Executive Functioning in Pediatric Multiple Sclerosis: Considering the Impact of Emotional and Psychosocial Factors

In adults, multiple sclerosis (MS) is associated with executive dysfunction, anxiety, depression, fatigue, and lowered quality of life. Similar problems may occur in pediatric MS, but the relationships between these variables have not yet been investigated. This study examined the associations among some of the most salient cognitive (executive functioning), psychological (anxiety, depression), and psychosocial (fatigue, quality of life, externalizing symptoms) factors affecting children with MS. Sixty-five patients with MS ages 6 to 18 were evaluated through the UCSF Regional Pediatric Multiple Sclerosis Center. Participants completed a neuropsychological assessment battery including the Verbal Fluency Test and Trail Making Test. Parents and children also completed rating forms assessing emotional functioning, fatigue, quality of life, and executive functioning. After controlling for significant demographic variables, higher levels of anxiety and depressive symptoms were associated with executive dysfunction on testing and self-report. In addition, higher reported executive dysfunction was associated with psychosocial difficulties, including higher levels of fatigue, worse quality of life, and more severe externalizing symptoms. The present study furthers our knowledge of the psychological and psychosocial factors associated with neurocognitive outcomes in pediatric MS. Recognition of these variables can inform medical and psychological treatment, as well as interventions in the home and community, to maximize a positive developmental trajectory.