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

Practice is the best of all instructors-Effects of enactment encoding and episodic future thinking on prospective memory performance in high-functioning adults with autism spectrum disorder

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. The present study investigated the effects of episodic future thinking (EFT) and enactment encoding (EE) on PM performance in autistic adults (ASD). A total of 72 autistic individuals and 70 controls matched for age, gender, and cognitive abilities completed a computerized version of the Dresden breakfast Task, which required participants to prepare breakfast following a set of rules and time restrictions. A two (group: ASD vs. controls) by three (encoding condition: EFT vs. EE vs. standard) between-subjects design was applied. Participants were either instructed to engage in EFT or EE to prepare to the different tasks prior to performing the Dresden breakfast or received standard instructions. Analyses of variance were conducted. Autism-spectrum-disorders (ASD) participants did not differ from control participants in their PM performance, regardless of which strategy they used. Compared to the standard condition, EE but not EFT improved time-based PM performance in all participants. This is the first study to find spared time-based PM performance in autistic individuals. The results confirm earlier results of beneficial effects of EE on PM performance. Findings are discussed with regards to the methodology used, sample composition as well as autistic characteristics.

Effectiveness of a Robot-Assisted Psychological Intervention for Children with Autism Spectrum Disorder

Difficulties with social interaction characterise children with Autism Spectrum Disorders and have a negative impact in their everyday life. Integrating a social-humanoid robot within the standard clinical treatment has been proven promising. The main aim of this randomised controlled study was to evaluate the effectiveness of a robot-assisted psychosocial intervention and the secondary aim was to investigate potential differences between a robot-assisted intervention group and a control group receiving intervention by humans only. The analysis of the results showed that robot-assisted intervention could be beneficial by improving children's psychosocial skills. This improvement was highlighted by neuropsychological testing and parent reporting. Group comparison only presented minimal statistically significant differences. The study underpins the potential of robot-assisted interventions to augment standard care.

Virtual Reality Training of Social Skills in Adults with Autism Spectrum Disorder: An Examination of Acceptability, Usability, User Experience, Social Skills, and Executive Functions

Poor social skills in autism spectrum disorder (ASD) are associated with reduced independence in daily life. Current interventions for improving the social skills of individuals with ASD fail to represent the complexity of real-life social settings and situations. Virtual reality (VR) may facilitate social skills training in social environments and situations similar to those in real life; however, more research is needed to elucidate aspects such as the acceptability, usability, and user experience of VR systems in ASD. Twenty-five participants with ASD attended a neuropsychological evaluation and three sessions of VR social skills training, which incorporated five social scenarios with three difficulty levels. Participants reported high acceptability, system usability, and user experience. Significant correlations were observed between performance in social scenarios, self-reports, and executive functions. Working memory and planning ability were significant predictors of the functionality level in ASD and the VR system's perceived usability, respectively. Yet, performance in social scenarios was the best predictor of usability, acceptability, and functionality level. Planning ability substantially predicted performance in social scenarios, suggesting an implication in social skills. Immersive VR social skills training in individuals with ASD appears to be an appropriate service, but an errorless approach that is adaptive to the individual's needs should be preferred.

Do emotionally salient cues improve prospective memory performance in children and adolescents with autism?

BACKGROUND

Prospective memory (PM) describes the ability to initiate and perform a planned action after a delay. Previous studies suggest reduced PM in autism spectrum disorder (ASD); especially when tasks put high demands on executive control resources. Increasing cue salience by presenting emotional cues improves PM performance in non-autistic populations.

AIMS

To explore whether children with ASD, whose processing of emotionally connoted information might differ from that of typically developing children, may also benefit from this type of salience in PM tasks.

METHODS AND PROCEDURES

Twenty-five children with and 25 children without ASD completed a 1-back ongoing task into which an event-based PM task was embedded. Emotional salience of PM cues was varied.

OUTCOMES AND RESULTS

Children with ASD performed as well as children without ASD on the PM task and equally benefited from emotionally salient cues. Specifically, negative cues increased PM performance compared to neutral cues in both groups CONCLUSIONS AND IMPLICATIONS: The findings are consistent with the multiprocess framework which postulates that salient PM cues increase performance by promoting automatic intention retrieval and reducing executive control demands. Children with ASD seem to show similar comprehension and accessibility to emotional cues as typically developing children.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Executive functions in youths with autism spectrum disorder and their unaffected siblings

BACKGROUND

Executive dysfunction is one of the main cognitive theories of autism spectrum disorder (ASD). Despite evidence of deficits in executive functions in individuals with ASD, little is known about executive dysfunctions as candidate cognitive endophenotypes for ASD. In this study, we investigated executive functions in youths with ASD, their unaffected siblings and typically developing controls (TDC).

METHODS

We recruited 240 youths with a clinical diagnosis of ASD (aged 6-18 years), 147 unaffected siblings of ASD youths, and 240 TDC youths. TDC youths were recruited based on the age and sex distribution of the ASD youths. Participants were assessed using the verbal Digit Span test and four executive function tasks from the Cambridge Neuropsychological Test Automated Battery, including Intra-dimensional/Extra-dimensional Shift (I/ED), Spatial Span (SSP), Spatial Working Memory (SWM), and Stocking of Cambridge (SoC).

RESULTS

ASD youths, relative to TDC, performed significantly worse in executive function tasks assessing verbal working memory (forward and backward digit span), set-shifting (I/ED), visuospatial working memory (SSP, SWM), and planning/problem solving (SoC). Furthermore, unaffected siblings, relative to TDC, performed worse in forward and backward digit recalls and made more errors in SWM. These results were independent of the effects of age, sex, IQ, and symptoms of attention-deficit/hyperactivity disorder.

CONCLUSIONS

Our findings support impaired executive functions in youths with ASD. However, unaffected siblings were mostly unimpaired except in the areas of verbal and spatial working memory, which may be potential cognitive endophenotypes for ASD.

Attentional Cueing and Executive Deficits Revealed by a Virtual Supermarket Task Coupled With Eye-Tracking in Autism Spectrum Disorder

Executive functioning (EF) impairments in Autism Spectrum Disorder (ASD) impact on complex functions, such as social cognition. We assessed this link between EF, attentional cueing, and social cognition with a novel ecological task, "EcoSupermarketX." Our task had three blocks of increasing executive load and incorporated social and non-social cues, with different degrees of saliency. Performance of ASD and typical neurodevelopment was compared. The ASD showed a significant performance dependence on the presence of contextual cues. Difficulties increased as a function of cognitive load. Between-group differences were found both for social and non-social salient cues. Eye-tracking measures showed significantly larger fixation time of more salient social cues in ASD. In sum, EcoSupermarketX is sensitive to detect EF and attentional cueing deficits in ASD.

Measuring the Impact of Bilingualism on Executive Functioning Via Inhibitory Control Abilities in Autistic Children

One factor that may influence how executive functions develop is exposure to more than one language in childhood. This study explored the impact of bilingualism on inhibitory control in autistic (n = 38) and non-autistic children (n = 51). Bilingualism was measured on a continuum of exposure to investigate the effects of language environment on two facets of inhibitory control. Behavioural control of motor impulses was modulated positively through increased bilingual exposure, irrespective of diagnostic status, but bilingual exposure did not significantly affect inhibition involving visual attention. The results partially support the hypothesis that bilingual exposure differentially affects components of inhibitory control and provides important evidence for families that bilingualism is not detrimental to their development.

Node Centrality Measures Identify Relevant Structural MRI Features of Subjects with Autism

Autism spectrum disorders (ASDs) are a heterogeneous group of neurodevelopmental conditions characterized by impairments in social interaction and communication and restricted patterns of behavior, interests, and activities. Although the etiopathogenesis of idiopathic ASD has not been fully elucidated, compelling evidence suggests an interaction between genetic liability and environmental factors in producing early alterations of structural and functional brain development that are detectable by magnetic resonance imaging (MRI) at the group level. This work shows the results of a network-based approach to characterize not only variations in the values of the extracted features but also in their mutual relationships that might reflect underlying brain structural differences between autistic subjects and healthy controls. We applied a network-based analysis on sMRI data from the Autism Brain Imaging Data Exchange I (ABIDE-I) database, containing 419 features extracted with FreeSurfer software. Two networks were generated: one from subjects with autistic disorder (AUT) (DSM-IV-TR), and one from typically developing controls (TD), adopting a subsampling strategy to overcome class imbalance (235 AUT, 418 TD). We compared the distribution of several node centrality measures and observed significant inter-class differences in averaged centralities. Moreover, a single-node analysis allowed us to identify the most relevant features that distinguished the groups.

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.

Executive Function Skills Are Linked to Restricted and Repetitive Behaviors: Three Correlational Meta Analyses

There is a consensus on the centrality of restricted and repetitive behaviors (RRBs) in the diagnosis of Autism Spectrum Disorder (ASD), yet the origins of these behaviors are still debated. We reconsider whether executive function (EF) accounts of RRBs should be revisited. EF deficits and high levels of RRBs are often pronounced in individuals with ASD and are also prevalent in young typically developing children. Despite this, the evidence is mixed, and there has been no systematic attempt to evaluate the relationship across studies and between task batteries. We examine recent evidence, and in three highly powered random-effects analyses (N = 2964), examine the strength of the association between RRB levels and performance on set shifting, inhibitory control, and parental-report based EF batteries. The analyses confirm significant associations between high levels of the behaviors and poor EF skills. Moreover, the associations remained stable across typical development and in individuals with ASD and across different types of EF measures. These meta-analyses consolidate recent evidence identifying that cognitive mechanisms correlate with high RRBs that are seen in individuals with ASD, as well as in typical development. We propose that the EF account may be critical for guiding future interventions in ASD research. LAY SUMMARY: Restricted and repetitive behaviors (RRBs) are diagnostic criteria for Autism yet also common in typical development, and if they persist over time some can have a negative impact on learning and social acceptance. The present meta-analyses found that high levels of RRBs related to poor performance on set-shifting and inhibitory control tasks, as well as high ratings on parental report scales. Future studies should create interventions that aim to improve these skills as they may help manage challenging RRBs.

Verbal and Figural Creativity in Children With Autism Spectrum Disorder and Typical Development

Previous studies have shown that individuals with autism spectrum disorder (ASD) demonstrate lower performance on creativity tasks. Yet, recent findings suggest that individuals with ASD are not necessarily impaired in verbal creativity, as measured by the novel metaphor generation task. The current study investigates verbal and figural creativity in 40 children with ASD (aged 11–14 years) and 39 peers with typical development (TD) (aged 11–15 years). We also tested the contribution of executive functions to the creative performance. A sentence completion questionnaire was used to test creative verbal generation, while a task of drawing non-existent objects was used to assess figural abilities. The results indicate that children with ASD generated a greater quantity of creative metaphors and showed greater use of a specific kind of representational change on the figural creativity task: cross-category insertions (e.g., a house with a tail). However, no correlation was found between the metaphor generation task and the use of cross-category insertions for either group. Results also showed that, whereas phonemic fluency contributed to the explained variance in novel metaphor generation in the ASD group, fluid intelligence, although only marginally, contributed to variance in novel metaphor generation in the TD group. These findings suggest that verbal creativity and figural creativity are two separate abilities relying on different cognitive resources. Our results show that those with ASD and TD differ in the cognitive abilities they use to perform the metaphor generation task. The research points to a unique creative cognition profile among children with ASD.

The Role of Inner Speech in Executive Functioning Tasks: Schizophrenia With Auditory Verbal Hallucinations and Autistic Spectrum Conditions as Case Studies

Several theories propose that one of the core functions of inner speech (IS) is to support subjects in the completion of cognitively effortful tasks, especially those involving executive functions (EF). In this paper we focus on two populations who notoriously encounter difficulties in performing EF tasks, namely, people diagnosed with schizophrenia who experience auditory verbal hallucinations (Sz-AVH) and people with autism spectrum conditions (ASC). We focus on these two populations because they represent two different ways in which IS can fail to help in EF tasks, which can be illustrative for other mental conditions. First, we review the main components of EF (see section "Executive Functions"). Then we explain the functions that IS is taken to perform in the domain of EF (see section "Inner Speech and Executive Functions") and review the evidence concerning problems about EF in the two populations of our study: Sz-AVH (see section "Executive Functions and Inner Speech in Sz-AVH") and ASC (see section "Executive Function and Inner Speech in ASC"). After this we further detail our account about what a properly functioning IS can do for both populations and how different IS profiles may impact EF performance: in the case of Sz-AVH, the uncontrolled and intrusive character of IS negatively affects EF performance, whereas in ASC, EF is not sufficiently supported by IS, given the tendency in this population to present a diminished use of IS (see section "IS in ASC and Sz-AVH: How It Relates to EF"). We finally briefly discuss Attention Deficit/Hyperactivity Disorder (ADHD) and Developmental Language Disorders (DLD) (see section "Further Considerations").

Characteristic Executive Dysfunction for High-Functioning Autism Sustained to Adulthood

The comprehensiveness and severity of executive dysfunction in high-functioning autism (HFA) spectrum disorder have not reached a unified conclusion especially in patients in adulthood. Clarifying this issue is critical for guiding clinical diagnosis and targeted intervention. The primary objective of the present meta-analysis was to study the characteristics of executive function (EF) in adults with HFA compared to typically developing (TD) adults, by taking five key components into consideration, including inhibition, working memory, flexibility, planning, and fluency. The PubMed and Embase databases were searched to identify peer-reviewed studies that compared EF in adults with and without HFA from 1980 to November 2018. Hedges' g effect sizes were computed to measure the primary outcome. Moderators like age, sex, and diagnostic tools were controlled using meta-regressions. Forty-two studies satisfying the selection criteria were included, which resulted in a large sample size of 2419 participants. A moderate overall effect size for reduced EF across domains was found in adults with HFA, compared with TD (g = 0.57, 95% confidence interval 0.47-0.66). Subsequently, a broad executive dysfunction was found in adults with HFA in this study (flexibility [g = 0.69], planning [g = 0.64], inhibition [g = 0.61], working memory [g = 0.48], fluency [g = 0.42]), with the predominated impairment on flexibility and planning. Taken together, these results provide evidence for the executive dysfunction hypothesis and may assist in the clinical diagnosis and targeted intervention, suggesting the necessity of sustained intervention on EF for individuals with HFA from childhood to adulthood. LAY SUMMARY: The meta-analysis explored the characteristics of EF in adults with high-functioning autism (HFA) comparing to typically developing controls. Moderate effect sizes for reduced EF across domains were found in adults with HFA, with the flexibility and planning being the most predominately impaired. A comprehensive measurement of EF in adults with HFA has important clinical implications for the diagnosis, treatment, prognosis, and a fundamental understanding for developmental trajectory of these patients.

Behavioral and Neuropsychological Evaluation of Executive Functions in Children with Autism Spectrum Disorder in the Gulf Region

This study examined the executive functioning abilities and development profiles of children with autism spectrum disorder (ASD). The participants were 119 children with ASD and 30 typically developing children (age range: 6–12 years) who were recruited from three Gulf states. The findings revealed executive functioning deficits in the ASD population when compared to the normative data or to those children without ASD. However, not all the forms of executive functioning were found to be impaired. Age-related differences in the patterns of performance on the utilized measures of executive functioning were also identified. The overall findings provide valuable information regarding the different components of the executive functions, which may prove useful in relation to the development of assessment protocols for ASD.

The impact of sensory processing on executive and cognitive functions in children with autism spectrum disorder in the school context

BACKGROUND

Theoretical approaches propose a hierarchical organization of sensory and higher-order cognitive processes, in which sensory processing influence some cognitive and executive functions.

AIMS

The main objective of this study was to analyze whether sensory processing dysfunctions can predict the cognitive and executive dysfunctions evaluated in a group of children with level 2 autism spectrum disorder (ASD) in the school context.

METHODS AND PROCEDURES

Two groups of children participated: an ASD group (n = 40) and a group of children with typical development (the comparison group, n = 40). The children's sensory processing was evaluated based on their teachers' perceptions, and the children's executive and cognitive functions were evaluated using direct performance measures.

RESULTS

In the ASD group, the sensory processing difficulties predicted executive and cognitive dysfunctions in the specific domains of inhibitory control, auditory sustained attention, and short-term verbal memory, after controlling the possible effect of ASD severity. Moreover, the ASD group showed higher levels of sensory, executive, and cognitive dysfunction than the comparison group.

CONCLUSIONS AND IMPLICATIONS

Future research should investigate whether adequate sensory interventions in children with ASD in the school context can improve these specific executive and cognitive functions.

Improvement of Planning Skills in Children With Autism Spectrum Disorder After an Educational Intervention: A Study From a Mixed Methods Approach

The literature confirms that individuals with autism spectrum disorder (ASD) have planning deficits. However, few interventions have targeted these deficits. The aims of this study were to: (1) show that the mixed methods approach can be useful in studying planning skills of children with ASD during and after an educational intervention; (2) assess whether the planning skills of two groups of children with ASD improved during the intervention and if this progress was maintained 1 month after completing the intervention. The groups were formed depending on each child’s severity level (SL) of ASD according to DSM-5: SL1 (requiring support) and SL2 (requiring substantial support). Each group was composed of four children. In the framework of mixed methods, we used observational methodology, which is considered as mixed methods in itself because it integrates qualitative and quantitative elements. A nomothetic/follow-up/multidimensional observational design was used. Planning skills manifested by children during the intervention were codified, as well as the scaffolding behaviors provided by the educational specialist. These skills and behaviors were also coded in one session, which took place 1 month after the intervention. Coded data of each group were submitted to prospective and retrospective lag sequential analysis. This informed of the sequential structure of planning skills performed by children in interaction with the educational specialist at the beginning and at the end of the intervention, as well as 1 month later after the intervention. The comparison of the patterns obtained in these three temporal moments allowed us to know the improvement of the two groups in the use of planning skills. Results showed that both groups improved their autonomous use of planning skills. However, SL1 group used successfully and autonomously complex planning skills, while SL2 group were unable to achieve this gain. SL2 group progressed in autonomy, but only using basic planning skills. Both groups can further improve their use of planning skills; therefore, the intervention should be adjusted to their characteristics and temporarily extended. These findings contribute to the, as yet, little studied field of intervention and assessment of planning skills in children with ASD using a mixed methods approach.

Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism: A Meta-analysis

Importance

The definition and nature of autism have been highly debated, as exemplified by several revisions of the DSM (DSM-III, DSM-IIIR, DSM-IV, and DSM-5) criteria. There has recently been a move from a categorical view toward a spectrum-based view. These changes have been accompanied by a steady increase in the prevalence of the condition. Changes in the definition of autism that may increase heterogeneity could affect the results of autism research; specifically, a broadening of the population with autism could result in decreasing effect sizes of group comparison studies.

Objective

To examine the correlation between publication year and effect size of autism-control group comparisons across several domains of published autism neurocognitive research.

Data Sources

This meta-analysis investigated 11 meta-analyses obtained through a systematic search of PubMed for meta-analyses published from January 1, 1966, through January 27, 2019, using the search string autism AND (meta-analysis OR meta-analytic). The last search was conducted on January 27, 2019.

Study Selection

Meta-analyses were included if they tested the significance of group differences between individuals with autism and control individuals on a neurocognitive construct. Meta-analyses were only included if the tested group difference was significant and included data with a span of at least 15 years.

Data Extraction and Synthesis

Data were extracted and analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline using fixed-effects models.

Main Outcomes and Measures

Estimated slope of the correlation between publication year and effect size, controlling for differences in methods, sample size, and study quality.

Results

The 11 meta-analyses included data from a total of 27 723 individuals. Demographic data such as sex and age were not available for the entire data set. Seven different psychological and neurologic constructs were analyzed based on data from these meta-analyses. Downward temporal trends for effect size were found for all constructs (slopes: -0.067 to -0.003), with the trend being significant in 5 of 7 cases: emotion recognition (slope: -0.028 [95% CI, -0.048 to -0.007]), theory of mind (-0.045 [95% CI, -0.066 to -0.024]), planning (-0.067 [95% CI, -0.125 to -0.009]), P3b amplitude (-0.048 [95% CI, -0.093 to -0.004]), and brain size (-0.047 [95% CI, -0.077 to -0.016]). In contrast, 3 analogous constructs in schizophrenia, a condition that is also heterogeneous but with no reported increase in prevalence, did not show a similar trend.

Conclusions and Relevance

The findings suggest that differences between individuals with autism and those without the diagnosis have decreased over time and that possible changes in the definition of autism from a narrowly defined and homogenous population toward an inclusive and heterogeneous population may reduce our capacity to build mechanistic models of the condition.

Empathy Impairment in Individuals With Autism Spectrum Conditions From a Multidimensional Perspective: A Meta-Analysis

Background: Although empathy has always been considered to be impaired in individuals with autism spectrum conditions (ASCs), the relevant findings have been inconsistent. The present meta-analysis aims to determine which empathy components are impaired and how culture, gender, and age moderate such empathy impairment.

Methods: By using “Autism,” “Asperger Syndrome,” “Empathy,” and related Chinese synonyms as keywords, we searched the databases of Weipu, Wanfang, CNKI, Web of Science, Science Direct, SpringerLink, and Elsevier through “subject” and “keyword” searches. We also conducted a manual search according to the references. In total, 51 studies from Eastern and Western countries were included in this meta-analysis, which comprised 144 independent effects, 2,095 individuals with ASCs and 2,869 controls without ASCs. For the retrieved data, Hedge's g was taken as the quantitative measure of effect, and CMA V2.0 software was used for publication bias tests (by using Rosenthal's Classic Failsafe-N and Egger's methods), heterogeneity tests (by using a Q-test, I²-test, and H-test) and a moderating effect test (by using a univariate regression model).

Results: The results showed that the empathy impairment evident in individuals with ASCs is component specific; that is, trait-cognitive empathy, trait-empathic concern, state-cognitive empathy, and state-empathic concern are impaired, whereas state-empathic accuracy remains intact, and trait-empathic accuracy is superior to the trait-empathic accuracy in neurotypical individuals. The univariate regression model showed that gender moderates the impairment of the trait-empathic concern, trait-empathic accuracy, and state-cognitive empathy in autistic individuals and that age moderates the impairment of the trait-cognitive empathy, trait-empathic accuracy, state-empathic concern, and state-empathic accuracy in autistic individuals. However, culture does not moderate any empathy components (trait-cognitive empathy, trait-empathic concern, or state-cognitive empathy) involved in the present meta-analysis.

Conclusions: These findings contribute to ending the controversy over the empathic integrity of individuals with ASCs and shed some light on future research about the empathy impairment of autistic individuals. More specifically, subsequent studies should distinguish specific empathy components and consider the role of gender and age when demonstrating empathy impairment in individuals with ASCs. Moreover, related studies based on Asian collectivist cultural samples and female samples should be further enriched.

Four Social Brain Regions, Their Dysfunctions, and Sequelae, Extensively Explain Autism Spectrum Disorder Symptomatology

Autism spectrum disorder (ASD) is a challenging neurodevelopmental disorder with symptoms in social, language, sensory, motor, cognitive, emotional, repetitive behavior, and self-sufficient living domains. The important research question examined is the elucidation of the pathogenic neurocircuitry that underlies ASD symptomatology in all its richness and heterogeneity. The presented model builds on earlier social brain research, and hypothesizes that four social brain regions largely drive ASD symptomatology: amygdala, orbitofrontal cortex (OFC), temporoparietal cortex (TPC), and insula. The amygdala's contributions to ASD largely derive from its major involvement in fine-grained intangible knowledge representations and high-level guidance of gaze. In addition, disrupted brain regions can drive disturbance of strongly interconnected brain regions to produce further symptoms. These and related effects are proposed to underlie abnormalities of the visual cortex, inferior frontal gyrus (IFG), caudate nucleus, and hippocampus as well as associated symptoms. The model is supported by neuroimaging, neuropsychological, neuroanatomical, cellular, physiological, and behavioral evidence. Collectively, the model proposes a novel, parsimonious, and empirically testable account of the pathogenic neurocircuitry of ASD, an extensive account of its symptomatology, a novel physiological biomarker with potential for earlier diagnosis, and novel experiments to further elucidate the mechanisms of brain abnormalities and symptomatology in ASD.

Purpose in adolescents diagnosed with an autism spectrum disorder

INTRODUCTION

Drawing from positive youth development theory, the research team examined purpose in life among adolescents diagnosed with an autism spectrum disorder (ASD).

METHODS

Members of the research team conducted paired interviews about purpose in life with adolescents diagnosed with an ASD and one of each adolescent's parents. Data collection took place in the south-central region of the US. The eight adolescent participants were in middle school, high school, and early college. The research team open-coded interview transcripts and condensed these codes into meta-codes to aid in determining the form of purpose for each participant.

RESULTS

Similar to what has been found in studies of neurotypical youth, participants distributed diversely across the forms of purpose, with all but one participant demonstrating some aspect of purpose.

CONCLUSIONS

The authors recommend practitioners consider the variety of supports they could provide to adolescents diagnosed with an ASD and consider encouraging these youth when their creative interests are sparked. Additionally, the research team invites the scholarly community to further investigate specific contextual supports and to develop ways of measuring purpose that do not rely on advanced language and social skills.

Executive Function in Autism Spectrum Disorder: History, Theoretical Models, Empirical Findings, and Potential as an Endophenotype

This review presents an outline of executive function (EF) and its application to autism spectrum disorder (ASD). The development of the EF construct, theoretical models of EF, and limitations in the study of EF are outlined. The potential of EF as a cognitive endophenotype for ASD is reviewed, and the Research Domain Criteria (RDoC) framework is discussed for researching EF in ASD given the multifaceted factors that influence EF performance. A number of executive-focused cognitive models have been proposed to explain the symptom clusters observed in ASD. Empirical studies suggest a broad impairment in EF, although there is significant inter-individual variability in EF performance. The observed heterogeneity of EF performance is considered a limiting factor in establishing EF as a cognitive endophenotype in ASD. We propose, however, that this variability in EF performance presents an opportunity for subtyping within the spectrum that can contribute to targeted diagnostic and intervention strategies. Enhanced understanding of the neurobiological basis that underpins EF performance, such as the excitation/inhibition hypothesis, will likely be important. Application of the RDoC framework could provide clarity on the nature of EF impairment in ASD with potential for greater understanding of, and improved interventions for, this disorder.