Executive function and practical implications

1. Emily Schworer (University of Wisconsin-Madison)
2. Madison Walsh (Colorado State University)
3. Elisa Rossi (University of Padua)
4. Sara Onnivello (University of Padua)

Correspondence: schworer@wisc.edu

Executive function (EF) is a known area of challenge for individuals with Down syndrome. These challenges have practical implications throughout the lifespan, from early precursors of EF that have been linked to language outcomes to the EF changes that correspond with early cognitive decline in adults with DS. EF also has implications for mental health (e.g., anxiety), overall cognitive development, and adaptive behavior (e.g., daily living skills).

Executive function profiles, adaptive behavior and cognitive abilities in youth with Down syndrome: implications for individualized intervention

1. Elisa Rossi (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)
2. Sara Onnivello (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)
3. Chiara Locatelli (Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna (A.O.U.BO), Bologna, Italy)
4. Chiara Marcolin (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)
5. Giacomo Sperti (Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna (A.O.U.BO), Bologna, Italy)
6. Aurora Platè (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)
7. Francesca Catapano (Department of Medical and Surgical Science (DIMEC), University of Bologna, Bologna, Italy)
8. Sara Colaianni (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)
9. Beatrice Vione (Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy)
10. Michela Cicilloni (Unit of Histology, Embryology and Applied Biology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy)
11. Giuseppe Ramacieri (Department of Medical and Surgical Science (DIMEC), University of Bologna, Bologna, Italy, Specialty School of Child Neuropsychiatry - Alma Mater Studiorum, University of Bologna, Bologna, Italy)
12. Silvia Lanfranchi (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)

Correspondence: elisa.rossi.12@pdh.unipd.it

Background: Executive functions (EF) are higher-order cognitive processes essential for goal-directed behavior. Previous research has shown that individuals with Down syndrome (DS) often experience EF impairments, with a profile of specific strengths and weaknesses. However, within-group variability in school-age individuals remains underexplored.

Research question: The present study aimed to identify EF profiles in youth with DS and to examine their associations with cognitive abilities and adaptive behavior, in order to inform more individualized clinical and educational interventions.

Method: Participants were 111 children and adolescents with DS aged 7–17 years. Caregiver-reported EF were assessed using the BRIEF-2. Latent profile analysis was conducted to identify EF profiles, and profiles were compared on verbal and non-verbal cognitive abilities and adaptive behavior.

Results: Three distinct EF profiles emerged, differing primarily in the severity and configuration of executive difficulties. Importantly, EF profiles were not associated with verbal or non-verbal cognitive abilities, but showed significant differences in adaptive behavior. Children exhibiting a clinically elevated EF profile demonstrated markedly lower adaptive functioning, whereas those with moderate difficulties or preserved EF profiles showed progressively better adaptive outcomes.

Conclusions: These findings have direct practical implications. Rather than relying on average EF scores, identifying EF profiles allows clinicians to better understand individual patterns of strengths and vulnerabilities that are meaningfully linked to everyday functioning. From an applied perspective, EF profiling can inform intervention planning by supporting the selection of targeted strategies aimed at improving adaptive behavior and participation in daily life.

Executive functions and behavioral difficulties in children and adolescents with Down syndrome

1. Sara Onnivello (Department of Developmental Psychology and Socialization, University of Padova, Italy)
2. Elisa Rossi (Department of Developmental Psychology and Socialization, University of Padova, Italy)
3. Sara Colaianni (Department of Developmental Psychology and Socialization, University of Padova, Italy)
4. Chiara Marcolin (Department of Developmental Psychology and Socialization, University of Padova, Italy)
5. Silvia Lanfranchi (Department of Developmental Psychology and Socialization, University Of Padua, Padua, Italy)

Correspondence: sara.onnivello@unipd.it

Background: Difficulties in executive functions (EF) and behavior are commonly reported in children and adolescents with Down syndrome (DS) and can significantly affect daily functioning at home and at school. EF, including inhibition, working memory, cognitive flexibility, and emotional regulation, play a key role in supporting adaptive behavior and self-regulation. However, limited research has examined how EF relate to behavioral difficulties across different developmental stages in DS, particularly from preschool age through adolescence.

Research Question: The present study aimed to investigate the relationship between EF and behavioral difficulties in preschool- and school-aged individuals with DS.

Method: A total of 181 individuals with Down syndrome participated in the study, including 68 preschool-aged children (3–6 years) and 113 school-aged children and adolescents (7–17 years). EF and behavioral difficulties were assessed using parent-report questionnaires, including the Behavior Rating Inventory of Executive Function – Preschool Version and Second Edition (BRIEF-P/BRIEF-2), the Strengths and Difficulties Questionnaire (SDQ), and the Autism Behavior Checklist (ABC). Correlational and regression analyses were conducted to examine associations between EF and behavioral difficulties and to identify age-specific predictors.

Results: Results showed significant associations between EF and behavioral difficulties, with stronger and more widespread correlations observed in the school-aged group. In preschool-aged children, correlations were mainly observed between EF subscales and ADHD-related difficulties on the SDQ, with additional associations involving ABC scores. In the older group, correlations increased in both number and strength, involving multiple SDQ subscales as well as ABC scores. Regression analyses highlighted both similarities and differences between age groups, indicating that specific executive function components differentially predicted behavioral difficulties across development.

Conclusion: These findings suggest that EF are closely linked to behavioral challenges in individuals with DS, particularly as environmental demands increase with age. From an applied perspective, the results highlight the potential value of early assessment and targeted support of EF. For clinicians, interventions aimed at strengthening EF may have a cascading positive effect on behavior regulation, attention, and emotional control. For families and educators, supporting EF in everyday contexts may help reduce behavioral difficulties and improve participation at home and at school. Overall, addressing EF represents a promising pathway for promoting adaptive functioning and quality of life in children and adolescents with DS.

Executive function and language abilities in children and young adults with Down syndrome

1. Emily Schworer (University of Wisconsin-Madison)
2. Amy Banasik
3. Marianne Elmquist
4. Ruth Litovsky
5. Sigan Hartley
6. Andrew Alexander
7. Jill Hoover
8. Audra Sterling

Correspondence: schworer@wisc.edu

Background. There is substantial variability in the communication and language outcomes of individuals with Down syndrome (DS). One potential source of variability may be executive function (EF) abilities, yet the connection between these domains is understudied. We sought to further characterize the relationship between EF abilities and language abilities.

Research question. What is the relationship between EFs and language abilities in children and young adults with DS?

Method. Participants included 38 individuals with DS between the ages of 11 and 25 years (M = 19.44; SD =4.55). EF was measured using the Corsi Block Tapping Task-Forward and the NIH Toolbox Flanker and Dimensional Change Card Sort (DCCS). Vocabulary was assessed with standardized measures. Language samples were collected using standardized conversation prompts and transcribed using the Systematic Analysis of Language Transcripts (SALT) conventions.

Results. When controlling for participant age, Corsi Block Tapping Task-Forward performance was significantly associated with the Peabody Picture Vocabulary Test (PPVT; r = .55, p < .001) and Expressive Vocabulary Test (EVT; r = .48, p = .004) raw scores. NIH Toolbox DCCS was correlated with all conversation language sampling variables (e.g., Mean Length of Utterance-morphemes [r = .60, p = .01] and Number of different words [r = .56, p = .02]).

Conclusions. This study provides preliminary evidence for the connection between EF and language in older childhood and early adulthood in DS. Short-term memory components (Corsi Block Tapping Task-Forward) were related to vocabulary assessments and cognitive flexibility (NIH Toolbox DCCS) was associated with spontaneous language variables from the language samples. The connect between EF and language is significant as we work to identify the factors that support the development of language skills in this population and identify potential targets for language and communication interventions.

Caregiver-reported social foundations and cognitive regulation in toddlers with Down syndrome

1. Madison Walsh (Colorado State University)
2. Miranda Pinks
3. Kaylyn Van Deusen
4. Mark Prince
5. Somer Bishop
6. Nicole Baumer
7. Deborah Fidler

Correspondence: Madison.Walsh@colostate.edu

Background: Down syndrome (DS) is associated with variable social developmental outcomes. Neurocognitive areas of vulnerability in DS, like executive function (EF), are a viable starting point for investigation into potential sources of individual differences in social development in children with DS. Research question: The present study investigated the association between early caregiver reported EF and social foundational skills in 105 young children with DS (M = 20.56 months, SD = 1.55). Methods: Caregivers completed the Early Executive Functions Questionnaire (EEFQ) and the Communication and Symbolic Behaviour Scales Developmental Profile, Infant-Toddler Checklist (CSBS-DP ITC). Children participated in a battery of research assessments, including the Bayley Scales of Infant Development, 4th edition (Bayley-4). EFFQ domain scores, and CSBS-DP ITC domain and percentile scores were calculated. Results: Substantial inter-individual variability was observed among toddlers with DS along foundational social and EF dimensions. Inhibitory control foundations were predictive of all three CSBS-DP ITC domain scores, and flexibility and working memory were associated with Speech and Symbolic domains, respectively. Additionally, CSBS percentile scores for composite domains were moderately associated with performances on the Bayley-4. Conclusions: Overall, findings from this study suggest that individual differences in social adaptation among children with DS may be linked to early developing EF skills in young children with DS. Difficulties in acquiring social communication and play skills could have cascading effects on developing social competencies and adaptive functioning more broadly. These cross-sectional findings serve as a step toward understanding individual differences in social competencies in this population, with potential implications for subsequent social trajectories. These findings may have implications for future interventions targeting regulatory vulnerabilities and social foundations in DS.