Theory of Mind and Executive Function in Preschoolers with Typical Development Versus Intellectually Able Preschoolers with Autism Spectrum Disorder

Effectiveness of Video Prompting Versus Picture Prompting in Improving Daily Living Skills of Autistic Children

IMPORTANCE

Static picture (SP) schedules are an established intervention for children with autism spectrum disorder (ASD), but the use of video modeling (VM) has not been thoroughly investigated.

OBJECTIVE

To compare the effectiveness of VM prompts versus SP prompts in improving autistic children's independence with daily living skills.

DESIGN

An experimental alternating treatment design.

SETTING

Approved private school for children with disabilities.

PARTICIPANTS

Seventeen participants (13 male and 4 female; ages 9-18 yr) with an ASD diagnosis.

INTERVENTION

Visual prompts using a tablet were provided during task participation, with data collected in two phases.

OUTCOMES AND MEASURES

Type and frequency of the prompts required to complete the task were documented for each participant during the intervention session.

RESULTS

Both VM and SP conditions resulted in improvements in at least one phase. Most participants demonstrated a decrease in the number of required cues to complete the task and an increase in independence to complete the task. The decrease in number of cues required from baseline to end of data collection indicated clinically meaningful improvement in task completion.

CONCLUSION

Both VM and SP prompts resulted in an increase in independence in daily living skills, with most participants demonstrating improvement in either condition, indicating that the use of visual prompts (either VM or SP) is effective with the ASD population. Plain-Language Summary: Occupational therapy practitioners who work with autistic children and adolescents often identify improving daily living skills as a goal area. Findings from this study build on evidence that supports the use of a visual aid (either static picture or video modeling) to improve autistic children's acquisition of daily living skills. The findings also highlight emerging evidence related to the level of function and effectiveness associated with the type of visual cue. Positionality Statement: This article primarily uses identity-first language (i.e., autistic person) and at times person-first language (i.e., person with autism) to reflect the variability in the language preferences of the autism community (Lord et al., 2022).

Integrated Life Skills Training and Executive Function Strategies in Children With Autism Spectrum Disorder in Qatar: A Pilot Study of a Randomized Controlled Trial

Background and aim Executive function (EF) impairment is common in children with autism spectrum disorder (ASD). EF strategies are considered effective in improving the therapeutic outcomes of children with ASD. This study primarily aimed to explore whether integrating EF strategies combined with regular occupational therapy intervention is more effective in improving daily life skills (DLS) and sensory integration/processing (SI/SP) skills than regular occupational therapy alone in children with ASD and secondarily aims to assess treatment outcomes on improving visual motor integration (VMI) skills. Methods A total of 17 participants (13 males, mean age 4.29 years, standard deviation 0.66) completed the study. Following the baseline assessments, the participants were randomly assigned to the treatment group (45-minute once-weekly individual occupational therapy plus EF strategies) or control group (45-minute once-weekly individual therapy sessions alone). All participants received one intervention per week for 14 weeks. All children were systematically evaluated using a pediatric functional independent measure (WeeFIM) and the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) to assess DLS, the Short Sensory Profile 2 (SSP2) to assess SP/SI, and the Beery VMI test (Beery VMI) to assess VMI. Assessments were conducted at baseline, seven weeks, and 14 weeks of treatment.  Results The analysis of the results between the treatment and control groups revealed that the treatment group had greater gains and significant differences in the mean values of both the WeeFIM and SSP2. In addition, notable distinctions were observed in the VB-MAPP transition subscale; although these differences did not reach statistical significance, they were clinically significant. Minimal differences were noted in the VMI between the two groups. Nevertheless, both groups showed statistically significant improvements across all outcome measures. Conclusions Our study provides preliminary evidence of the efficacy of EF strategies combined with regular occupational therapy for DLS, SP/SI, and VMI in children with ASD. The differences between the groups support further evaluation of the effectiveness of EF strategies for the next stage of a larger randomized clinical trial.

Predictors of individual differences in minimally verbal peer communication exchanges following peer-oriented social intervention

School-age children on the autism spectrum who are minimally verbal (MVAS) use a limited repertoire of spontaneous communicative spoken words and reveal large heterogeneity in cognitive functioning. Despite the challenges to form peer social engagement posed by their unique social-communicative profile, few interventions have targeted peer interactions in the MVAS population. This study explored predictors of individual differences in treatment response among 54 school-age minimally verbal autistic children (8-16 years) following an RCT "school-based peer social intervention" (S-PSI) that compared two peer-oriented intervention modalities (conversation versus collaboration) versus a waitlisted control group. We examined autistic-symptom severity, age, verbal and nonverbal IQ, executive functions, and sensory-processing profile for their contribution to children's ability to form relevant spontaneous communication exchanges with a peer partner. Main findings revealed that larger deficits in sensory-processing (sensory-avoidance and sensory low-registration) and in executive functions contributed to greater growth in "relevant" (i.e., adequately attuned, participatory, reciprocal) communication following both interventions, but not for the waitlisted controls. Additionally, older participants with lower verbal and nonverbal IQ improved communication's relevancy more after the conversation intervention, whereas the collaboration intervention was more beneficial for younger participants. Lower autistic-symptom severity contributed to larger growth in relevancy for all groups. By identifying individual-level predictors of spontaneous, attuned, participatory, and reciprocal (i.e., "relevant") communication exchanges with peers, we optimized S-PSI personalization for this uniquely nonverbal, heterogeneous MVAS population. These new channels for tailoring peer interventions to better meet individuals' needs may result in reduced social isolation and loneliness and enhanced well-being.

Cognitive flexibility in autism: Evidence from young autistic children

We examined the cognitive flexibility performance of young autistic children and a group of neurotypical peers. Thirty-six autistic children (72-83 months) and 200 age-matched typically-developing children were assessed on the Children's Color Trails Test (CCTT), a semantic and a phonemic verbal fluency task. The results showed that the autistic children performed worse than their neurotypical peers in the switching component of the CCTT. In the fluency tests, the autistic group generated overall fewer word items than their neurotypical peers, however, their poorer performance was driven by specific linguistic stimuli in the fluency tasks. The findings suggest that cognitive flexibility for the autistic children was affected in the nonverbal CCTT only, while poor performance in semantic and phonemic fluency seemed to be inherent to the language properties of the verbal fluency tasks.

Brief Report: The Factors Associated with Social Cognition in Children with Autism Spectrum Disorder

This study examined whether school-aged autistic children without co-occurring intellectual disabilities (autisticWoID) show similar difficulty on Theory of Mind (ToM) tasks as young autisticWoID children and if these difficulties are related to problems in domain-general aspects of cognition. Eighty-one autisticWoID and 44 neurotypical (NT) children between the ages of 8-16 years participated in this study and were matched on verbal IQ. ToM performance significantly and independently differentiated many, but not all, autisticWoID and NT participants above and beyond the effects of working memory and inferential thinking. However, these cognitive variables did not fully explain difficulties with social cognition in autisticWoID children. These findings have implications for understanding autism, the factors that may impact intervention for social cognition in autism, and the factors that impact the education of autistic children who may struggle in general education classrooms.

Improving Executive Function of Children with Autism Spectrum Disorder through Cycling Skill Acquisition

PURPOSE

Executive dysfunction has been widely reported in children with autism spectrum disorder (ASD). Although studies have clearly documented the cognitive benefits of physical exercise on cognition in children, similar studies in children with ASD are scarce. The purpose of this study was to compare the effect of cognitively engaging exercise and noncognitively engaging exercise on executive function in children with ASD.

METHODS

Sixty-two children diagnosed with ASD (50 males and 12 females, Mage = 9.89 ± 1.53 yr, Mheight = 1.43 ± 0.15 m, and Mweight = 44.69 ± 11.96 kg) were randomly assigned into three groups: learning to ride a bicycle (n = 22), stationary cycling (n = 20), and control (n = 20). Four executive function components (planning, working memory, flexibility, and inhibition) were assessed.

RESULTS

Results revealed significant improvements in all executive function components in the learning to ride a bicycle group (Ps < 0.05) but not in the other two groups after controlling for age and IQ.

CONCLUSION

Our findings highlight the value of cognitive engagement in exercise programs designed to improve cognition in children with ASD.

Pragmatic Language in Children and Adolescents With Autism Spectrum Disorder: Do Theory of Mind and Executive Functions Have a Mediating Role?

Pragmatic language (PL) is defined as the ability to use language effectively in communicative exchanges. Previous findings showed that deficits in PL are a core characteristic of the communicative profile of individuals with autism spectrum disorder (ASD). While different lines of research have revealed a close link between PL and theory of mind (ToM), and between PL and executive functions (EFs), to our knowledge, few studies have explored the relationship between these three domains in children with ASD, and their results have been contradictory. The present study thus aimed to contribute to our understanding of PL in children with ASD and to analyze the underlying mediating role of ToM and EFs. PL is a complex and multifaceted construct. In the present study, we focused on two specific aspects, such as the comprehension of nonliteral language, and the ability to make inferences. After testing 143 participants (73 with ASD), our results confirmed that impairments in PL are a crucial feature of the ASD profile. Children with ASD were also more impaired than their typically developing peers in both ToM and EFs. When the mediating role of ToM and EFs on PL was considered, it emerged that only ToM contributed significantly to the relationship between group and PL. We discussed the potential importance of interventions not focused exclusively on PL, but also involving ToM. LAY SUMMARY: In everyday life, we use pragmatic language to interact successfully with others. Individuals with autism experience significant difficulty in pragmatic language, showing consequent impairments in communication. This study compared the comprehension of nonliteral language, and the ability to make inferences of children with autism and children with typical development, focusing on the role of social and cognitive abilities. Children with autism had difficulties in pragmatic language compared to children with typical development. In addition, the capacity to consider the perspective, intentions and beliefs of other people contributed significantly to the pragmatic language. Autism Res 2021, 14: 932-945. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Altered Connectivity During a False-Belief Task in Adults With Autism Spectrum Disorder

BACKGROUND

Deficits in social communication are one of the main features of autism spectrum disorder (ASD). Adults with ASD show atypical brain activity during false-belief understanding, an aspect of social communication involving the ability to infer that an individual can have an incorrect belief about a situation. Our study is the first to investigate whether adults with ASD exhibit differences in frequency-specific functional connectivity patterns during false-belief reasoning.

METHODS

We used magnetoencephalography to contrast functional connectivity underlying false-belief understanding between 40 adults with ASD and 39 control adults. We examined whole-brain phase synchrony measures during a false-belief task in 3 frequency bands: theta (4-7 Hz), alpha (8-14 Hz), and beta (15-30 Hz).

RESULTS

Adults with ASD demonstrated reduced theta-band connectivity compared with control adults between several right-lateralized and midline regions such as the medial prefrontal cortex, right temporoparietal junction, right inferior frontal gyrus, and right superior temporal gyrus. During false-belief trials, they also recruited a network in the beta band that included primary visual regions such as the bilateral inferior occipital gyri and the left anterior temporoparietal junction.

CONCLUSIONS

Reduced theta-band synchrony between areas associated with mentalizing, inhibition, and visual processing implies some difficulty in communication among these functions in ASD. This impairment in top-down control in the theta band may be counterbalanced by their engagement of a beta-band network because both the left anterior temporoparietal junction and beta-band oscillations are associated with attentional processes. Thus, adults with ASD demonstrate alternative neural mechanisms for successful false-belief reasoning.

Human Figure Drawings in Children with Autism Spectrum Disorders: A Possible Window on the Inner or the Outer World

Background: Tests based on human figure drawings (HFD) have captured the attention of clinicians and psychologists for a long time. The aim of the present study was to evaluate the performance of HFD of children with autism spectrum disorders (ASDs) relative to typically developing (TD) controls. Methods: All children were asked to draw three human figures (man, woman, self-portrait) and were evaluated with a neuropsychological battery. HFD were scored according to the Maturity Scale, and correlative approaches testing maturity against neuropsychological scores were applied. Results: ASDs presented marked deficits in maturity. No significant correlation emerged for both groups between maturity and the theory of mind test. On the contrary, positive and significant correlations between maturity and the affect recognition test (AR) were found, with group-specific patterns. In TD, this result regarded drawings of others, but not self-portraits, while an opposite pattern emerged for ASD, whose sole maturity in self-portraits significantly correlated with the AR scores. Conclusion: These findings suggest that the use of HFD tests with individuals with autism may not be used in clinical practices. However, in basic research, HFDs could be used to highlight dependencies between drawing performance and neuropsychological features, thus possibly providing hints on the functioning of autism.

Metacognition and behavioral regulation predict distinct aspects of social functioning in autism spectrum disorder

Executive function (EF) deficits are common in autism spectrum disorder (ASD), and previous studies suggest that EF may influence or predict social functioning. Thus, EF is a potential treatment target in this population. However, the nature of how specific metacognition and behavioral regulation components of EF may differentially impact social function remains unclear. The goal of the current study was to examine the relationships between sub-components of EF (e.g., working memory, shifting, inhibition, etc.) and social functioning as measured by parent ratings on the Behavior Rating Inventory of Executive Functioning (BRIEF) and the Social Responsiveness Scale (SRS), while controlling for the influence of age, sex, and IQ. A second goal was to examine whether BRIEF scores were predictive of clinician-rated measures of ASD symptoms. Behavioral data were acquired from the Autism Brain Imaging Data Exchange-II database and included 106 children with ASD (ages 5-13). Based on analysis of parent ratings, self-monitoring skills predicted social awareness; shifting ability predicted social cognition; working memory and monitoring skills predicted social communication; initiation predicted social motivation; and shifting ability predicted restrictive and repetitive behaviors among children with ASD. Parent ratings on the BRIEF did not predict clinician-rated measures of ASD symptoms; this requires further study. Overall, the current findings indicate that metacognition and behavioral regulation both contribute to social functioning in ASD, although they each have distinct patterns of influence on different aspects of social functioning. These findings have promising implications for tailoring social interventions for ASD that target specific EF skills.

The fair decision-making of children and adolescents with high-functioning autism spectrum disorder from the perspective of dual-process theories

BACKGROUND

Fairness has received much attention in our society. At present, the findings regarding fair decision-making in high-functioning autism spectrum disorder (HF-ASD) are inconsistent. Previous studies have shown that the fair decision-making of typically developing children is influenced by theory of mind (ToM) and executive functioning (EF). As those with HF-ASD have defects in both domains, this study aims to explore the differences in fair decision-making between children and adolescents with HF-ASD and those with typical development (TD).

METHODS

We used a simple ultimatum game (UG) to explore 31 children and adolescents with HF-ASD and 38 children and adolescents with TD. T tests and chi-square tests were used to compare group differences, and Pearson correlation analysis and stepwise regression analysis were used to analyse the mechanisms influencing the two groups' unfair acceptance rates.

RESULTS

The results show that children with HF-ASD are more likely to accept unfair offers, but for adolescents, the difference is not significant. Regression analysis showed that the interaction between the behavior regulation index (BRI) and age could negatively predict the unfair acceptance rate of children and adolescents with HF-ASD. Working memory and ToM can negatively predict the unfair acceptance rate of those with TD.

CONCLUSION

This study concluded that the development of fair decision-making by children and adolescents with HF-ASD falls far behind that of those with TD. Intuition processes play a dominant role in the fair decision-making processes of children and adolescents with HF-ASD, and we believe that comorbidity, age, experience and emotional management are important factors influencing the fair decision-making of individuals with HF-ASD.

A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder

Difficulties with both executive functions and language skills are common but variable in autism spectrum disorder (ASD). Executive functions and language skills are related to one another, such that vocabulary, syntax, and pragmatics are related to domains of working memory, shifting, and inhibition in ASD, although the directionality of these relationships remains unclear. Moreover, interventions that target pragmatic ability have been found to improve executive function skills, and conversely, executive function interventions are linked with improvements in social skills in children with ASD. We review the literature on executive functions, language skills, and their relationship in ASD; discuss factors that may be driving inconsistent findings; and explore clinical applications from the research thus far.

Executive Functions and Symptom Severity in an Italian Sample of Intellectually Able Preschoolers with Autism Spectrum Disorder

A novel battery (BAFE; Valeri et al. 2015) was used in order to assess three executive function (EF) abilities (working memory, inhibition and shifting) in a sample of 27 intellectually able preschoolers with autism spectrum disorder (ASD) compared with 27 typically developing children matched on age and nonverbal IQ. Differences in EF skills were analyzed in participants with distinct ASD symptom severity. Children with ASD performed worse than typical controls on both set-shifting and inhibition, but not on visuo-spatial working memory. Additionally, children with more severe ASD symptoms showed a worse performance on inhibition than children with milder symptoms. These results confirm the presence of EF deficits and highlight a link between ASD symptoms and EF impairments in preschool age.

Successful attentional set-shifting in 2-year-olds with and without Autism Spectrum Disorder

The development of executive function is necessary for flexible and voluntary control of behavior. Deficits in executive function are purported to be a primary cause of behavioral inflexibility—a core clinical symptom—in Autism Spectrum Disorder (ASD). Attentional set-shifting has traditionally been measured with the Dimensional Change Card Sort, however, this task requires following verbal instructions. Here, we used a novel visual search task that does not require verbal instructions in conjunction with eye-tracking to test attentional set-shifting in 2-year-old toddlers diagnosed with ASD (N = 29) and chronological age-matched typically developing controls (N = 30). On each trial, a relevant and an irrelevant target were embedded in a set of feature-conjunction distractors, and toddlers were tasked with searching for the relevant target. Critically, after a set of trials the targets switched roles (i.e., the previously relevant target became irrelevant, and the previously relevant target became irrelevant). We measured visual search performance prior to and following a target switch. We found that both groups of toddlers could readily switch targets, and found strikingly similar performance between typically developing toddlers and toddlers with ASD. Our results challenge the centrality of deficits in attentional set-shifting to early behavioral inflexibility in ASD.

Do you know what I'm thinking? Temporal and spatial brain activity during a theory-of-mind task in children with autism

•

First MEG study of neural underpinnings of theory of mind differences in autism.

•

Children with autism show decreased LTPJ activity from 300 to 375 and 425 to 500 ms.

•

Children with autism also show increased RIFG activity from 325 to 375 ms.

•

Co-incident lower LTPJ and higher RIFG activity implies compensatory use of RIFG.

•

Executive functions may augment impaired theory of mind in autism.

The social impairments observed in children with autism spectrum disorder are thought to arise in part from deficits in theory of mind, the ability to understand other people’s thoughts and feelings. To determine the temporal-spatial dynamics of brain activity underlying these atypical theory-of-mind processes, we used magnetoencephalography to characterize the sequence of functional brain patterns (i.e. when and where) related to theory-of-mind reasoning in 19 high-functioning children with autism compared to 22 age- and sex-matched typically-developing children aged 8–12 during a false-belief (theory-of-mind) task. While task performance did not differ between the two groups, children with autism showed reduced activation in the left temporoparietal junction between 300–375 and 425–500 ms, as well as increased activation in the right inferior frontal gyrus from 325 to 375 ms compared to controls. The overlap in decreased temporoparietal junction activity and increased right inferior frontal gyrus activation from 325 to 375 ms suggests that in children with autism, the right inferior frontal gyrus may compensate for deficits in the temporoparietal junction, a neural theory-of-mind network hub. As the right inferior frontal gyrus is involved in inhibitory control, this finding suggests that children with autism rely on executive functions to bolster their false-belief understanding.

Executive function predicts theory of mind but not social verbal communication in school-aged children with autism spectrum disorder

BACKGROUND

The association between Executive Function (EF) and Theory of Mind (ToM) in autism spectrum disorder (ASD) has been mainly investigated using false belief tasks, whilst less is known about the EF effect on other ToM facets. Furthermore, the role EF plays in social communication in ASD is mainly assessed using parent-report EF ratings rather than direct assessment.

AIMS

The aim of this study was to shed more light on the effect of performance-based EF measures on ToM and social communication in middle childhood in ASD relative to neurotypical controls.

METHODS AND PROCEDURES

Cross-sectional data were collected from 64 matched, school-aged children with and without ASD (8-12 years old), tested on measures of EF (inhibition, working memory, cognitive flexibility), ToM mental state/emotion recognition and social verbal communication.

OUTCOMES AND RESULTS

Significant group differences were observed only in selective EF skills (inhibition &cognitive flexibility) and social verbal communication. EF working memory contributed to the explained variance of ToM but not social verbal communication in middle childhood.

CONCLUSIONS AND IMPLICATIONS

These findings suggest that EF and ToM are still associated in middle childhood and EF may be a crucial predictor of ToM across childhood in ASD. Implications are discussed regarding the social-cognitive impairment relationship in ASD.

Parents' impaired emotion recognition abilities are related to children's autistic symptoms in autism spectrum disorder

OBJECTIVE

We aimed to explore whether parents of children with autism spectrum disorder (ASD) had impaired emotion recognition abilities and whether this deficit was related to their children's autistic symptoms.

METHODS

The autistic symptoms of 31 ASD children were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Fifty parents of ASD children and 34 parents of typically developing (TD) children completed an emotion recognition task (ERT).

RESULTS

The numbers of correct ERT responses were lower for parents of ASD children than for parents of TD children with respect to recognizing sadness, disgust, fear, and all emotions (P=0.01, 0.04, 0.02, and 0.00, respectively). Controlled for parental age, gender, and the intelligence quotients of both the parents and children, a negative correlation was found between the total number of correct ERT responses for parents of ASD children and these children's "restricted, repetitive, and stereotyped patterns of behavior" scores on the ADI-R (r=-0.32; P=0.03).

CONCLUSION

Parents of ASD children showed impaired emotion recognition abilities compared with parents of TD children. This parental deficit in emotion recognition ability was related to the autistic symptoms of ASD children.

Stimulation of Executive Functions as Part of the Language Intervention Process in Children with Autism Spectrum Disorder

AIMS

Identifying effective methods for stimulating language and communication of children with autism spectrum disorder (ASD) is fundamental to the effective use of available resources to support these children. This pilot study was designed to explore the potential benefits of a program of stimulation of executive functions (SEF) on the functional aspects of language and communication through the assessment of the functional communicative profile and social-cognitive performance.

METHODS

Twenty children, aged 5-12 years, with a diagnosis of ASD participated in the study. Two stimulation programs were offered over a 10- to 12-week period as part of the regular services offered to these children through a University's speech and language therapy outpatient clinic in São Paulo, Brazil. Children either received SEF intervention in their home implemented by their parent/s, with close monitoring by the speech-language pathologist (SLP) (group 1), or they received SEF by the SLP during regular speech-language therapy individual sessions (group 2).

RESULTS

The findings suggested that there were differences between the children's pre- and posttest performance. Significantly different performances were observed in the areas of occupation of communication space, proportion of communicative interactivity, and social-cognitive performance.

CONCLUSION

The inclusion of activities to stimulate executive function abilities in language intervention for children with ASD warrants further investigation.

Early executive dysfunction in ASD: Simple versus complex skills

Despite the strong evidence of executive function (EF) impairment in Autism Spectrum Disorder (ASD), findings in the preschool period have been inconsistent. Whereas some research has supported an early deficit, many studies have not found early differences in EF. The present study assessed simple and complex components of three EF abilities: working memory, inhibition, and shifting, using a novel battery, the Preschool EF Battery (PEFB; Garon, Smith & Bryson, Child Neuropsychology, 20, 713-736, 2014). Previous research has indicated that the PEFB is sensitive to age differences in typically developing (TD) children aged 18-60 months. Current participants were 34 preschoolers (M = 54.79 months) diagnosed with ASD and 255 TD preschoolers (M = 42.98 months). Results indicated significant differences between the two groups in the three EF abilities, but specific findings were moderated by mental and chronological age. The findings highlight the importance of testing simpler EF skills in very young children with ASD. Autism Res 2018, 11: 318-330. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Given that executive functions (EF) have been found to predict various outcomes such as academic ability and occupational success, sensitive early assessment is important. The current study suggests the presence of early EF deficits in preschool children with autism spectrum disorder. The study highlights the importance of considering how EF develops during early life in typically developing children in order to design sensitive EF measures.

Hot and cool executive function in children and adolescents with autism spectrum disorder: Cross-sectional developmental trajectories

The development of executive function (EF) in autism spectrum disorder (ASD) has only been investigated using "cool"-cognitive-EF tasks. Little is known about the development of "hot"-affective-EF and whether it follows a similar developmental pathway. This study employed a cross-sectional developmental trajectories approach to examine the developmental changes in cool (working memory, inhibition, and planning) and hot EF (delay discounting and affective decision-making) of ASD participants (n = 79) and controls (n = 91) relative to age and IQ, shedding more light on the hot-cool EF organization. The developmental trajectories of some aspects of cool EF (working memory and planning) differed significantly as a function of age in ASD participants relative to controls. For both hot EFs, no significant age-related changes were found in either group. These findings extend our understanding regarding the maturation of EF from childhood through adolescence in ASD.

The Oral Narrative Comprehension and Production Abilities of Verbal Preschoolers on the Autism Spectrum

Purpose

This study described the oral narrative comprehension and production skills of verbal preschool-age children on the autism spectrum and investigated correlations between oral narrative ability and norm-referenced language test performance.

Method

Twenty-nine preschool-age children (aged 4;0–5;9 years;months) with autism, who obtained an age-equivalent score of at least 36 months on the expressive communication subscale of the Vineland Adaptive Behavior Scales–Second Edition (Sparrow, Cicchetti, & Balla, 2005), participated. Children listened to an unfamiliar fictional narrative and answered comprehension questions afterward. After listening to the narrative a second time, children were asked to retell the narrative without picture support. Narratives were transcribed and analyzed for length, semantic diversity, grammatical complexity and accuracy, intelligibility, inclusion of critical events, and narrative stage.

Results

All children participated in the comprehension task, and 19 children produced an analyzable narrative retell. Compared with published data on typically developing children, significant difficulties were observed in narrative comprehension, intelligibility, and grammatical accuracy. Most of the children told descriptive or action sequences, with only 1 child producing an abbreviated episode. Significant positive correlations were found (a) between performance on the Peabody Picture Vocabulary Test–Fourth Edition (Dunn & Dunn, 2007) and semantic diversity and narrative comprehension and (b) between parent-reported receptive communication competence (Vineland Adaptive Behavior Scales–Second Edition) and narrative comprehension.

Conclusions

This study provides preliminary evidence of specific difficulties in oral narrative comprehension and production skills in verbal preschoolers on the autism spectrum.

The association between theory of mind, executive function, and the symptoms of autism spectrum disorder

It has been strongly argued that atypical cognitive processes in autism spectrum disorder (ASD) contribute to the expression of behavioural symptoms. Comprehensive investigation of these claims has been limited by small and unrepresentative sample sizes and the absence of wide-ranging task batteries. The current study investigated the cognitive abilities of 100 adolescents with ASD (mean age = 15 years 6 months), using 10 tasks to measure the domains of theory of mind (ToM) and executive function (EF). We used structural equation modelling as a statistically robust way of exploring the associations between cognition and parent-reported measures of social communication and restricted and repetitive behaviours (RRBs). We found that ToM ability was associated with both social communication symptoms and RRBs. EF was a correlate of ToM but had no direct association with parent-reported symptom expression. Our data suggest that in adolescence ToM ability, but not EF, is directly related to autistic symptom expression. Autism Res 2018, 11: 95-109. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

The behaviours that are common to autism spectrum disorder (ASD) have been linked to differences in thinking ability. We assessed autistic adolescents and found that social communication difficulties and the presence of restricted and repetitive behaviours related to difficulties in understanding other peoples' minds (theory of mind). In contrast, these behaviours were not associated with the general thinking abilities involved in planning and executing tasks (executive function).

Social Cognition in Children with High-Functioning Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Associations with Executive Functions

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children's ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention.

Planning Skills in Autism Spectrum Disorder Across the Lifespan: A Meta-analysis and Meta-regression

Individuals with an autism spectrum disorder (ASD) are thought to encounter planning difficulties, but experimental research regarding the mastery of planning in ASD is inconsistent. By means of a meta-analysis of 50 planning studies with a combined sample size of 1755 individuals with and 1642 without ASD, we aim to determine whether planning difficulties do exist and which factors contribute to this. Planning problems were evident in individuals with ASD (Hedges'g = 0.52), even when taking publication bias into account (Hedges'g = 0.37). Neither age, nor task-type, nor IQ reduced the observed heterogeneity, suggesting that these were not crucial moderators within the current meta-analysis. However, while we showed that ASD individuals encounter planning difficulties, the bias towards publishing positive findings restricts strong conclusions regarding the role of potential moderators.

Dynamic Assessment of Figurative Language of Children in the Autistic Spectrum: The Relation to Some Cognitive and Language Aspects

The objectives of this study were to examine (a) differences in figurative language, analogical reasoning, executive functions (EF), theory of mind (ToM), and local/central coherence (LCC) of children with high-functioning autism (HFA; n = 32) and typically developing (TD; n = 32) children; (b) improvement of figurative language using dynamic assessment; and (c) prediction of proverbial understanding by the cognitive variables. A sample of 5- to 11-year-old children with HFA was pair matched with a group of TD children on age, gender, vocabulary, and socioeconomic status (SES). Participants were administered tests of proverbial understanding, metaphorical construction, analogies, language ability, EF, LCC, and ToM. TD children scored higher than children with HFA on all tests. In the HFA group, proverbial understanding was predicted by LCC and verbal ability and in the TD group by metaphorical construction and EF. These findings refute the argument that figurative language among HFA is a function of only verbal ability.

The Sally-Anne test: an interactional analysis of a dyadic assessment

BACKGROUND

The Sally-Anne test has been extensively used to examine children's theory of mind understanding. Many task-related factors have been suggested to impact children's performance on this test. Yet little is known about the interactional aspects of such dyadic assessment situations that might contribute to the ways in which children respond to the test questions.

AIMS

To examine the interactional factors contributing to the performance of two children in the Sally-Anne test. To identify the interactional practices used by the tester administering the task and to describe how interactional features can pose challenges in the critical belief and reality questions for both the tester and the testee.

METHODS & PROCEDURES

The Sally-Anne test was carried out as part of a project examining children's interactions in a technology-enhanced environment. The present study uses video recordings of two children with communication disorders (one with a current diagnosis of autism spectrum disorder [ASD]) and an adult tester. We draw on a multimodal approach to conversation analysis (CA) to examine the sequential organization of the test questions and answers.

OUTCOMES & RESULTS

The children drew on diverse resources when producing responses to the test questions: responding verbally, pointing or manually handling objects. The tester treated these responses differently depending on how they were produced. When the child pointed at an object and verbally indicated their response, the tester moved on to the next question apparently accepting the child's answer. When the child manually handled an object or produced a quiet verbal response, the tester repeated the question indicating that the child's actions did not constitute an adequate response to a test question. In response to this, both children modified or changed their previous responses. Through monitoring each other, the tester and the child produced actions highly responsive to the features of each other's conduct, which underpinned the conduct of the test itself.

CONCLUSIONS & IMPLICATIONS

Children's responses in the test might not be solely indicative of socio-cognitive capacities but also show orientation to interactional nuances. The study proposes that children can demonstrate diverse ways of responding to questions, yet testers may treat these as test-irrelevant behaviours if they do not correspond to the scoring criteria. A video-based CA study can broaden our understanding of children's pragmatic competencies in responsiveness that may not always embody an expected form. This can have implications for the development of future assessment tasks and revision of existing scoring practices.

Depression in Adolescents with ASD: A Pilot RCT of a Group Intervention

Depression is a potentially life threatening affective disorder that is highly prevalent in individuals with autism spectrum disorders (ASD). This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of a cognitive behavioural intervention for depression in adolescents with ASD. Participants were randomly assigned to the intervention group, or wait-list control group. Although recruitment was extremely difficult, attendance was favourable and attrition was low, and participants reported being satisfied with the programme. No significant treatment effect was revealed on the Beck Depression Inventory or Emotion Regulation Questionnaire. However despite the small sample size (n = 20), there was a trending treatment effect measured by the Depression Anxiety Stress Scale: Depression Subscale. Limitations and areas of future research are discussed.

The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis

Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.

Oxytocin and vasopressin hormone genes in children's externalizing problems: A cognitive endophenotype approach

Externalizing problems are among the most common mental health problems of children. Research suggests that these problems are heritable, yet little is known about the specific genes involved in their pathophysiology. The current study examined a genotype-endophenotype-phenotype model of externalizing problems in 320 preschool-aged children. Markers of the oxytocin (OXT) and arginine vasopressin (AVP) hormone genes were selected as candidates owing to their known association with psychopathology in other domains. We tested whether OXT and AVP variants were related to children's externalizing problems, as well as two cognitive endophenotypes presumed to underlie these problems: theory of mind (ToM) and executive functioning (EF). Externalizing problems were assessed at age 4.5 using a previously-validated rating scale. ToM and EF were measured with age-appropriate tasks. Using a family-based association design and controlling for non-genomic confounds, support was found for an association between a two-marker OXT haplotype (rs2740210-rs2770378) and a two-marker AVP haplotype (rs1887854-rs3761249) and externalizing problems. Specific associations of these haplotypes with ToM and EF were also observed. Further, ToM and EF were shown to independently and jointly predict externalizing problems, and to partially mediate the effects of OXT and AVP on externalizing problems. This study provides the first evidence that genetic variation in OXT and AVP may contribute to individual differences in childhood externalizing problems, and that these effects may operate through emerging neurocognitive abilities in the preschool period.

Autism spectrum disorder and attention-deficit/hyperactivity disorder in early childhood: A review of unique and shared characteristics and developmental antecedents

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have overlapping characteristics and etiological factors, but to which extent this applies to infant- and preschool age is less well understood. Comparing the pathways to ASD and ADHD from the earliest possible stages is crucial for understanding how phenotypic overlap emerges and develops. Ultimately, these insights may guide preventative and therapeutic interventions. Here, we review the literature on the core symptoms, temperament and executive function in ASD and ADHD from infancy through preschool age, and draw several conclusions: (1) the co-occurrence of ASD and ADHD increases with age, severity of symptoms and lower IQ, (2) attention problems form a linking pin between early ASD and ADHD, but the behavioral, cognitive and sensory correlates of these attention problems partly diverge between the two conditions, (3) ASD and ADHD share high levels of negative affect, although the underlying motivational and behavioral tendencies seem to differ, and (4) ASD and ADHD share difficulties with control and shifting, but partly opposite behaviors seem to be involved.