Sociodemographic correlates of cognitive performance in healthy children and adolescents

Elisabeth Mai^1*Christof Meigen¹Ricarda Schmidt^2,3Juliane Ludwig¹Tanja Poulain^1,2,4Wieland Kiess^1,2,4

• ¹LIFE – Leipzig Research Center for Civilization Diseases, Leipzig University, Leipzig, Germany
• ²German Center for Child and Adolescent Health (DZKJ), partner site Leipzig/Dresden, Leipzig, Germany
• ³Department of Psychosomatic Medicine and Psychotherapy, Behavioral Medicine Research Unit, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
• ⁴Department of Women and Children's Health, Hospital for Children and Adolescents and Center for Pediatric Research (CPL), Leipzig University, Leipzig, Germany

Background: The maturation of cognitive abilities, a key aspect of childhood development, is associated with numerous outcomes later in life. Socioeconomic variables have been shown to influence this developmental trajectory. Given the growing global socioeconomic inequality, it is essential to account for socioeconomic factors when conducting research on cognitive development. While previous studies often focused on single cognitive domains and small cohorts or age groups, this study aimed to assess the association between sex, maternal education, and cognitive performance using three standard cognitive tests in a large cohort of healthy children and adolescents and to explore Tetris as a game-based cognitive test. Methods: Cognitive performance was examined in 9- to 19-year-olds using four tests (Trail Making Test, Mental Rotation Test, Continuous Performance Test, Tetris). Data were collected between October 2019 and December 2023 as part of the LIFE Child study, conducted in Leipzig (Germany), involving 770 participants for Tetris, Trail Making, and Mental Rotation, and 888 participants for the Continuous Performance Test. Multiple regression models, adjusted for age, considered sex and maternal education as independent variables. Results: Younger boys showed lower attention and inhibition control than girls, but improved during puberty, ultimately outperforming girls in the Continuous Performance Test. In Tetris, boys cleared more lines but made more rotation and movement faults than same-aged girls. No sex differences were observed in the Trail Making and Mental Rotation Test. Children of mothers with higher education made fewer errors in the Mental Rotation Test and were more attentive and less impulsive in the Continuous Performance Test than children of mothers with lower education. Tetris performance was significantly associated with the Mental Rotation and Trail Making Test. Conclusion: Cognitive performance patterns varied by sex and maternal education, highlighting the importance of distinguishing typical developmental variation from cognitive delay to guide individual support. Lower maternal education emerged as a potential risk factor for poorer cognitive performance, relevant for targeted interventions. We recommend further investigating Tetris as a game-based cognitive test.