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：

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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，而功能性残疾通常部分是由精神疾病的认知障碍引起的。然而，关于认知与精神症状之间的关联，研究一直报告看似相反的发现。目的确定儿童的一般认知与精神健康症状之间的关联是否在不同症状严重程度下存在差异。设计、设置和参与者总共 5175 名患有完全性认知障碍的儿童。对正在进行的青少年大脑和认知发展 (ABCD) 研究中相隔 2 年（第一次评估时年龄为 9 至 11 岁）的 2 个时间点的数据进行了评估，评估了 2016 年 9 月至 2020 年 8 月期间的一般认知因素和心理健康症状。全美 21 个站点。多项式和广义加性模型推导了不同症状严重程度范围内认知和精神症状之间的连续关联。数据分析时间为 2022 年 12 月至 2024 年 4 月。主要结果和测量主要根据儿童行为检查表报告的总体和分量表特定症状来评估总体认知测试分数（一般认知）。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）。先前报道的关于一般认知和症状之间关联的混合研究结果可能包括几种潜在的、相反的关联，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，具体取决于所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的认知显着正相关（更高的认知=更多症状），与高症状负担时的认知显着负相关。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显着正相关和负相关，具体取决于分析样本中查询的症状严重程度范围。这些结果似乎与之前研究中的混合结果相一致，这些研究隐含地假设症状严重程度与整个心理健康范围内的认知能力呈线性关系。由于在低症状严重程度样本和高症状严重程度样本中认知和症状之间的关联可能相反，这些结果揭示了临床丰富认知障碍研究的必要性。