Executive (Dys)Functions and ODD and CD: A Systematic Review and Meta-Analysis

Objective: Precursors of antisocial behavior in children may be associated with neuropsychological deficits, namely in executive functions (EF). The main objective of this systematic review and meta-analysis was to synthesize evidence of the relation between EF performance and early manifestations of antisocial behavior in children and adolescents. Method: The procedures of this systematic review and meta-analysis were based on the PRISMA recommendations. The review was based on a systematic search in the EBSCOhost and Pubmed databases. Fifty studies were included in this review, 37 of which contributed with data for meta-analysis. All studies examined the possible relation between the EF measures and behavior problems in childhood and adolescence. Meta-analytical procedures were performed, and the overall effect size was calculated from random-effect models, using the Comprehensive Meta-Analysis software. Results: A substantial part of the studies report EF deficits in children and adolescents who present behavior problems, revealing that these deficits are already present in youth, long before being associated with antisocial behavior in adults, especially when in comorbidity with attention-deficit hyperactivity disorder (ADHD). Specifically, typical controls (TC) performed significantly better than disruptive behavior disorders (DBD) groups on measures of overall EF, g = -.35, 95% CI [-0.48, -0.22], p < .001. Similar results were found for working memory, g = -.26, 95% CI [-0.45, -0.07], p < .001, cognitive inhibition, g = -.30, 95% CI [-0.57, -0.04], p = .03, behavioral inhibition, g = -.45, 95% CI [-0.71, -0.19], p = .001, and cognitive flexibility (tests scores), g = -.31, 95% CI [-0.60, -0.02], p = .04. Comparing DBD + ADHD participants with TC, no significant differences were found, either for overall EF or for each dimension. Finally, DBD participants performed better than DBD + ADHD participants on measures of overall EF, g = .20, 95% CI [0.08, 0.33], p = .002. Conclusion: These findings are in line with neuropsychological theories arguing that executive dysfunctions may interfere with the children's and/or adolescents' ability to control their own conduct, in order to inhibit inappropriate behaviors in favor of the prosocial ones. This review and meta-analysis also identify the main characteristics and potential limitations of the existing studies.