Executive function in children with neurodevelopmental conditions: a systematic review and meta-analysis
Ayesha K Sadozai, Carter Sun, Eleni A. Demetriou, Amit Lampit, Martha Munro, Nina Perry et al. · 2024 · 91 citationsRead the paper
Executive function (EF) delays are well documented in paediatric neurodevelopmental conditions (NDCs). There is no consensus about whether EF delay represents a transdiagnostic feature of NDCs. This systematic review and meta-analysis synthesized 180 studies reporting two or more NDC comparisons on EF, examined differences between NDCs, and the moderating effects of gender, age, publication year, DSM editions and assessment types. Studies using established EF measures across seven domains (attention, fluency, set-shifting, set-switching, response inhibition, planning and working memory) in participants under 18 were included. Summary effects were compared: (1) for all reported NDCs relative to control, (2) for each individual NDC relative to control and (3) between NDC groups. Results confirmed that EF delay was a transdiagnostic feature of neurodevelopmental delay, with a moderate effect size of delay across all NDCs (g = 0.56, 95% confidence interval (CI) 0.49-0.63) compared with control. This effect increased with comorbidities (g = 0.72, 95% CI 0.59-0.86), DSM-5 criteria and informant measures. Comparisons between NDCs revealed few differences: children with tic disorders (TD) showed smaller EF delays, children with attention-deficit/hyperactivity disorder (ADHD) showed larger delays in attention, response inhibition, planning and working memory compared with TD and specific learning disorders, while children with autism spectrum disorders showed greater delays on set-switching compared with ADHD. Findings support transdiagnostic models of neurodevelopment to further a developmentally sensitive science that can reveal how EF delays contribute to brain circuitry, symptom profiles and functioning, and ultimately support early interventions and outcomes for all children with NDCs.
What the full text shows
Shown in the lab- Executive function (EF) delay is a transdiagnostic feature of paediatric neurodevelopmental conditions (NDCs) compared to controls. — g = 0.56 (95% CI 0.49-0.63) (All reported NDCs in participants under 18)
- EF delay is more severe in children with comorbid NDCs than those with a single NDC diagnosis. — g = 0.72 (comorbid) vs g = 0.53 (single NDC) (Comparison of comorbid vs single NDC recruitment groups)
- Informant-based measures report significantly larger EF delays than performance-based measures. — g = 1.47 (informant) vs g = 0.49 (performance) (Across NDCs)
- Use of DSM-5 criteria is associated with larger EF delay effect sizes compared to previous DSM editions. — g = 0.92 (DSM-5) vs g = 0.49 (DSM-III) and g = 0.47 (DSM-IV) (Overall EF measures)
- Children with ADHD show greater EF delays in attention, response inhibition, and working memory compared to children with tic disorders (TD). — Attention g = 0.46; Response inhibition g = 0.46; Working memory g = 1.49 (ADHD vs TD comparison)
- Children with ASD show greater delays in set-shifting compared to children with ADHD. — g = -0.19 (ADHD performed better) (ASD vs ADHD comparison)
- Setup
- 180 studies; 2,031 outcomes; participants under 18 years old; EF domains including attention, fluency, set-shifting, set-switching, response inhibition, planning, and working memory.
- How
- Systematic review and meta-analysis of 180 studies using Hedges’ g effect size estimates. The authors analyzed seven EF domains across various NDCs, employing moderator analyses for age, gender, DSM edition, and assessment type.
- Limitations
- Low number of studies for lesser-investigated NDCs (e.g., FASD) · IQ was not included as a primary covariate · Lack of longitudinal study data · Inconsistent control for comorbidity across included studies
Summarized by Gemma 4 from the open-access full text · 3 Oct 2026. Read it