||
Flexibilidad |
No |
14,75 |
18 |
24 |
–1,61 |
0,107 |
0,187 |
Sí |
8,00 |
||||||
Memoria de trabajo |
No |
14,29 |
29 |
35 |
–0,60 |
0,544 |
0,635 |
Sí |
11,67 |
||||||
TA: trastorno específico del aprendizaje. |
Executive function deficits and neurodevelopmental disorders in childhood and adolescence Introduction. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has new criteria that include a diagnostic reference to neurodevelopmental disorders. Neurodevelopmental disorders are diverse, and even though they are independent diagnostic entities they share common manifestations in people with brain damage or dysfunction of the prefrontal cortex; that is, neurodevelopmental disorders present different alterations in executive functions. Development. The aim of the present study was to offer an overview of the recent findings on executive functioning in children, adolescents and young adults with different neurodevelopmental disorders: autistic spectrum disorder, attention-deficit/hyperactivity disorder and specific learning disorder. Hence, with this objective, 27 studies from the literature were reviewed. The results indicate a statistically significant association between the dimension of flexibility and attention deficit/hyperactivity disorder (W of Wilcoxon = 123.0; p = 0.011), and flexibility with autistic spectrum disorder (W of Wilcoxon = 101.5; p = 0.003); and absence of a statistically significant association between the different assessed dimensions and specific learning disorder. Conclusions. The dimensions of executive functioning are affected to a variable degree in different neurodevelopmental disorders. We can hypothesis that the dimensions that are affected in the different neurodevelopmental disorders can be characterized in terms of the existence of a continuum, and occasionally those dimensions are too complex to establish categorical limits when comparing different neurodevelopmental disorders. Key words. Attention deficit/hyperactivity disorder. Autism spectrum disorder. Flexibility. Inhibition. Specific learning disorder. Working memory. |
Anexo. Estudios analizados: metodología, trastornos del neurodesarrollo y déficits ejecutivos. |
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Metodología |
Trastornos del neuro-desarrollo |
Déficits ejecutivos |
Instrumentos de evaluación |
||||
Participantes |
Edad (media ± DE) (años) |
CI (media ± DE) |
Funciones ejecutivas |
Inteligencia |
|||
Huang et al [11] |
N DT = 427 N TDAH+TA = 942 N TDAH = 799 N 6-8 años = 1.043 N 9-11 años = 870 N 12-14 años = 496 |
Rango: 6-8 Rango: 9-11 Rango: 12-14 |
CI DT = 112,93 ± 13,87 CI TDAH+TA = 98,66 ± 13,87 CI TDAH = 105,17 ± 14,36 |
TA TDAH (subtipo combinado) |
Inhibición Actualización |
Stroop Color-Word Test Trail-Making Test Behavior Rating Inventory of Executive Function (versión padres) |
Chinese-Wechsler Intelligence Scale for Children |
Gooch et al [48] |
N DT = 74 N Trast. lenguaje = 79 N TA = 90 |
T2 meses de estudio = 4,7 ± 0,3 T3 meses de estudio = 5,7 ± 0,29 T4 meses de estudio = 6,5 ± 0,36 |
CI = 106,57 ± 19,07 |
TA (dislexia) Trastorno del lenguaje |
Inhibición Atención Memoria visuoespacial |
Head Toes Knees and Shoulders Visual Search Block Recall Working Memory Test Battery for Children Go/No-Go Task |
Wechsler Preschool and Primary Scales of Intelligence – 3rd edition (Block Design) |
Menghini et al [73] |
N DT = 65 N TA = 60 |
Edad DT = 11,94 Edad TA = 11,43 |
CI DT = no disponible en la versión de texto completa CI TA ± Dislexia = 103 ± 11,28 |
TA (dislexia) |
Planificación Fluidez |
Category Fluency Test Wisconsin Card Sorting Test |
Wechsler Intelligence Scale for Children Raven Colored Progressive Matrices |
Shuai et al [10] |
N DT = 88 N TDAH = 44 |
Edad DT = 8,4 ± 0,8 Edad TDAH = 8,4 ± 0,9 |
CI DT = 106,4 ± 11,6 CI TDAH = 106,3 ± 12,1 |
TDAH |
Inhibición Memoria de trabajo Planificación |
Behavior Rating Inventory of Executive Function Conners’ Parent Scale Stroop Color and Word Test Rey-Osterrieth Complex Figure Test Trail Making Test Torre de Hanoi Visual Field Test False-Belief task |
Chinese-Wechsler Intelligence Scale for Children-Revised |
Hwang et al [51] |
N DT = 35 N TDAH = 26 |
Edad DT = 13,91 ± 2,13 Edad TDAH = 14,53 ± 2 |
CI DT = 105,06 ± 12,67 CI TDAH = 106,42 ± 13,03 |
TDAH |
Inhibición |
Conners’ Parenting Score |
Wechsler Abbreviated Scale of Intelligence (2-subtest form) |
Karalunas et al [49] |
N DT = 44 N TDAH = 63 |
Rango: 5-6 |
CI DT = 106,79 ± 9,78 CI TDAH = 97,45 ± 14,5 |
TDAH |
Inhibición Memoria de trabajo |
Walk-a-line Slowly Task Peg Tapping Task Head-Toes-Knees-ShouldersTask Choice-Delay Task Go/No-Go Task Backward Word Span Task Finger Windows Task from the Wide Range Assessment of Memory and Learning, Second Edition Dimensional Change Card Sort |
Stanford-Binet Intelligence Scale – Fifth Edition (Vocabulary and Matrices) |
Pineda et al [47] |
N DT = 372 N TDAH = 249 |
Edad DT = 8,3 ± 1,5 Edad TDAH = 8 ± 1,4 |
CI > 85 |
TDAH |
Planificación Fluidez Razonamiento |
Wisconsin Card Sorting Test-Abbreviated Version Mental Control domain of the Wechsler Memory Scale |
Escala completa de CI No disponible el nombre de la escala aplicada en la versión completa |
Jacobson et al [56] |
N DT = 21 N TDAH = 41 |
Edad DT = 11,46 ± 1,63 Edad TDAH = 10,97 ± 1,41 |
CI DT = 105,66 ± 11,88 CI TDAH = 91,7 ± 12,2 |
TDAH |
Inhibición Memoria de trabajo Fluidez Velocidad de procesamiento de la información |
Wechsler Intelligence Scale for Children-Fourth Edition-I Digit Span Backward Wechsler Intelligence Scale for Children-Fourth Edition-I Letter-Number Sequencing Simple Reaction Time and Go/No-Go Tests Rapid Automatized Naming |
Wechsler Intelligence Scale for Children-Fourth Edition. General Ability Index score |
Willcutt et al [52] |
N DT = 121 N TA = 93 N TDAH = 52 N TDAH + TA = 48 |
Rango: 8-16 |
CI > 70 |
TA (dificultades de lectura) TDAH |
Inhibición Memoria de trabajo |
Wisconsin Card Sorting Test Contingency Naming Test Continuous Performance Test Stopping Task Sentence Span Task Counting Span Task Trail Making Test Stroop Color and Word Test |
Wechsler Intelligence Scale for Children |
Samyn et al [53] |
N DT = 148 N TDAH = 30 N TEA = 31 |
Edad DT = 12,73 ± 1,48 Edad TEA = 12,83 ± 1,41 Edad TDAH = 13,16 ± 1,61 |
CI DT = 107,21 ± 11,68 CI TDAH = 108,20 ± 12,63 CI TEA = 101,16 ± 12,48 |
TDAH TEA |
Inhibición Atención |
Go/No-Go Task Animal Stroop Task Focused Attention Task Shifting Attention Task-Auditory |
Wechsler Intelligence Scale for Children-Third Edition: Vocabulary, Similarities, Picture Arrangement and Block Design |
Schoemaker et al [50] |
N DT = 56 N TDAH = 61 N Trastorno del comportamiento = 33 N TDAH + Trastorno del comportamiento = 52 |
Edad DT = 4,6 ± 0,6 Edad TDAH = 4,6 ± 0,61 Edad Trastorno del comportamiento = 4,3 ± 0,7 Edad TDAH + Trastorno del comportamiento = 4,51 ± 0,56 |
CI DT = 111,65 ± 10,32 CI TDAH = 101,29 ± 12 CI Trastorno del comportamiento = 101,89 ± 10,9 CI TDAH + Trastorno del comportamiento = 99,76 ± 11,61 |
TDAH Trastorno del comportamiento |
Inhibición Memoria de trabajo |
Go/No-Go Task Modified Snack Delay Shape School – Inhibit Condition (computarizada) Nine Boxes and Delayed Alternation |
Raven Colored Progressive Matrices |
Shuai et al [54] |
N DT = 375 N TDAH = 125 |
Rango: 6-15 |
CI < 80 |
TDAH |
Inhibición Memoria de trabajo Flexibilidad Planificación Fluidez |
Stroop Color and Word Test Rey-Osterrieth Complex Figure Test Trail Making Test Torre de Hanoi Verbal Fluency Test |
Wechsler Intelligence Scale for Chinese Children-Revised |
Han y Chan [68] |
N DT = 30 N TEA = 30 |
Rango: 8-17 |
CI DT = 109,8 ± 11,59 CI TEA de alto desarrollo = 105,2 ± 21,61 CI TEA de bajo desarrollo = 50,3 ± 12,73 |
TEA |
Inhibición Flexibilidad Planificación |
D2 test of concentration Five point test (5-point) Children’s Color Trail Test Tower of California Test Go/No-Go Task |
Wechsler Intelligence Scale for Children-Third Edition, short form Stanford-Binet Intelligence Scale - Fourth Edition |
Pugliese et al [58] |
N TEA con discapacidad Intelectual = 64 |
8,43 ± 2,29 |
CI TEA = 107,03 ± 19,83 |
TEA con discapacidad intelectual |
Autorregulación |
Behavior Rating Inventory of Executive Function |
Wechsler Abbreviated Scale of Intelligence |
Van Eylen et al [69] |
N DT = 50 N TEA = 50 |
Rango: 8-18 |
CI DT = 107,72 ± 9,3 CI TEA = 104,32 ± 10,83 |
TEA |
Inhibición Memoria de trabajo Flexibilidad Planificación Velocidad de procesamiento de la información |
Go/No-Go Task Flanker Task Wisconsin Card Sorting Test Switch Task Design fluency Test Spatial Working Memory Test (CANTAB) Search strategy Spatial Span Test (Wechsler Nonverbal Scale of Ability - Nederlandstalige bewerking) Tower test (Delis-Kaplan Executive Function System) Behavior Rating Inventory of Executive Function |
Dutch-Wechsler Intelligence Scale for Children – 3rd edition/Dutch-Wechsler Adult Intelligence Scale – 3rd edition |
Hagberg et al [64] |
N TEA = 68 |
Rango: 16- 36,5 DE: 4,7 |
CI TEA Persistent nonverbal learning difficulties = 96,50 ± 18,30 CI TEA Childhood ‘only’ non verbal learning difficulties = 102,1 ± 14,5 CI TEA Never nonverbal learning difficulties = 99,4 ± 17,5 |
TA (dificultades de aprendizaje no verbal) TEA |
Inhibición Memoria de trabajo Atención |
Dysexecutive Syndrome Questionnaire |
Wechsler Adult Intelligence Scale-Third Edition |
Merchán et al [59] |
N DT = 32 N TEA = 23 |
Edad DT = 12,9 ± 2,5 Edad TEA = 12,5 ± 2,5 |
CI DT = 106,81 ± 11,02 CI TEA = 99,2 ± 18,81 |
TEA (sin discapacidad intelectual) |
Inhibición Memoria de trabajo Flexibilidad Atención |
Wechsler Adult Intelligence Scale-Third Edition (dígitos directos, dígitos inversos, letras y números) Trail Making Test (partes A y B) Wisconsin Card Sorting Test Continuous Performance Test-II Test de palabras y colores Stroop |
Wechsler Adult Intelligence Scale-Third Edition Wechsler Adult Intelligence Scale-revised (WISC-R) En el grupo con TEA se aplicó la escala completa En el grupo con DT se emplearon los subtests: vocabulario y cubos |
Stephanie y Julie [65] |
N DT = 32 N TEA = 17 |
Rango: 4-9 |
CI DT = 84,4 ± 21,3 CI TEA = 77,8 ± 27,2 |
TEA |
Inhibición Flexibilidad |
Computerized version of the Dimensional Change Card-Sorting Task |
Raven’s Progressive Matrices |
Van Eylen et al [55] |
N DT = 100 N TEA = 113 |
Grupo niños: Edad DT = 12,86 ± 2,89 Edad TEA = 12,9 ± 2,98 Grupo adultos: Edad DT = 45,43 ± 5,66 Edad TEA = 44,04 ± 4,6 |
CI DT = 110,58 ± 10,75 CI TEA = 109,08 ± 13,1 |
TEA |
Inhibición Flexibilidad Fluidez |
Go/No-Go task Flanker task Wisconsin Card Sorting Test Switch Task Uso de tareas de objetos Delis-Kaplan Executive Function System Spatial working memory test (CANTAB) Spatial span test (Wechsler Nonverbal Scale of Ability - Nederlandstalige bewerking) Tower test (Delis-Kaplan Executive Function System) Behavior Rating Inventory of Executive Function |
Wechsler Abbreviated Scale of Intelligence |
Chen et al [60] |
8-12 años N DT = 63 N TEA = 53 13-18 años N DT = 51 N TEA = 58 |
Grupo 8-12 años: Edad DT = 10,65 ± 1,31 Edad TEA = 9,96 ± 1,37 Grupo 13-18 años: Edad DT = 14,41 ± 1,42 Edad TEA = 14,72 ± 1,53 |
Grupo 8-12 años: CI DT = 114,94 ± 8,92 CI TEA = 108,58 ± 15,97 Grupo 13-18 años: CI DT = 109,92 ± 9,54 CI TEA = 107,07 ± 12,83 |
TEA |
Memoria de trabajo Planificación |
CANTAB computerized |
Wechsler Intelligence Scale for Children-Third Edition (Digit Span) |
Robinson et al [61] |
N DT = 54 N TEA = 54 |
Edad DT = 12,08 ± 2,3 Edad TEA = 12,53 ± 2,8 |
CI DT = 104,8 ± 9,07 CI TEA = 103,53 ± 10,54 |
TEA |
Inhibición Flexibilidad Planificación Automonitorización |
Torre de Londres Wisconsin Card Sorting Task Stroop Junior Hayling Test Verbal Fluency |
Wechsler Abbreviated Scale of Intelligence |
Maister et al [66] |
N DT = 14 N TEA = 14 |
Edad DT = 12,1 ± 0,6 Edad TEA = 12,2 ± 0,1 |
Experimento 1: CI DT = 46,4 ± 7,4 CI TEA = 43,9 ± 6,4 Experimento 2: CI DT = 44,3 ± 6,3 CI TEA = 41,6 ± 8,3 |
TEA |
Memoria relacional |
Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional A phonemic verbal fluency task and a semantic verbal fluency task Stroop task |
Raven’s Standard Progressive Matrices |
Pellicano et al [62] |
N DT = 30 N TEA = 30 |
Edad DT = 4,41 ± 0,87 Edad TEA = 4,43 ± 1,01 |
CI Verbal_DT = 101,87 ± 11,01 CI Verbal_TEA = 96,53 ± 15,52 CI Manipulativo_DT = 102,33 ± 12,63 CI Manipulativo_TEA = 101,63 ± 14,97 |
TEA |
Inhibición Memoria de trabajo Flexibilidad |
Dimensional Change Card Sort Corsi Blocks Task Less is More Task |
Wechsler Preschool and Primary Scales of Intelligence – 3rd edition |
Lukito et al [67] |
N TEA = 100 |
Rango: 10-12 |
CI TEA = 84,3 ± 18 |
TEA |
Inhibición Memoria de trabajo Flexibilidad Planificación Actualización |
Opposite Worlds, part of the Test of Everyday Attention for Children and Luria Hand Game Trail Making Test Card sorting task |
Wechsler Abbreviated Scale of Intelligence |
Kenworthy et al [63] |
N TEA = 67 |
Edad TEA participante en UOT = 9,49 ± 1 Edad TEA participante en SS = 9,58 ± 1,1 |
CI TEA_UOT = 108,8 ± 18,52 CI TEA_SS = 107,63 ± 17,2 |
TEA (nivel de funcionamiento alto) |
Flexibilidad Planificación |
Behavior Rating Inventory of Executive Function Change Task |
Wechsler Abbreviate Scale of Intelligence |
Boxhoorn et al [77] |
N DT = 22 N TEA = 23 N TDAH-Inatento = 23 N TDAH-Combinado = 52 |
Edad DT = 9,77 ± 2,4 Edad TEA = 10,04 ± 2,3 Edad TDAH-Inatento = 9,91 ± 1,8 Edad TDAH-Combinado = 9,76 ± 1,8 |
CI DT = 112 ± 13 CI TEA = 104,96 ± 18,3 CI TDAH-Inatento = 98,17 ± 12,2 CI TDAH-Combinado = 102,33 ± 11,2 |
TDAH TEA |
Atención Control/supervisión |
Child Behaviour Checklist |
Escala completa de CI No disponible el nombre de la escala aplicada |
Happé et al [76] |
N DT = 32 N TEA = 32 N TDAH = 30 |
Edad DT = 11,2 ± 2 Edad TEA = 10,9 ± 2,4 Edad TDAH = 11,6 ± 1,7 |
CI DT = 106,8 ± 13,4 CI TEA = 99,7 ± 18,7 CI TDAH = 99,1 ± 17,7 |
TA TEA |
Memoria de trabajo Flexibilidad Planificación |
Go/No-Go Task Verbal fluency: FAS Verbal fluency: categories Design fluency CANTAB intradimensional/extradimensional CANTAB stockings of Cambridge CANTAB spatial working memory |
Wechsler Intelligence Scale for Children-Third Edition |
CANTAB: Cambridge Neuropsychological Test Automated Battery; CI: cociente intelectual; DE: desviación estándar; DT: desarrollo típico; SS: Social Skills Intervention; TA: trastorno específico del aprendizaje; TDAH: trastorno por déficit de atención/hiperactividad; TEA: trastorno del espectro autista; UOT: Unstuck and On Target. |