Summary: Children who experience cognitive difficulties, such as attention problems or problems with working memory, have an increased risk of developing mental health disorders as young adults.
Source: University of Birmingham
Children experiencing cognitive problems such as low attention, poor memory or lack of inhibition may later suffer mental health issues as teenagers and young adults, a new study reveals. Targeting specific markers in childhood for early treatment may help to minimise the risk of children developing certain psychopathological problems in adolescence and adult life, such as borderline personality disorder, depression and psychosis.
Cognitive deficits are core features of mental disorders and important in predicting long-term prognosis – the researchers’ work indicates that individual patterns of such deficits predate specific mental disorders.
Analysing data from an initial UK cohort of 13,988 individuals born between April 1991 and December 1992, researchers discovered a number of key and specific links between childhood cognitive problems and mental health issues in later life, namely:
Deficits in sustained attention in eight-year-olds precede development of borderline personality disorder (BPD) symptoms at 11-12 years and depression at 17-18 years;
Difficulties with inhibition in eight-year-olds were associated with psychotic experiences at 17-18 years; and
Working memory deficits in 10-year-olds were related to hypomania at 22-23 years.
The international team of researchers from the UK and Finland, led by experts from the University of Birmingham, published its findings today in JAMA Network Open.
The leading author of the study Dr. Isabel Morales-Muñoz, from the University of Birmingham’s Institute for Mental Health and the Finnish Institute for Mental Health, in Helsinki, commented: “Our study highlights the potential impact of childhood cognitive deficits on young people’s mental health, suggesting specific associations with certain conditions. Prevention strategies focussed on easing these specific cognitive issues could help to reduce the likelihood of such children developing linked mental health problems in adolescence and early adulthood.”
The study was the first analysis following subjects over a significant period of time to explore specific associations between cognitive deficits in childhood and several psychopathological issues in young people.
Deficits in sustained attention at eight years being associated with BPD symptoms at 11-12 years is consistent with similar deficits in adult BPD patients linked to difficulties in sticking to therapy programmes. Previous evidence also suggests a significant link between adult BPD and childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms -indicating that ADHD could represent a risk factor for BPD.
The study also supports the theory that lack of inhibition in childhood precedes later psychotic experiences, with a lack of inhibitory control common in psychotic disorders such as schizophrenia.
Researchers found that working memory deficits in childhood were linked to hypomania in young adults, but when they checked for co-existing psychopathological conditions this association disappeared – indicating that further investigation is needed.
Mental disorders cause a significant disease burden globally and at least 10% of children and adolescents worldwide have a mental disorder. 75% of mental disorders diagnosed in adults have their onset in childhood and adolescence.
Bipolar disorder, depression and psychosis commonly emerge during adolescence and continue in young adulthood – potentially related to anomalies in the way adolescents mature caused by psychosocial, biological or environmental factors.
“It’s crucial to study the onset of mental disorders at these early stages and evaluate which risk factors predate these conditions and in what way. These factors are core features of mental disorders such as psychosis and mood disorders,” commented co-author Professor Matthew Broome.
“Deficits in cognitive function, ranging from decreased attention and working memory to disrupted social cognition and language, are common in psychiatric disorders. They severely compromise quality of life and could potentially predate serious mental health conditions by several years,” commented the senior author of the study Professor Steven Marwaha.
About this mental health research news
Source: University of Birmingham Contact: Dominic Benson – University of Birmingham Image: The image is in the public domain
Longitudinal Associations Between Cognitive Deficits in Childhood and Psychopathological Symptoms in Adolescence and Young Adulthood
Importance Cognitive deficits are core features of mental disorders and are important in predicting long-term prognosis. However, it is still unknown whether individual patterns of cognitive deficits predate specific mental disorders.
Objective To investigate the specificity of the associations of attention, working memory, and inhibition in childhood with borderline personality disorder (BPD), psychosis, depression, and hypomania in adolescence and young adulthood.
Design, Setting, and Participants This cohort study obtained data from the Avon Longitudinal Study of Parents and Children in the United Kingdom. All pregnant women resident in Avon, United Kingdom, with an expected date of delivery from April 1, 1991, and December 31, 1992, were eligible. Data analysis was conducted from April 1 to September 30, 2020. The sample initially comprised 13 988 participants who were alive at 1 year of age. For this study, data were available for 6333 individuals reporting on any psychopathological measure at ages 11 to 12 years, 4903 individuals at ages 17 to 18 years, and 2963 individuals at 22 to 23 years.
Exposures Sustained attention, selective attention, and attentional control were assessed with the Test of Everyday Attention for Children at age 8 years, and working memory and inhibition were assessed at age 10 years with the Counting Span Task and the stop-signal paradigm, respectively.
Main Outcomes and Measures Symptoms of BPD were assessed at ages 11 to 12 years, psychotic experiences and depression were examined at ages 17 to 18 years, and hypomania was examined at ages 22 to 23 years.
Results Among 5315 individuals included in the statistical analysis, 2551 (48.0%) were male and 2764 (52.0) were female. Higher sustained attention at 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (adjusted odds ratio [aOR], 0.964; 95% CI, 0.933-0.996; P = .03), better performance on inhibition at age 10 years with decreased risk of psychotic experiences at ages 17 to 18 years (aOR, 0.938; 95% CI, 0.890-0.989; P = .02), higher sustained attention at age 8 years with decreased risk of depressive symptoms at ages 17 to 18 years (aOR, 0.969; 95% CI 0.938-0.9997; P = .048), and better performance in working memory at age 10 years with decreased risk of hypomania symptoms at ages 22 to 23 years (aOR, 0.694; 95% CI, 0.529-0.911; P = .008). After controlling for potential psychopathological overlay, all the associations remained, except for working memory and hypomania.
Higher sustained attention at age 8 years was associated with decreased risk of BPD symptoms at ages 11 to 12 years (β = −0.05; P < .001) and of depression at ages 17 to 18 years (β = −0.03; P = .04), and better performance in inhibition at age 10 years was associated with decreased risk of psychotic experiences at ages 17 to 18 years (β = −0.03; P = .04).
Conclusions and Relevance These findings suggest that specific cognitive deficits in childhood are distinctively associated with different psychopathological symptoms in young people. Furthermore, these results suggest the potential of early cognitive interventions in childhood as a way of modifying or attenuating risk for subsequent psychopathological symptoms.