By: Brad M. Farrant, Janet Fletcher and Murray T. Maybery
The present study analyzed the concurrent and longitudinal relations among cognitive flexibility, theory of mind, and hyperactivity/inattention in a sample of 70 typically developing children ( age = 61.4 months, SD= 8.3 months). Mothers and teachers reported on children’s hyperactivity/inattention using the strengths and difficulties questionnaire (Goodman, 1997), cognitive flexibility was measured using the dimension change card sort task (Zelazo, 2006), and theory of mind was assessed using a battery of tasks. Cognitive flexibility and theory of mind scores were found to be significantly negatively correlated with the level of hyperactivity/inattention at both time points. Furthermore, year 1 cognitive flexibility score was found to be a significant predictor of year 2 hyperactivity/inattention score after controlling for child age, gender, and year 1 hyperactivity/inattention score. Directions for future research include training studies which would further our understanding of these relationships and allow more effective interventions.
The ability to focus attention and regulate behavior is a key determinant of scholastic achievement and occupational success [1–3]. Indeed, these self-control skills are viewed as desirable by parents, teachers, and employers alike  and high levels of problems with focusing or sustaining attention and regulating behavior are core clinical features used to diagnose attention-deficit hyperactivity disorder (ADHD). However, many children with symptoms of hyperactivity and inattention do not meet the criteria for a formal ADHD diagnosis and parents and education professionals are confronted with the challenge of working with these children . The present study investigated the cognitive factors associated with symptoms of hyperactivity/inattention in typically developing children during the early school years.
Much of the research into the development of children’s self-regulation skills has been conducted within the executive function framework . Inhibitory control, working memory, and cognitive flexibility are components of executive function that contribute to the development of self-regulation . These executive function components follow different trajectories across early development such that the preschool period is characterized by dramatic improvements in inhibitory control, whereas the development of cognitive flexibility accelerates during the early school years .
According to cognitive complexity and control (CCC) theory, cognitive flexibility refers to the ability to flexibly shift between multiple incompatible perspectives or descriptions of an object or event . Linguistically formulating conflicting perspectives or descriptions and embedding these under a higher-order rule enable the ability to flexibly shift between these conflicting perspectives or descriptions [8–10]. This ability to formulate and use higher-order rules enables children to formulate more complex and integrated rule systems which then allow them to control their attention and behavior in a relatively top-down fashion [10, 11]. Perseverative behavior occurs when children lack the ability to integrate incompatible pieces of knowledge into a more complex rule system. Thus, CCC theory predicts that children with more advanced cognitive flexibility skills will have better attention and behavior regulation skills.
Although we are unaware of any research which directly assesses the relationship between cognitive flexibility and hyperactivity/inattention in typical development there is some research which has investigated the cognitive flexibility skills of children with ADHD. A number of studies have found that cognitive flexibility is impaired in children with ADHD [12–15]. However, other studies have failed to find impaired cognitive flexibility in children with ADHD [16, 17]. A recent meta-analysis also observed inconsistent results regarding whether ADHD is associated with a cognitive flexibility (set-shifting) deficit . One possible explanation for the inconsistency in these findings is that studies of children with ADHD tend to involve children with a wide range of ages. Hence, the role of accelerated cognitive flexibility development in the early school years  may be masked in some of these studies by the inclusion of older children. Thus, our understanding of the developmental relationship between cognitive flexibility and hyperactivity/inattention would benefit from research focused on the early school years.
Another issue worthy of consideration is the relationships among cognitive flexibility, theory of mind (ToM), and hyperactivity/inattention. ToM involves the cognitive capacity to impute causal mental states to self and others in order to explain and predict behavior . According to CCC theory, ToM development relies on the development of cognitive flexibility [9, 10, 20] because the embedding of one set of judgments (or rules) within another allows the ability to flexibly shift between conflicting psychological perspectives . Furthermore, it has been argued that one of the reasons that the development of cognitive flexibility enables better self-control is that “the reasoning involved in inferring mental states is also needed for conceptualizing one’s own actions and controlling one’s behavior” . In other words, ToM development mediates the relationship between cognitive flexibility and attention and behavior regulation skills.
A number of studies have found a correlation between performance on the dimension change card sort (DCCS) task  and performance on ToM tasks in both typically developing children [22–26] and children with autism . The DCCS task measures children’s cognitive flexibility by assessing whether they can flexibly shift between two sorting rules (based on color and shape). The findings of longitudinal research with typically developing children using the DCCS and ToM (false belief) tasks also support the argument that cognitive flexibility facilitates ToM development .
There is also some evidence supporting the argument that ToM development facilitates the ability to regulate attention and behavior. Several studies have found that ToM is impaired in children and adults with ADHD [29–31]. On the other hand, several studies have failed to find impaired ToM in children with ADHD [32–34]. However, there is also evidence indicating that ToM is impaired in children with attention deficits who do not have a formal diagnosis  and a significant negative relationship has been found between ToM scores and attention problems in children clinically referred for attention and behavior problems . Here again the fact that studies of children with ADHD tend to involve children with a wide range of ages provides a possible explanation for the inconsistency in these findings.
In summary, there is some evidence in support of the existence of a relationship between cognitive flexibility and ToM. However, the evidence for relationships between these cognitive factors and hyperactivity/inattention is inconsistent and comes from studies of ADHD rather than typical development. Furthermore, the hypothesized relationships between cognitive flexibility, ToM, and self-regulation discussed above also suggest that ToM may mediate the relationship between cognitive flexibility and hyperactivity/inattention . Thus, our understanding of the cognitive factors associated with symptoms of hyperactivity/inattention in typically developing children would benefit from research designed to test these relationships.
The purpose of the present study was to further our understanding of the developmental relationships among cognitive flexibility, ToM, and hyperactivity/inattention in typical development by examining these relationships concurrently and longitudinally. Thus, cognitive flexibility, ToM, and hyperactivity/inattention were assessed for a group of children at an early point in their schooling (Year 1: Y1) and again one year later (Y2).
Drawing on CCC theory and the findings of previous research, it was hypothesized that more advanced cognitive flexibility and ToM skills would be associated with lower levels of hyperactivity/inattention. It was also predicted that ToM would mediate the concurrent relationship between cognitive flexibility and hyperactivity/inattention. For the longitudinal analyses, it was hypothesized that Y1 cognitive flexibility would predict Y2 ToM after controlling for Y1 ToM and that Y1 cognitive flexibility and ToM would predict Y2 hyperactivity/inattention after controlling for the relevant Y1 scores. We also investigated the possibility that hyperactivity/inattention interferes with the subsequent development of cognitive flexibility and ToM. This was done by testing whether Y1 hyperactivity/inattention predicts Y2 cognitive flexibility and ToM after controlling for the relevant Y1 scores.
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