Executive Functioning May Be Connected to Child Health Behaviors, ECHO Cohort Study Suggests

Author(s): Nichole Kelly, Derek Kosty, Leslie Leve et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health supported this research.

Why was this study needed?

Executive functioning refers to the cognitive processes that relate to a person’s ability to shift attention (cognitive flexibility), control impulsive actions (behavioral inhibition), and remember multiple pieces of information while solving a problem (working memory). Studies with adults suggest that lower executive functioning is related to less engagement in health-promoting behaviors, which increases risk for chronic disease. This study aimed to understand how these three domains of executive functioning relate to health behaviors in different age groups (early childhood, middle childhood, and adolescence). The goal was to inform more specific and developmentally tailored intervention strategies that target executive functioning to improve health behaviors and ultimately reduce chronic disease risk in children.

What were the study results?

Across all age groups, children with higher working memory also had more health-promoting eating behaviors, such as less frequent intake of sugary drinks and saturated fats. In middle childhood, children who showed more cognitive flexibility and behavioral inhibition also ate more fruits and vegetables and engaged in more physical activity. In adolescence, children with higher scores in all three executive function domains reported more engagement in physical activity. Researchers did not find significant connection between child sleep and executive functioning in this study.

What was the study's impact?

The results of this study can help researchers and clinicians plan better interventions that target children’s executive functioning to improve their health behaviors and, ultimately, their risk for chronic disease. For example, the results of this study suggest that early intervention targeting children’s working memory may help improve their dietary behaviors throughout childhood. However, associations with executive functioning observed in this study were small, so other interventions may be needed to support families in developing health-promoting behaviors. Additionally, because this study looked at this association at only one point in time for each child, it isn’t clear whether executive functioning influences health behaviors or vice versa.

Who was involved?

The study included children and their parents/caregivers from 38 ECHO Cohort Study Sites across 78 locations in the U.S. and Puerto Rico. Children from three life stages participated in the study: 2,074 in early childhood (age 5–8 years), 3,230 in middle childhood (age 8–12 years), and 1,416 in adolescence (age 12–18 years).

What happened during the study?

During the study, participating children completed computer tasks to measure their executive functioning. Participants also shared details about their diet, physical activity, and sleep through parent- and/or child-reported questionnaires. Additionally, information on income, positive parenting, neighborhood crime, and greenspace was collected.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

To continue identifying the best health intervention strategies, researchers could continue to explore how executive functioning relates to health behaviors by collecting data on how these effects change over time.

Where can I learn more?

Access the full journal article, titled “Children’s executive functioning and health behaviors across pediatric life stages and ecological contexts,” in the Journal of Behavioral Medicine.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 9, 2025

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