Meta-cognition and Psychopathology in Children and Adolescents

Abstract

Understanding of the cognitive mechanisms of psychopathology in adults has contributed to the development of promising advances in treatment. There remains a dearth of similar evidence in child and adolescent psychopathology. There are calls to bridge developmental and clinical approaches to research and a move to consider the applicability of adult models of psychopathology. This thesis explores the contribution of two related aspects of cognitive function that represent core components of the Self-Regulatory Executive Function (S-REF) model of adult psychopathology (Wells, 2009) in child and adolescent populations: executive function (EF) and meta-cognition. Paper one systematically reviews the evidence that EF assessed at or before 5 years is associated with symptoms of internalizing psychopathology to test for prospective associations and determine which dimensions of EF are most predictive of symptoms. Fourteen studies that included 3428 participants used longitudinal multi-panel designs and administered a performance measure of EF at or before 5 years. Statistics from tests of association between EF and a subsequently administered measure of internalizing psychopathology were examined. Overall, poorer performance on EF measures was associated with increased risk for internalizing problems, particularly anxiety. Measures of complex response inhibition such as the day/night task most consistently demonstrated significant association with psychopathology. However, the direction of effects varied as a function of child temperament and parenting experiences. Higher levels of response inhibition were associated with increased risk for psychopathology in children with temperamental vulnerability and experience of over-controlling parenting. The ability to flexibly shift attention was protective in similar contexts. The reviewed evidence indicates that measures of EF in early childhood could indicate risk for internalizing problems. Response inhibition and attention shifting may provide a target for early intervention. Future research should select, assess and report on specific EF components in relation to outcomes. Meta-cognitive beliefs (MCB) - implicit and explicit beliefs about cognition have been associated with psychopathology in adults and adolescents (Sun et al.,2018). Paper two aimed to test the independent contribution of MCB over and above theory of mind (ToM) to psychopathology in a high-risk adolescent sample. We assessed MCB in 41 adopted adolescents who were participating in a longitudinal study of outcomes in adoption. ToM was assessed during middle childhood and parents reported on child psychopathology during middle childhood and again in adolescence. We found no association between MCB and ToM. MCB but not ToM were positively correlated with psychopathology. Furthermore, adolescent reports of dysfunctional MCB were significantly positively associated with parent reported internalizing psychopathology independent of ToM, demographics and language. There was no linear association between MCB, ToM and extent of early maltreatment or adversity. This is consistent with previous studies of ToM and suggests that future research should focus on alternative aetiological mechanisms (e.g., emotion socialization). Findings suggest that the S-REF model of psychopathology may provide a useful framework for understanding the mechanisms of internalizing disorder in adolescent maltreated populations, which has important theoretical and clinical implications. Paper three provides an overview of the theoretical underpinnings of the thesis, methodological strengths and weaknesses of each paper and the implications of the findings for theory and clinical practice.

Date of Award	31 Dec 2018
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Adrian Wells (Supervisor)