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Mental illnesses are a leading cause of disability globally. Across 17 psychiatric disorders, functional disability is often in part caused by cognitive impairments. However, cognitive heterogeneity in mental health is poorly understood, particularly in children.

We used generalized additive models (GAMs) to reconcile discrepant reports of cognitive impairment across classes of psychiatric symptoms in 4,782 children and their parents. Specifically, we derive relationships between cognition and psychopathology across different ranges and classes of symptom burdens. We additionally evaluate generalizability across sex-assigned-at-birth (SAAB) and federal poverty status. Finally, we incorporate a measure of scholastic performance as a real-world measure of functional ability. Associations were tested at the 99% confidence level.

We demonstrate that the previously-reported, weak, negative, and linear relationship between general cognition and general psychopathology consists of several stronger but opposed relationships. Externalizing symptoms are negatively associated with cognition, but internalizing symptoms are positively associated with cognition at low symptom burdens. This phenomenon holds across parental and child symptoms. Finally, we provide evidence that, compared to laboratory measures of cognition, school grades are more accurate and generalizable indicators of psychopathological burden in children.

The most common approach to quantifying the relationship between cognition and psychopathology systematically underestimates the strength and complexity of this relationship. Grades …