Data-driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders.

BACKGROUND: Impairment of executive function (EF), the goal-directed regulation of thoughts, actions, and emotions, drives negative outcomes and is common across neurodevelopmental disorders including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). A primary challenge to its amelioration is heterogeneity in symptom expression within and across disorders. Parsing this heterogeneity is necessary to attain diagnostic precision, a goal of the NIMH Research Domain Criteria Initiative. We aimed to identify transdiagnostic subtypes of EF that span the normal to impaired spectrum and establish their predictive and neurobiological validity. METHODS: Community detection was applied to clinical parent-report measures in 8-14-year-old children with and without ADHD and ASD from two independent cohorts (discovery N = 320; replication N = 692) to identify subgroups with distinct behavioral profiles. Support vector machine (SVM) classification was used to predict subgroup membership of unseen cases. Preliminary neurobiological validation was obtained with existing functional magnetic resonance imaging (fMRI) data on a subsample (N = 84) by testing hypotheses about sensitivity of EF subgroups versus DSM categories. RESULTS: We observed three transdiagnostic EF subtypes characterized by behavioral profiles that were defined by relative weakness in: (a) flexibility and emotion regulation; (b) inhibition; and (c) working memory, organization, and planning. The same tripartite structure was also present in the typically developing children. SVM trained on the discovery sample and tested on the replication sample classified subgroup membership with 77.0% accuracy. Split-half SVM classification on the combined sample (N = 1,012) yielded 88.9% accuracy (this SVM is available for public use). As hypothesized, frontal-parietal engagement was better distinguished by EF subtype than DSM diagnosis and the subgroup characterized with inflexibility failed to modulate right IPL activation in response to increased executive demands. CONCLUSIONS: The observed transdiagnostic subtypes refine current diagnostic nosology and augment clinical decision-making for personalizing treatment of executive dysfunction in children.

Attachment and emotion regulation: A person-centred examination and relations with coping with rejection, friendship closeness, and emotional adjustment.

Guided by attachment theory of emotion regulation (ER), the current study utilized a person-centred approach to identify clusters of individuals that differed in their attachment representations and ER, and further examined individual differences in socio-emotional functioning based on these profiles. Participants included 658 emerging adults (M = 19.9, SD = 2.7, 65.5% female) who completed surveys measuring responses to rejection, friendship closeness, and emotional maladjustment. Five clusters were identified: secure regulated (19%), disorganized unregulated (21%), anxious unregulated (16%), emotive (21%), and avoidant suppressor (22%). Each group displayed unique patterns, with the secure regulated group reporting significantly less withdrawal, retribution, rumination, and emotional maladjustment, and the disorganized unregulated group reporting the poorest functioning across all indicators. Significant cluster × sex effects were also found for friendship closeness. These findings suggest the importance of considering attachment and ER, and implications for attachment theory and development are discussed. Statement of contribution What is already known on this subject? Insecure attachment representations are a significant risk factor for poorer outcomes across development. Hyperactivating and deactivating strategies are maladaptive responses to coping with emotional threat. These strategies are an extension of the internal working model and positive correlates of poorer functioning. What does this study add? Previous studies have over-relied on variable-centred approaches to replicate findings of attachment theory. A person-centred approach allowing for the joint consideration of patterns of both attachment and ER strategies. The identification of five novel profiles revealing unique differences in three important domains of functioning.