Executive Functions as Mediators Between Adolescent Emotion Regulation and Mental Health Symptoms

Adolescence is a developmental period characterized by nuanced biopsychosocial changes and vulnerability to internalizing and externalizing symptoms (Johnson et al., 2018; Merikangas et al., 2010), highlighting the need to identify transdiagnostic processes behind both symptom types. Emotion regulation and executive functioning offer promise as such targets. Both develop during adolescence (Best & Miller, 2010; Cracco et al., 2017), differentially correlate with internalizing and externalizing symptoms (Brenning et al., 2022; Romer & Pizzagalli, 2021), and respond to treatment (Carballo-Marquez et al., 2025). This study examined the developmental sequence between emotion dysregulation and executive functioning in a longitudinal study using 84 community adolescents. Multi-level mediation tested specific executive functions (i.e., inhibition, shifting/flexibility, working memory, emotional control, and planning) as mechanisms through which emotion dysregulation predicts internalizing and externalizing symptoms one year later. Results found that emotion dysregulation and executive functions correlate with internalizing symptoms, and cool executive functions correlated similarly but with slightly more restriction of range with externalizing symptoms. Year one emotion dysregulation predicted future executive functioning; however, executive functions did not predict year two emotion dysregulation. Shifting/flexibility emerged as a mediator for both symptom types, and inhibition mediated the association between emotion dysregulation and externalizing symptoms. Implications from this study include that shifting/flexibility serves as a transdiagnostic process in adolescent mental health, which is consistent with findings that flexibility among regulation strategies protects against mental health difficulties (Lougheed & Hollenstein, 2012). Clinicians treating adolescents with high levels of internalizing or externalizing symptoms may seek to target flexibility among emotion regulation strategies as well as emotion regulation training.