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Characteristics of child psychiatric outpatients with slow processing speed and potential mechanisms of academic impact


While slow processing speed (PS) is well documented in youth with ADHD, growing evidence suggests that this difficulty affects children with other neuropsychiatric conditions. Clarifying the relationship between slow PS and different forms of psychopathology is important clinically, given the potential impact of PS on academic functioning, and conceptually. In 751 youth, ages 6–21, consecutively referred for neuropsychiatric evaluation, we examined the association between slow PS (i.e., Wechsler PS Index < 85) and seven neuropsychiatric diagnostic groups. In 492 of these youth, we also related slow PS to eight psychopathology symptom dimensions. Finally, we modeled the relationship between PS, other cognitive functions and academic achievement. Data are from the Longitudinal Study of Genetic Influences on Cognition. Analyses included one-sample t tests, ANOVA, logistic regression, mixed modeling, and structural equation modeling (SEM), controlling for age, sex, and medication. Compared to normative data, all clinical groups showed PS decrements. Compared to referred youth without full diagnoses and accounting for other psychopathology, risk for slow PS was elevated in youth with autism spectrum disorder (OR = 1.8), psychotic disorders (OR = 3.4) and ADHD-inattentive type (OR = 1.6). Having multiple comorbidities also increased risk for slow PS. Among dimensions, inattention (OR = 1.5) associated with slow PS but did not fully explain the association with autism or psychosis. In SEM, PS had direct effects on academic achievement and indirect effects through working memory. Findings extend evidence that PS relates to multiple aspects of child psychopathology and associates with academic achievement in child psychiatric outpatients.

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This research was supported by funding from the David Judah Foundation to Alysa Doyle and Ellen Braaten and from the Stanley Center for Psychiatric Research and NIMH (R01 MH116037) to Alysa Doyle.

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Correspondence to Alysa E. Doyle.

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On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors report no conflicts of interest. Drs. Doyle, Vuijk, Forchelli, Ward, Cook and O’Keefe and Ms. Lee, Ms. Lind, Ms. Samkavitz, and Mr. McGuinness have no additional affiliations to disclose. Dr. Braaten serves on the boards of Magination Press. She receives royalties from books published by Guilford Press Bright Kids Who Can’t Keep Up and The Child Clinician’s Report Writing Handbook and by Sage The Sage Encyclopedia of Intellectual and Developmental Disorders.

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Braaten, E.B., Ward, A.K., Forchelli, G. et al. Characteristics of child psychiatric outpatients with slow processing speed and potential mechanisms of academic impact. Eur Child Adolesc Psychiatry (2020). https://doi.org/10.1007/s00787-019-01455-w

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  • Processing speed
  • Cross-disorder
  • Child psychiatry
  • Outpatients
  • Academic achievement
  • Working memory