Executive Function: Cognition and Behaviour in Adults with Autism Spectrum Disorders (ASD)

Characterizing Inhibitory Control Challenges Among Autistic Adults: An Examination of Demographic and Psychiatric Moderators and Associations with Anxiety Symptomatology

Autism spectrum disorder is associated with elevated rates of mental health difficulties and executive function challenges. Emerging evidence links executive function to mental health in autistic individuals. However, less is known about (a) everyday inhibitory control difficulties among autistic adults; (b) the influence of sex assigned at birth and co-occurring attention deficit/hyperactivity disorder (ADHD) features on inhibition challenges; and (c) relations between inhibition challenges and anxiety symptoms. Drawing upon data from 732 autistic adults aged 18-83, this online study examined self-reported inhibitory control in autistic adults and the influence of assigned sex and ADHD screening status (based on a positive screening score on a self-report tool) on the degree of inhibitory control challenges experienced. In addition, this research examined relations between inhibitory control challenges and anxiety symptoms, and the moderating role of assigned sex and ADHD screening status in this relationship. Autistic adults endorsed significantly more inhibitory control challenges relative to published norms. Participants assigned female reported more difficulties in inhibitory control relative to sex-adjusted normative expectations than participants assigned male. Participants who screened positive for ADHD reported more inhibitory control challenges than those who screened negative. Greater endorsement of inhibitory control challenges was associated with greater anxiety symptomatology; this relationship was moderated by ADHD screening status, but not by assigned sex. Inhibitory control is an area of difficulty in autistic adults and is associated with anxiety symptomatology, suggesting that inhibitory control may be a valuable intervention target to improve emotional well-being in autistic adults.

The canonical correlation between executive function and social skills in children with autism spectrum disorder and potential pathways to physical fitness

Research on the relationship between core and comorbid features in children with Autism Spectrum Disorder (ASD), particularly executive function, remains limited. Additionally, the role of physical fitness in supporting ASD children's growth and development appears critical. This study investigates the relationship between executive function, social skills, and physical health in children with ASD. A total of 428 male participants were enrolled, including 117 diagnosed with ASD (mean age: 10.25 ± 1.481 years) and 311 with typical development (mean age: 9.56 ± 1.261 years). The results showed that children with ASD had significantly lower executive function and social interaction abilities than those with typical development (P < 0.05). A strong correlation was found between executive function and social skills (first canonical correlation coefficient: 0.641, P < 0.001), with 20.4% of the variation in social abilities explained by executive function. Specifically, emotional control, working memory, social perception, social cognition, and autistic behaviors influenced ASD children's development. While balance did not correlate significantly with physical fitness (P > 0.05), muscle strength showed a stronger effect (r = -0.485 to -0.535, P < 0.05). Improving physical fitness may help alleviate deficits in executive function and social skills. These findings provide early insights into the relationship between executive function and social skills in ASD, emphasizing the potential role of physical activity.

Factor Analysis of the Autism Spectrum Rating Scales Parent Report 6-18 in a Complex Community Sample

There is a need for research on autism questionnaire psychometrics outside of the standardization sample. This study investigated the factor structure of the Autism Spectrum Rating Scales-Parent report for ages 6-18 (ASRSp6) in a well-characterized community sample of 696 children (autism [AUT] n = 231; non-autism [NOT] n = 465; X̄age = 10.03) prospectively evaluated with the Autism Diagnostic Observation Schedule-2, a gold-standard autism diagnostic measure. The original author-identified structure demonstrated poor model fit. Exploratory Factor Analysis with a randomly selected half of the sample (n = 346) suggested retaining 17-items on three factors (Rigid/Sensory, Social, and Executive Function [EF]), explaining 55% of the variance. Confirmatory Factor Analysis with the remaining participants (n = 350) indicated good model fit. Partial measurement invariance was observed for diagnostic (AUT/NOT) and gender (male/female) groups. Correlations with the DSM-5p6 (an ASRSp6 scale) were high. Mean differences were observed between AUT/NOT groups for Social; when controlling for age, marginal differences (p = 0.02 - 0.03) were observed for all factors but EF. Social also demonstrated significant AUC regardless of control variables. However, AUC values for Social and other factors, while significant, were in the poor range; correlations with ADOS-2 scores were weak or non-significant. Despite improving the factor structure, the Total-17 does not appear to measure ASD-specific traits. However, these findings provide a basis for further research on ASD questionnaires.

Predicting Post-School Outcomes in Autistic Young Adults One Year after High School Graduation

The aim of the present longitudinal study was to identify malleable factors during the last year of high school that predicted post-school outcomes in autistic youth one year after high school graduation. We then explored whether depressive symptoms in high school mediated the associations between other malleable factors and post-school outcomes. Thirty-two autistic youth and a parent completed surveys during the youth's final year of high school (T1) and one-year post-high school graduation (T2). Malleable factors measured at T1 included social communication skills, executive functions, responsibility for daily tasks, and depressive symptoms. The T2 young adult outcome measure included both objective and subjective indicators of productivity, social well-being, and autonomy in living situation. All malleable factors except social communication skills were significantly correlated with young adult outcomes. T1 executive functions, responsibility for daily tasks, and depressive symptoms jointly predicted 40.2% of the variance in young adult outcomes. Only depressive symptoms explained a significant amount of unique variance in young adult outcomes. In addition, depressive symptoms mediated the predictive association between executive functioning and young adult outcomes. The findings suggest that depressive symptoms may be a key intervention target for autistic high school students. Adapting cognitive behavioral approaches to comprehensively address multiple transdiagnostic factors such as executive functions, responsibility for daily tasks, and mental health may be a promising avenue to promote positive post-school outcomes in this population.

Self-Set Goals: Autistic Adults Facilitating Their Self-Determination Through Digitally Mediated Social Stories

Background

Personalized and practical support can facilitate autistic adults' independence and agency and can enable enhanced self-determination while influencing quality of life. Notwithstanding, traditional supports or interventions for autistic adults typically seek to address perceived challenges associated with autism, rather than identify what the autistic person wants support with. In this research, we explored the potential to empower autistic people by attaining their own self-set goals with the support of digitally mediated Social Stories.

Methods

We conducted a pre/post quasiexperimental design to investigate the usefulness and effectiveness of digitally mediated Social Stories for autistic adults to support the attainment of their self-set goals. Thirty-three autistic participants self-set goals and self-developed Social Stories using a digital application. We collected closeness-to-goal measures at baseline and after 2 weeks of reading their digitally mediated Social Stories themselves and we compared them with a control condition. We then evaluated the goals participants were interested in. The autistic adults also evaluated the usefulness of the intervention for them.

Results

Over 2 weeks, the use of self-set goals, combined with a digitally mediated Social Story, elicited a statistically significant increase in closeness-to-goal ratings with a large effect size. The majority of participants reported that digitally mediated Social Stories were an appropriate and effective form of self-support. Our analysis of the participants' goals indicated that autistic adults predominantly identified a need for support with increasing nonsocial behaviors.

Conclusion

Self-developed digitally mediated Social Stories can effectively support autistic adults in reaching their self-set goals. Digitally mediated Social Stories can support reflection on one's goals, increase commitment toward goals, break down tasks into meaningful parts, as well as create meaningful predictions for autistic adults. Thus, digitally mediated Social Stories have the potential to empower autistic adults to self-support reaching self-set goals.

Transition to Adulthood: Executive Functions and Independent Living Skills in Autistic Young Adults

This study investigated differences in independent living skills and executive functioning skills between autistic and neurotypical young adults in addition to how executive functioning skills contribute to independent living skills in autistic young adults. Participants completed the Adaptive Behavior Assessment System as a measure of independent living skills and the Behavioral Rating Inventory of Executive Function Adult version to measure executive functioning abilities. The Weekly Calendar Planning Activity was also used as a novel measure of performance-based executive functioning skills. Results demonstrated that independent living skills and executive functioning skills were significantly lower in autistic adults (p<.001) than neurotypical young adults. The WCPA also indicated deficits in the autistic population as demonstrated by following fewer rules, utilizing fewer strategies, lower accuracy, and lower self-awareness of performance. Within autistic adults, self-reported measures of executive functioning skills robustly correlated with independent living skills. While the Weekly Calendar Planning Activity accuracy correlated strongly with self-reported measures of executive function, the accuracy did not significantly correlate with the ABAS-3 scores suggesting a discrepancy between self-report and performance-based measures of executive functioning skills. Results indicated that the Weekly Calendar Planning Activity shows promise to inform clinical practice by providing a window into how the integration of multiple executive functioning skills impact challenges with everyday living in the adult autistic population.

Neurocognitive features in childhood & adulthood in autism spectrum disorder: A neurodiversity approach

OBJECTIVES

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a diverse profile of cognitive functions. Heterogeneity is observed among both baseline and comorbid features concerning the diversity of neuropathology in autism. Symptoms vary depending on the developmental stage, level of severity, or comorbidity with other medical or psychiatric diagnoses such as intellectual disability, epilepsy, and anxiety disorders.

METHOD

The neurodiversity movement does not face variations in neurological and cognitive development in ASD as deficits but as normal non-pathological human variations. Thus, ASD is not identified as a neurocognitive pathological disorder that deviates from the typical, but as a neuro-individuality, a normal manifestation of a neurobiological variation within the population.

RESULTS

In this light, neurodiversity is described as equivalent to any other human variation, such as ethnicity, gender, or sexual orientation. This review will provide insights about the neurodiversity approach in children and adults with ASD. Using a neurodiversity approach can be helpful when working with children who have autism spectrum disorder (ASD).

DISCUSSION

This method acknowledges and values the various ways that people with ASD interact with one another and experience the world in order to embrace the neurodiversity approach when working with children with ASD.

Exploring the landscape of adult autism research in psychology: a bibliometric and network analysis

The global prevalence of autism spectrum disorder (ASD) is increasing. ASD manifests with persistent social communication and interaction challenges, limited interests, and repetitive behaviors. As the scientific literature on ASD in adults varies greatly, mapping the recent global research becomes valuable for enhancing comprehension of this subject. This study aims to map recent global scientific publications on ASD in adults. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, bibliometrics, and network analyses, we assessed 850 articles indexed in the Web of Science Core Collection between 2013 and 2022 assigned to the research area of psychology. Findings indicate an annual average growth of 11.69%. Key keywords include Emotion, Anxiety, and Depression, with Anxiety, Depression, and Mental Health as central nodes in the network. Rehabilitation, Behavioral Sciences, and Psychiatry frequently co-occur, and Psychology, Psychiatry, and 'Neurosciences and Neurology' are central nodes in the network of research areas. The United States of America and the United Kingdom lead in publications, with the United Kingdom being the most central country in the network. King's College London and the University of California are the main research organizations, with King's College London as the central node in the network. The American Psychiatric Association's DSM-5-TR was the most cited reference in the period. This comprehensive analysis contributes to understanding the landscape of ASD research in adults, providing insights for future research and fostering collaborations.

The Effect of Attention on Auditory Processing in Adults on the Autism Spectrum

This study examined the effect of attention on auditory processing in autistic individuals. Electroencephalography data were recorded during two attention conditions (passive and active) from 24 autistic adults and 24 neurotypical controls, ages 17-30 years. The passive condition involved only listening to the clicks and the active condition involved a button press following single clicks in a modified paired-click paradigm. Participants completed the Adolescent/Adult Sensory Profile and the Social Responsiveness Scale 2. The autistic group showed delayed N1 latencies and reduced evoked and phase-locked gamma power compared to neurotypical peers across both clicks and conditions. Longer N1 latencies and reduced gamma synchronization predicted greater social and sensory symptoms. Directing attention to auditory stimuli may be associated with more typical neural auditory processing in autism.

Autistic Adults Avoid Unpredictability in Decision-Making

Decision-making under unpredictable conditions can cause discomfort in autistic persons due to their preference for predictability. Decision-making impairments might furthermore be associated with a dysregulation of sex and stress hormones. This prospective, cross-sectional study investigated decision-making in 32 autistic participants (AP, 14 female) and 31 non-autistic participants (NAP, 20 female) aged 18-64 years. The Iowa Gambling Task (IGT) and the Cambridge Risk Task (CRT) were used to assess decision-making under ambiguity and under risk with known outcome probabilities, respectively. Cortisol, estradiol, and testosterone serum levels were related to decision-making performance. Groups did not differ in overall IGT and CRT performance, but compared with NAP, AP preferred less profitable card decks with predictable outcomes while avoiding those with unpredictable outcomes. AP required more time to reach decisions compared to NAP. Additionally, AP without comorbid depression performed significantly worse than NAP in the IGT. Estradiol and cortisol concentrations were significant predictors of CRT scores in NAP, but not in AP. The study results imply that AP are 'risk-averse' in decision-making under ambiguity as they avoided choice options with unpredictable losses in comparison to NAP. Our findings highlight the intolerance for uncertainty, particularly in ambiguous situations. Thus, we recommend being as transparent and precise as possible when interacting with autistic individuals. Future research should explore decision-making in social situations among individuals with ASD, factoring in person-dependent variables such as depression.

The Relationship Between Attention, Sensory Processing, and Social Responsiveness Among Adults on the Autism Spectrum

This study evaluated attention, sensory processing, and social responsiveness and the relationship between these constructs among autistic and neurotypical adults. Participants included 24 autistic adults (17-30 years) and 24 neurotypical peers who completed the Test of Everyday Attention, Adolescent/Adult Sensory Profile (AASP), and the Social Responsiveness Scale-2. Autistic individuals showed greater attention, sensory processing, and social responsiveness challenges compared to neurotypical peers. Using mediation models, we showed that the relationship between attention and social responsiveness was mediated by sensory processing, specifically the low registration and sensation-seeking AASP quadrants. The relationship between attention, sensory processing, and social responsiveness suggests that adults with greater attention issues may have greater sensory and social challenges. Specifically, having poor attention may lead to poor sensory processing skills which compound poor social responsiveness. Understanding the relationships between these domains is critical for developing effective interventions and support for autistic adults.

Everyday Executive Function in Preschoolers with Autism and Links with Intellectual Functioning, Adaptive Behavior, and Autism Symptoms

Impairments in executive function (EF) among individuals with autism spectrum disorder and their association with negative academic, adaptive, and social functioning outcomes have been widely reported over the past 20 years. However, there remains a lack of understanding of EF in autism during the preschool period, an age at which several crucial abilities (including EF) emerge. The present study therefore sought to document everyday EF in preschool-aged children with autism and its associations with other clinical characteristics. Parents rated the EF of their preschool-aged child with autism (M = 30-65 months, N = 288) using the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P; Gioia, G. A., Espy, K. A., & Isquith, P. K. (2003). Behavior Rating Inventory of Executive Function-Preschool Version. Psychological Assessment Resources.). Intellectual quotient, adaptive behavior, and autism symptom severity were also assessed. Preschoolers with ASD displayed impairments in everyday EF, particularly in relation with inhibition and working memory. Greater challenges in EF were strongly associated with lower levels of adaptive behavior and a higher severity of autistic symptoms. To a lesser extent, EF challenges were also associated with lower levels of intellectual functioning. The early assessment and detection of EF difficulties in preschoolers with ASD may assist in developing and integrating specific intervention targets to improve these essential abilities within existing early intervention programs for ASD. This could help to maximize their effectiveness and limit the extent of difficulties these children may face growing up.

The Brunswik Lens Model: a theoretical framework for advancing understanding of deceptive communication in autism

Due to differences in social communication and cognitive functioning, autistic adults may have greater difficulty engaging in and detecting deception compared to neurotypical adults. Consequently, autistic adults may experience strained social relationships or face increased risk of victimization. It is therefore crucial that research investigates the psychological mechanisms that are responsible for autistic adults' difficulties in the deception process in order to inform interventions required to reduce risk. However, weaknesses of extant research exploring deception in autism include a heavy focus on children and limited theoretical exploration of underlying psychological mechanisms. To address these weaknesses, this review aims to introduce a system-level theoretical framework to the study of deception in autistic adulthood: The Brunswik Lens Model of Deception. Here, we provide a comprehensive account of how autism may influence all processes involved in deception, including: Choosing to Lie (1), Producing Deception Cues (2), Perceiving Deception Cues (3), and Making the Veracity Decision (4). This review also offers evidence-based, theoretical predictions and testable hypotheses concerning how autistic and neurotypical adults' behavior may differ at each stage in the deception process. The call to organize future research in relation to a joint theoretical perspective will encourage the field to make substantive, theoretically motivated progress toward the development of a comprehensive model of deception in autistic adulthood. Moreover, the utilization of the Brunswik Lens Model of Deception in future autism research may assist in the development of interventions to help protect autistic adults against manipulation and victimization.

The mediators for the link between autism and real-world executive functions in adolescence and young adulthood

LAY ABSTRACT

Childhood factors that predict real-world executive function in autism spectrum disorder during the transition into adulthood are largely unknown. This study aimed to identify the predictors for the behavioral and cognitive aspects of real-world executive function in late adolescent and young adult autistic populations. We followed up 289 autistic youth (mean age 11.6 years) and 203 non-autistic controls (10.7 years) to their ages of 16.9 and 15.8, respectively. The Behavior Rating Inventory of Executive Function scale was used to measure the real-world executive function at late adolescence and young adulthood at follow-up. Potential predictors such as autistic symptoms, inattention or hyperactivity symptoms, peer relationship, emotional symptoms, and parenting styles were assessed in childhood at first enrollment. The results showed that childhood inattention, withdrawn behaviors, social communication difficulties, and child-reported emotion and inattention/hyperactivity may predict real-world lower executive function in late adolescence and young adults with autism. When separating executive function into behavioral and cognitive aspects, we found that oppositional behaviors and peer problems were specific predictors for behavioral regulation and cognitive function, respectively. Our findings suggested that treating common predictors in childhood, such as inattention, may potentially improve real-world executive function in autism during the transition into adulthood.

Contrasting Views of Autism Spectrum Traits in Adults, Especially in Self-Reports vs. Informant-Reports for Women High in Autism Spectrum Traits

There is uncertainty among researchers and clinicians about how to best measure autism spectrum dimensional traits in adults. In a sample of adults with high levels of autism spectrum traits and without intellectual disability (probands, n = 103) and their family members (n = 96), we sought to compare self vs. informant reports of autism spectrum-related traits and possible effects of sex on discrepancies. Using correlational analysis, we found poor agreement between self- and informant-report measures for probands, yet moderate agreement for family members. We found reporting discrepancy was greatest for female probands, often self-reporting more autism-related behaviors. Our findings suggest that autism spectrum traits are often underrecognized by informants, making self-report data important to collect in clinical and research settings.

The inquiry of the learning support index connotation of adults with autism spectrum disorder

In this study, a questionnaire survey using the Delphi Technique was conducted among 22 expert group members. We construct the connotation of learning support indicators for adults with autism spectrum disorder (ASD) based on survey results. In this study, there are five levels of significance. After three rounds of questionnaire surveying, the average of all questions was >4.0, with a standard deviation of <1, and 37 questions were reserved. The average opinion of the expert members of the Delphi Technique on the importance of connotation topics increased and the standard deviation decreased sequentially, yielding the result of opinion convergence, indicating that the expert members agreed on the importance of the topic of the survey. The research results indicate that the connotation question is reduced from 52 questions to 37 questions through three aspects: writing and expression, simplification and merging of questions, and consideration criteria for various score indicators of the question. On a theoretical level, this study is expected to provide a reference for the connotation construction of learning support indicators for adults with ASD.

Autism Traits and Cognitive Performance: Mediating Roles of Sleep Disturbance, Anxiety and Depression

Theories about autism spectrum disorder (ASD) have addressed cognitive deficits however few have examined how comorbid diagnoses, including sleep disturbance, anxiety and depression contribute to the underlying deficits. We investigated potential mediations of common ASD comorbidities in the relationship between sub-clinical autism traits and cognitive performance using an international community sample. Cognitive tasks assessed working memory [executive functioning (EF) theory], mental state attribution [theory of mind (ToM)], and global/local visual processing [weak central coherence (WCC) theory]. Structural equation modelling (SEM) demonstrated sleep disturbance and anxiety mediated the relationship of autism traits on measures of EF, but not WCC and ToM. This suggests that treating the symptoms of sleep disturbance and anxiety may lead to improvements in working memory.

Animacy Processing in Autism: Event-Related Potentials Reflect Social Functioning Skills

Though previous studies with autistic individuals have provided behavioral evidence of animacy perception difficulties, the spatio-temporal dynamics of animacy processing in autism remain underexplored. This study investigated how animacy is neurally encoded in autistic adults, and whether potential deficits in animacy processing have cascading deleterious effects on their social functioning skills. We employed a picture naming paradigm that recorded accuracy and response latencies to animate and inanimate pictures in young autistic adults and age- and IQ-matched healthy individuals, while also employing high-density EEG analysis to map the spatio-temporal dynamics of animacy processing. Participants' social skills were also assessed through a social comprehension task. The autistic adults exhibited lower accuracy than controls on the animate pictures of the task and also exhibited altered brain responses, including larger and smaller N100 amplitudes than controls on inanimate and animate stimuli, respectively. At late stages of processing, there were shorter slow negative wave latencies for the autistic group as compared to controls for the animate trials only. The autistic individuals' altered brain responses negatively correlated with their social difficulties. The results suggest deficits in brain responses to animacy in the autistic group, which were related to the individuals' social functioning skills.

Effects of sensory integration training on balance function and executive function in children with autism spectrum disorder: evidence from Footscan and fNIRS

Introduction

This study investigates the efficacy of sensory integration training (SIT) in enhancing balance and executive functions in children with autism spectrum disorder (ASD), with the aim of highlighting its potential for organizing and processing sensory information in the brain.

Methods

Utilizing Footscan for biomechanical evidence and functional near-infrared spectroscopy (fNIRS) for neural activation, we engaged two participant groups: a control group (n = 9) and an experimental group (n = 9). Assessments involved the Sharpened Romberg Test (SRT) for balance under varied visual conditions and the Go/No-Go task for executive function.

Results

The SIT intervention significantly improved balance function, particularly in Visual Deprivation (VD) scenarios. Neurophysiological data revealed heightened activation in the right Inferior Frontal Gyrus (R-IFG) and right Middle Frontal Gyrus (R-MFG), suggesting enhanced executive function. The potential of R-IFG/MFG activation as a reliable biomarker for assessing executive function in ASD was identified.

Discussion

The study provides empirical evidence supporting SIT's effectiveness in enhancing balance and executive functions in children with ASD. The therapy not only improves sensory processing and motor skills but also appears to compensate for sensory deficits, particularly in vision, vestibular perception, and proprioception. Enhanced neural activation in specific PFC regions underscores SIT's role in improving cognitive aspects, including inhibitory control and cognitive flexibility. The multidisciplinary approach adopted for this research highlights the intricate interplay between sensory-motor functions and cognitive control in ASD, paving the way for integrated therapeutic strategies. Despite these advancements, the mechanisms through which SIT exerts these multifaceted effects require further exploration.

Pathways to Psychopathology Among Autistic Adults

PURPOSE OF REVIEW

Autistic adults frequently require treatment of mental health problems. Increased rates of suicidality and diminished quality of life among autistic people may be partially attributable to psychiatric symptoms. Some risk factors for mental health problems in autistic people are likely the same as risk factors present in neurotypical individuals, but unique factors that are specific to neurodivergent individuals, and some even more specific to autistic people, may exist. Understanding pathways from autism to mental health problems could inform intervention efforts at the individual and societal levels.

RECENT FINDINGS

We review a growing body of research identifying risk processes across the affective, cognitive, and social domains. Consistent with the principle of equifinality, different processes appear to independently and jointly lead to heightened risk for the onset of mental health problems. Autistic adults frequently utilize mental healthcare services, and experience heightened risk for chronic impairment as a result of mental health problems. Understanding causal and developmental risk processes in autism should inform personalized treatment. We synthesize extant research on these processes and offer suggestions for addressing them therapeutically and societally.

Executive Functions and Public Health: A Narrative Review

Executive functions (EFs) skills are necessary for regulating the thoughts, emotions, and actions which are associated with many aspects of daily functioning. Executive dysfunction (EDFs) is present in a wide range of mental disorders. New study indicates that EFs may predict health behavior and make it easier to engage in a variety of healthy activities. In this narrative review, EFs and public health are briefly discussed. In general, 133 articles met the inclusion criteria (published 2018-2023) which were reviewed. EFs affect the mental and physical health. Besides individual problems, people with mental problems have heavy costs to society. Mental health cannot be considered separately from general health. Consequently, preventive and therapeutic approaches to mental health should be considered not only at the level of the whole society, but also at the global level.

Changes in cytokine and cytokine receptor levels during postnatal development of the human dorsolateral prefrontal cortex

In addition to their traditional roles in immune cell communication, cytokines regulate brain development. Cytokines are known to influence neural cell generation, differentiation, maturation, and survival. However, most work on the role of cytokines in brain development investigates rodents or focuses on prenatal events. Here, we investigate how mRNA and protein levels of key cytokines and cytokine receptors change during postnatal development of the human prefrontal cortex. We find that most cytokine transcripts investigated (IL1B, IL18, IL6, TNF, IL13) are lowest at birth and increase between 1.5 and 5 years old. After 5 years old, transcriptional patterns proceeded in one of two directions: decreased expression in teens and young adults (IL1B, p = 0.002; and IL18, p = 0.004) or increased mean expression with maturation, particularly in teenagers (IL6, p = 0.004; TNF, p = 0.002; IL13, p < 0.001). In contrast, cytokine proteins tended to remain elevated after peaking significantly around 3 years of age (IL1B, p = 0.012; IL18, p = 0.026; IL6, p = 0.039; TNF, p < 0.001), with TNF protein being highest in teenagers. An mRNA-only analysis of cytokine receptor transcripts found that early developmental increases in cytokines were paralleled by increases in their ligand-binding receptor subunits, such as IL1R1 (p = 0.033) and IL6R (p < 0.001) transcripts. In contrast, cytokine receptor-associated signaling subunits, IL1RAP and IL6ST, did not change significantly between age groups. Of the two TNF receptors, the 'pro-death' TNFRSF1A and 'pro-survival' TNFRSF1B, only TNFRSF1B was significantly changed (p = 0.028), increasing first in toddlers and again in young adults. Finally, the cytokine inhibitor, IL13, was elevated first in toddlers (p = 0.006) and again in young adults (p = 0.053). While the mean expression of interleukin-1 receptor antagonist (IL1RN) was highest in toddlers, this increase was not statistically significant. The fluctuations in cytokine expression reported here support a role for increases in specific cytokines at two different stages of human cortical development. The first is during the toddler/preschool period (IL1B, IL18, and IL13), and the other occurs at adolescence/young adult maturation (IL6, TNF and IL13).

A mixed methods study of autistic adults' mental health therapy experiences

Autistic adults are at high risk for co-occurring mental health problems and need access to effective and appropriate mental health treatment. However, the relative effectiveness or acceptability of specific mental health strategies among autistic adults has not been previously examined. The current study sought to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health strategies using a mixed methods approach. Autistic adults (n = 303, ages 21-77) completed online surveys and open-ended questions about their mental health and therapy experiences. Most (88.8%) had participated in therapy, with cognitive approaches being the most common. Regarding overall therapy experiences, qualitative analyses revealed four primary themes and nine subthemes. Therapist acceptance and understanding were seen as critical for therapy success, and many participants felt that therapy was helpful for personal growth. However, many participants found that talking in session was challenging and noted that aspects of the session format affected their ability to engage in therapy. Regarding specific strategies, four cross-cutting themes and eight strategy-specific subthemes were identified. A variety of strategies were seen as helpful for reducing anxiety and improving mood. However, autistic adults reported trouble generalizing strategies to daily life and found some techniques to be difficult to implement due, in part, to their unique autism-related needs. As the first study of its kind, the results underscore the importance of establishing a safe and accepting therapeutic relationship, providing accommodations to support communication needs, and considering individual differences and preferences when selecting mental health strategies for autistic clients.

Improving adaptive behaviors for autistic adults without intellectual disability through executive function training

Executive functioning (EF) is a cognitive process used to perform various daily activities throughout one's lifespan. Autistic adults without intellectual disabilities (ID) also experience difficulties with EF, which is closely associated with adaptive behaviors. For this reason, it is important to improve adaptive behaviors through enhanced use of EF for autistic adults to transition into adulthood successfully. This study aims to conduct a randomized controlled trial to evaluate the effectiveness of a newly developed and modified intervention program. Thirty autistic adults without ID were randomly assigned to the treatment or waitlist group. The participants and caregivers completed various assessments and self-report questionnaires to measure everyday EF and adaptive behaviors. We performed linear mixed-effect modeling to compare the two groups. Data collected at pre-, middle, post-, and follow-up based on participants who completed the program were used to explore changes across time. While there were significant differences in the EF utility-scale (F=5.46, p = .027) between the treatment and waitlist groups, no group x time interactions were detected in other measures. Everyday EF and adaptive behaviors improved when comparing measurements at different time points (p < .001). Our program is Korea's first evidence-based intervention to improve everyday EF and adaptive behaviors for autistic adults without ID.

Executive Function in Autism: Association with ADHD and ASD Symptoms

There is substantial comorbidity between autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD), and there are well-documented executive functioning (EF) deficits in both populations. An important question concerns whether EF deficits in children with ASD are related to severity of ASD, ADHD, or both. We examined ADHD and ASD symptoms in relation to ratings of EF in the home and classroom. The sample comprised 64 children (55 males) diagnosed with ASD (mean age = 9.26 years; mean FSIQ = 92). Analyses indicated that parent and teacher ratings of EF (except Shift and Emotional Control) were consistently related to ADHD symptom severity, but not to ASD severity. Thus, functioning in the domains of Shift and Emotional control appear relatively spared, whereas performance in all other EF was impaired in relation to ADHD symptoms.

Repeating patterns: Predictive processing suggests an aesthetic learning role of the basal ganglia in repetitive stereotyped behaviors

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors (RSBs) can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches-for example, sensory shielding strategies versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson's disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of (external) new sensory information, relative to the precision of (internal) predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors.

Effect of sex and autism spectrum disorder on oxytocin receptor binding and mRNA expression in the dopaminergic pars compacta of the human substantia nigra

Oxytocin is an endogenous neuropeptide hormone that influences social behaviour and bonding in mammals. Variations in oxytocin receptor (OXTR) expression may play a role in the social deficits seen in autism spectrum disorder. Previous studies from our laboratory found a dense population of OXTR in the human substantia nigra (SN), a basal ganglia structure in the midbrain that is important in both movement and reward pathways. Here, we explore whether differences in OXTR can be identified in the dopaminergic SN pars compacta of individuals with autism. Postmortem human brain tissue specimens were processed for OXTR autoradiography from four groups: males with autism, females with autism, typically developing (TD) males and TD females. We found that females with autism had significantly lower levels of OXTR than the other groups. To examine potential gene expression differences, we performed in situ hybridization in adjacent slides to visualize and quantify OXTR mRNA as well as mRNA for tyrosine hydroxylase. We found no differences in mRNA levels for either gene across the four groups. These results suggest that a dysregulation in local OXTR protein translation or increased OXTR internalization/recycling may contribute to the differences in social symptoms seen in females with autism. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.

Psychophysiological aspects of autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental illness marked by chronic difficulties with mutual social interaction and communication, as well as restricted or repetitive patterns of behavior, interests, or activities. ASD symptoms commonly appear in early childhood and can be identified by the age of 2 years. Early detection of ASD allows for better therapeutic interventions and management, which has been shown to lessen children's long-term intellectual, behavioral, and functional deficits while also improving family consequences. In the present review, we are focusing on important psychophysiological aspects of autism spectrum disorders.

Differences in daily life executive functioning between people with autism and people with schizophrenia

This is a comparative analysis of everyday executive functioning between individuals with Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSD) and controls using Dysexecutive Questionnaire-Spanish (DEX-Sp), to identify patterns of difficulties. Also we assessed the relationship between EF and adaptive behavior as measured by the Vineland Adaptive Behavioral Scale-II. Common areas of everyday executive functions were established as problematic in individuals with ASD and SSD related to Disinhibition and Apathy, while Disorganization and Impulsivity was gravely affected in ASD group only. The degree of Dysexecutive Syndrome was predictive of adaptive behavior in ASD group only. These suggest that DEX-Sp could be a useful tool in differentiating areas of strength and weaknesses in clinical groups such as ASD and SDD.

Effects of the Early Phase of COVID-19 on the Autistic Community in Sweden: A Qualitative Multi-Informant Study Linking to ICF

While the COVID-19 pandemic is ongoing, early outcome studies indicate severe and pervasive global effects of the pandemic and associated measures to prevent the spread of the virus. General population studies, as well as insight into the outcomes for particular groups, will be necessary in order to mitigate potentially long-term effects as well as to prepare for future epidemics or pandemics. The pandemic conditions have been marked by rapid and abrupt changes and unpredictability which are circumstances that leave the autistic population particularly vulnerable to adverse outcomes following the distinctive features of the diagnosis. Studies are only beginning to delineate the outcomes of the global autism community and the present study adds to these findings by providing a local, multi-perspective, qualitative analysis of the lived experiences of the Swedish autism community. In this study, autistic youth and adults, caregivers of autistic individuals, as well as representatives of Swedish interest organizations were interviewed. Thematic analysis was performed on the population as a whole and patterns of results were formalized according to the International Classification of Function, Disability and Health (ICF-CY). Participants report wide-ranging adverse outcomes of the pandemic relating to mental health and access to support, participation in daily activities and socialization, education, and work as well as parental resources. However, participants also report positive outcomes relating to a reduction in specific social and everyday demands, and normalization of lived experiences. Additionally, interviews outlined some strategies used to cope during pandemic conditions. Implications of these findings are discussed.

Suspected feigning of autism in adults: a clinician survey, indications and proposed guidelines

Purpose

This paper aims to provide a discussion and summary of a clinician survey exploring the experiences of suspected feigned autism.

Design/methodology/approach

This study is an online survey targeting a range of autism professionals, with varying levels of experience, working in different clinical settings.

Findings

Approximately half of the professionals who completed the survey reported experiencing situations of suspected feigning of adult autism across a range of clinical contexts and with various motivations. In terms of best indications of potential feigning, most clinicians reported “textbook” self-descriptions of problem behaviours with vague examples, as well as inconsistent presenting problems and mismatch with any known developmental history. Approximately half of clinicians expressed the view that autism was more difficult to feign than a psychiatric disorder and had experienced situations involving differences in professional opinion as to an individual autism diagnosis.

Research limitations/implications

The survey is limited by a potential sample bias and no information regarding the clinical characteristics of those suspected to have feigned autism. However, these initial findings offer further questions for future research to pursue.

Originality/value

As an initial examination of practicing clinicians’ experiences of suspected feigned autism, the survey highlights the complexities of an autism diagnosis and suggests feigning is a potential clinical scenario. Some guidance as to when to suspect possible feigned autism is also offered, as well as a provisional assessment protocol.

Intact fluency in autism? A comprehensive approach of verbal fluency task including word imageability and concreteness

Verbal fluency is a cognitive function reflecting executive functions and the ability to retrieve the appropriate information from memory quickly. Previous studies reported conflicting results—impaired and intact verbal fluency—in autism spectrum disorder (ASD). Most studies concentrate on overall word productivity, errors, perseverations, clustering, or switching. We used a comprehensive approach to evaluate the reported discrepancy in the literature and introduced a new angle using the concept of word abstraction and imageability. Moreover, we analyzed the performance in two‐time intervals (0–30 s and 31–60 s) to assess the temporal dynamics of verbal fluency and a possible activation or initiation deficit in autism. Sixteen adults with ASD and 16 neurotypical control participants, matched by gender, age, and education level, participated in our study. Contrary to our expectations, we did not find a significant difference between groups in word productivity, the number of errors, clustering, or temporal dynamics, neither in semantic nor in phonemic fluency tasks. Surprisingly, the two study groups' performance did not differ in terms of imageability or concreteness characteristics either. Our results raise the possibility that verbal fluency performance is intact in autism. We also suggest using a comprehensive approach when measuring fluency in autism.

Atypical Neural Responses of Cognitive Flexibility in Parents of Children With Autism Spectrum Disorder

Impaired cognitive flexibility has been repeatedly demonstrated in autism spectrum disorder (ASD). There is strong evidence for genetic involvement in ASD. First-degree relatives of individuals with ASD may show mild deficits in cognitive inflexibility. The present study investigated cognitive flexibility and its neuroelectrophysiological mechanisms in first-degree relatives of individuals with ASD to assess its potential familiality. Forty-five biological parents of individuals/children with ASD (pASD) and thirty-one biological parents of typically developing individuals/children (pTD), matched by gender, age, and IQ, were enrolled. The broad autism phenotype questionnaire (BAPQ) and cognitive flexibility inventory (CFI) were used to quantitatively assess autistic traits and cognitive flexibility in daily life, respectively. The task-switching paradigm was used to evaluate the behavioral flexibility in a structured assessment situation. Event-related potentials (ERPs) induced by this paradigm were also collected. Results showed that compared with the pTD group, the pASD group had lower CFI scores (t = −2.756, p < 0.01), while both groups showed an equivalent “switch cost” in the task-switching task (p > 0.05). Compared with the pTD group, the pASD group induced greater N2 amplitude at F3, F4, Fz, and C4 (F = 3.223, p < 0.05), while P3 amplitude and latency did not differ between the two groups. In addition, there was a significant negative correlation between the CFI total scores and BAPQ total scores in the pASD group (r = −0.734, p < 0.01). After controlling for age and IQ, the N2 amplitude in the frontal lobe of pASD was negatively correlated with the CFI total scores under the repetition sequence (r = −0.304, p = 0.053). These results indicated that pASD had deficit in cognitive flexibility at the self-reported and neurological levels. The cognitive flexibility difficulties of parents of children with ASD were related to autistic traits. These findings support that cognitive flexibility is most likely a neurocognitive endophenotype of ASD, which is worthy of further investigation.

Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition

Autism spectrum disorder (ASD) is associated with neurocognitive impairment, including executive dysfunctioning and social cognition (SC) deficits. Cognitive remediation (CR) is a behavioral training-based intervention aiming to improve cognitive processes. Its first use in psychiatry interested patients with schizophrenia, in whom promising results have been shown. Integrated CR programs targeting both social and non-social cognition have demonstrated to be effective in improving both cognitive domains and functional outcomes. CR studies in children and adolescents with ASD are still new, those regarding CR approaches combining social and executive functioning remediation are scares. One study examining the efficacy of cognitive enhancement therapy (CET) for improving cognitive abilities in ADS adults, showed significant differential increases in neurocognitive function and large social-cognitive improvements. Therefore, taking into account the overlap between ASD and schizophrenia, and considering the close link between executive functions (EF) and SC, we suggest that integrative approach in ASD could result in better outcomes. The present perspective aimed to highlight cognitive remediation (CR) programs contributions in ASD (especially in children and adolescents), and to discuss the value of combining social and non-social programs.

The relationship between autism spectrum and sleep-wake traits

Autistic children and adults often have sleep disturbances, which may affect their and their family's quality of life. Yet, the relationship between sleep-wake patterns and autism spectrum traits is understudied. Identifying such relationships could lead to future research elucidating common mechanistic underpinnings. Thus, we aimed to determine whether sleep-wake patterns, specifically related to sleep, physical activity, and the daily sleep-wake rhythm (i.e., circadian rhythm), are associated with autism spectrum-related traits. Accelerometer-derived sleep-wake parameters were estimated in individuals with autistic spectrum traits and their family members (N = 267). We evaluated autism spectrum traits using the Social Responsiveness Scale (SRS) to assess the presence and severity of social impairment and the Behavior Rating Inventory of Executive Function (BRIEF) to assess executive function. The linear multivariate regression analysis (using SOLAR-Eclipse) showed that in adults, increased core autism spectrum traits and executive dysfunction were associated with disruption of several sleep-wake parameters, particularly related to the daily sleep-wake rhythm, and that executive dysfunction was associated with disrupted sleep quality and level of physical activity. We highlight the interplay between daytime function and disrupted sleep-wake patterns, specifically related to the daily sleep-wake rhythm, that could guide future research into common mechanisms.

Independent living in adults with autism spectrum disorder: Stakeholders' perspectives and experiences

Independent living is a basic human right that enables individuals with disabilities to determine where they live, who they live with and what kind of support that they receive. Limited research exists regarding the challenges that adults with autism spectrum disorder (ASD) may face when attempting to live independently. Given the importance of independent living for adults with ASD, this study aimed to examine the perspectives of stakeholders about independent living among adults with ASD.

METHODS

We recruited a total of 19 stakeholders including adults with ASD and parents of adults with ASD from Canadian provinces. In-depth, semi-structured interviews were conducted to identify factors affecting independent living among adults with ASD. Interviews were transcribed and analyzed using thematic analysis to identify overarching themes.

RESULTS

Three themes emerged in our findings, including: a) Psychophysical stability and daily living; b) Financial management and planning; and c) Integrated community living and independence.

CONCLUSION

The findings from this study suggest that adults with ASD face several challenges related to independent living. Factors related to psychophysical stability and daily living, financial management, and integrated community living and housing were all found to influence the ability of adults with ASD to live independently. By exploring stakeholders' perspectives of independent living for adults with ASD, this study provides some insight that can help inform the development of programs and services to facilitate independent living for adults with ASD.

Everyday Executive Function and Self-Awareness in Agenesis of the Corpus Callosum

OBJECTIVE

Agenesis of the corpus callosum (AgCC) is associated with a range of cognitive deficits, including mild to moderate problems in higher order executive functions evident in neuropsychological assessments. Previous research has also suggested a lack of self-awareness in persons with AgCC.

METHOD

We investigated daily executive functioning and self-awareness in 36 individuals with AgCC by analyzing self-ratings on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A), as well as ratings on the same instrument from close relatives. Discrepancies between self- and informant-ratings were compared to the normative sample and exploratory analyses examined possible moderating effects of participant and informant characteristics.

RESULTS

Significant deficiencies were found in the Behavioral Regulation and Metacognitive indices for both the self and informant results, with elevated frequency of metacognition scores in the borderline to clinical range. Informants also endorsed elevated frequency of borderline to clinically significant behavioral regulation scores. The proportion of AgCC participants whose self-ratings indicated less metacognitive impairment than informant-ratings was greater than in the normative sample. Self-ratings of behavioral regulation impairment decreased with age and informant-ratings of metacognition were higher in males than females.

CONCLUSIONS

These findings provide evidence that individuals with AgCC experience mild to moderate executive functioning problems in everyday behavior which are observed by others. Results also suggest a lack of self-understanding or insight into the severity of these problems in the individuals with AgCC, particularly with respect to their metacognitive functioning.

Executive Function Brain Network Activation Predicts Driving Hazard Detection in ADHD

Drivers with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are at increased risk of experiencing driving difficulties. An important aspect of driving safety and skill involves hazard detection. This functional magnetic resonance imaging study examined the neural responses associated with driving hazard detection in drivers with ASD, ADHD, and typically developing (TD) drivers. Forty participants (12 ASD, 15 ADHD, 13 TD) ages 16-30 years completed a driving simulator task in which they encountered social and nonsocial hazards; reaction time (RT) for responding to hazards was measured. Participants then completed a similar hazard detection task in the MRI scanner so that neural response to hazards could be measured. Activation of regions of interest considered part of the executive function (EF) and theory of mind (ToM) networks were examined and related to driving simulator behavior. Results showed that stronger activation of the EF network during social hazard processing, including the bilateral dorsolateral prefrontal cortex and posterior parietal cortex, was associated with faster RT to social hazards among drivers with ADHD, but not among drivers with ASD. This provides the first evidence of a relationship between EF network brain activation and driving skills in ADHD and suggests that alterations in this network may underlie driving behavior. In comparison, the current study did not observe a relationship between ToM network activation and RT to social hazards in any group. This study lays the groundwork for relating neural activation to driving behavior among individuals with NDDs.

Evaluation of the "Let's Get Organized" group intervention to improve time management: protocol for a multi-centre randomised controlled trial

BACKGROUND

Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. "Let's Get Organized" (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation.

METHODS

The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years.

DISCUSSION

A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.

A review of executive functioning challenges and strengths in autistic adults

Objective: There has been a steady rise in research characterizing executive functioning (EF) impairments in autistic individuals but limited research investigating EF strengths. This review provides a summary of current EF research in autistic adults with a focus on EF challenges and strengths and potential sources of heterogeneity in research findings. New avenues for addressing gaps in our understanding of EF strengths are proposed.Method: A review of the EF literature was conducted. One hundred twenty-four studies of inhibition, working memory, cognitive flexibility, fluency, planning, decision-making, and subjective measures of EF in autistic adults were included.Results: Autistic adults with average intellectual functioning demonstrate difficulties with cognitive flexibility, phonemic fluency, and working memory. Strengths in planning, decision-making, and semantic verbal fluency were evident in some but not all studies. Findings regarding inhibition are inconclusive. Key findings across each EF domain are discussed and sources of potential heterogeneity across studies were evaluated. The type of measure used appears to contribute to heterogeneous findings. Subjective EF measures revealed more consistent findings of deficits in autistic adults than objective EF measures.Conclusions: Research reveals areas of EF weaknesses as well as strengths in autistic adults. Unlike EF challenges, EF strengths are not well understood. Future research identifying EF strengths is needed to improve services and supports for autistic adults. Further investigation of potential factors that interact with or constrain EF such as comorbid disorders, verbal ability, sensory processing, and other factors specific to autism will be critical to move the field forward and increase understanding of how EF is related to everyday functioning in autistic adults.

Autism - A Comprehensive Array of Prominent Signs and Symptoms

BACKGROUND

Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by multiple psychological and physiological impairments in young children. According to the recent reports, 1 out of every 58 newly-born children is suffering from autism. The aetiology of the disorder is complex and poorly understood, hindering the adaptation of targeted and effective therapies. There are no well- established diagnostic biomarkers for autism. Hence the analysis of symptoms by the pediatricians plays a critical role in the early intervention.

METHODS

In the present report, we have emphasized 24 behavioral, psychological and clinical symptoms of autism.

RESULTS

Impaired social interaction, restrictive and narrow interests, anxiety, depression; aggressive, repetitive, rigid and self-injurious behavior, lack of consistency, short attention span, fear, shyness and phobias, hypersensitivity and rapid mood alterations, high level of food and toy selectivity; inability to establish friendships or follow the instructions; fascination by round spinning objects and eating non-food materials are common psychological characteristics of autism. Speech or hearing impairments, poor cognitive function, gastrointestinal problems, weak immunity, disturbed sleep and circadian rhythms, weak motor neuromuscular interaction, lower level of serotonin and neurotransmitters, headache and body pain are common physiological symptoms.

CONCLUSION

A variable qualitative and quantitative impact of this wide range of symptoms is perceived in each autistic individual, making him/her distinct, incomparable and exceptional. Selection and application of highly personalized medical and psychological therapies are therefore recommended for the management and treatment of autism.

Brain mRNA Expression Associated with Cortical Volume Alterations in Autism Spectrum Disorder

Numerous studies report abnormal cerebral cortex volume (CCV) in autism spectrum disorder (ASD); however, genes related to CCV abnormalities in ASD remain largely unknown. Here, we identify genes associated with CCV alterations in ASD by performing spatial correlations between the gene expression of 6 donated brains and neuroimaging data from 1,404 ASD patients and 1,499 controls. Based on spatial correlations between gene expression and CCV differences from two independent meta-analyses and between gene expression and individual CCV distributions of 404 patients and 496 controls, we identify 417 genes associated with both CCV differences and individual CCV distributions. These genes are enriched for genetic association signals and genes downregulated in the ASD post-mortem brain. The expression patterns of these genes are correlated with brain activation patterns of language-related neural processes frequently impaired in ASD. These findings highlight a model whereby genetic risk impacts gene expression (downregulated), which leads to CCV alterations in ASD.

The Dynamic Differences between Self- and Other-Oriented Mental Inferences: An ERP Study on a False-Belief Task

Theory of mind (ToM) refers to the ability to infer others' mental states. In our everyday lives, we need to interact constantly and appropriately with others. Not only is ToM involved in understanding others' mental states (other-oriented mental inferences), but it also helps to keep our own mental states (self-oriented mental inferences). In this study, we designed a false-belief task using event-related potential (ERP) measures to investigate the dynamic differences between the two types of mental inferences. In the false-belief task, participants were prompted with a cue to attribute a belief to either themselves (self-oriented) or another person (other-oriented). Results showed that other-oriented false-belief attribution elicited a larger late positive component (LPC; 320~440 ms post-cue onset) than the one elicited by self-oriented attribution at bilateral parieto-occipital electrodes, and also a larger late negative component (LNC; 380~500 ms post-cue onset) at frontal-central electrodes. In addition, the difference in amplitude of LPC between the two types of false-belief attribution was positively correlated with self-reported autistic traits measured by the Autism Spectrum Quotient (AQ). Based on prior literature, we propose that the LPC and LNC reflect the processes of self-other distinction and conflict control, respectively. Moreover, the difficulty in distinguishing other from the self is related to one's degree of autistic traits.

Associating executive dysfunction with behavioral and socioemotional problems in children with epilepsy. A systematic review

As children with epilepsy may have a number of learning and behavioral problems, it is important that insight into the underlying neurocognitive differences in these children, which may underlie these areas of challenge is gained. Executive function (EF) problems particularly are associated with specific learning abilities as well as behavioral problems. We aim to review systematically the current status of empirical studies on the association between EF problems and behavior and socioemotional problems in children with epilepsy. After search, 26 empirical studies were identified, most of them of moderate quality. Overall, attention problems were the most reported cognitive deficit in test assessment and the most reported problem by parents. In 54% of the studies, children with epilepsy scored below average compared to controls/normative samples on different aspects of EF. Most studies reported behavior problems, which ranged from mild to severe. Forty-two percent of the studies specifically reported relationships between EF deficits and behavioral problems. In the remaining studies, below average neuropsychological functioning seemed to be accompanied by above average reported behavioral problems. The association was most pronounced for cognitive control and attention in relation to externalizing behavior problems. This cognitive control is also associated with social functioning. Relevant epilepsy variables in this relationship were early age at onset and high seizure frequency.Future research should distinguish specific aspects of EF and take age into account, as this provides more insight on the association between EF and behavior in pediatric epilepsy, which makes it possible to develop appropriate and early intervention.

Patterns of Relational Framing in Executive Function: An Investigation of the Wisconsin Card Sorting Test

Executive function (EF) is a concept widely used to describe higher order cognitive functioning. However, the concept seems to lack a precise definition upon which even experts in the area can agree. Examples of existing definitions describe EF as capacities for independent self-serving behavior and aspects of working memory, planning and organizational skills. It has been argued that the definition of EF is too imprecise, in terms of informing effective interventions. To possibly understand the range of behaviors termed EF in a more workable way, we administered a well-known computerized test (the Wisconsin Card Sorting Test; WCST) of EF to a sample of normal functioning participants (n = 11). During administration, they were asked questions about their ways of thinking. Transcriptions of questions and answers were analyzed in search of common patterns, using a behavioral theory of language and cognition (relational frame theory; RFT). The analysis suggested that a specific relationship between deictic and temporal framing, on the one hand, and coordination and spatial framing, on the other, was in effect when participants performed well on the WCST. At critical time points during the test (i.e., when need for EF was arguably most acute), deictic and temporal framing dominated participants’ behavior, whereas coordination and spatial framing were used relatively less.

Profiling planning skills and cognitive flexibility of adults with autism spectrum disorders: Preliminary results from an exploratory service-based study

Background: Executive functions (EF) impairments have long been observed in children and youths with autism spectrum disorders (ASD). Until very recently, little attention has been paid to examine EF profiles of adults with ASD. Given the importance of EF to cope with the demands of daily life and participate in society (e.g. maintaining an employment), this study reports on a preliminary investigation aimed at exploring planning skills and cognitive flexibility in a sample of adults with ASD and without intellectual disability. A secondary aim was to explore the contribution of both intellectual functioning and socio-demographic variables on efficiency of EF. Method: Twenty-nine autistic adults (age range 18-50) were assessed using the Tower of London (ToL) test and the Wisconsin Card Sorting Test (WCST). Intellectual functioning was assessed with the Wechsler Adult Intelligence Scale - IV. Results: From the evaluations emerged poor performances in sub-processes related to planning skills as assessed by ToL (number of Moves, Correct Reponses, and Execution time). In contrast, WCST performance did not result impaired in any of the indicators considered. Exploratory analyses revealed a strong relationship between the time needed to complete the planning tasks and visuo-spatial reasoning. Further, strong inverse associations were found between global intellectual functioning and chronological age in the WCST. Conclusions: The results of this study highlight mixed EF profiles in a sample of adults with ASD. Future investigations may build on the results of the present study to understand whether evaluating planning abilities of adults with ASD by means of measures that do not require a time-limit would yield different results compared to time-constrained assessment procedures.

An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training

Objective: To examine the development of executive functions, in preschool children with autism spectrum disorders (ASD), receiving early intensive behavioral training (EIBI). Method: Executive functions (EF) were assessed with The Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P), by parents and preschool teachers at the time of diagnostic assessment and after 15 months of EIBI intervention. Ten children with ASD (M = 2.9 years, nine males) participated in the study. Reliable Change Index scores were computed for each of the participants in order to investigate any significant change in BRIEF-P T-scores. Results: Three children showed a significant improvement in EF, based on parent ratings. Four children showed a significant improvement in EF based on preschool teacher ratings. Conclusion: Findings indicating a reliable improvement in one third of preschool children with ASD receiving EIBI are encouraging but need to be replicated in larger scale controlled studies.

Short-Term Memory Span and Cross-Modality Integration in Younger and Older Adults With and Without Autism Spectrum Disorder

This study tested whether adults with autism spectrum disorder (ASD) show the same pattern of difficulties and absence of age-related differences in short-term memory (STM) as those that have been reported in episodic long-term memory (LTM). Fifty-three adults with ASD (age range: 25-65 years) were compared to 52 age-, biological sex-, and intelligence-matched typically developing (TD; age range: 21-67 years) adults on three STM span tasks, which tested STM performance for letters (Verbal), grid locations (Visuospatial), or letters in grid locations (Multimodal). A subsample of 34 TD and 33 ASD participants ranging in age from 25 to 64 years completed a fourth Multimodal Integration task. We also administered the Color Trails Test as a measure of executive function. ASD participants' accuracy was lower than that of the TD participants on the three span tasks (Cohen's d: 0.26-0.50). The Integration task difference was marginally significant (p = .07) but had a moderate effect size (Cohen's d = 0.50). Regression analyses confirmed reduced STM performance only for older TD participants. Analyses also indicated that executive processes played a greater role in the ASD group's performance. The demonstration of similar difficulties and age-related patterning of STM in ASD to those documented for LTM and the greater recruitment of executive processes by older ASD participants on the Integration task suggest a compensatory role of frontal processes both as a means of achieving undiminished task performance and as a possible protection against older age cognitive decline in ASD. Longitudinal research is needed to confirm this. Autism Res 2020, 13: 1970-1984. © 2020 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: Little is known about short-term memory (STM) in younger and older adults with autism spectrum disorder (ASD). This study tested different kinds of STM and showed that ASD adults remembered shorter sequences of letters, crosses, or letters in grid cells less well than matched participants with typical development. However, older ASD individuals performed similarly to younger ASD individuals, nor showing the reduction in performance usually seen with older age. The data suggest that ASD individuals use different underlying mechanisms when performing the tasks and that this might help protect their memory as they grow older.

The Implications of Motor and Cognitive Inhibition for Hot and Cool Executive Functions: The Case of Quadrato Motor Training

Enabling the ceasing of ongoing or prepotent responses and the controlling of interference, motor inhibition facilitates the development of executive functions (EFs) such as thought before action, decision-making, self-regulation of affect, motivation, and arousal. In the current paper, a characterization is offered of the relationship between motor inhibition and the executive functioning system, in the context of a proposed division into predominantly affective (hot) and cognitive (cool) components corresponding to neural trajectories originating in the prefrontal cortex. This division is central to understanding the effects of a specifically-structured sensorimotor movement training practice, known as Quadrato Motor Training (QMT), on hot and cool EFs. QMT's effects on crucial mechanisms of integrating different EF components are discussed.