Neurocognitive Impairments Across Adolescent Mental Health Disorders: An Umbrella Review of Systematic Reviews and Meta-Analyses

Abstract

Background: Adolescence is a critical neurodevelopmental period characterized by ongoing maturation of prefrontal and limbic brain networks supporting higher-order cognitive processes. The emergence of mental health disorders during this developmental stage may be associated with alterations in cognitive functioning across multiple domains. Growing evidence suggests that depression, anxiety, ADHD, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), eating disorders, and psychosis-spectrum conditions are associated with measurable neurocognitive differences and impairment. However, existing evidence remains fragmented across diagnostic categories, cognitive domains, assessment methods, and methodological approaches.

Objective: To systematically identify, appraise, and synthesize evidence from systematic reviews and meta-analyses examining neurocognitive outcomes among adolescents with mental health disorders, with emphasis on disorder-specific patterns of cognitive impairment, affected domains, and evidence consistency.

Methods:  This umbrella review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Systematic reviews and meta-analyses examining neurocognitive outcomes among adolescents with mental health disorders were identified through systematic searches of PubMed/MEDLINE, Scopus, APA PsycINFO, Embase, Web of Science Core Collection, and Cochrane CENTRAL. The final database searches were conducted between 29 and 30 August 2026, and complete database-specific search strategies are provided in Supplementary Appendix 1. Eligible reviews included adolescents aged approximately 10-19 years diagnosed with a mental health disorder and examining standardized neurocognitive outcomes, including attention, working memory, memory, executive function, processing speed, language, or global cognition. Reviews including broader age ranges were eligible when adolescent-specific data were available or when the mean sample age was ≤19 years. We assessed the methodological quality of included reviews using AMSTAR-2 and evaluated risk of bias using ROBIS. We extracted and synthesized quantitative findings, including reported effect sizes and domain-specific outcomes, narratively by diagnostic category and cognitive domain. Due to substantial heterogeneity across disorders, cognitive measures, participant characteristics, and analytical approaches, quantitative pooling across reviews was not performed.

Results: Fourteen systematic reviews and meta-analyses were included in the narrative synthesis. Evidence from included reviews indicated neurocognitive impairments across several cognitive domains among adolescents with mental health disorders, although the magnitude and consistency of findings varied across diagnostic categories. Executive function and working memory impairments were among the most consistently reported findings, particularly in ADHD and depressive disorders. Depression-related cognitive impairments were observed across memory, attention, executive function, and language domains. ADHD was associated with moderate-to-large executive function impairments, while psychosis-spectrum and clinical high-risk populations demonstrated broader cognitive impairments involving global cognition, memory, executive function, and processing speed. Findings across anxiety-spectrum disorders, OCD, PTSD, and eating disorders were comparatively heterogeneous and domain-specific.

Conclusion: Adolescent mental health disorders are associated with measurable, domain-specific neurocognitive differences that may influence academic functioning, treatment engagement, and rehabilitation planning. Findings highlight the potential value of cognitive screening and targeted remediation approaches within adolescent mental health services.