A meta-analysis of cognitive flexibility in autism spectrum disorder

Slow but Steady: Similarities and Differences in Executive Functioning Between Autistic and Non-Autistic Adults

Prior research has established differences between autistic and non-autistic individuals across the domains of executive function (EF). While some early theories portrayed these differences as universal to the autism spectrum, recent findings have been quite mixed. Factors like small samples, the components of EF being measured, and the age and intelligence quotient (IQ) of those being compared may contribute to this diversity in results. Moreover, research suggests performance over time might fluctuate in different patterns for autistic and non-autistic individuals. To test EF differences and the possible influence of these factors upon them, we recruited a sample of over 900 autistic and non-autistic participants (with generally average/above average IQ levels) from 18 to 77 years of age. They completed a battery of tasks measuring inhibition, cognitive flexibility, working memory, and attentional orienting to social and nonsocial cues. We found that performance was similar between groups in our primary measures of EF, although autistic participants were consistently slower, more susceptible to the effects of spatial cueing, and more prone to certain errors in the working memory task. Differences between groups were generally not influenced by participants' age, gender, or IQ. Performance over time varied only in the working memory task. While autistic adults may still face related challenges in real life, these findings suggest that being autistic does not necessarily imply executive dysfunction on a basic cognitive level, contradicting theories assuming universal impairments therein. Moreover, the lack of influence of included demographic factors suggests that explanations for discrepancies in the literature lie elsewhere.

Intact but Protracted Facial and Prosodic Emotion Recognition Among Autistic Adults

Despite extensive research efforts, it is unclear how autistic and non-autistic individuals compare in their ability to recognize emotions. Differences in demographic and task factors have been proposed as explanations for divergent findings, but limitations in samples and designs have obscured insight into this possibility. This study investigated the extent of emotion recognition differences among autistic adults and the influence of these factors upon them. We recruited a large sample of autistic and non-autistic adults (N = 1,239) spanning across adulthood (18-76 years). In three online experiments, we compared their performance in recognizing emotions from basic facial expressions, complex expressions conveyed by the eyes alone, and prosodic elements of speech. Autistic individuals performed as well as non-autistic ones in terms of recognition accuracy/sensitivity across measures and emotional categories but took longer to do so. We also detected comparable influences of age, estimated intelligence quotient, and gender (as well as task demands) on both groups. While autistic adults may differ in how they process emotional stimuli, they can do so effectively when given sufficient time. Accordingly, efforts to help autistic individuals improve their ability to recognize emotions may be more fruitful if they focus on efficiency over accuracy. Additionally, reaction time data may offer greater insight than accuracy into differences between autistic and non-autistic individuals on emotion recognition tasks. The similar effects of the demographic and task factors we analyzed on both groups suggest that explanations of the discrepancies in prior literature lie elsewhere.

Convergence on CaMK4: A Key Modulator of Autism-Associated Signaling Pathways in Neurons

Although the precise underlying cause(s) of autism spectrum disorder remain unclear, more than 1000 rare genetic variations are associated with the condition. For many people living with profound autism, this genetic heterogeneity has impeded the identification of common biological targets for therapy development for core and comorbid traits that include significant impairments in social communication and repetitive and restricted behaviors. A substantial number of genes associated with autism encode proteins involved in signal transduction and synaptic transmission that are critical for brain development and function. CAMK4 is an emerging risk gene for autism spectrum disorder that encodes the CaMK4 (calcium/calmodulin-dependent protein kinase 4) enzyme. CaMK4 is a key component of a Ca2+-activated signaling pathway that regulates neurodevelopment and synaptic plasticity. In this review, we discuss 3 genetic variants of CAMK4 found in individuals with hyperkinetic movement disorder and comorbid neurological symptoms including autism spectrum disorder that are likely pathogenic with monogenic effect. We also comment on 4 other genetic variations in CAMK4 that show associations with autism spectrum disorder, as well as 12 examples of autism-associated variations in other genes that impact CaMK4 signaling pathways. Finally, we highlight 3 environmental risk factors that impact CaMK4 signaling based on studies of preclinical models of autism and/or clinical cohorts. Overall, we review molecular, genetic, physiological, and environmental evidence that suggest that defects in the CaMK4 signaling pathway may play an important role in a common autism pathogenesis network across numerous patient groups, and we propose CaMK4 as a potential therapeutic target.

Autism spectrum disorder and anorexia nervosa: Investigating the behavioural and neurocognitive overlap

Autism spectrum disorder (autism) and anorexia nervosa (AN) share many clinical features. Two key neurocognitive correlates of the autistic dyad, specifically, mentalising (social impairment) and set-shifting (restricted and repetitive behaviours/interests [RRBI]) were investigated in a sample of 327 adult participants with autism (n = 100; 50 females, 50 male), AN (n = 82; 54 females, 28 male), autism and AN (n = 45; 36 females, 9 male), and 100 (50 female, 50 male) control participants from the general population. A battery of self-report (Autism Spectrum Quotient, Eating Disorder Examination Questionnaire, Reflective Function Questionnaire, and Repetitive Behaviour Questionnaire 2 - Adult version) and performance-based (Wisconsin Card Sort Task [WCST] and Penn Emotion Recognition Test [ER-40]) measures were administered online. Clinical participants reported greater mentalising difficulty, more repetitive behaviour, and displayed worse mentalising ability compared to controls, with no difference between the clinical groups. Eating disorder psychopathology predicted error (total and perseverative) rates on the WCST, while lower levels of autistic traits were positively associated with ER-40 accuracy. We provide evidence that clinical features of autism and AN might have specific neurocognitive relevance. Improved understanding of the mechanisms underlying the overlapping features of autism and AN can have critical implications for early detection and improved and tailored intervention.

Is there evidence that playing games promotes social skills training for autistic children and youth?

LAY ABSTRACT

There is growing interest in using games to help autistic children and youth learn social skills. However, there is no clear agreement on the best way to design these games to ensure they are most effective. In our research, we reviewed studies that used games to teach social skills to autistic children and youth. We aimed to describe the different types of games, identify which ones were most successful and understand the psychological methods used. We searched five databases and found 3070 studies, which we narrowed down to 17 that met our criteria. Each of these 17 studies reported that their game helped improve social skills in autistic children. Interestingly, all these studies used some form of technology, even though this was not a requirement. However, we noticed that many studies were not clear on what specific social skills they were targeting or how they defined 'social skills'. For future work, we suggest that game-based interventions should be more clearly based on established theories. In addition, it is important to involve autistic people in the design of these games to ensure they meet their needs effectively.

Association of self-harm and suicidality with psychiatric co-occurring conditions in autistic individuals: a systematic review and pooled analysis

Background

Autistic individuals frequently experience psychiatric co-occurring conditions, but the association with self-harm/suicidality according to these conditions was not yet elucidated. We aimed to summarize the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic people.

Methods

We systematically searched PubMed, Scopus, Embase, Web of Science, and Cochrane Database of Systematic Reviews until June 4, 2024 (PROSPERO registration number: CRD42023412860). Observational studies were included that provided information to calculate the odds ratio (OR) regarding the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic individuals. We summarized the identified associations by presenting OR range or meta-analyzing when 7 or more estimates are available.

Findings

The systematic search found 20 eligible studies with 301,841 participants. Our findings suggested that autistic individuals with any psychiatric disorder (k = 1; OR 3.55; 95% CI 1.27-9.98), ADHD (k = 3; OR range: 1.07-1.65), or mood disorder (k = 1; OR 1.26; 95% CI 1.05-1.51) may be associated with higher odds of self-harm than those without these conditions. We identified potential positive associations between suicidality and the following co-occurring conditions: any psychiatric disorder (k = 1; OR 11.65; 95% CI 10.68-12.71), psychotic disorder (k = 4; OR range: 1.95-10.97), mood disorder (k = 3; OR range: 1.75-9.82), bipolar disorder (k = 2; OR range: 2.55-4.95), depressive disorder (k = 10; pooled OR 2.29; 95% CI 1.39-3.77), trauma- and stress-related disorder (k = 2; OR range: 1.28-10.47), and adjustment disorder (k = 1; OR 3.52; 95% CI 2.89-4.28).

Interpretation

We found psychiatric co-occurring conditions that may be associated with higher odds of self-harm/suicidality in autistic individuals. However, our findings should be interpreted with caution considering the limited number of included studies. We suggested that clinicians should remain vigilant for autistic individuals with psychiatric co-occurring conditions for their potentially higher likelihood of self-harm and suicidality.

Funding

This research was supported by a grant of the R&D project, funded by the National Center for Mental Health (grant number: MHER22A01).

High autistic traits linked with reduced performance on affective task switching: An ERP study

Few studies have investigated affective flexibility in individuals with high autistic traits. In the present study, we employed affective task-switching paradigm combined with event related potential (ERP) technology to explore affective flexibility in individuals with high autistic traits. Participants were instructed to switch between identifying the gender (gender task) and emotion (emotion task) of presented faces. Two groups of participants were recruited based on the Autism Spectrum Quotient (AQ) scores: a High Autistic Group (HAG) and a Low Autistic Group (LAG). The results confirmed that the HAG exhibited greater behavioral emotion switch costs and increased N2 and decreased P3 components when switching to the emotion task. Additionally, we identified an affective asymmetric switch cost in the HAG, where the switch cost for the emotion task was larger than for the gender task at both behavioral and electrophysiological levels. In contrast, a symmetrical switch cost was observed in the LAG. These findings indicate that the HAG experiences difficulties with affective flexibility, particularly in tasks involving emotional processing. The patterns of affective asymmetric switch costs observed in both groups differed from previous results in autistic children and the general population, suggesting that the relative dominance of gender and emotion tasks may vary between the two groups. We propose that the dominance of emotion tasks declines as autistic traits increase.

Executive Functioning Profiles in Neurodevelopmental Disorders: Parent-Child Outcomes

BACKGROUND/OBJECTIVES

Children with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) exhibit more executive function (EF) deficits compared to typically developing (TD) peers. EF deficits are linked to various impairments in daily functioning and increased parental stress. The first aim of the present study is to investigate EFs in children with ASD and ADHD compared to their TD peers. The second aim is to explore profiles of executive functions in children with ASD and ADHD and, finally, to determine the differences of EF profiles in relation to parental stress and children's functional impairments.

METHODS

The sample comprised 30 TD children, 47 children with ASD, and 34 children with ADHD, aged 8 to 12 years. Parents completed questionnaires of parenting stress, and children's social and daily-life functioning. Parents and teachers reported information about children's EF.

RESULTS

The results indicated significantly greater impairment of EFs in the clinical groups compared to the TD group. Moreover, three distinct clusters of functioning were identified based on the severity of reported EF difficulties. The significant findings showed that children with more severe EF profiles were associated with greater daily impairment and higher levels of perceived parental stress.

CONCLUSIONS

Given the impact of EF deficits on the lives of children with ASD and ADHD and their families, it is crucial that studies like this enhance our understanding and inspire future interventions aimed at improving executive functions in children with ASD and ADHD. Such interventions could help reduce parental stress and improve daily functioning.

Systematic Review of Executive Function Stimulation Methods in the ADHD Population

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by elevated motor activity, impulsivity, and attention deficit. Approximately 5% of the population suffers from this disorder. Among the key explanations of ADHD, executive functions play an important role in understanding the symptomatology present in this disorder and in determining the main treatment strategies for affected patients. We present a systematic review that seeks to identify the treatment methods developed to support executive functions in individuals with ADHD. Methods: Articles were analyzed in the SCOPUS, PUBMED, and Science Direct databases. Initially, 739 articles were found. After applying inclusion and exclusion criteria, 30 articles remained and were included in the data extraction process. Results: Among the primary treatments identified, 14 studies propose psychological training for executive functions, 9 studies recommend medication, 5 studies suggest digital interventions, and 1 study advocates for sports as beneficial for executive functions. Conclusions: The data are discussed around the need to develop new proposals to enhance the executive functions of individuals with ADHD, thereby improving their performance in educational, personal, social, and family activities impacted by this disorder.

The brain entropy dynamics in resting state

As a novel measure for irregularity and complexity of the spontaneous fluctuations of brain activities, brain entropy (BEN) has attracted much attention in resting-state functional magnetic resonance imaging (rs-fMRI) studies during the last decade. Previous studies have shown its associations with cognitive and mental functions. While most previous research assumes BEN is approximately stationary during scan sessions, the brain, even at its resting state, is a highly dynamic system. Such dynamics could be characterized by a series of reoccurring whole-brain patterns related to cognitive and mental processes. The present study aims to explore the time-varying feature of BEN and its potential links with general cognitive ability. We adopted a sliding window approach to derive the dynamical brain entropy (dBEN) of the whole-brain functional networks from the HCP (Human Connectome Project) rs-fMRI dataset that includes 812 young healthy adults. The dBEN was further clustered into 4 reoccurring BEN states by the k-means clustering method. The fraction window (FW) and mean dwell time (MDT) of one BEN state, characterized by the extremely low overall BEN, were found to be negatively correlated with general cognitive abilities (i.e., cognitive flexibility, inhibitory control, and processing speed). Another BEN state, characterized by intermediate overall BEN and low within-state BEN located in DMN, ECN, and part of SAN, its FW, and MDT were positively correlated with the above cognitive abilities. The results of our study advance our understanding of the underlying mechanism of BEN dynamics and provide a potential framework for future investigations in clinical populations.