Set shifting in children and adolescents with anorexia nervosa: An exploratory systematic review and meta-analysis

Katie Lang, Daniel Stahl, Jonathan Espie, Janet Treasure, Kate Tchanturia*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

121 Citations (Scopus)


Set shifting inefficiencies in adults with anorexia nervosa (AN) are established, however the neurocognitive profile of children and adolescents with AN is less clear. This study aimed to provide a review of the literature.

Electronic databases were used to search for manuscripts.

Meta-analysis was performed on seven studies using two neuropsychological tests (Trail Making Task, TMT; Wisconsin Card Sorting Task, WCST). The mean difference in outcome between AN and healthy control (HC) groups was standardized by calculating Cohen's d. Meta-analysis of TMT studies showed a nonsignificant negative, pooled standardized mean difference of −0.005 (95% C.I. −0.416 to 0.406, z = 0.02, p = .98). WCST studies revealed a nonsignificant pooled effect size of d = 0.196 (95% C.I. −0.091–0.483, z = 1.34, p = .18). Studies which did not allow for a calculation of effect size typically showed a nonsignificant, worse performance by the AN groups.

The inefficiencies in set shifting that are apparent in the adult AN literature do not appear to be as pronounced in children. This may suggest that set shifting difficulties in adult AN are the result of starvation or indicative of longer duration of illness. Larger studies are needed to confirm these impressions.
Original languageEnglish
Pages (from-to)394-399
Number of pages6
JournalInternational Journal of Eating Disorders
Issue number4
Publication statusPublished - May 2014


  • anorexia nervosa
  • thinking style
  • set-shifting
  • cognitive flexibility
  • executive function
  • adolescent


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