ImportanceMental illnesses are a leading cause of disability globally, and functional disability is often in part caused by cognitive impairments across psychiatric disorders. However, studies have consistently reported seemingly opposite findings regarding the association between cognition and psychiatric symptoms.ObjectiveTo determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children.Design, Setting, and ParticipantsA total of 5175 children with complete data at 2 time points assessed 2 years apart (aged 9 to 11 years at the first assessment) from the ongoing Adolescent Brain and Cognitive Development (ABCD) study were evaluated for a general cognition factor and mental health symptoms from September 2016 to August 2020 at 21 sites across the US. Polynomial and generalized additive models afforded derivation of continuous associations between cognition and psychiatric symptoms across different ranges of symptom severity. Data were analyzed from December 2022 to April 2024.Main Outcomes and MeasuresAggregate cognitive test scores (general cognition) were primarily evaluated in relation to total and subscale-specific symptoms reported from the Child Behavioral Checklist.ResultsThe sample included 5175 children (2713 male [52.4%] and 2462 female [47.6%]; mean [SD] age, 10.9 [1.18] years). Previously reported mixed findings regarding the association between general cognition and symptoms may consist of several underlying, opposed associations that depend on the class and severity of symptoms. Linear models recovered differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens higher cognition = more symptoms) and significantly negatively associated with cognition at high symptom burdens.Conclusions and RelevanceThe association between mental health symptoms and general cognition in this study was nonlinear. Internalizing symptoms were both positively and negatively associated with general cognition at a significant level, depending on the range of symptom severities queried in the analysis sample. These results appear to reconcile mixed findings in prior studies, which implicitly assume that symptom severity tracks linearly with cognitive ability across the entire spectrum of mental health. As the association between cognition and symptoms may be opposite in low vs high symptom severity samples, these results reveal the necessity of clinical enrichment in studies of cognitive impairment.

中文翻译：

---

儿童的精神症状、认知和症状严重程度


重要性精神疾病是全球残疾的主要原因，而功能障碍通常部分是由精神疾病中的认知障碍引起的。然而，关于认知与精神症状之间关联的研究一直报告看似相反的发现。目的确定儿童一般认知与心理健康症状之间的关联在不同症状严重程度下是否存在差异。设计、设置和参与者2016 年 9 月至 2020 年 8 月，在美国的 21 个地点，共有 5175 名在相隔 2 年（第一次评估时为 9 至 11 岁）评估的 2 个时间点具有完整数据的儿童对一般认知因素和心理健康症状进行了评估。多项式和广义加性模型提供了在不同症状严重程度范围内认知和精神症状之间连续关联的推导。主要结果和措施总认知测试分数（一般认知）主要根据儿童行为检查表中报告的总症状和子量表特定症状进行评估。结果样本包括 5175 名儿童（2713 名男性 [52.4%] 和 2462 名女性 [47.6%];平均 [SD] 年龄，10.9 [1.18] 岁）。以前报道的关于一般认知与症状之间关联的混合发现可能包括几个潜在的、对立的关联，这些关联取决于症状的类别和严重程度。线性模型恢复了一般认知和心理健康症状之间的不同关联，具体取决于查询的症状严重程度的范围。 非线性模型证实，内化症状与低症状负担时认知呈显著正相关，较高认知 = 更多症状），与高症状负担下的认知呈显著负相关。结论和相关性本研究中心理健康症状与一般认知之间的关联是非线性的。内化症状与一般认知呈正相关和负相关，具体取决于分析样本中查询的症状严重程度的范围。这些结果似乎与先前研究中混合的发现相吻合，这些研究隐含地假设症状的严重程度与整个心理健康范围内的认知能力呈线性关系。由于认知与症状之间的关联在低症状严重程度与高症状严重程度样本中可能相反，因此这些结果揭示了认知障碍研究中临床富集的必要性。