A meta-analysis of the executive function components inhibition, shifting, and attention in intellectual disabilities

Background Executive function is a concept for higher-order cognitive functions, which have the role of controller and modulator of cognitive abilities. The consensus in the literature is that people with an intellectual disability perform significantly lower on executive function tasks than groups matched on chronological age. The comparison with groups matched on mental age is less clear. Therefore, the objective of this meta-analysis was to investigate to what extent executive function is impaired in people with intellectual disability compared with a typically developing control group matched on mental age. It was also investigated if the executive function component and intellectual disability aetiology moderated the effect. Methods Eligibility criteria were participants with intellectual disability (IQ <= 75) without a dual diagnosis; a comparison group matched on mental age; executive function outcome reported in a group comparison study design with n >= 10. Working memory tasks and ratings of executive function were not included. The literature search yielded 6637 potentially interesting articles. Twenty-six studies (with 99 effect sizes) including 1395 participants were included in the quantitative synthesis. Results A multilevel random-effects meta-analysis found that people with intellectual disability performed statistically significantly lower than the mental age-matched group on the executive function tasks, g = -0.34, 95% confidence interval = [-0.53, -0.16]. However, the heterogeneity between effect sizes was large. The intellectual disability aetiology moderator was significant, but it only reduced the heterogeneity marginally. Conclusion The overall conclusion is that individuals with an intellectual disability have more problems with executive function tasks than mental age-matched controls. Limitations are the large unexplained variance and the remarkably high number (69) of different tests that were used, which make more detailed conclusions problematic. This meta-analysis implies that future studies need to be of better quality, to have higher power, and to a higher degree use the same executive function tests.