Executive Functioning in Swedish Youth: Informant Perspectives, Developmental Patterns, and Links to Clinical Profiles, Mental Health, and Academic Achievement
(2025)- Abstract
- This thesis examines executive functioning (EF) among Swedish youth. EF is defined as a set of neurocognitive processes regulating cognitive, emotional, and behavioral activities essential for goal-directed behavior. I assessed EF using the self-, parent-, and teacher-report forms from the original and second editions of the Behavior Rating Inventory of Executive Function (BRIEF and BRIEF2).
A primary aim of this thesis was to evaluate the psychometric properties of the Swedish BRIEF2 in a gender- and age-balanced community sample (Study I). In addition, I explored EF across clinical groups, including youth with neurodevelopmental disorders (NDDs) and psychiatric conditions such as obsessive compulsive disorder (OCD), anxiety,... (More) - This thesis examines executive functioning (EF) among Swedish youth. EF is defined as a set of neurocognitive processes regulating cognitive, emotional, and behavioral activities essential for goal-directed behavior. I assessed EF using the self-, parent-, and teacher-report forms from the original and second editions of the Behavior Rating Inventory of Executive Function (BRIEF and BRIEF2).
A primary aim of this thesis was to evaluate the psychometric properties of the Swedish BRIEF2 in a gender- and age-balanced community sample (Study I). In addition, I explored EF across clinical groups, including youth with neurodevelopmental disorders (NDDs) and psychiatric conditions such as obsessive compulsive disorder (OCD), anxiety, and depression (Studies II and III). Finally, I investigated the associations between EF, mental health, and academic achievement in an adolescent community sample (Study IV).
Study I supported the BRIEF2’s original three-factor structure (Behavioral, Emotional, and Cognitive Regulation) across informants, with internal consistency ranging from moderate to excellent. The model fit was weaker for teacher ratings. Age and gender differences varied by informant: adolescents reported greater EF difficulties with age, while parents and teachers reported fewer. Girls self-reported greater EF difficulties than did boys, although parents and teachers generally reported the opposite, except in emotional control. All of these differences had small effect sizes.
Study II revealed that youth with OCD or anxiety disorders exhibited moderately elevated EF difficulties compared to community peers, but did not differ significantly from each other. EF was not associated with OCD symptom dimensions, severity, or treatment outcome.
In Study III, youth with NDDs showed substantial EF impairments across all domains, regardless of comorbidity, compared to both non-NDD (i.e., anxiety disorders) and control groups. The non-NDD and control groups also differed significantly on six of the nine EF domains, with moderate effect sizes. No significant differences were found between the NDD-only and NDD plus comorbidity groups, although youth with dual NDDs exhibited more EF difficulties than did those with a single NDD.
Study IV indicated that adolescents with self-reported NDDs reported significantly more EF difficulties, especially among younger students. Self-rated EF was strongly linked to internalizing symptoms, while teacher EF ratings showed weaker associations, suggesting that such difficulties may be less visible in classroom settings. Girls self-reported having more EF difficulties, whereas teachers rated more difficulties in boys. Teacher-rated EF was the strongest predictor of academic performance. Among girls, internalizing symptoms strengthened the link between EF and achievement, possibly reflecting compensatory strategies.
Together, these findings contribute to an understudied area of everyday EF in adolescents as assessed by multiple informants. The key takeaways include the importance of considering both informant and gender perspectives, as well as specific EF domains (e.g., shifting, emotional control, organization) for mental health and academic success. I discuss the methodological and conceptual challenges, encouraging future researchers to refine EF assessments and continue investigating EF, particularly among adolescent girls, to inform school-based interventions. (Less) - Abstract (Swedish)
- I denna avhandling undersöktes exekutiva funktioner (EF) hos svenska barn och ungdomar. EF definierades som en uppsättning neurokognitiva processer som reglerar kognitiva, emotionella och beteendemässiga aktiviteter, viktiga för målinriktat handlande. EF bedömdes med hjälp av själv-, föräldra- och lärarskattningar av den första och andra upplagan av Behavior Rating Inventory of Executive Function (BRIEF och BRIEF2). Ett huvudsakligt syfte med avhandlingen var att utvärdera den svenska versionen av BRIEF2 i en svensk kontext (Studie I). Vidare undersöktes EF i kliniska grupper, vilka innefattade ungdomar med neuropsykiatriska funktionsnedsättningar (NPF), samt psykiatriska tillstånd såsom tvångssyndrom (OCD), ångest och depression (Studie... (More)
- I denna avhandling undersöktes exekutiva funktioner (EF) hos svenska barn och ungdomar. EF definierades som en uppsättning neurokognitiva processer som reglerar kognitiva, emotionella och beteendemässiga aktiviteter, viktiga för målinriktat handlande. EF bedömdes med hjälp av själv-, föräldra- och lärarskattningar av den första och andra upplagan av Behavior Rating Inventory of Executive Function (BRIEF och BRIEF2). Ett huvudsakligt syfte med avhandlingen var att utvärdera den svenska versionen av BRIEF2 i en svensk kontext (Studie I). Vidare undersöktes EF i kliniska grupper, vilka innefattade ungdomar med neuropsykiatriska funktionsnedsättningar (NPF), samt psykiatriska tillstånd såsom tvångssyndrom (OCD), ångest och depression (Studie II och III). Slutligen analyserades sambanden mellan EF, psykisk hälsa och skolprestationer hos svenska högstadieelever (Studie IV).
Studie I bekräftade BRIEF2:s ursprungliga trefaktorsstruktur (beteende-, emotionell- och kognitiv reglering). Ålders- och könsskillnader varierade beroende på informant: ungdomar rapporterade ökade EF-svårigheter med stigande ålder, medan föräldrar och lärare rapporterade minskade svårigheter. Flickor självrapporterade fler EF-svårigheter än pojkar, medan föräldrar och lärare generellt sett rapporterade motsatsen, förutom för emotionell kontroll. Samtliga skillnader hade små effektstorlekar.
Studie II visade att ungdomar med OCD eller ångestsyndrom uppvisade måttligt förhöjda EF-svårigheter jämfört med jämnåriga utan diagnos, men de kliniska grupperna skilde sig inte signifikant från varandra. EF var inte associerat med specifika OCD-dimensioner, symtomsvårighetsgrad eller behandlingsutfall.
I Studie III uppvisade ungdomar med NPF omfattande EF-nedsättningar inom samtliga domäner, oavsett komorbiditet, jämfört med både icke-NPF-gruppen (dvs. ångestsyndrom) och kontrollgruppen. Även grupperna icke-NPF och kontroll skilde sig signifikant åt på sex av de nio EF-domänerna, med måttliga effektstorlekar. Ungdomar med dubbeldiagnos (ADHD och Autism) uppvisade större EF-svårigheter än de med en enbart en NPF-diagnos.
Studie IV visade att ungdomar med självrapporterade NPF rapporterade signifikant fler EF-svårigheter, särskilt hos de yngre eleverna. Självskattade EF var starkt kopplade till internaliserande symtom (t ex ångest och depressionsproblematik), medan lärarskattningarna visade svagare samband, vilket antyder att dessa svårigheter kan vara mindre synliga i klassrumssammanhang. Flickor självrapporterade fler EF-svårigheter, medan lärare skattade pojkars svårigheter som mer utmärkande. Lärarskattade EF visade sig vara den starkaste prediktorn för skolprestationer (betyg). Hos flickor förstärkte internaliserande symtom (ångest och depression) sambandet mellan EF och skolprestation, vilket potentiellt speglar kompensatoriska strategier.
Sammantaget bidrar dessa resultat till ett relativt outforskat område: beteendemässiga, vardagliga EF hos svenska barn och ungdomar, bedömda utifrån flera informanter. Centrala slutsatser är att det är viktigt att beakta både informant- och könsperspektiv, liksom specifika EF-domäner (t.ex. flexibilitet, emotionell kontroll, organisation) i relation till psykisk hälsa och skolframgång. Avhandlingen diskuterar metodologiska och konceptuella utmaningar relaterade till EF-begreppet och uppmuntrar framtida forskare att förfina bedömningen av EF och att särskilt undersöka själv- lärar- och föräldraskattade EF hos flickor. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/cf9c1142-7fc1-4b42-87a2-5fe61afab46f
- author
- Ilahi, Frida LU
- supervisor
-
- Daiva Daukantaité LU
- Eva Hoff LU
- opponent
-
- Associate Professor Huizinga, Mariëtte, Vrije Universiteit Amsterdam
- organization
- publishing date
- 2025-09
- type
- Thesis
- publication status
- published
- subject
- keywords
- executive function, executive functioning, adolecents, BRIEF2, Behavior Rating Inventory of Executive Function, mental health, ADHD, autism, OCD, anxiety, depression, academic achievement, developmental psychology
- pages
- 96 pages
- publisher
- Lund University (Media-Tryck)
- defense location
- Spoletorp Hörsal, Spolegatan 1R, Lund
- defense date
- 2025-10-17 13:00:00
- ISBN
- 978-91-8104-612-0
- 978-91-8104-613-7
- language
- English
- LU publication?
- yes
- id
- cf9c1142-7fc1-4b42-87a2-5fe61afab46f
- date added to LUP
- 2025-09-18 10:29:42
- date last changed
- 2025-09-23 10:10:35
@phdthesis{cf9c1142-7fc1-4b42-87a2-5fe61afab46f, abstract = {{This thesis examines executive functioning (EF) among Swedish youth. EF is defined as a set of neurocognitive processes regulating cognitive, emotional, and behavioral activities essential for goal-directed behavior. I assessed EF using the self-, parent-, and teacher-report forms from the original and second editions of the Behavior Rating Inventory of Executive Function (BRIEF and BRIEF2). <br/><br/>A primary aim of this thesis was to evaluate the psychometric properties of the Swedish BRIEF2 in a gender- and age-balanced community sample (Study I). In addition, I explored EF across clinical groups, including youth with neurodevelopmental disorders (NDDs) and psychiatric conditions such as obsessive compulsive disorder (OCD), anxiety, and depression (Studies II and III). Finally, I investigated the associations between EF, mental health, and academic achievement in an adolescent community sample (Study IV). <br/><br/>Study I supported the BRIEF2’s original three-factor structure (Behavioral, Emotional, and Cognitive Regulation) across informants, with internal consistency ranging from moderate to excellent. The model fit was weaker for teacher ratings. Age and gender differences varied by informant: adolescents reported greater EF difficulties with age, while parents and teachers reported fewer. Girls self-reported greater EF difficulties than did boys, although parents and teachers generally reported the opposite, except in emotional control. All of these differences had small effect sizes. <br/><br/>Study II revealed that youth with OCD or anxiety disorders exhibited moderately elevated EF difficulties compared to community peers, but did not differ significantly from each other. EF was not associated with OCD symptom dimensions, severity, or treatment outcome. <br/><br/>In Study III, youth with NDDs showed substantial EF impairments across all domains, regardless of comorbidity, compared to both non-NDD (i.e., anxiety disorders) and control groups. The non-NDD and control groups also differed significantly on six of the nine EF domains, with moderate effect sizes. No significant differences were found between the NDD-only and NDD plus comorbidity groups, although youth with dual NDDs exhibited more EF difficulties than did those with a single NDD. <br/><br/>Study IV indicated that adolescents with self-reported NDDs reported significantly more EF difficulties, especially among younger students. Self-rated EF was strongly linked to internalizing symptoms, while teacher EF ratings showed weaker associations, suggesting that such difficulties may be less visible in classroom settings. Girls self-reported having more EF difficulties, whereas teachers rated more difficulties in boys. Teacher-rated EF was the strongest predictor of academic performance. Among girls, internalizing symptoms strengthened the link between EF and achievement, possibly reflecting compensatory strategies. <br/><br/>Together, these findings contribute to an understudied area of everyday EF in adolescents as assessed by multiple informants. The key takeaways include the importance of considering both informant and gender perspectives, as well as specific EF domains (e.g., shifting, emotional control, organization) for mental health and academic success. I discuss the methodological and conceptual challenges, encouraging future researchers to refine EF assessments and continue investigating EF, particularly among adolescent girls, to inform school-based interventions.}}, author = {{Ilahi, Frida}}, isbn = {{978-91-8104-612-0}}, keywords = {{executive function; executive functioning; adolecents; BRIEF2; Behavior Rating Inventory of Executive Function; mental health; ADHD; autism; OCD; anxiety; depression; academic achievement; developmental psychology}}, language = {{eng}}, publisher = {{Lund University (Media-Tryck)}}, school = {{Lund University}}, title = {{Executive Functioning in Swedish Youth: Informant Perspectives, Developmental Patterns, and Links to Clinical Profiles, Mental Health, and Academic Achievement}}, url = {{https://lup.lub.lu.se/search/files/228226622/Frida_Ilahi_-_WEBB.pdf}}, year = {{2025}}, }