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Executive Functions and Emotion Regulation as Predictors of Internalising Symptoms among Adults with Down Syndrome: A Transdiagnostic Perspective

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Title: Executive Functions and Emotion Regulation as Predictors of Internalising Symptoms among Adults with Down Syndrome: A Transdiagnostic Perspective
Language: English
Authors: García-Villamisar, Domingo, Álvarez-Couto, María, del Pozo, Araceli
Source: Journal of Intellectual & Developmental Disability. 2020 45(3):204-210.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 7
Publication Date: 2020
Document Type: Journal Articles
Reports - Research
Descriptors: Executive Function, Emotional Response, Predictor Variables, Down Syndrome, Adults, Depression (Psychology), Anxiety
DOI: 10.3109/13668250.2019.1669004
ISSN: 1366-8250
Abstract: Introduction: There is evidence of high rates of psychopathological disorders such as anxiety or depression in adults with Down syndrome. Additionally, difficulties in executive functions and emotion regulation play an essential role in adaptive functioning of people with Down syndrome. Method: We used different questionnaires with a sample of 42 adults with Down syndrome (aged 18-40 years) to determine if difficulties in executive functions and emotion regulation are related to and can predict internalising symptoms. Results: Positive and significant correlations were found between dysexecutive functioning and emotion dysregulation and internalising symptoms. Multiple linear regression analyses indicated that dysexecutive functioning and emotion dysregulation are both predictors of the existence of internalising symptoms. Conclusions: These findings suggest that intervention in emotion regulation and executive functions must be taken into account in order to positively influence the presence of internalising symptoms. Further research is needed to attend to both capacities comprehensively, especially concerning emotion regulation.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1261383
Database: ERIC
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  Value: <anid>AN0144525229;ddi01sep.20;2020Jul14.05:06;v2.2.500</anid> <title id="AN0144525229-1">Executive functions and emotion regulation as predictors of internalising symptoms among adults with Down syndrome: A transdiagnostic perspective </title> <p>Introduction: There is evidence of high rates of psychopathological disorders such as anxiety or depression in adults with Down syndrome. Additionally, difficulties in executive functions and emotion regulation play an essential role in adaptive functioning of people with Down syndrome. Method: We used different questionnaires with a sample of 42 adults with Down syndrome (aged 18–40 years) to determine if difficulties in executive functions and emotion regulation are related to and can predict internalising symptoms. Results: Positive and significant correlations were found between dysexecutive functioning and emotion dysregulation and internalising symptoms. Multiple linear regression analyses indicated that dysexecutive functioning and emotion dysregulation are both predictors of the existence of internalising symptoms. Conclusions: These findings suggest that intervention in emotion regulation and executive functions must be taken into account in order to positively influence the presence of internalising symptoms. Further research is needed to attend to both capacities comprehensively, especially concerning emotion regulation.</p> <p>Keywords: Executive functions; emotion regulation; down syndrome; predictors; internalising symptoms</p> <p>Down syndrome (DS) is currently the leading genetic cause of intellectual disability (Gunbey et al., [<reflink idref="bib12" id="ref1">12</reflink>]; Kruszka et al., [<reflink idref="bib16" id="ref2">16</reflink>]), which refers to a neurodevelopmental disorder that involves intellectual and adaptive functioning deficits (Marchal et al., [<reflink idref="bib20" id="ref3">20</reflink>]).</p> <p>According to the recent literature (Belva & Matson, [<reflink idref="bib2" id="ref4">2</reflink>]; Mallardo, Cuskelly, White, & Jobling, [<reflink idref="bib19" id="ref5">19</reflink>]; Peña-Salazar et al., [<reflink idref="bib26" id="ref6">26</reflink>]; Platt, Keyes, McLaughlin, & Kaufman, [<reflink idref="bib27" id="ref7">27</reflink>]), there is a high probability that people with intellectual disabilities (ID) will develop some psychopathology compared to the general population: 65.1% <emph>v.</emph> 52.7% for any disorder and 30.5% <emph>v.</emph> 18.4% for specific phobia (Platt et al., [<reflink idref="bib27" id="ref8">27</reflink>]). While people with DS are less likely to have psychopathological disorders than other people with ID (Straccia, Baggio, & Barisnikov, [<reflink idref="bib36" id="ref9">36</reflink>]; Tassé et al., [<reflink idref="bib37" id="ref10">37</reflink>]), they are more likely to experience anxiety or depression disorders (Cunningham, [<reflink idref="bib4" id="ref11">4</reflink>]; Foley et al., [<reflink idref="bib9" id="ref12">9</reflink>]; Walton & Kerr, [<reflink idref="bib39" id="ref13">39</reflink>]).</p> <p>Depression is the most frequent psychopathology in DS with a prevalence rate ranging from 5% to 12% (Tassé et al., [<reflink idref="bib37" id="ref14">37</reflink>]; Walton & Kerr, [<reflink idref="bib39" id="ref15">39</reflink>]). Although it may appear at any time throughout the life span, research has shown there is a higher incidence in the adolescent and young adult population (Cunningham, [<reflink idref="bib4" id="ref16">4</reflink>]; Straccia et al., [<reflink idref="bib36" id="ref17">36</reflink>]; Walton & Kerr, [<reflink idref="bib39" id="ref18">39</reflink>]) compared with other development stages, such as childhood. In addition, numerous studies (e.g., Straccia et al., [<reflink idref="bib36" id="ref19">36</reflink>]; Tassé et al., [<reflink idref="bib37" id="ref20">37</reflink>]; Walton & Kerr, [<reflink idref="bib39" id="ref21">39</reflink>]) have shown an increase in the presence of depression as age increases, so the likelihood of developing depression in people with DS enhances with age. Similarly, anxiety can appear at any moment during the person's life, being some stressful event that has not been adequately handled one of the most common triggers for people with DS (Cunningham, [<reflink idref="bib4" id="ref22">4</reflink>]). As for depression, higher rates are found during adolescence and adulthood (Peña-Salazar et al., [<reflink idref="bib26" id="ref23">26</reflink>]; Platt et al., [<reflink idref="bib27" id="ref24">27</reflink>]).</p> <p>In terms of symptomatology, in a study involving 49 people aged 13–29 years with DS who were seen in specialised psychiatric clinics in the USA, cognitive impairment and behavioural changes, such as irritability and social withdrawal, were the most common depression symptoms (Dykens et al., [<reflink idref="bib7" id="ref25">7</reflink>]). Symptomatology of anxiety was characterised by generalised excessive preoccupations, specific fears, and, to a lesser extent, repetitive and/or compulsive behaviours (Dykens et al., [<reflink idref="bib7" id="ref26">7</reflink>]). These results were consistent with those of Walton and Kerr ([<reflink idref="bib39" id="ref27">39</reflink>]) literature review. Thus, these internalising symptoms interact in significant ways with the existing cognitive phenotype of DS.</p> <p>The characteristics of executive functions play an important role in the cognitive phenotype in DS. Executive functions refer to a set of skills that regulate people's actions and behaviour to solve problems to achieve short-, medium- and long-term goals (Diamond, [<reflink idref="bib6" id="ref28">6</reflink>]). There is a growing body of literature that recognises disturbance of executive functions (referred as executive dysfunction) as a feature in DS, where deficits in functions such as inhibition, planning, working memory, flexibility or problem solving are common (Costanzo et al., [<reflink idref="bib3" id="ref29">3</reflink>]; Daunhauer et al., [<reflink idref="bib5" id="ref30">5</reflink>]; Janke & Klein-Tasman, [<reflink idref="bib15" id="ref31">15</reflink>]; Will, Fidler, & Daunhauer, [<reflink idref="bib40" id="ref32">40</reflink>]). Although it seems that executive functions profile improves and maintains during adulthood, DS adults still have difficulties with these capabilities (Lee et al., [<reflink idref="bib17" id="ref33">17</reflink>]; Loveall, Conners, Tungate, Hahn, & Osso, [<reflink idref="bib18" id="ref34">18</reflink>]). These difficulties have an impact on adaptive behaviours (Tomaszewski, Fidler, Talapatra, & Riley, [<reflink idref="bib38" id="ref35">38</reflink>]), so taking these findings into account is vital for designing interventions appropriate to these deficits.</p> <p>Emotion regulation also has a pivotal role in adaptive behaviour. Emotion regulation is a process by which people try to understand the emotions they have experienced, when they have experienced them and how they have expressed those, so they can handle emotional situations and adapt their emotional response to the context (Gross, [<reflink idref="bib11" id="ref36">11</reflink>]). Thus, emotion regulation is the process of evaluating or valuing an experienced emotion, being able to manage one's emotions and controlling the expression of one's own feelings. Emotion regulation research in DS is limited (Pochon, Touchet, & Ibernon, [<reflink idref="bib30" id="ref37">30</reflink>]); however, researchers have shown some deficits in handling emotions in children with DS (Jahromi, Gulsrud, & Kasari, [<reflink idref="bib14" id="ref38">14</reflink>]).</p> <p>Most research in this area has focused on other components of emotion regulation, such as facial recognition of emotional expressions (Moore, Conners, & Barth, [<reflink idref="bib23" id="ref39">23</reflink>]; Pochon et al., [<reflink idref="bib30" id="ref40">30</reflink>]; Pochon & Declerq, [<reflink idref="bib28" id="ref41">28</reflink>]; Pochon & Declerq, [<reflink idref="bib29" id="ref42">29</reflink>]; Santana, De Souza, & Feitosa, [<reflink idref="bib33" id="ref43">33</reflink>]). Results have highlighted that children and adolescents with DS show some difficulties in areas such as recognition of complex emotions like fear or surprise, when compared to typically developing and nonspecific intellectual disability children (Moore et al., [<reflink idref="bib23" id="ref44">23</reflink>]; Pochon & Declerq, [<reflink idref="bib29" id="ref45">29</reflink>]; William, Wishart, Pitcairn, & Willis, [<reflink idref="bib41" id="ref46">41</reflink>]; Wishart, Cebula, Willis, & Pitcairn, [<reflink idref="bib43" id="ref47">43</reflink>]). These findings have important implications because they show that people with DS have difficulties with emotional features, and in so they have to be taken into account when it comes to intervention.</p> <p>During adulthood, people with DS face many changes such as differences between their peers' future experiences and theirs, participation in society or the death of a relative (Mallardo et al., [<reflink idref="bib19" id="ref48">19</reflink>]; Tassé et al., [<reflink idref="bib37" id="ref49">37</reflink>]). These situations may require both proper executive functioning and emotional regulation to be managed as adaptive as possible (Hofmann, Schmeichel, & Baddeley, [<reflink idref="bib13" id="ref50">13</reflink>]; Tomaszewski et al., [<reflink idref="bib38" id="ref51">38</reflink>]). Poor management could lead to the development of emotional disorders, such as depression or anxiety (internalising symptoms) (Hofmann et al., [<reflink idref="bib13" id="ref52">13</reflink>]). Considering that internalising disorders such as depression and anxiety are more common in people with DS, it is proposed to study both variables (executive functions and emotion regulation) in relation to the appearance of internalising symptoms in adults with DS, with the aim of knowing and analysing the existing association between them.</p> <p>It is now well established that executive functions and emotion regulation are crucial aspects of adaptive behaviour (Hofmann et al., [<reflink idref="bib13" id="ref53">13</reflink>]; Tomaszewski et al., [<reflink idref="bib38" id="ref54">38</reflink>]), so the study of both in DS is considered fundamental, due to deficits in both aspects.</p> <p>We take into account the transdiagnostic approach, which considers that psychopathological disorders share a set of cognitive and behavioural processes in their appearance and maintenance. Emotional disorders share common deficit mechanisms which, if properly intervened or worked on, imply an improvement in the intervention and treatment of the disorders (Aldao, [<reflink idref="bib1" id="ref55">1</reflink>]). In this research, executive functions and emotion regulation are considered important areas to reduce or prevent the appearance of the internalising symptoms, since both emotional regulation deficits and executive functioning would help to maintain the internalising symptoms.</p> <p>This paper examines if executive functions and emotion regulation influence and predict internalising symptoms in young people and adults with DS. We hypothesised that (<reflink idref="bib1" id="ref56">1</reflink>) there will be positive and significant correlations between executive dysfunction and emotion dysregulation and internalising symptoms and that (<reflink idref="bib2" id="ref57">2</reflink>) executive dysfunction and emotion dysregulation will be positive predictors for internalising symptoms.</p> <hd id="AN0144525229-2">Method</hd> <p></p> <hd id="AN0144525229-3">Participants</hd> <p>The convenience sample was recruited through contact with different associations that work towards the social and employment inclusion of people with intellectual disabilities in Madrid. Seven psychologists and educators from three specialised employment centres and two occupational centres who worked with the persons regularly filled the questionnaires. Each professional involved in this study had postgraduate training and experience in intellectual disability since they had been working with this group for approximately 10 years. Furthermore, professionals knew participants since they had joined the centres, and they worked with them on a daily basis providing psycho-educational services through different activities such as dance, social skills workshops, or support on the job. It can be, therefore assumed that these professionals knew participants quite well.</p> <p>The inclusion criteria were people with DS and mild to moderate intellectual disability (defined by the evaluations conducted at each centre and the clinical history of each participant where they had followed DSM 5 diagnostic criteria) aged 18–40 years. This age limitation was due to the likelihood of Alzheimer's disease in this population when they reach late adulthood (40–45 years and older) (Esbensen, Boshkoff, Amaral, Tan, & Macks, [<reflink idref="bib8" id="ref58">8</reflink>]). Diagnoses of dementia and depression can be mistaken with the presence of symptoms of depression since both impact cognitive functioning and lead to similar behavioural changes (Esbensen et al., [<reflink idref="bib8" id="ref59">8</reflink>]). We wanted to avoid this possible confusion by eliminating this potential confound.</p> <p>Forty-two participants (23 men and 19 women) formed the study sample. Their mean age was 26 years and 6 months (range 18–40 years, SD = 5.2 years). Informed consent was obtained from parents or authorised representatives of the participants prior to the administration of the measures.</p> <hd id="AN0144525229-4">Procedure</hd> <p>An information sheet with the approach and objectives of the investigation was written and it was given to different institutions that work with individuals with intellectual disabilities. The psychologists and educators explained the project to the families when necessary and picked up the participant consent form from each family. Professionals with responsibilities for the psychosocial area (psychologists and educators) were asked to identify individuals with DS aged 18–40 years, and to complete three questionnaires for every individual. Each evaluator covered information for five or six subjects evaluated one by one at different times.</p> <hd id="AN0144525229-5">Measures</hd> <p></p> <hd id="AN0144525229-6">Psychopathology Inventory for Mentally Retarded Adults-II (PIMRA-II, Belva & Matson, 2015...</hd> <p>We assessed internalising symptoms with the Psychopathology Inventory for Mentally Retarded Adults-II (PIMRA-II). This questionnaire assesses psychopathology in individuals with mild to moderate intellectual disabilities. It is comprised of 88 items and 9 subscales: depression (13 items), attention deficit hyperactivity disorder (ADHD) (9 items), autism spectrum disorder (ASD) (8 items), psychosexual disorder (9 items), somatic disorder (8 items), anxiety (13 items), behaviour disorder (9 items), psychosis (9 items), and mania (7 items). The subscales Depression (e.g., depressed mood most of the day, almost every day, as indicated by a subjective report or observation by others) and Anxiety (e.g., often complains of dizziness, chest pain, or shortness of breath despite evidence of not having a physical problem) were used (26 items as a whole) in this study. The inventory is rated on a 3-point scale (0 = <emph>it is never a problem</emph>; 1 = <emph>it is sometimes a problem</emph>; 2 = <emph>it is very often a problem</emph>) and items summed to produce a total score. In our investigation, this questionnaire had a good internal consistency (<emph>α</emph> =.782 Depression scale of Psychopathology Inventory for Mentally Retarded Adults-II; and <emph>α</emph> =.822 Anxiety scale of Psychopathology Inventory for Mentally Retarded Adults-II).</p> <hd id="AN0144525229-7">Dysexecutive Questionnaire (DEX, Wilson, Alderman, Burgess, Emslie, & Evans, 1996)</hd> <p>The Dysexecutive Questionnaire (DEX) was used to assess executive functions. It has 20 items divided into five domains: Planning (e.g., has difficulty planning or thinking about the future); Lack of inhibition (e.g., does or says embarrassing things when is with others); Impulsivity (e.g., seems unconcerned about how should behave in some situations); Persistence (e.g., when says one thing, does something different); and Difficulty in inhibition (e.g., is indifferent or unaware of the sensation caused by his/her behaviour towards others) (Pedrero et al., [<reflink idref="bib25" id="ref60">25</reflink>]). The 20-item scale is rated on a 5-point scale (0 = <emph>never</emph>; 1 = <emph>hardly ever</emph>; 2 = <emph>sometimes</emph>; 3 = <emph>often</emph>; 4 = <emph>very often</emph>) and items summed to produce a total score. In the study, this questionnaire had an excellent internal consistency (<emph>α</emph> =.885 Dysexecutive Questionnaire).</p> <hd id="AN0144525229-8">Emotion Regulation Checklist (ERC, Shields & Cicchetti, 1997)</hd> <p>In order to find the association between emotion regulation and internalising symptoms we used the Emotion Regulation Checklist (ERC). This questionnaire assesses some aspects of emotion regulation through observed behaviour with two variables: adaptive emotion regulation, described as the capacity to adjust adaptively one's arousal to the environment, and emotional lability or negativity, depicted as the person's responses to handle negative emotions (Molina et al., [<reflink idref="bib22" id="ref61">22</reflink>]). The 24-item scale is rated on a 4-point scale (1 = <emph>hardly ever</emph>; 2 = <emph>sometimes</emph>; 3 = <emph>often</emph>; 4 = <emph>very often</emph>) and items summed to produce two total scores: adaptive emotion regulation (8 items, e.g., can say when he or she is feeling sad, angry or mad, fearful or afraid) and emotional lability (16 items, e.g., is easily frustrated). In this study, this questionnaire had a good internal consistency (<emph>α</emph> =.624 for the Emotion regulation subscale; and <emph>α</emph> =.741 for the Emotional lability subscale).</p> <hd id="AN0144525229-9">Statistical analysis</hd> <p>Statistical analyses were performed using SPSS Statistics Base. Association between independent variables dysexecutive function, emotion regulation and dependent variable internalising symptoms were assessed using Pearson's correlation coefficient. Multiple linear regression analysis was used to identify the predictors of the internalising symptoms and the proportion of depression and anxiety explained by deficits in executive functions and emotion regulation.</p> <hd id="AN0144525229-10">Results</hd> <p>Pearson's correlation coefficient results show the association between internalising symptoms and the executive dysfunction and emotion regulation. According to the relation between executive dysfunction and internalising symptoms, results show (see Table 1) a positive and significant correlation between depression and executive dysfunction (<emph>r</emph> =.648; <emph>p</emph> <.01) and between anxiety and executive dysfunction (<emph>r</emph> =.717; <emph>p</emph> <.01).</p> <p>Table 1. Pearson correlation coefficient results between internalising symptoms, executive dysfunction and emotion regulation.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td /><td>2</td><td>3</td><td>4</td><td>5</td><td>M</td><td>SD</td></tr></thead><tbody><tr><td>1: DE<sup>a</sup></td><td char=".">.825**</td><td char=".">.648**</td><td char=".">−.451**</td><td char=".">.593**</td><td char=".">2.71</td><td char=".">2.65</td></tr><tr><td>2: AN<sup>b</sup></td><td char="." /><td char=".">.717**</td><td char=".">−.413**</td><td char=".">.656**</td><td char=".">3.05</td><td char=".">3.22</td></tr><tr><td>3: DEX<sup>c</sup></td><td char="." /><td char="." /><td char=".">−.436**</td><td char=".">.597**</td><td char=".">27.05</td><td char=".">11.76</td></tr><tr><td>4: RE<sup>d</sup></td><td char="." /><td char="." /><td char="." /><td char=".">−.222**</td><td char=".">26.24</td><td char=".">3.51</td></tr><tr><td>5: LE<sup>e</sup></td><td char="." /><td char="." /><td char="." /><td char="." /><td char=".">30.77</td><td char=".">6.07</td></tr></tbody></table> </ephtml> </p> <p>Notes: **<emph>p </emph><.01. Abbreviations: DE (a) = Internalising symptoms (depression) measured with the Psychopathology Inventory for Mentally Retarded Adults-II, PIMRA-II; AN (b) = Internalising symptoms (anxiety) measured with the Psychopathology Inventory for Mentally Retarded Adults-II, PIMRA-II; DEX (c) = Executive dysfunction measured with Dysexecutive Questionnaire, DEX; RE (d) = Emotion regulation measured with Emotion Regulation Checklist, ERC; LE (e) = Emotional lability measured with Emotion Regulation Checklist, ERC.</p> <p>In order to find the association between emotion regulation and internalising symptoms, the Emotion regulation and Emotional lability subscales of the ERC were analysed. Results in Table 1 show a negative and significant correlation between Emotion regulation and Depression (<emph>r</emph> = −.451; <emph>p</emph> <.01) and between Emotion regulation and Anxiety (<emph>r</emph> = −.413; <emph>p </emph><.01). Table 1 also shows a positive and significant correlation between Emotional lability and Depression (<emph>r</emph> =.593; <emph>p</emph> <.01) and between Emotional lability and Anxiety (<emph>r</emph> =.656; <emph>p</emph> <.01).</p> <p>A multiple linear regression analysis was used to know how executive dysfunction and emotion regulation explain the existence of internalising symptoms. The results of the predictor model for Depression (see Table 2) show that the presence of depressive symptomatology is partly explained by Executive dysfunction, Emotion regulation and Emotional lability (<emph>R</emph><sups>2 </sups>=.526).</p> <p>Table 2. Multiple linear regression analysis for depression predictors.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>DV</td><td>Predictors variables</td><td><italic>R</italic><sup>2</sup></td><td><italic>F</italic></td><td><italic>β</italic></td><td>B</td><td><italic>t</italic></td></tr></thead><tbody><tr><td>Depression</td><td>DEX</td><td char=".">.526</td><td char=".">14.060**</td><td char=".">.352</td><td char=".">.079</td><td char=".">2.332*</td></tr><tr><td /><td>ER</td><td char="." /><td char="." /><td char=".">−.223</td><td char=".">−.169</td><td char=".">−1.796*</td></tr><tr><td /><td>EL</td><td char="." /><td char="." /><td char=".">.333</td><td char=".">.145</td><td char=".">2.384*</td></tr></tbody></table> </ephtml> </p> <p>Notes: **<emph>p <</emph>.01, *<emph>p </emph><.05. Abbreviations: DEX = Executive dysfunction measured with Dysexecutive Questionnaire, DEX; ER = Emotion regulation measured with Emotion Regulation Checklist, ERC; EL = Emotional lability measured with Emotion Regulation Checklist, ERC.</p> <p>Table 3 shows the results of the predictor model for anxiety. These results suggest that the existence of anxiety symptoms is partly explained by Executive dysfunction and Emotion regulation and Emotional lability (<emph>R</emph><sups>2 </sups>=.611).</p> <p>Table 3. Multiple linear regression analysis for anxiety predictors.</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>DV</td><td>Predictors variables</td><td><italic>R</italic><sup>2</sup></td><td><italic>F</italic></td><td><italic>β</italic></td><td>B</td><td><italic>t</italic></td></tr></thead><tbody><tr><td>Anxiety</td><td>DEX</td><td char=".">.611</td><td char=".">19.907**</td><td char=".">.440</td><td char=".">.121</td><td char=".">3.212**</td></tr><tr><td /><td>ER</td><td char="." /><td char="." /><td char=".">−.141</td><td char=".">−.130</td><td char=".">−1.253</td></tr><tr><td /><td>EL</td><td char="." /><td char="." /><td char=".">.362</td><td char=".">.193</td><td char=".">2.867**</td></tr></tbody></table> </ephtml> </p> <p>Notes: **<emph>p <</emph>.01 Abbreviations: DEX = Executive dysfunction measured with Dysexecutive Questionnaire, DEX; ERC = Emotion regulation and emotional lability measured with Emotion Regulation Checklist, ERC.</p> <hd id="AN0144525229-11">Discussion</hd> <p>In line with our hypotheses, a positive and significant association between executive dysfunction and internalising symptoms exists. We found that executive dysfunction in DS is related to the development of internalising symptoms in adults with DS, consistent with and broadening the results of Pritchard, Kalback, McCurdy, and Capone ([<reflink idref="bib31" id="ref62">31</reflink>]) research, who found that children with DS and some psychopathology presented more problems in executive functions. Also, and as hypothesised, there was a significant negative relation between emotion regulation and internalising symptoms. We found that an inadequate emotion regulation and high emotional lability influence the onset of internalising symptoms; consistent with Jahromi et al. ([<reflink idref="bib14" id="ref63">14</reflink>]) investigation, where it was indicated that an inadequate emotions handling could lead to undesired emotional states in people with DS.</p> <p>Concerning the predictors of internalising symptoms, results were in line with previous studies. Firstly, our data show that executive dysfunction influences the presence of internalising symptoms, so it would be convenient to train the executive functions in DS in order to influence positively in adaptive behaviour (Tomaszewski et al., [<reflink idref="bib38" id="ref64">38</reflink>]). Secondly, emotion regulation partly explains the existence of internalising symptoms, thus an inadequate emotion regulation and high emotional lability may influence the presence of internalising symptoms, as it has been highlighted in previous studies (Jahromi et al., [<reflink idref="bib14" id="ref65">14</reflink>]). For this reason, we consider it important the explicit study of emotional regulation in people with DS, since although they exhibit fewer problems in this area, there is a relationship between the poor handling of emotional experiences and the presence of internalising symptoms (Gonçalves et al., [<reflink idref="bib10" id="ref66">10</reflink>]; Noel, [<reflink idref="bib24" id="ref67">24</reflink>]).</p> <p>Taking into account these results we consider it important to continue studying emotion regulation in people with DS and other ID. It is necessary to develop a specific questionnaire to evaluate this variable in this population. This would provide more precise information on the characteristics of this capacity in people with intellectual disabilities and it would contribute to the improvement of interventions, which would focus more precisely on the emotional regulation needs of this population. Also, we consider it interesting to focus the study in more emotion regulation components such as emotion regulation strategies. In so doing, other elements of the emotion regulation could be studied, such as the implementation of strategies, thus obtaining more information on the characteristics of this process in DS and contributing positively to the development of interventions.</p> <p>We consider the design and the development of a program similar to that of McWilliams, De Terte, Leathem, Malcolm, and Watson ([<reflink idref="bib21" id="ref68">21</reflink>]) as beneficial for the improvement of the emotion regulation in this population. This program aims to help people with intellectual disabilities to regulate emotions, mainly anger, sadness and worry, and to develop strategies to manage emotions through five phases: relaxation, chain analysis, emotion recognition, emotion regulation and relapse prevention. It is designed to be developed in a group setting in order to facilitate social learning, practise new skills and engage with others by receiving and providing feedback (McWilliams et al., [<reflink idref="bib21" id="ref69">21</reflink>]).</p> <hd id="AN0144525229-12">Limitations</hd> <p>This study has some limitations; thus, some caution is needed in forming conclusions. A limitation is the sample size. If a larger sample had been available, the results could have been generalised to a greater extent.</p> <p>Another limitation is related to the selected scales, in particular, the evaluation of emotion regulation. There is no specific instrument, as far as we know, that evaluates emotion regulation in people with ID. Despite having been used in other studies with young people and adults (Reis et al., [<reflink idref="bib32" id="ref70">32</reflink>]; Smith & Walden, [<reflink idref="bib35" id="ref71">35</reflink>]) and being the most appropriate, because it has to be completed by people close to the one being evaluated, the ERC may have affected the results obtained. In addition, the emotion regulation process has been proven to be inherent and internal to each individual. However, it is important to note that the emotion regulation has not been assessed by participants with DS but by proxy professionals, which might have affected the obtained results. It would therefore be interesting for future research to evaluate emotion regulation with personal answers from DS individuals.</p> <p>This study relied on reports of executive functions and emotion regulation, with therapists being the primary responders. Although each evaluator covered information across a maximum of six subjects, and evaluated them separately, there may have been bias in informant reports.</p> <p>Furthermore, a more comprehensive study, such as inclusion of a sample with ID but without DS would have been interesting to be able to verify other statements in the literature consulted, such as although people with ID and without DS have more psychopathological disorders, depression is higher in people with DS than in people with unspecified ID (Cunningham, [<reflink idref="bib4" id="ref72">4</reflink>]; Dykens et al., [<reflink idref="bib7" id="ref73">7</reflink>]).</p> <hd id="AN0144525229-13">Conclusions and implications</hd> <p>It can be assumed that the presence of psychological disorders such as depression and anxiety in adults (aged 18–40) with DS is influenced by problems in executive functions and emotion regulation, as shown by our analyses of predictors of internalising symptoms in adults with DS. The results of this study indicate that there is a link between the presence of anxiety or depression, or both in this population and the mismanagement of emotional situations and difficulties in executive functions. Future research could explore what is the basis for this relationship and specify the role of the deficits in executive functions and emotion regulation.</p> <p>Secondly, this information can be used to develop targeted interventions aimed at training executive functions and emotion regulation together to prevent the development or appearance of internalising symptoms. This has to be taken into account by the professionals who work with this population, focusing on those functions and capabilities with the most significant deficits (working memory, inhibition, problem-solving, etc.). Further studies are needed to better understand the functioning and influence of these processes in adults with DS, especially regarding emotion regulation.</p> <hd id="AN0144525229-14">Acknowledgements</hd> <p>The authors would like to thank all participants in the study for their involvement. All authors have contributed to, seen, and approved of the manuscript and agree to the order of authors as listed on this page.</p> <hd id="AN0144525229-15">Disclosure statement</hd> <p>No potential conflict of interest was reported by the authors.</p> <ref id="AN0144525229-16"> <title> References </title> <blist> <bibl id="bib1" idref="ref55" type="bt">1</bibl> <bibtext> Aldao, A. (2012). Emotion regulation strategies as transdiagnostic processes: A closer look at the invariance of their form and function. Spanish Journal of Clinical Psychology, 17 (3), 261 – 277.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref4" type="bt">2</bibl> <bibtext> Belva, B. C., & Matson, J. L. (2015). 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Journal of Intellectual Disability Research, 51 (7), 551 – 563.</bibtext> </blist> </ref> <aug> <p>By Domingo García-Villamisar; María Álvarez-Couto and Araceli del Pozo</p> <p>Reported by Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib12" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib16" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib20" firstref="ref3"></nolink> <nolink nlid="nl4" bibid="bib19" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib26" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib27" firstref="ref7"></nolink> <nolink nlid="nl7" bibid="bib36" firstref="ref9"></nolink> <nolink nlid="nl8" bibid="bib37" firstref="ref10"></nolink> <nolink nlid="nl9" bibid="bib39" firstref="ref13"></nolink> <nolink nlid="nl10" bibid="bib15" firstref="ref31"></nolink> <nolink nlid="nl11" bibid="bib40" firstref="ref32"></nolink> <nolink nlid="nl12" bibid="bib17" firstref="ref33"></nolink> <nolink nlid="nl13" bibid="bib18" firstref="ref34"></nolink> <nolink nlid="nl14" bibid="bib38" firstref="ref35"></nolink> <nolink nlid="nl15" bibid="bib11" firstref="ref36"></nolink> <nolink nlid="nl16" bibid="bib30" firstref="ref37"></nolink> <nolink nlid="nl17" bibid="bib14" firstref="ref38"></nolink> <nolink nlid="nl18" bibid="bib23" firstref="ref39"></nolink> <nolink nlid="nl19" bibid="bib28" firstref="ref41"></nolink> <nolink nlid="nl20" bibid="bib29" firstref="ref42"></nolink> <nolink nlid="nl21" bibid="bib33" firstref="ref43"></nolink> <nolink nlid="nl22" bibid="bib41" firstref="ref46"></nolink> <nolink nlid="nl23" bibid="bib43" firstref="ref47"></nolink> <nolink nlid="nl24" bibid="bib13" firstref="ref50"></nolink> <nolink nlid="nl25" bibid="bib25" firstref="ref60"></nolink> <nolink nlid="nl26" bibid="bib22" firstref="ref61"></nolink> <nolink nlid="nl27" bibid="bib31" firstref="ref62"></nolink> <nolink nlid="nl28" bibid="bib10" firstref="ref66"></nolink> <nolink nlid="nl29" bibid="bib24" firstref="ref67"></nolink> <nolink nlid="nl30" bibid="bib21" firstref="ref68"></nolink> <nolink nlid="nl31" bibid="bib32" firstref="ref70"></nolink> <nolink nlid="nl32" bibid="bib35" firstref="ref71"></nolink>
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  Data: Executive Functions and Emotion Regulation as Predictors of Internalising Symptoms among Adults with Down Syndrome: A Transdiagnostic Perspective
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  Data: <searchLink fieldCode="AR" term="%22García-Villamisar%2C+Domingo%22">García-Villamisar, Domingo</searchLink><br /><searchLink fieldCode="AR" term="%22Álvarez-Couto%2C+María%22">Álvarez-Couto, María</searchLink><br /><searchLink fieldCode="AR" term="%22del+Pozo%2C+Araceli%22">del Pozo, Araceli</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Intellectual+%26+Developmental+Disability%22"><i>Journal of Intellectual & Developmental Disability</i></searchLink>. 2020 45(3):204-210.
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 7
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  Data: <searchLink fieldCode="DE" term="%22Executive+Function%22">Executive Function</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Down+Syndrome%22">Down Syndrome</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink>
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  Data: 10.3109/13668250.2019.1669004
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  Data: 1366-8250
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  Data: Introduction: There is evidence of high rates of psychopathological disorders such as anxiety or depression in adults with Down syndrome. Additionally, difficulties in executive functions and emotion regulation play an essential role in adaptive functioning of people with Down syndrome. Method: We used different questionnaires with a sample of 42 adults with Down syndrome (aged 18-40 years) to determine if difficulties in executive functions and emotion regulation are related to and can predict internalising symptoms. Results: Positive and significant correlations were found between dysexecutive functioning and emotion dysregulation and internalising symptoms. Multiple linear regression analyses indicated that dysexecutive functioning and emotion dysregulation are both predictors of the existence of internalising symptoms. Conclusions: These findings suggest that intervention in emotion regulation and executive functions must be taken into account in order to positively influence the presence of internalising symptoms. Further research is needed to attend to both capacities comprehensively, especially concerning emotion regulation.
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        PageCount: 7
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      – SubjectFull: Executive Function
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      – SubjectFull: Emotional Response
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      – SubjectFull: Predictor Variables
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      – SubjectFull: Down Syndrome
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      – SubjectFull: Adults
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      – SubjectFull: Depression (Psychology)
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      – SubjectFull: Anxiety
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      – TitleFull: Executive Functions and Emotion Regulation as Predictors of Internalising Symptoms among Adults with Down Syndrome: A Transdiagnostic Perspective
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            NameFull: García-Villamisar, Domingo
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