Revue de neuropsychologie


Executive function in children: epistemological approach and clinical semiology Volume 4, issue 4, Décembre 2012

Universités Angers-Nantes, faculté des lettres, langues et sciences humaines, laboratoire de psychologie des Pays de Loire, LUNAM, EA4638, Processus de pensée et contextes, 11, boulevard Lavoisier, 49045 Angers cedex 01, France, CHU de Nantes, hôpital Mère-Enfant, Centre référent du langage, unité pédiatrique des troubles d’apprentissage, Nantes, France, CHU de Nantes, Centre de compétence nantais de neurofibromatose, Nantes, France, CHU d’Angers, département de neurologie, unité de neuropsychologie, Angers, France, Université de Savoie, laboratoire interuniversitaire de psychologie, Chambéry, France

It has been a long time since executive function (EF) and their disorders in children have received full interest in neuropsychology. Over the past 25 years, however, there is growing evidence that impairment of EF is relatively common in the paediatric population. Clinical issues in EF disorders have become a topic of considerable interest as the development of these processes are considered to have a main role in learning abilities, behaviour regulation and social knowledge acquisition. In this paper, we firstly propose to examine the different factors, which contribute to the delayed development of systematic studies in this research area, towards an epistemological approach. Among these factors are intrinsic developmental changes associated to frontal lobe and EF components, absence of consensual theoretical framework, late emergence of adapted assessment tools, early plasticity long-lasting conception, and difficulty to read the executive symptoms. All of these factors should be considered to allow a better definition of the specific features associated with EF disorders within the context of child neuropsychology. Secondly, we try to outline the main characteristics of executive dysfunction in paediatric diseases, relying on recent research data showing an early vulnerability of frontal-subcortical neuronal circuits in both acquired and neurodevelopmental disorders. Case and cross-sectional studies show that EF impairment can involve regulation of social behaviour and/or a wide range of cognitive processes as described in brain-injured adults. The following statements can be made about these deficits: (1) they are frequent even if (2) their symptomatology is variable and possibly dissociated, (3) with immediate or delayed deficiencies onset but generally lasting effects. Executive dysfunction often results in (4) severe consequences for school and social integration. In addition (5), clinical manifestations could depend on intrafrontal lesions localization. Accordingly, a systematic early and longitudinal investigation of EF in varied paediatric clinical settings is strongly recommended.