Relationship between anxiety and executive functioning among youth with Down syndrome

Down syndrome (DS) is commonly associated with various cognitive and behavioral challenges including difficulty with executive functioning (EF) and elevated levels of anxiety symptoms. In the general population, high levels of anxiety are associated with difficulties with EF tasks like initiation and cognitive shifting, with some bidirectional findings between these two constructs. Given the high overlapping behavioral presentation of symptoms of anxiety and challenges in EF, the present study examined the relationship between anxiety symptoms and EF in a sample of 139 individuals with DS ages 6-17 years to better understand their interrelationship and directionality in this population. Participants were rated by parents at two different time points, one year apart. For the entire sample, at baseline, concurrent associations were observed between several measures of EF and measures of anxiety and internalizing symptoms. Among the sample, some participants had co-occurring anxiety diagnoses prior to testing. Our results suggest that those with co-occurring anxiety exhibited more pronounced co-occurring difficulties in several areas of EF than those without co-occurring anxiety. Longitudinally, EF-shifting and EF-working memory at baseline predicted anxiety symptoms a year later while baseline anxiety predicted subsequent challenges with EF-shifting and EF-initiation a year later. Our findings suggest that while there are concurrent relationships between several measures of EF and anxiety, the longitudinal relationship is more nuanced. Our findings highlight the need for targeted mental health interventions in those with DS, as well as awareness of the overlap of anxiety with EF.