New research indicates that attentional dysregulation is a crucial factor that connects cognitive impairments and various mental health problems in adolescents. The study, published in Scientific Reports, highlights the importance of understanding and addressing cognitive performance in the context of mental health. It suggests that targeting attentional difficulties early on may help prevent or alleviate cognitive and emotional problems in individuals with psychiatric conditions.

The motivation behind this study was to investigate the relationship between cognitive deficits and psychopathology, specifically focusing on attention dysregulation, which refers to difficulties in controlling and focusing attention, as a potential key factor that connects various mental health problems.

Earlier studies have shown that reduced cognitive performance is common across different psychiatric disorders. There is also a substantial overlap among different forms of mental health issues in population samples. However, the exact cause and effect relationship between these factors is still unclear.

“Mental health problems can have variable trajectories and largely different symptoms, which psychiatry continues to struggle to research and understand,” explained study author Clark Roberts, who recently obtained his PhD in Psychiatry/Clinical Neuroscience at the University of Cambridge.

“While hallmark symptoms in categorical mental disorders can be quite distinct, psychopathological dimensions tend to covary together – referred to as the P-Factor. Confusingly for precision psychiatry, categorical diagnosis in patient samples all appear to show general deficits in ranging cognitive batteries employed by researchers (C-factor).

“Nosology, the branch of medicine concerned with classifying diseases and mental disorders, has struggled to make sense of this, given its general aim for precision in diagnosis,” Roberts said. “While the P- and C-Factors inform us of widespread comorbidity in mental disorders, they still do little in explaining hallmark symptoms, the connections and dynamics between symptoms, or potentially influential transdiagnostic mechanisms and features.”

“Therefore, the aim of this research was to examine potentially central features among covarying psychopathological dimensions and frequently observed general cognitive deficits therein.”

To address these questions, the researchers conducted a longitudinal analysis using the Adolescent Brain Cognitive Development (ABCD) cohort, which included a large sample of 11,876 adolescents aged 9-12. The study employed an extensive cognitive task battery and measured various dimensions of psychopathology.

The cognitive outcomes were measured using age-corrected measures of fluid and crystallized intelligence, which were derived from different cognitive tests. The fluid outcome encompassed executive functions such as inhibitory control, shifting, and working memory, while the crystallized abilities were related to language and verbal tasks.

The psychopathological dimensions were assessed using the Parent-Child Behavioral Checklist (CBL), which contains distinct DSM-oriented psychiatric symptoms related to ADHD, anxiety, depression, and other dimensions. Parents rated their child’s frequency and accuracy of these symptoms during testing.

The researchers had two main hypotheses: first, that attentional dysregulation would be responsible for the general cognitive difficulties seen in people with different psychiatric disorders, and second, that it would be strongly associated with other mental health issues.

“Attention is a central function for effective learning and cognition in brains, often acting as an interface, and serving to conditionally parametrize information for agents interacting in complex environments,” Roberts told PsyPost. “My interest was to examine 1.) the degree to which attention dysregulation may influence and connect with wide-ranging mental health problems and 2.) potentially functions as a bridge between mental health problems and deficits in commonly used cognitive tasks employed by researchers.”

The findings supported these hypotheses. The study showed that the cognitive problems commonly observed in people with mental health conditions are largely influenced by their level of attentional dysregulation, especially in cases of anxiety or low mood.

Interestingly, individuals experiencing anxiety or depression without the attentional dysregulation characteristic of Attention-Deficit/Hyperactivity Disorder (ADHD) did not show significant cognitive impairments. In other words, when individuals experience anxiety or depression without these ADHD traits, their cognitive performance seems to be relatively intact and, in some cases, even better than controls. This suggests that attentional dysregulation might be the primary factor contributing to cognitive difficulties in these conditions.

“In one of the largest cohorts to date, with over 11,000 children, the relationship between low mood/anxiety and wide-ranging cognitive outcomes is relatively weak,” Roberts explained. “In fact, when controlling for attention dysregulation proxies, any predictive relationships go away. Further, individuals who experience high anxiety and low mood but concurrently score low in dimensions of attention dysregulation are not only comparable to controls, but outperform them in some cognitive tasks. Therefore, while low mood/anxiety are considered subjectively negative states, they may not necessarily be clear proxies for dysfunctional components of biology or general cognition on their own within some ranges.”

Moreover, the researchers found that attentional dysregulation might play a role in connecting various mental health problems. For example, it linked to symptoms of anxiety and depression, and it was associated with traits like impulsivity, which could influence cognitive performance.

“Dysregulated attentional control systems in the brain – with symptoms sometimes contentiously referred to as ADHD at developmental extremes – can impair normative cognitive/educational performance and generate negative ongoing social interactions,” Roberts told PsyPost. “These then interactively and straightforwardly form feedback loops with anxiety and depression (and many other mental health problems).”

“This research confirms that developmental attention problems can exacerbate wide-ranging mental health dimensions, perhaps in part by developmentally and/or causally maintaining the structure of psychopathological networks, and by producing ongoing negative feedback with the environment whether socially or cognitively. We explored several important and distinct bridging symptoms and feedback occurring between attention problems and frequently comorbid dimensions of anxiety/low mood.”

The researchers also observed that perfectionism seemed to buffer against some of the cognitive and educational deficits linked to other psychopathological traits. Perfectionism refers to having high standards and striving for excellence in one’s actions and achievements. Individuals with high levels of perfectionism may be highly motivated to perform well in tasks, and this intrinsic motivation towards better performance appeared to positively influence cognitive outcomes.

Moderate levels of trait worry, which is related to anxiety, also showed a beneficial effect on cognitive performance, forming an inverted U-shaped relationship. This means that some worry or anxiety may actually enhance cognitive functioning up to a certain point.

“Creating a more nuanced and perhaps surprising picture, perfectionism seems to be a dimension positively associated with nearly all negative mental health dimensions while also being positively associated with cognitive performance,” Roberts told PsyPost. “In fact, some of the highest scores on cognitive outcomes were adolescents who showed moderate levels of anxiety and high perfectionism. Perfectionism may actually buffer against some of the negative outcomes of other psychopathological dimensions on cognitive performance, perhaps due to how it represents some individuals’ higher regard for others’ evaluations.”

But the study, like all research, includes some caveats.

“Likely the biggest limitation is that this study relied on parent assessments of adolescent attention problems and is therefore subject to some measurement bias. Importantly, attention is a multifarious construct in psychology research which can confusingly refer to many different processes and measurements,” Roberts explained.

“In this context, attention dysregulation likely refers to inefficient control of self-motivational systems directing normative top-down goal-directed actions over time given the metrics used. Thankfully, this was an extensive sample and parents have lots of exposure to their children in many contexts.”

“Further, distinct mental health problems may occur at different developmental stages, thus it is important to confirm this work in adults,” Roberts said. “Lastly, attention dysregulation can be both a cause and effect of mental health problems and while some of these analyses suggest there is a potentially causal developmental relationship, it is not possible to understand these dynamics better without further research.”

Nevertheless, the study provides evidence that attentional dysregulation is a key factor contributing to cognitive difficulties in adolescents, especially those with anxiety or low mood. While general mental health issues might be linked to cognitive impairments, attention regulation problems appear to be an essential factor in these impairments.

“ADHD remains a contentious diagnostic classification,” Roberts added. “While some do suffer debilitating extremes, it’s likely not as binary as once thought. Preliminary evidence suggests ADHD is associated with deviations in brain development and function, but it remains unclear whether this may be an adaptive function in some contexts – such as foraging. Still, contemporary normative demands in vocational and social environments may strongly exacerbate negative features of poor attentional control – which likely everybody experiences to varying degrees.”

The study, “Impact and centrality of attention dysregulation on cognition, anxiety, and low mood in adolescents“, was authored by Clark Roberts, Barbara J. Sahakian, Shuquan Chen, Samantha N. Sallie, Clare Walker, Simon R. White, Jochen Weber, Nikolina Skandali, Trevor W. Robbins, and Graham K. Murray.


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