Executive Functioning in Youth With and Without Chronic Pain

Abstract

Objectives: Preliminary research in youth with chronic pain suggests differences in attention and working memory, which has been similarly demonstrated in adults with chronic pain. There has been little research on other aspects of executive functioning (EF) in this population despite its critical role in problem solving, school functioning, and coping. This study aimed to examine differences in several aspects of EF between youth with chronic pain and a nonchronic pain comparison group using performance-based neuropsychological tests and a behavior rating scale. Materials and Methods: Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a general intelligence screener. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent-report and self-report behavior rating of EF was also administered. Results: Recruitment from 2 tertiary-care pain clinics resulted in a sample of 26 youth with chronic pain (80.8% girls) and their parents. A comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants with chronic pain had significantly lower scores on several performance-based tests of working memory/divided attention, inhibition, and flexibility/alternating attention than the comparison group. Statistically significant group differences were also found on behavior ratings of emotion control, shifting, task initiation and completion, working memory, planning and organization, overall emotion and cognitive regulation as well as global EF. Covariate analysis was conducted in all analyses where there were significant group differences and several observed group differences remained. Discussion: This study is one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behavior ratings. Our findings suggest EF differences in youth with chronic pain, across a variety of domains and may suggest risk for specific cognitive processing weaknesses in this population. Medical and educational teams should work toward identification, treatment, and compensatory support for EF within individualized pain management for youth.

Advancing the Measurement of Executive Functioning in Pediatric Chronic Pain

“…For example, Verhoeven and colleagues [18] measured Inhibitory Control and WM, however these are only two of several EF domains. Turner and colleagues [50] included multiple measurement methods, and their results demonstrated concordance between performance-based tasks and behavior ratings. However, the study sample was small (n = 26 youth with chronic pain), thus generalizability is limited.…”

“…Given the complex, multifaceted nature of EF it is perhaps not surprising that those studying cognitive difficulties in the context of pediatric chronic pain have utilized a variety of measurement approaches (Table 1). Some have cast a wide net, broadly gauging EF across various domains [15,16,49,50], whereas others have focused more narrowly on individual components of EF, such as working memory [17,23,51]. In some cases, researchers have utilized measures of EF without explicitly referring to EF [17,51].…”

“…Participants were instructed to identify the ink color and suppress their automatic response to read the word. More recently, Turner and colleagues [50] used several performance-based experimental EF tasks (See Table 1) and found that youth with chronic pain had significantly lower scores on several tests of working memory, divided attention, inhibition, and flexibility.…”

“…Research on EF measurement-regardless of clinical population-has consistently found low magnitude correlations between different methods of measuring EF [50]. For example, self-reports of EF (e.g., BRIEF-2) are often weakly related to experimental performance-based EF measures (e.g., Go/No-Go [53], Wisconsin Card Sort Task [50]).…”

“…Research on EF measurement-regardless of clinical population-has consistently found low magnitude correlations between different methods of measuring EF [50]. For example, self-reports of EF (e.g., BRIEF-2) are often weakly related to experimental performance-based EF measures (e.g., Go/No-Go [53], Wisconsin Card Sort Task [50]). This is partially due to the fact that questionnaire measures of EF tend to focus on "everyday" manifestations of EF impairment, as opposed to EF in a context-free, optimally controlled environment.…”