Associations between executive functions and mental health outcomes for adults with autism spectrum disorder

A digital intervention to support childhood cognition after the COVID-19 pandemic: a pilot trial

Difficulties in executive functioning (EF) can result in impulsivity, forgetfulness, and inattention. Children living in remote/regional communities are particularly at risk of impairment in these cognitive skills due to reduced educational engagement and poorer access to interventions. This vulnerability has been exacerbated by the COVID-19 pandemic and strategies are needed to mitigate long-term negative impacts on EF. Here we propose a pilot trial investigating the benefits, feasibility, and acceptability of a school-based EF intervention for primary school students (6-8 years) living in regional, developmentally vulnerable, and socio-economically disadvantaged communities. Students were randomised to a digital intervention or teaching as usual, for 7 weeks. Children completed measures of EF and parents/educators completed ratings of everyday EF and social/emotional wellbeing at pre-intervention, post-intervention, and 3-month follow-up. Change in EFs (primary outcome), everyday EF, and social/emotional wellbeing (secondary outcomes) from pre- to post-intervention and pre-intervention to 3-month follow-up were examined. Feasibility and acceptability of the intervention was assessed through educator feedback and intervention adherence.Protocol Registration: The stage 1 protocol for this Registered Report was accepted in principle on 20 April 2023. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/WT3S2 . The approved Stage 1 protocol is available here: https://osf.io/kzfwn .

Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems

LAY ABSTRACT

Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.

The latent structure of the Delis-Kaplan system for autism

A core feature of autism is deficits in executive functioning (EF), including difficulty with planning, cognitive flexibility, and working memory. Despite a growing need for evidence-based assessments of EF for autism populations, statistical models of many commonly used measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), have not been investigated for a sample of autistic participants. The purpose of this study was to address a gap in the literature regarding the latent structure of the D-KEFS in a sample of autistic individuals. The D-KEFS is one of the most widely used clinical assessments of executive function, but its factor structure has not been examined in a sample of autistic participants. Reliability analyses were performed for sample subgroups based on participants' clinical and demographic characteristics, including IQ, autism severity, age, and race/ethnicity. Verbal Fluency (VF) was found to consistently decrease or not affect the overall reliability score. Additionally, one- and two-factor structure models were tested for the D-KEFS with a sample of autistic participants. The one-factor model was not found to be a good fit for the data. However, the two-factor model, with Cognitive Flexibility and Abstraction latent factors, was found to fit the data relatively well. This two-factor model was reexamined excluding the VF observed variable, resulting in a better overall model fit. Communication deficits are a common feature of autism, which explains why the VF task, that requires participants to produce novel words, may not be an adequate measure of executive function for autism populations.

Exercise habits and mental health: Exploring the significance of multimodal imaging markers

Engaging in regular physical activity and establishing exercise habits is known to have multifaceted benefits extending beyond physical health to cognitive and mental well-being. This study explores the intricate relationship between exercise habits, brain imaging markers, and mental health outcomes. While extensive evidence supports the positive impact of exercise on cognitive functions and mental health, recent advancements in multimodal imaging techniques provide a new dimension to this exploration. By using a cross-sectional multimodal brain-behavior statistic in participants with different exercise habits, we aim to unveil the intricate mechanisms underlying exercise's influence on cognition and mental health, including the status of depression, anxiety, and quality of life. This integration of exercise science and imaging promises to substantiate cognitive benefits on mental health and uncover functional and structural changes underpinning these effects. This study embarks on a journey to explore the significance of multimodal imaging metrics (i.e., structural and functional metrics) in deciphering the intricate interplay between exercise habits and mental health, enhancing the comprehension of how exercise profoundly shapes psychological well-being. Our analysis of group comparisons uncovered a strong association between regular exercise habits and improved mental well-being, encompassing factors such as depression, anxiety levels, and overall life satisfaction. Additionally, individuals who engaged in exercise displayed enhanced brain metrics across different modalities. These metrics encompassed greater gray matter volume within the left frontal regions and hippocampus, improved white matter integrity in the frontal-occipital fasciculus, as well as more robust functional network configurations in the anterior segments of the default mode network. The interplay between exercise habits, brain adaptations, and mental health outcomes underscores the pivotal role of an active lifestyle in nurturing a resilient and high-functioning brain, thus paving the way for tailored interventions and improved well-being.

The effectiveness of a program based on mental imagery on improvement working memory in children with ASD in inclusion classroom

This study examines the effectiveness of a program based on mental imagery on improvement working memory in children with Autism spectrum disorder (ASD) in inclusion classroom. 30 children (both sexes; 20 boys and 10 girls) with ASD aged 7-8 years old in primary one from school for inclusion were recruited. T-tests analyses were performed to determine whether there were differences between pretest and posttest measures for both the intervention and control groups. Quantitative data obtained at the beginning and end of the experimental process were analyzed in the SPSS 23.00 package program. Then, the necessary tests were conducted to determine the difference in the working memory performance level children in the experimental and control groups. T-test analysis for the differences in post- test mean scores between control and treatment groups in working memory(WM) shows that the intervention group outperformed the control group in numerical, verbal, and visual memory.

Emotion Regulation and Executive Function: Associations with Depression and Anxiety in Autism

Background

Adolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention.

Method

Fifty-seven autistic adolescents and adults (16-25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms.

Results

ASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety.

Conclusions

Although preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.

Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT

LAY ABSTRACT

Autistic youth and adults are more likely to experience psychiatric symptoms (e.g. depression, anxiety) and to use psychiatric services than non-autistic people, yet research on evidence-based approaches to enhance psychiatric care for autistic people is limited. Measurement-based care is an evidence-based approach to psychotherapy that improves outcomes for clients, clinicians, and organizations by routinely administering and evaluating measures to clients. Despite this, research on measurement-based care systems for autistic clients is sparse. To address this gap, we developed an autism-adapted measurement-based care (MBC-AUT) system for and with autistic people and pilot tested the system in an outpatient psychiatry clinic to investigate the preliminary feasibility, acceptability, benefits, and barriers to this system for clients and clinicians. Findings suggested that the MBC-AUT system was a feasible and acceptable system for the first 18 autistic youth, their caregivers, and autistic adults to use the system. In semi-structured interviews, clients and clinicians discussed the benefits of the MBC-AUT system to various therapeutic processes, as well as several important barriers to the use of the system. We offer potential solutions to address these barriers and to reduce client and clinician burden, and propose future directions for this line of research to increase access to more autistic people. As autistic clients continue to seek psychological services amid social landscapes of increasing complexity (e.g. COVID-19 pandemic), efforts to enhance the delivery of psychotherapy for this population are critical.

A cognitive neurogenetic approach to uncovering the structure of executive functions

One central mission of cognitive neuroscience is to understand the ontology of complex cognitive functions. We addressed this question with a cognitive neurogenetic approach using a large-scale dataset of executive functions (EFs), whole-brain resting-state functional connectivity, and genetic polymorphisms. We found that the bifactor model with common and shifting-specific components not only was parsimonious but also showed maximal dissociations among the EF components at behavioral, neural, and genetic levels. In particular, the genes with enhanced expression in the middle frontal gyrus (MFG) and the subcallosal cingulate gyrus (SCG) showed enrichment for the common and shifting-specific component, respectively. Finally, High-dimensional mediation models further revealed that the functional connectivity patterns significantly mediated the genetic effect on the common EF component. Our study not only reveals insights into the ontology of EFs and their neurogenetic basis, but also provides useful tools to uncover the structure of complex constructs of human cognition.

Adding the missing voice: How self-report of autistic youth self-report on an executive functioning rating scale compares to parent report and that of youth with attention deficit hyperactivity disorder or neurotypical development

LAY ABSTRACT

Executive functions are often impaired in autistic people and relate to important outcomes such as mental health, success in school and work, and quality of life. Evaluating executive functions helps autistic people, clinicians, and families identify targets for external supports and skill building. Youth self-report of executive function has not been studied, yet we know that self-report from autistic youth is key to understanding other cognitive/behavioral phenomena in autism such as anxiety, obsessions/compulsions, sensory sensitivities, and repetitive behaviors. We investigated self- and parent-report of executive function problems in 197 autistic youth without intellectual disability (ages 11-18 years), including the magnitude and profiles of executive function problems autistic youth report across subdomains of executive function. We compared autistic self-report with that of 114 youth with attention deficit hyperactivity disorder without intellectual disability and 197 neurotypical youth. We found that autistic youth report significant executive function problems compared to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverged regarding the magnitude of the youth's executive function difficulties, but both identify inflexibility as the most impaired executive function subdomain. Autistic youth and their parents were somewhat more concordant in their report of executive function problems than youth with attention deficit hyperactivity disorder and their parents, but only showed moderate concordance at best. These findings elevate the importance of asking autistic youth directly about their executive functioning when engaging them in assessment and intervention, or researching executive functions in autism.

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

Purpose

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

Design/methodology/approach

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

Findings

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

Research limitations/implications

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

Originality/value

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

Advancing the Personalization of Assessment and Intervention in Autistic Adolescents and Young Adults by Targeting Self-Determination and Executive Processes

As autistic adolescents and young adults navigate the transition to adulthood, there is a need to partner with them to identify strengths and needed supports to enable goal-directed actions. This article conceptually integrates research on self-determination, defined by Causal Agency Theory, and executive processes in autism to provide direction for future research and practice. We describe how integrating research on self-determination and executive processes could enable autistic adolescents and young adults to be engaged in the process of assessing executive processes and self-determination. We discuss how this can better inform personalization of supports for self-determination interventions by focusing on support needs related to executive processes, including inhibitory control and cognitive flexibility, from a strengths-based perspective. We discuss how this can enable self-determination interventions that promote outcomes aligned with the values of the autistic community.

Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

BACKGROUND

Autism Spectrum Disorder is often associated with deficits in executive functions (EFs), which is contributing significantly to individuals with ASD's difficulties in conducting an independent life, particularly considering social skills. Technologies offer promising opportunities to structure EF intervention programs for children on the autistic spectrum.

METHODS

This study aimed to review the effectiveness of randomized controlled trials or quasi-experimental studies of EF interventions delivered to children and young people (up to 23 years old) with a diagnosis of ASD. A special focus was dedicated to document the effectiveness of computerized and non-computerized cognitive training on (1) EFs and on (2) ASD symptomatology and social skills. Of 2601 studies retrieved, 19 fulfilled the inclusion criteria.

RESULTS

Most of the interventions identified were effective in enhancing EFs and reducing symptoms in children and young people with ASD. Limited evidence is available on their generalization to untrained skills (i.e., social abilities) as well as long-term effects.

CONCLUSIONS

There is growing evidence for overall effectiveness of EF training, particularly when computerized. However, caution should be taken when interpreting these findings owing to methodological limitations, the minimal number of papers retrieved, and a small samples of included studies.

A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum

Background

The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well.

Methods

Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist.

Results

Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies.

Discussion

Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40489-021-00293-4.

A review of executive functioning challenges and strengths in autistic adults

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

A transdiagnostic examination of anxiety and stress on executive function outcomes in disorders with social impairment

BACKGROUND

Executive function (EF) difficulties characterise a number of psychiatric conditions and EF impairment may be a predisposing factor and/or consequence of anxiety and stress. The aim of the study was to examine EF factors in a mixed clinical cohort (Autism Spectrum Disorder and Social Anxiety Disorder) characterised by social impairment and investigate the influence of trait anxiety and state-based depression, anxiety and stress.

METHODS

In Study 1, a factor analysis identified EF and non-EF latent factor structures (N=205). In Study 2, (N=137) multiple regression analyses investigated the association between trait anxiety and state based depression, anxiety and stress, on EF and non-EF cognitive domains and on the two composite indices of the Behavioural Rating Inventory of Executive Function (BRIEF).

RESULTS

Trait anxiety was associated with better performance on neuropsychological measures of EF while state-based stress was associated with lower EF performance. A dissociation was observed between trait anxiety and state stress on the two behavioural indices of the BRIEF. Depression, anxiety and stress did not predict performance on non-EF cognitive domains.

LIMITATIONS

The cross-sectional design precludes cause-effect conclusions, further only self-report measures of affect were utilised and our performance measures of EF did not include a working memory test.

CONCLUSIONS

The results demonstrate that trait anxiety and state-based stress influence EF processes across disorders with social impairment. The transdiagnostic efficacy of this finding can facilitate remediation strategies, it may also contribute to individuals with Autism Spectrum Disorder gaining better access to mental health services.

Components of Executive Control in Autism Spectrum Disorder: A Functional Magnetic Resonance Imaging Examination of Dual-Mechanism Accounts

BACKGROUND

It remains unclear whether executive control (EC) deficits in autism spectrum disorder (ASD) represent a failure in proactive EC (engaged and maintained before a cognitively demanding event) or in reactive EC (engaged transiently as the event occurs). We addressed this question by administering a paradigm investigating components of EC in a sample of individuals with ASD and typically developing individuals during functional magnetic resonance imaging.

METHODS

During functional magnetic resonance imaging, 141 participants (64 ASD, 77 typically developing) completed a rapid preparing to overcome prepotency task that required participants to respond to an arrow probe based on the color of an initially presented cue. We examined functional recruitment and connectivity in the frontoparietal task control, cingulo-opercular task control, salience, and default mode networks during cue and probe phases of the task.

RESULTS

ASD participants showed evidence of behavioral EC impairment. Analyses of functional recruitment and connectivity revealed that ASD participants showed significantly greater activity during the cue in networks associated with proactive control processes, but on the less cognitively demanding trials. On the more cognitively demanding trials, cue activity was similar across groups. During the probe, connectivity between regions associated with reactive control processes was uniquely enhanced on more-demanding (relative to less-demanding) trials in individuals with ASD but not in typically developing individuals.

CONCLUSIONS

The current data suggest that rather than arising from a specific failure to engage proactive or reactive forms of EC, the deficits in EC commonly observed in ASD may be due to reduced proactive EC and a consequent overreliance on reactive EC on more cognitively demanding tasks.

Autism research is 'all about the blokes and the kids': Autistic women breaking the silence on menopause

OBJECTIVES

The menopause is a major transition marked by considerable challenges to health and well-being. Its impact on autistic women has been almost largely ignored but is of significant concern, given the poorer physical and mental health, emotion regulation and coping skills, and the common social isolation of this group. We aimed to explore awareness and perception of the menopause; menopausal experiences and their impact across each individual's life; ways that menopause with autism might differ from a non-autistic menopause; and what optimal support might look like.

DESIGN

A qualitative interview study.

METHODS

Comprehensive interviews were conducted with 17 autistic participants (16 of whom identified as cisgender women). Inductive thematic analysis was used, guided by IPA principles and literature.

RESULTS

Four major themes were identified: (1) covering the long journey of our participants to recognizing autism in adulthood; (2) menopausal awareness and perceptions; (3) symptoms and their impact; and (4) ways that a neurodiverse menopause might differ from the norm. Menopausal experiences varied greatly and some participants experienced marked deterioration in daily function and coping skills, mental health, and social engagement. Menopausal awareness was often low, so too was confidence in help from health care professionals.

CONCLUSIONS

These findings implicate the potential for menopause to severely compromise health and well-being of autistic people and indicate an area of underserved support needs.

'When my autism broke': A qualitative study spotlighting autistic voices on menopause

LAY ABSTRACT

Autistic girls are known to struggle with the onset of menstruation, reporting that during their period, sensory sensitivities are heightened, it becomes more difficult to think clearly and control their emotions and they struggle more with everyday life and self-care. Yet surprisingly, nothing is known about how autistic women handle the menopausal transition in midlife. In non-autistic women, the menopause brings many physical changes and challenging symptoms from hot flushes to feeling more anxious and depressed. Because autistic women are already vulnerable to suicide, poor physical and mental health, and because they may already struggle with planning, controlling their emotions and coping with change, the menopause may be an especially challenging time. Yet, not one single study exists on the menopause in autism, so we conducted an online discussion (focus group) with seven autistic women. They confirmed that very little is known about menopause in autistic people, very little support is available and that menopause might be especially difficult for autistic people. Autism-related difficulties (including sensory sensitivity, socializing with others and communicating needs) were reported to worsen during the menopause, often so dramatically that some participants suggested they found it impossible to continue to mask their struggles. Participants also reported having extreme meltdowns, experiencing anxiety and depression, and feeling suicidal. This study highlights how important it is that professionals pay attention to menopause in autism, and discusses future research directions.

Exploring the spatial working memory and visual perception in children with autism spectrum disorder and general population with high autism-like traits

The aim of the study is to compare the spatial working memory and visual perception between children with autism spectrum disorder (ASD) and typically developing control (TDC). Furthermore, this study validated whether this impairment was a feature of autism in general population with different autism-like traits (ALTs). This study contains two parts: case-control study and community population study. The ASD group and the control group were enlisted voluntarily (ASD group, n = 52; control group, n = 32). In the population study, we recruited 2994 children. Based on the scores of Autism Spectrum Quotient (AQ), children were divided into two groups (higher ALTs n = 122, lower ALTs n = 122). The participants completed the cognition tasks focusing on spatial working memory, visual-motor integration, and Intelligence. Analysis of covariance (ANCOVA) was conducted, with potential confounders IQ, age, and gender were controlled. Pearson correlations were computed by controlling the IQ and age as covariate to better understand the relations between visual perception, spatial working memory, and autism-like traits. In the case-control study, the results of cognition tasks focusing on the spatial working memory and visual perception indicated underperformance in children with ASD. In the community population study, we found that individuals with higher ALTs performed worse than children with lower ALTs in spatial working memory. Pearson correlation analysis suggested that a correlation between SWM total errors and visual perception was identified both in the children with ASD and in community population (ASD group, r = -0.592, p<0.001; general population, r = -0.201, p = 0.003). It suggested that spatial working memory deficit was a characteristic of autism, and may be distributed across the general population. Furthermore, we speculated a correlation between spatial working memory and visual perception in children with ASD and in general population.

How I See and Feel About Myself: Domain-Specific Self-Concept and Self-Esteem in Autistic Adults

Few studies have examined the self-perceptions of autistic adults. This study aimed firstly to investigate domain-specific self-concepts and global self-esteem in autistic adults. The second aim was to examine associations between autism self-appraisals, perceived social support and global self-concept and self-esteem. The third was to determine which domains of self-concept were most closely associated with self-esteem. Participants included 71 autistic adults aged 18-70 years and 65 age, sex and education matched typically developing individuals. Participants completed an online survey of autism characteristics, global self-esteem and domain-specific self-concepts (i.e. likeability, task accomplishment, power, giftedness, invulnerability, and morality), self-appraisals about autism, and perceived social support. Autistic participants reported significantly lower power and global self-esteem than typically developing individuals after controlling for autism characteristics. More positive self-appraisals about autism (i.e. greater perceived benefits and lower helplessness) were significantly related to better global self-concept and self-esteem. Global self-esteem was significantly and positively associated with perceptions of giftedness, emotional resilience and power. These findings suggest that autistic adults may perceive themselves as having a low sense of power in their relationships and have negative global perceptions of their self-worth. However, those able to find positive meaning or benefits associated with autism are likely to have more positive global self-perceptions. This study provides new insights into how autistic adults perceive themselves which may guide the focus of psychosocial interventions that seek to recognize and promote unique talents and emotional resilience.

Aging in Autism Spectrum Disorder

Most research on autism spectrum disorder (ASD) has focused on younger individuals, but there is increasing awareness that more must be known about the clinical needs and outcomes of older adults with ASD. This article reviews what is known about barriers to recognition in the elderly, the prevalence of ASD over the lifespan, outcomes in adulthood in comparison to the general population, co-occurring psychiatric diagnoses, and healthcare needs in this population.

Brief Report: Screening Adults with Autism Spectrum Disorder for Anxiety and Depression

Although depression and anxiety are the most common comorbidities in individuals with Autism Spectrum Disorder (ASD), descriptive data for their prevalence among autistic adults are limited. This study provides descriptive data for a cohort of 155 autistic adults (mean age = 27.1 years, SD = 11.9) of average IQ on the short-form version of the Depression Anxiety Stress Scales and the Mini Social Phobia Inventory. Also included were 79 non-ASD participants (mean age = 26.2, SD = 10.2) who completed the mini-SPIN. A substantial percentage (39-46%) of autistic adults scored within the 'Moderate' to 'Extremely Severe' range on the DASS-21. The DASS-21 would be a valuable rapid screening device for these comorbid conditions in autistic adults.

The impact of disability type and visibility on self-concept and body image: Implications for mental health nursing

WHAT IS KNOWN ON THE SUBJECT?: Physical appearance, as in the case of individuals with physical disabilities who use a cane, walker or wheelchair, also influence others' reactions and as a result, may lead to one's negative or positive feelings and thoughts. A disability that is not observable by others, as in the case of individuals with psychiatric disabilities (mental illnesses), may also have a negative impact on one's feelings and thoughts, due to stigma associated with psychiatric disabilities. To date, research has mainly focused on the way persons with a noticeable type of disability think about themselves. It is also important to evaluate the impact of disability type on ones' feelings and thoughts, and compare persons with visible and invisible disabilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We asked 119 adults (over the age of 18 years) with different types of disabilities to complete a set of questionnaires and found that those who had a disability that was not observable by others (a psychiatric disability) felt more negative about themselves and their body than those who had a disability that was observable by others (a physical disability). The study extends the current knowledge on the impact of disability type and its visibility on the way persons with disabilities think about themselves. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that healthcare services should be modified to address the psychological needs of people with different types of disability. Mental health nurses should identify practices in the community that will improve the feelings and thoughts of consumers with disabilities, and especially those who cope with a psychiatric disability. Abstract Introduction Individuals with disabilities often face stigma and discrimination, which may negatively affect their self-concept. To date, research has mainly focused on the psychological implications of living with a noticeable physical disability. Less attention has been given to individuals with invisible psychiatric disabilities as a stigmatized subgroup in the disability community. Aim To evaluate the impact of disability type and its visibility on the self-concept and body image. Method A cross-sectional quantitative study design was implemented to compare the self-concept and body image of individuals with visible physical disabilities and individuals with invisible psychiatric disabilities (n = 119). Pearson correlations, ANOVA and multiple linear regression models were performed. Results Individuals with invisible psychiatric disabilities reported lower levels of self-concept and body image compared to individuals with visible physical disabilities. Gender, family status and the severity level of the disability were found to be associated with self-concept and body image. Discussion The study extends the current knowledge by showing that disability visibility might play a protective role for persons with physical disabilities compared to persons with psychiatric disabilities. Implications for Practice Mental health nurses should apply practices to enhance the self-concept and body image of consumers with invisible psychiatric disabilities.

Need for closure and cognitive flexibility in individuals with autism spectrum disorder: A preliminary study

The need for closure (NFC), a desire for a firm answer and less ambiguity, has a key role in cognitive flexibility in typical development (TD) populations. This study investigated this motivational construct and its relation to cognitive inflexibility in autism spectrum disorder (ASD). Compared with individuals with TD, those with ASD reported higher levels in preference for predictability and closed-mindedness and lower levels in decisiveness. These NFC facets were significantly associated with cognitive flexibility in ASD as well as TD groups. The study findings provide further insights into the motivational underpinnings of flexible behavior in ASD.

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.

Executive Function Skills in School-Age Children With Autism Spectrum Disorder: Association With Language Abilities

PURPOSE

This article reviews research on executive function (EF) skills in children with autism spectrum disorder (ASD) and the relation between EF and language abilities. The current study assessed EF using nonverbal tasks of inhibition, shifting, and updating of working memory (WM) in school-age children with ASD. It also evaluated the association between children's receptive and expressive language abilities and EF performance.

METHOD

In this study, we sought to address variables that have contributed to inconsistencies in this area of research-including task issues, group comparisons, and participant heterogeneity. EF abilities in children with ASD (n = 48) were compared to typically developing controls (n = 71) matched on age, as well as when statistically controlling for group differences in nonverbal cognition, socioeconomic status, and social communication abilities. Six nonverbal EF tasks were administered-2 each to evaluate inhibition, shifting, and WM. Language abilities were assessed via a standardized language measure. Language-EF associations were examined for the ASD group as a whole and subdivided by language status.

RESULTS

Children with ASD exhibited significant deficits in all components of EF compared to age-mates and showed particular difficulty with shifting after accounting for group differences in nonverbal cognition. Controlling for social communication-a core deficit in ASD-eliminated group differences in EF performance. A modest association was observed between language (especially comprehension) and EF skills, with some evidence of different patterns between children on the autism spectrum with and without language impairment.

CONCLUSIONS

There is a need for future research to examine the direction of influence between EF and language. It would be beneficial for EF interventions with children with ASD to consider language outcomes and, conversely, to examine whether specific language training facilitates aspects of executive control in children on the autism spectrum.

PRESENTATION VIDEO

https://doi.org/10.23641/asha.7298144.