Executive Function in Autism: Association with ADHD and ASD Symptoms

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 The results showed that childhood inattention, withdrawn behaviors, social communication difficulties, and child-reported emotion and inattention/hyperactivity may predict real-world lower executive function in late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.

Higher Sensory Sensitivity is Linked to Greater Expansion Amongst Functional Connectivity Gradients

Insofar as the autistic-like phenotype presents in the general population, it consists of partially dissociable traits, such as social and sensory issues. Here, we investigate individual differences in cortical organisation related to autistic-like traits. Connectome gradient decomposition based on resting state fMRI data reliably reveals a principal gradient spanning from unimodal to transmodal regions, reflecting the transition from perception to abstract cognition. In our non-clinical sample, this gradient's expansion, indicating less integration between visual and default mode networks, correlates with subjective sensory sensitivity (measured using the Glasgow Sensory Questionnaire, GSQ), but not other autistic-like traits (measured using the Autism Spectrum Quotient, AQ). This novel brain-based correlate of the GSQ demonstrates sensory issues can be disentangled from the wider autistic-like phenotype.

Differentiating Post-Digital Nannying Autism Syndrome from Autism Spectrum Disorders in Young Children: A Comparative Cross-Sectional Study

Excessive exposure of young children to digital devices has increased in recent years. Much research has shown that early excessive screentime is associated with autistic-like symptoms. This study aimed to differentiate children with Post-Digital Nannying Autism Syndrome (PDNAS) from children with autism spectrum disorders (ASD) and typically developing children (TDC), both behaviorally and cognitively. This study is comparative and cross-sectional and included three groups of children. The first group consisted of 15 young children with subthreshold autism symptoms. They had not received a formal diagnosis of ASD and had been exposed to digital devices for more than half of their waking time. The second group consisted of 15 young children with ASD, and the third group consisted of 15 young TDC. A lifestyle checklist, a modified checklist for autism in toddlers (M-CHAT), a behavioral flexibility rating scale-revised (BFRS-R), the Gilliam autism rating scale (GARS-2), and a behavior rating inventory of executive functioning-preschool version (BRIEF-P) were used to compare the three groups. The results showed that executive functions and behavioral flexibility were more impaired in children with ASD than in children with PDNAS and in TDC. Also, we found that there was no significant difference in the severity of autism symptoms between the children with ASD and the children with PDNAS. Early excessive exposure to digital devices may cause autism-like symptoms in children (PDNAS). Children with PDNAS are different from children with ASD in executive functions and behavioral flexibility. Further research is needed in this area.

The relationship between executive function, neurodevelopmental disorder traits, and academic achievement in university students

Difficulties with executive function have often been identified in individuals with various neurodevelopmental disorders such as Autism Spectrum Disorder (ASD), Attention-Deficit Hyperactivity Disorder (ADHD), and Developmental Co-ordination Disorder (DCD). Additionally, in childhood and adolescence, executive functioning is an important predictor of academic achievement. However, less research has explored these relationships in adult students, and those with a high level of neurodevelopmental disorder traits but no clinical diagnosis. Therefore, the current study aimed to assess whether ASD, ADHD, and DCD traits can predict academic achievement in university students, and whether traits of these neurodevelopmental conditions moderate the relationship between executive function and academic achievement. Both neurotypical students and those with a clinical diagnosis of a neurodevelopmental disorder were able to participate, with the majority being neurotypical. Participants completed four self-report questionnaires and provided a measure of academic achievement based on their university assignment results. Traits of ASD, ADHD, and DCD alone did not predict achievement, however, traits of ADHD and DCD significantly moderated the relationship between executive function and academic achievement. ASD traits did not significantly moderate this relationship. Implications and suggestions for future research are also discussed.

Elevated symptoms of executive dysfunction predict lower adaptive functioning in 3-year-olds with autism spectrum disorder

Executive functioning (EF) deficits co-occur frequently with autism spectrum disorder (ASD) and have a long-term detrimental impact on quality of life of children and their families. Timely identification of risk for EF vulnerabilities may hasten access to early intervention and alleviate their long-term consequences. This study examines (1) if EF deficits are elevated in toddlers with ASD compared to nonautistic siblings of children with ASD, typically developing (TYP) toddlers, and toddlers with atypical developmental presentation; and (2) if EF deficits have a detrimental effect on adaptive functioning in ASD. Participants were recruited between September 2014 and October 2019 and included 73 toddlers with ASD, 33 nonautistic siblings of children with ASD, 35 toddlers with atypical development, and 28 TYP toddlers matched on chronological age (M = 39.01 months, SD = 3.11). EF deficits were measured using the BRIEF-P; adaptive skills were measured using the VABS-II. Whenever appropriate, analyses were controlled for MSEL verbal and nonverbal developmental quotient, ADOS-2 autism severity scores, and sex. Analyses revealed that toddlers with ASD exhibited elevated BRIEF-P scores across all domains compared to each of the three comparison groups. Higher BRIEF-P scores were associated with lower adaptive social, communication, and daily living skills while controlling for symptom severity, verbal and nonverbal functioning, and sex. In conclusion, marked vulnerabilities in EF are already present in 3-year-old toddlers with ASD and are predictive of the level of adaptive functioning in ASD. EF vulnerabilities in toddlers should be targeted for intervention to improve long-term outcomes in ASD. LAY SUMMARY: Many children with autism experience vulnerabilities in executive functioning (EF), which may include challenges with inhibition, working memory, cognitive flexibility, and planning. The study shows that these vulnerabilities can already be detected at age three and that their presence is linked with lower social, communication, and daily living skills. Screening children with ASD for EF challenges and helping those who have difficulties may improve their long-term outcomes.

Executive Functions in Children and Adolescents with Autism Spectrum Disorder, Grade 1 and 2, vs. Neurotypical Development: A School View

Background: Autism spectrum disorders are neurodevelopmental disorders characterized by deficits in social and communication functioning. Previous studies suggest that people with autism spectrum disorders have deficits in executive functions, having found a relationship with cognitive flexibility, planning, working memory, inhibition or self-control, but it is especially with respect to cognitive flexibility where the greatest dysfunctions have been found. The objective of this research was to compare the executive functioning of a group of children and adolescents diagnosed with autism spectrum disorders with another with neurotypical development in an educational context. Methods: This was a cross-sectional, descriptive and multicenter confirmatory study in which 121 people who participated acted as informants, with 70 of them being education professionals who work with people with autism spectrum disorders grade 1 and 2 and 51 of them being teachers who work with people of neurotypical development; these individuals were selected through non-probabilistic sampling. Results: People diagnosed with autism spectrum disorders obtained significantly higher scores on the Behavior Rating Inventory of Executive Function-2 scale for the nine clinical scales and the four indexes that compose it compared to the group of people with neurotypical development; in addition, the average scores obtained are clinically significant, with them being elevated for the group with autism spectrum disorders. This study confirms that children and adolescents with autism spectrum disorders experience greater difficulties with respect to their executive functions than children with neurotypical development.

Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children

Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co‐occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7‐ to 11‐year‐old autistic children, we explored: (1) whether co‐occurring attention‐deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, “For whom is training effective?” We also explored: (2) the extent to which changes in a brain‐based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, “How is training effective?” We found that EF training improved behavioral inhibition only for children with clinically significant co‐occurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre‐to‐post change in an EEG‐based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior.

Exploring Cultural Differences in Autistic Traits: A Factor Analytic Study of Children with Autism in China and the Netherlands

Autism spectrum disorders are diagnosed globally, but recognition, interpretation and reporting may vary across cultures. To compare autism across cultures it is important to investigate whether the tools used are conceptually equivalent across cultures. This study evaluated the factor structure of the parent-reported Autism Spectrum Quotient Short Form in autistic children from China (n = 327; 3 to 17 years) and the Netherlands (n = 694; 6 to 16 years). Confirmatory factor analysis did not support the two-factor hierarchical model previously identified. Exploratory factor analysis indicated culturally variant factor structures between China and the Netherlands, which may hamper cross-cultural comparisons. Several items loaded onto different factors in the two samples, indicating substantial variation in parent-reported autistic traits between China and the Netherlands.