More Than IQ: Executive Function Explains Adaptive Behavior Above and Beyond Nonverbal IQ in Youth With Autism and Lower IQ

Everyday Executive Function in Preschoolers with Autism and Links with Intellectual Functioning, Adaptive Behavior, and Autism Symptoms

Impairments in executive function (EF) among individuals with autism spectrum disorder and their association with negative academic, adaptive, and social functioning outcomes have been widely reported over the past 20 years. However, there remains a lack of understanding of EF in autism during the preschool period, an age at which several crucial abilities (including EF) emerge. The present study therefore sought to document everyday EF in preschool-aged children with autism and its associations with other clinical characteristics. Parents rated the EF of their preschool-aged child with autism (M = 30-65 months, N = 288) using the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P; Gioia, G. A., Espy, K. A., & Isquith, P. K. (2003). Behavior Rating Inventory of Executive Function-Preschool Version. Psychological Assessment Resources.). Intellectual quotient, adaptive behavior, and autism symptom severity were also assessed. Preschoolers with ASD displayed impairments in everyday EF, particularly in relation with inhibition and working memory. Greater challenges in EF were strongly associated with lower levels of adaptive behavior and a higher severity of autistic symptoms. To a lesser extent, EF challenges were also associated with lower levels of intellectual functioning. The early assessment and detection of EF difficulties in preschoolers with ASD may assist in developing and integrating specific intervention targets to improve these essential abilities within existing early intervention programs for ASD. This could help to maximize their effectiveness and limit the extent of difficulties these children may face growing up.

Developmental associations between cognition and adaptive behavior in intellectual and developmental disability

BACKGROUND

Intellectual and developmental disabilities (IDDs) are associated with both cognitive challenges and difficulties in conceptual, social, and practical areas of living, commonly referred to as adaptive behavior (DSM-5). Although cross-sectional associations between intelligence or cognition and adaptive behavior have been reported in IDD populations, no study to date has examined whether developmental changes in cognition contribute to or track with changes in adaptive behavior. The present study sought to examine associations of longitudinal developmental change in domains of cognition (NIH Toolbox Cognition Battery, NIHTB-CB) and adaptive behavior domains (Vineland Adaptive Behavior Scales-3; VABS-3) including Socialization, Communication, and Daily Living Skills (DLS) over a two year period in a large sample of children, adolescents and young adults with IDD.

METHODS

Three groups were recruited, including those with fragile X syndrome, Down syndrome, and other/idiopathic intellectual disability. Eligible participants (n = 263) included those who were between 6 and 26 years (mage = 15.52, sd = 5.17) at Visit 1, and who had a diagnosis of, or suspected intellectual disability (ID), including borderline ID, with a mental age of at least 3.0 years. Participants were given cognitive and adaptive behavior assessments at two time points over a two year period (m = 2.45 years, range = 1.27 to 5.56 years). In order to examine the association of developmental change between cognitive and adaptive behavior domains, bivariate latent change score (BLCS) models were fit to compare change in the three cognitive domains measured by the NIHTB-CB (Fluid Cognition, Crystallized Cognition, Total Cognition) and the three adaptive behavior domains measured by the VABS-3 (Communication, DLS, and Socialization).

RESULTS

Over a two year period, change in cognition (both Crystallized and Total Composites) was significantly and positively associated with change in daily living skills. Also, baseline cognition level predicted growth in adaptive behavior, however baseline adaptive behavior did not predict growth in cognition in any model.

CONCLUSIONS

The present study demonstrated that developmental changes in cognition and adaptive behavior are associated in children and young adults with IDD, indicating the potential for cross-domain effects of intervention. Notably, improvements in DLS emerged as a primary area of adaptive behavior that positively related to improvements in cognition. This work provides evidence for the clinical, "real life" meaningfulness of changes in cognition detected by the NIHTB-CB in IDD, and provides empirical support for the NIHTB-CB as a fit-for-purpose performance-based outcome measure for this population.

Central Executive and Default Mode Networks: An Appraisal of Executive Function and Social Skill Brain-Behavior Correlates in Youth with Autism Spectrum Disorder

Atypical connectivity patterns have been observed for individuals with autism spectrum disorders (ASD), particularly across the triple-network model. The current study investigated brain-behavior relationships in the context of social skills and executive function profiles for ASD youth. We calculated connectivity measures from diffusion tensor imaging using Bayesian estimation and probabilistic tractography. We replicated prior structural equation modeling of behavioral measures with total default mode network (DMN) connectivity to include comparisons with central executive network (CEN) connectivity and CEN-DMN connectivity. Increased within-CEN connectivity was related to metacognitive strengths. Our findings indicate behavior regulation difficulties in youth with ASD may be attributable to impaired connectivity between the CEN and DMN and social skill difficulties may be exacerbated by impaired within-DMN connectivity.

Adaptive behaviour deficits in individuals with 3q29 deletion syndrome

BACKGROUND

3q29 deletion syndrome (3q29del) is associated with a significantly increased risk for neurodevelopmental and neuropsychiatric phenotypes. Mild to moderate intellectual disability (ID) is common in this population, and previous work by our team identified substantial deficits in adaptive behaviour. However, the full profile of adaptive function in 3q29del has not been described nor has it been compared with other genomic syndromes associated with elevated risk for neurodevelopmental and neuropsychiatric phenotypes.

METHODS

Individuals with 3q29del (n = 32, 62.5% male) were evaluated using the Vineland Adaptive Behaviour Scales, Third Edition, Comprehensive Parent/Caregiver Form (Vineland-3). We explored the relationship between adaptive behaviour and cognitive function, executive function, and neurodevelopmental and neuropsychiatric comorbidities in our 3q29del study sample, and we compared subjects with 3q29del with published data on fragile X syndrome, 22q11.2 deletion syndrome and 16p11.2 deletion and duplication syndromes.

RESULTS

Individuals with 3q29del had global deficits in adaptive behaviour that were not driven by specific weaknesses in any given domain. Individual neurodevelopmental and neuropsychiatric diagnoses had a small effect on adaptive behaviour, and the cumulative number of comorbid diagnoses was significantly negatively associated with Vineland-3 performance. Both cognitive ability and executive function were significantly associated with adaptive behaviour, and executive function was a better predictor of Vineland-3 performance than cognitive ability. Finally, the severity of adaptive behaviour deficits in 3q29del was distinct from previously published data on comparable genomic disorders.

CONCLUSIONS

Individuals with 3q29del have significant deficits in adaptive behaviour, affecting all domains assessed by the Vineland-3. Executive function is a better predictor of adaptive behaviour than cognitive ability in this population and suggests that interventions targeting executive function may be an effective therapeutic strategy.

Developmental Associations between Cognition and Adaptive Behavior in Intellectual and Developmental Disability

Background

Intellectual and developmental disabilities (IDDs) are associated with both cognitive challenges and difficulties in conceptual, social, and practical areas of living (DSM-5). Individuals with IDD often present with an intellectual disability in addition to a developmental disability such as autism or Down syndrome. Those with IDD may present with deficits in intellectual functioning as well as adaptive functioning that interfere with independence and living skills. The present study sought to examine associations of longitudinal developmental change in domains of cognition (NIH Toolbox Cognition Battery, NIHTB-CB) and adaptive behavior domains (Vineland Adaptive Behavior Scales-3; VABS-3) including Socialization, Communication, and Daily Living Skills (DLS) over a two-year period.

Methods

Eligible participants for this multisite longitudinal study included those who were between 6 and 26 years at Visit 1, and who had a diagnosis of, or suspected intellectual disability (ID), including borderline ID. Three groups were recruited, including those with fragile X syndrome, Down syndrome, and other/idiopathic intellectual disability. In order to examine the association of developmental change between cognitive and adaptive behavior domains, bivariate latent change score (BLCS) models were fit to compare change in the three cognitive domains measured by the NIHTB-CB (Fluid, Crystallized, Composite) and the three adaptive behavior domains measured by the VABS-3 (Communication, DLS, and Socialization).

Results

Over a two-year period, change in cognition (both Crystalized and Composite) was significantly and positively associated with change in daily living skills. Also, baseline cognition level predicted growth in adaptive behavior, however baseline adaptive behavior did not predict growth in cognition in any model.

Conclusions

The present study demonstrated that developmental improvements in cognition and adaptive behavior are associated in children and young adults with IDD, indicating the potential for cross-domain effects of intervention. Notably, improvements in Daily Living Skills on the VABS-3 emerged as a primary area of adaptive behavior that positively related to improvements in cognition. This work provides evidence for the clinical, "real life" meaningfulness of the NIHTB-CB in IDD, and important empirical support for the NIHTB-CB as a fit-for-purpose performance-based outcome measure for this population.

Associations between executive functions, intelligence and adaptive behaviour in children and adolescents with mild intellectual disability

Background: The purpose of this study was to explore the role of everyday executive functions in relation to intelligence and adaptive behaviour in children and adolescents with mild intellectual disability. Method: A group of children and adolescents, previously diagnosed with mild intellectual disability were assessed according to intelligence, everyday executive functions and adaptive behaviour. The association between everyday executive functions and intelligence was examined, and it was explored whether intelligence or everyday executive functions would best predict adaptive behaviour. Results: Adaptive behaviour was significantly predicted by executive functions, but not by intelligence. Nor was intelligence significantly related to everyday executive functions in this group. Conclusions: Although fundamental in diagnosing intellectual disability, intelligence cannot predict adaptive behaviour. Assessing everyday executive functions and adaptive behaviour, as well as acknowledging the strong association between them, provides valuable information in the process of optimizing developmental support for children and adolescents with mild intellectual disability.

Adaptive behavior deficits in individuals with 3q29 deletion syndrome

Background

3q29 deletion syndrome (3q29del) is associated with a significantly increased risk for neurodevelopmental and neuropsychiatric phenotypes. Mild to moderate intellectual disability (ID) is common in this population, and previous work by our team identified substantial deficits in adaptive behavior. However, the full profile of adaptive function in 3q29del has not been described, nor has it been compared to other genomic syndromes associated with elevated risk for neurodevelopmental and neuropsychiatric phenotypes.

Methods

Individuals with 3q29del (n=32, 62.5% male) were evaluated using the Vineland Adaptive Behavior Scales, Third Edition, Comprehensive Parent/Caregiver Form (Vineland-3). We explored the relationship between adaptive behavior and cognitive function, executive function, and neurodevelopmental and neuropsychiatric comorbidities in our 3q29del study sample, and we compared subjects with 3q29del to published data on Fragile X syndrome, 22q11.2 deletion syndrome, and 16p11.2 deletion and duplication syndromes.

Results

Individuals with 3q29del had global deficits in adaptive behavior that were not driven by specific weaknesses in any given domain. Individual neurodevelopmental and neuropsychiatric diagnoses had a small effect on adaptive behavior, and the cumulative number of comorbid diagnoses was significantly negatively associated with Vineland-3 performance. Both cognitive ability and executive function were significantly associated with adaptive behavior, and executive function was a better predictor of Vineland-3 performance than cognitive ability. Finally, the severity of adaptive behavior deficits in 3q29del was distinct from previously published data on comparable genomic disorders.

Conclusions

Individuals with 3q29del have significant deficits in adaptive behavior, affecting all domains assessed by the Vineland-3. Executive function is a better predictor of adaptive behavior than cognitive ability in this population and suggests that interventions targeting executive function may be an effective therapeutic strategy.

Executive functions in daily living skills: A study in adults with autism spectrum disorder

Introduction

Adults with autism and adults with schizophrenia show difficulties in adaptive skills, especially those related to daily functioning. Some studies suggest that adaptive skills are associated with deficits in executive functions (EF), while others indicate that intelligence quotient (IQ) might also play a role. Literature suggests that autistic symptoms further affect adaptive skills. The interest of the current study, therefore, was to explore to what extent IQ, EFs as well as core autistic symptoms predict adaptive skills.

Methods

To do this, 25 controls, 24 adults with autism, and 12 with schizophrenia were assessed on IQ (Wechsler Adult Intelligence Scale), and executive functioning. The EF was measured with neuropsychological tasks (inhibition, updating, and task switching) and with the Dysexecutive-Spanish Questionnaire (DEX-Sp) which assessed everyday life EF problems. Core ASD symptoms were measured using the Autism Diagnostic Observation Schedule, the Autism Spectrum Quotient-Short version (AQ-S), and the Repetitive Behavior Questionnaire - 3 (RBQ-3).

Results

The results indicated EF difficulties in both, autism and schizophrenia. The IQ explained a high percentage of the variance found in adaptive skills, but only in the autism group. We can conclude, therefore, that high IQ is associated with low adaptive skills levels and EFs affect adaptive functioning in people with autism; however, this does not explain the difficulties in adaptive functioning in the schizophrenia group. Core features of autism assessed with self-report questionnaires (but not the ADOS-2) predicted low scores on the adaptive skills, only in the autism group.

Discussion

Both EF measures predicted adaptive skills scores in autism, but not in schizophrenia. Our results suggest that different factors affect the adaptive functioning in each disorder. For instance, the EFs should be a central focus for improvement, especially for individuals with autism.

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.

Adaptive Behavior Profiles in Autism Spectrum Disorder

PURPOSE OF REVIEW

The goal of this paper is to provide an overview of profiles of adaptive behavior in autism spectrum disorder and highlight the importance of these everyday skills in optimizing self-sufficiency throughout life.

RECENT FINDINGS

Research has clearly confirmed that adaptive deficits exist in ASD, particularly in social skills. These impairments are highly associated with co-occurring conditions such as executive functioning impairments, psychiatric conditions, and even psychosis. There tends to be a discrepancy between intellectual capacity and adaptive functioning, particularly in autistic individuals without cognitive and language delays, with this gap widening between childhood and adulthood. Although cognition and language skills are associated with good outcome in ASD, they are insufficient in the absence of intact adaptive behavior. There is a critical need to emphasize the importance of adaptive functioning in diagnostic evaluations and treatment/intervention programs to ensure that every autistic individual has the potential for success.

Theory of mind in schizophrenia: a comparison of subgroups with low and high IQ

BACKGROUND

Social cognitive impairment is common in schizophrenia, but it is unclear if it is present in individuals with high IQ. This study compared theory of mind (ToM) in schizophrenia participants with low or high IQ to healthy controls.

METHODS

One hundred and nineteen participants (71 healthy controls, 17 high IQ (IQ ≥115), and 31 low IQ (IQ ≤95) schizophrenia participants) were assessed with the Movie for the Assessment of Social Cognition, providing scores for total, cognitive, and affective ToM, along with overmentalizing, undermentalizing, and no-mentalizing errors. IQ was measured with Wechsler Abbreviated Scale of Intelligence; clinical symptoms with the Positive and Negative Syndrome Scale.

RESULTS

Healthy controls performed better than the low IQ schizophrenia group for all ToM scores, and better than the high IQ schizophrenia group for the total score and under- and no-mentalizing errors. The high IQ group made fewer overmentalizing errors and had better total and cognitive ToM than the low IQ group. Their number of overmentalizing errors was indistinguishable from healthy controls.

CONCLUSION

Global ToM impairment was present in the low IQ schizophrenia group. Overmentalizing was not present in the high IQ group and appears related to lower IQ. Intact higher-level reasoning may prevent the high IQ group from making overmentalizing errors, through self-monitoring or inhibition. We propose that high IQ patients are chiefly impaired in lower-level ToM, whereas low IQ patients also have impaired higher-level ToM. Conceivably, this specific impairment could help explain the lower functioning reported in persons with intact IQ.

Real-world executive functioning for autistic children in school and home settings

LAY ABSTRACT

Executive functioning skills are important for children to be able to control thoughts, emotions, and actions, and for their ability to adapt to different settings. Previous studies have found that autistic children have difficulty with executive functioning, but most of these studies took place in the home setting. Executive functioning skills in autistic children have not yet been fully examined in the school setting. This is a knowledge gap that needs to be addressed because the school setting is potentially one of the most demanding in terms of executive functioning and is a setting where executive function interventions are already being used for autistic children. In order to learn more about executive functioning for autistic children in the school setting, this study compared ratings of executive function from autistic children's caregivers and school professionals. The study found that autistic children experience similar but not identical executive function challenges across school and home settings and that supports may differ in each setting. Having information about differences in executive functioning challenges and supports for autistic children across settings can help lead to development of supports that are tailored to each setting.

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

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

Differences in daily life executive functioning between people with autism and people with schizophrenia

This is a comparative analysis of everyday executive functioning between individuals with Autism Spectrum Disorder (ASD), Schizophrenia Spectrum Disorders (SSD) and controls using Dysexecutive Questionnaire-Spanish (DEX-Sp), to identify patterns of difficulties. Also we assessed the relationship between EF and adaptive behavior as measured by the Vineland Adaptive Behavioral Scale-II. Common areas of everyday executive functions were established as problematic in individuals with ASD and SSD related to Disinhibition and Apathy, while Disorganization and Impulsivity was gravely affected in ASD group only. The degree of Dysexecutive Syndrome was predictive of adaptive behavior in ASD group only. These suggest that DEX-Sp could be a useful tool in differentiating areas of strength and weaknesses in clinical groups such as ASD and SDD.

Intrinsic Structural Connectivity of the Default Mode Network and Behavioral Correlates of Executive Function and Social Skills in Youth with Autism Spectrum Disorders

Brain connectivity of individuals with autism spectrum disorders (ASD) is heterogenous, as are the behavioral manifestations. The current study investigated brain-behavior relationships in the context of social skills and executive function profiles with data from the Autism Brain Imaging Database Exchange II. We calculated connectivity measures from diffusion tensor imaging using Bayesian estimation and probabilistic tractography. Subsequently, we performed structural equation modeling by regressing three latent factors, yielded from an exploratory factor analysis, onto total default mode network (DMN) connectivity. Both social regulation processing and self-directed cognitive processing factors moderately, negatively correlated with total DMN connectivity. Our findings indicate social regulation processing difficulties in youth with ASD may be attributable to impaired connectivity between the anterior and posterior DMN.

Caregiver-reported executive functioning and associated adaptive and challenging behaviour in children with histories of developmental delay

BACKGROUND

Deficits in executive functioning (EF) have been measured in individuals with developmental disabilities, such as autism spectrum disorder and attention-deficit/hyperactivity disorder, through the use of behaviour rating scales and performance-based assessment. Associations between EF and variables such as challenging and adaptive behaviour have been observed; however, limited research exists on EF profiles in children with heterogeneous developmental delay or with intellectual disability (ID) or the impact of EF on adaptive and challenging behaviour with this population.

METHODS

The present study sought to examine the EF profile of 93 children (75 male and 18 female) previously identified with developmental delay in early childhood. EF was assessed using the Behaviour Rating Inventory of Executive Function, Second Edition (BRIEF-2). Children were categorised into an ID group (n = 14) or no ID group (n = 79) based on scores from cognitive and adaptive behaviour assessments. EF profiles were investigated and compared by group. In addition, the impact of EF on both adaptive behaviour and challenging behaviour was measured using hierarchical linear regressions.

RESULTS

Statistically significant differences in caregiver-reported EF were not observed between groups; however, both the ID and the no ID group scores were elevated as reported by their caregivers. For the overall sample, caregiver-EF accounted for significant variance in both adaptive (22%) and challenging (68%) behaviour after accounting for child age and sex.

CONCLUSIONS

Results indicated deficits in EF for children with and without ID. The significance of EF was accounted for in both adaptive and challenging behaviour for all children in the sample. Future research could elucidate the role of adaptive and challenging behaviour in understanding EF variability among children with histories of developmental delay.

Enhancing research practices in intellectual and developmental disabilities through person-centered outcome evaluation

BACKGROUND

Research practices in IDD need to align current values towards people with IDD, the current understanding of IDD, and best practices regarding change strategies and valued outcomes.

AIMS

To describe the components to-and application of-a person-centered outcome evaluation model that meets the above criteria.

METHODS AND PROCEDURES

A person-centered evaluation logic model is used to identify and describe a conceptual framework (input), a change strategy (throughput), personal outcomes (outcome), and meaningful impacts (output).

OUTCOMES AND RESULTS

Specific person-centered outcomes and exemplary outcome indicators are presented for two outcome evaluation frameworks: human functioning dimensions, and the four theoretical perspectives on IDD: biomedical, psychoeducational, sociocultural, and justice.

CONCLUSIONS AND IMPLICATIONS

A person-centered approach to outcome evaluation enhances research practices in IDD by identifying and assessing valued personal outcomes that align current values, understanding, and best practices; increases transparency; facilitates accountability; and expands understanding.

Inhibitory Dimensions and Delay of Gratification: A Comparative Study on Individuals with Down Syndrome and Typically Developing Children

While previous research on inhibition in people with Down syndrome (DS) reported contradictory results, with no explicit theoretical model, on the other hand, a more homogeneous impaired profile on the delay of gratification skills emerged. The main goal of the present study was to investigate response inhibition, interference suppression, and delay of gratification in 51 individuals with DS matched for a measure of mental age (MA) with 71 typically developing (TD) children. Moreover, we cross-sectionally explored the strengths and weaknesses of these components in children and adolescents vs. adults with DS with the same MA. A battery of laboratory tasks tapping on inhibitory sub-components and delay of gratification was administrated. Results indicated that individuals with DS showed an overall worse performance compared to TD children on response inhibition and delay of gratification, while no differences emerged between the two samples on the interference suppression. Additionally, our results suggested that older individuals with DS outperformed the younger ones both in response inhibition and in the delay of gratification, whereas the interference suppression still remains impaired in adulthood. This study highlights the importance of evaluating inhibitory sub-components considering both MA and chronological age in order to promote more effective and evidence-based training for this population.

The shifting perspectives study protocol: Cognitive remediation therapy as an adjunctive treatment to family based treatment for adolescents with anorexia nervosa

BACKGROUND

Adolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied.

METHODS/DESIGN

This is a randomized controlled trial designed to determine if CRT is effective in increasing flexibility in adolescents with anorexia and/or their parents. Participants are adolescents 12-18 years old with anorexia and their parents. 54 family groups will be randomized into one of three groups: FBT only, FBT plus Parent-focused CRT, or FBT plus Adolescent-focused CRT. Psychosocial, neurocognitive, and behavioral measures will be collected throughout the study.

DISCUSSION

This is the first study of its kind to apply CRT to parents. All forms of CRT in the context of anorexia have targeted the individual with anorexia's thinking style. We propose that it may be impactful to target the parent of the adolescent with anorexia as parents carry the burden of treatment and re-nourishment of their child during FBT and may have similar thinking styles.

CONCLUSION

This study takes an experimental therapeutics approach to further our understanding of the mechanisms of treatment for adolescents with anorexia. It focuses on increasing cognitive flexibility in patients or their parents and determining the appropriate dose of CRT needed to achieve positive change.

TRIAL REGISTRATION

ClinicalTrails.gov Identifier NCT03928028.

Predictors of adaptive functioning in preschool aged children with autism spectrum disorder

Difficulties in adaptive functioning are common in autism spectrum disorder (ASD) and contribute to negative outcomes across the lifespan. Research indicates that cognitive ability is related to degree of adaptive functioning impairments, particularly in young children with ASD. However, the extent to which other factors, such as socioeconomic status (SES) and ASD symptom severity, predict impairments in adaptive functioning remains unclear. The goal of this study was to determine the extent to which SES, ASD symptom severity, and cognitive ability contribute to variability in domain-specific and global components of adaptive functioning in preschool-aged children with ASD. Participants were 99 preschool-aged children (2-6 years) with ASD who attended a tertiary diagnostic service. Results demonstrate that cognitive ability accounted for a significant proportion of variance in domain-specific and global components of adaptive functioning, with higher cognitive ability predicting better adaptive functioning. Results also demonstrate that SES accounted for some variability in domain-specific communication skills and global adaptive functioning when compared to basic demographic factors alone (age and gender). By contrast, ASD symptom severity did not predict variability in domain-specific or global components of adaptive functioning. These findings provide support for a relationship between cognitive ability and adaptive functioning in preschool-aged children with ASD and help to explain specific contributions of verbal and nonverbal ability to adaptive functioning; from this, we can better understand which children are likely to show the greatest degree of impairments across components of adaptive functioning early in development. LAY SUMMARY: People with autism often have difficulties with everyday communication, daily living, and social skills, which are also called adaptive functioning skills. This study investigated factors that might be related to these difficulties in preschoolers with autism. We found that better cognitive ability, but not autism symptoms, were associated with better adaptive functioning. This suggests that interventions for young children with autism should take into account cognitive ability to better understand which children are likely to have difficulties with adaptive functioning.

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.

The Transition to Adulthood for Young People with Autism Spectrum Disorder

The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.

Brief Report: Performance-Based Executive Functioning Abilities are Associated with Caregiver Report of Adaptive Functioning in Autism Spectrum Disorder

Executive functioning is thought to contribute to adaptive behavior skills development in individuals with autism spectrum disorder (ASD). However, supporting data are largely based on caregiver reports of executive functioning. The current study evaluated whether performance-based measures of executive functioning (working memory and inhibition) explained unique variance in parent-reported adaptive functioning among youth with ASD without an intellectual disability. Both spatial and verbal working memory were associated with adaptive functioning, particularly communication and daily living skills. Our findings demonstrate a robust relationship between working memory and adaptive functioning that translates across different measurement modalities. This preliminary study highlights that targeting executive functioning may be a critical component of an adaptive function training program.

An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training

Objective: To examine the development of executive functions, in preschool children with autism spectrum disorders (ASD), receiving early intensive behavioral training (EIBI). Method: Executive functions (EF) were assessed with The Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P), by parents and preschool teachers at the time of diagnostic assessment and after 15 months of EIBI intervention. Ten children with ASD (M = 2.9 years, nine males) participated in the study. Reliable Change Index scores were computed for each of the participants in order to investigate any significant change in BRIEF-P T-scores. Results: Three children showed a significant improvement in EF, based on parent ratings. Four children showed a significant improvement in EF based on preschool teacher ratings. Conclusion: Findings indicating a reliable improvement in one third of preschool children with ASD receiving EIBI are encouraging but need to be replicated in larger scale controlled studies.

Greater Individual Variability in Functional Brain Activity during Working Memory Performance in young people with Autism and Executive Function Impairment

BACKGROUND

Individuals with autism spectrum disorder (ASD) often present with executive functioning (EF) deficits, including spatial working memory (SWM) impairment, which impedes real-world functioning. The present study examined task-related brain activity, connectivity and individual variability in fMRI-measured neural response during an SWM task in older youth and young adults with autism and clinically significant EF impairment.

METHODS

Neuroimaging was analyzed in 29 individuals with ASD without intellectual disability who had clinically significant EF impairment on the Behavior Rating Inventory of Executive Function, and 20 typically developing controls (participant age range=16-34). An SWM N-Back task was performed during fMRI. SWM activity (2-Back vs. 0-Back) and task-related dorsolateral prefrontal cortex (DLPFC) connectivity was examined within and between groups. Variability of neural response during SWM was also examined.

RESULTS

During SWM performance both groups activated the expected networks, and no group differences in network activation or task-related DLPFC-connectivity were found. However, greater individual variability in the pattern of SWM activity was found in the ASD versus the typically developing control group.

CONCLUSIONS

While there were no group differences in SWM task-evoked activity or connectivity, fronto-parietal network engagement was found to be more variable/idiosyncratic in ASD. Our results suggest that the fronto-parietal network may be shifted or sub-optimally engaged during SWM performance in participants with ASD with clinically significant EF impairment, with implications for developing targeted interventions for this subgroup.

The Transition to Adulthood for Young People with Autism Spectrum Disorder

The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.

Adaptive Behavior in Youth with Autism Spectrum Disorder: The Role of Flexibility

Cognitive and behavioral flexibility are important predictors of adaptive behavior in school-age autistic youth. While prior research has utilized broad measures of flexibility, the current study uses the multi-dimensional Flexibility Scale-Revised to examine which specific flexibility skills relate to adaptive functioning. Through parent-report measures on 216 autistic youth, flexibility explained 22.2% of variance in adaptive socialization skills (p < 0.001). Specifically, Social Flexibility accounted for significant variance in adaptive socialization skills, while Transitions/Change approached significance. In exploratory analyses, flexibility explained 11.5% of variance in Communication skills (p < 0.001). This pattern remained after controlling for co-occurring ADHD symptoms. The current study helps to refine the relationship between flexibility and adaptive behavior, which may ultimately help to inform more targeted interventions.

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.