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Lee KS, Gau SSF, Tseng WL. Autistic Symptoms, Irritability, and Executive Dysfunctions: Symptom Dynamics from Multi-Network Models. J Autism Dev Disord 2024; 54:3078-3093. [PMID: 37453959 DOI: 10.1007/s10803-023-05981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 07/18/2023]
Abstract
Socio-cognitive difficulties in individuals with autism spectrum disorder (ASD) are heterogenuous and often co-occur with irritability symptoms, such as angry/grouchy mood and temper outbursts. However, the specific relations between individual symptoms are not well-represented in conventional methods analyzing aggregated autistic symptoms and ASD diagnosis. Moreover, the cognitive-behavioral mechanisms linking ASD to irritability are largely unknown. This study investigated the dynamics between autistic (Social Responsiveness Scale) and irritability (Affective Reactivity Index) symptoms and executive functions (Cambridge Neuropsychological Test Automated Battery) in a sample of children and adolescents with ASD, their unaffected siblings, and neurotypical peers (N = 345, aged 6-18 years, 78.6% male). Three complementary networks across the entire sample were computed: (1) Gaussian graphical network estimating the conditional correlations between symptom nodes; (2) Relative importance network computing relative influence between symptoms; (3) Bayesian directed acyclic graph estimating predictive directionality between symptoms. Networks revealed numerous partial correlations within autistic (rs = .07-.56) and irritability (rs = .01-.45) symptoms and executive functions (rs = -.83 to .67) but weak connections between clusters. This segregated pattern converged in all directed and supplementary networks. Plausible predictive paths were found between social communication difficulties to autism mannerisms and between "angry frequently" to "lose temper easily." Autistic and irritability symptoms are two relatively independent families of symptoms. It is unlikely that executive dysfunctions explain elevated irritability in ASD. Findings underscore the need for researching other mood and cognitive-behavioral bridge symptoms, which may inform individualized treatments for co-occurring irritability in ASD.
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Grants
- R00 MH110570 NIMH NIH HHS
- R00MH110570 NIMH NIH HHS
- NSC98-3112-B-002-004 Ministry of Science and Technology, Taiwan
- NSC99-2627- B-002-015 Ministry of Science and Technology, Taiwan
- NSC100-2627-B-002-014 Ministry of Science and Technology, Taiwan
- NSC101-2627-B- 002-002 Ministry of Science and Technology, Taiwan
- NSC 101-2314-B-002-136-MY3 Ministry of Science and Technology, Taiwan
- NHRI-EX104-10404PI National Health Research Institute, Taiwan
- NHRI-EX105-10404PI National Health Research Institute, Taiwan
- NHRI-EX106-10404PI National Health Research Institute, Taiwan
- NHRI-EX107-10404PI National Health Research Institute, Taiwan
- NHRI-EX108-10404PI National Health Research Institute, Taiwan
- NHRI-EX110-11002PI National Health Research Institute, Taiwan
- NHRI-EX111-11002PI National Health Research Institute, Taiwan
- 10R81918- 03101R892103 AIM for Top University Excellent Research Project
- 102R892103 AIM for Top University Excellent Research Project
- R00MH110570 NIMH NIH HHS
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Terroux A, Mello C, Morin D, Rivard M. Everyday Executive Function in Preschoolers with Autism and Links with Intellectual Functioning, Adaptive Behavior, and Autism Symptoms. J Autism Dev Disord 2024:10.1007/s10803-024-06463-7. [PMID: 38990368 DOI: 10.1007/s10803-024-06463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
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.
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Affiliation(s)
- Amélie Terroux
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Catherine Mello
- Department of Psychology, Penn State University - Berks, Tulpehocken Road, P.O. Box 7009, Reading, PA, 19610, USA.
| | - Diane Morin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Mélina Rivard
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
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3
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Yeung MK, Bai J, Mak KL. Longitudinal changes in executive function in autism spectrum disorder: A systematic review and meta-analyses. Autism Res 2024. [PMID: 38975618 DOI: 10.1002/aur.3196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/23/2024] [Indexed: 07/09/2024]
Abstract
Individuals with an autism spectrum disorder (ASD) diagnosis show impairment in executive function (EF). However, findings are mixed regarding differences in the age effect on EF between autistic individuals and persons with typical development (TD). Questions remain regarding whether the age-related trajectories of EF in ASD are the same as or different from those in TD. To bridge this knowledge gap, we conducted a systematic review and meta-analyses of longitudinal studies that compared age-related changes in EF between ASD and TD groups (preregistration: osf.io/j5764). A literature search was conducted using PubMed, PsycINFO, and Web of Science on January 29, 2024. After screening by two independent reviewers, 14 longitudinal studies were included. Random-effects meta-analyses of studies involving a maximum total of 518 autistic and 3558 TD children and adolescents (mean baseline ages: 5.7-12.0 years) showed that ASD had significantly poorer EF than TD at both baseline and follow-up. However, there was no significant group difference in the age-related change in EF across domains, including working memory, inhibition, shifting, and planning. Robust Bayesian meta-analyses also provided substantial evidence in favor of the null hypothesis that ASD and TD groups showed similar changes over time for most EF processes. Limitations of the literature included the limited number of longitudinal studies and a narrow range of developmental stages and EF constructs analyzed across studies. Altogether, these findings suggest that autistic children and adolescents generally can improve in EF over time similarly to their neurotypical peers. This has important implications for parents and educators, encouraging appropriate EF training and intervention for autistic children and adolescents at an early stage.
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Affiliation(s)
- Michael K Yeung
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
- University Research Facility of Human Behavioral Neuroscience, The Education University of Hong Kong, Hong Kong, China
| | - Jieru Bai
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Kwai-Lai Mak
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
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Blume J, Dhanasekara CS, Kahathuduwa CN, Mastergeorge AM. Central Executive and Default Mode Networks: An Appraisal of Executive Function and Social Skill Brain-Behavior Correlates in Youth with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1882-1896. [PMID: 36988766 DOI: 10.1007/s10803-023-05961-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
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.
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Affiliation(s)
- Jessica Blume
- Department of Human Development and Family Sciences, Texas Tech University, P.O. Box 41230, Lubbock, TX, 79409-1230, USA.
| | | | - Chanaka N Kahathuduwa
- Department of Psychiatry and Neurology, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Ann M Mastergeorge
- Department of Human Development and Family Sciences, Texas Tech University, P.O. Box 41230, Lubbock, TX, 79409-1230, USA
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All K, Chawarska K, Macari SL. Early executive functioning predicts externalizing problems in neurodiverse preschoolers. Autism Res 2024; 17:1053-1065. [PMID: 38476104 PMCID: PMC11251695 DOI: 10.1002/aur.3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Children with autism spectrum disorder (ASD) often exhibit externalizing problems, which have been linked with increased anxiety and depression, peer rejection, and parental stress. Identification of early predictors of externalizing behaviors in autism will facilitate identification of vulnerable children and implementation of early preventative interventions. There is ample evidence that executive functioning, social functioning, and temperament are predictive of later externalizing problems in general populations, but less is known about these relations in ASD and other neurodiverse populations, particularly in the early preschool years. To address this gap, we assessed the relations between executive functioning, social functioning, and temperament at age 3 and externalizing problems at age 5 in a sample of neurodiverse children with ASD and other neurodevelopmental disorders and delays. Analyses revealed that severity of early executive functioning impairment predicted increased externalizing problems. Severity of social autism symptoms moderated this relationship such that the effect of executive functioning on externalizing problems decreased as autism symptoms increased. These findings suggest that executive functioning is an important target for identifying and developing interventions for vulnerable children and underscore the necessity of considering severity of autism symptoms when researching the development of externalizing problems in children with neurodevelopmental disorders.
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Affiliation(s)
- Katherine All
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katarzyna Chawarska
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Suzanne L Macari
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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Caldani S, Humeau E, Delorme R, Bucci MP. Inhibition functions can be improved in children with autism spectrum disorders: An eye-tracking study. Int J Dev Neurosci 2023; 83:431-441. [PMID: 37218472 DOI: 10.1002/jdn.10276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Cognitive remediation therapy interventions could improve cognitive functioning in subjects with autism. To investigate the benefit of a short cognitive training rehabilitation in children with autism spectrum disorder (ASD) on pursuit and fixation performances. We recruited two groups (G1 and G2) of 30 children with ASD, sex-, IQ- and age-matched (mean 11.6 ± 0.5 years), and pursuit and fixation eye movements were recorded twice at T1 and T2. Between T1 and T2, a 10-min cognitive training was performed by the G1 group only, whereas the G2 group had a 10-min of rest. For all children with ASD enrolled in the study, there was a positive correlation between restricted and repetitive behaviour scores of both Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and the number of saccades recorded during the fixation task at T1. At T1, oculomotor performances were similar for both groups of ASD children (G1 and G2). At T2, we observed a significant reduction in the number of saccades made during both pursuit and fixation tasks. Our findings underlined the importance to promote cognitive training rehabilitation for children with ASD, leading to a better performance in inhibitory and attention functioning responsible for pursuit and fixation eye movement's performance.
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Affiliation(s)
- Simona Caldani
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
| | - Elise Humeau
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Maria Pia Bucci
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
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Lupi E, Tucci F, Casula L, Novello RL, Guerrera S, Vicari S, Valeri G. Early and stable difficulties of everyday executive functions predict autism symptoms and emotional/behavioral problems in preschool age children with autism: a 2-year longitudinal study. Front Psychol 2023; 14:1092164. [PMID: 37583604 PMCID: PMC10425204 DOI: 10.3389/fpsyg.2023.1092164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Longitudinal studies of autistic children show that autism symptoms and emotional/behavioral problems vary and change over time. However, the factors that affect this variability remain far from certain and very little is known about what take place in the preschool period and the role of executive functions (EF). Methods Here, we test the influence of stable difficulties in everyday executive functioning (EEF) during early childhood across 2 years on autistic symptoms and emotional and behavioral problems. Twenty-nine autistic children (24 males and 5 females) were assessed twice within the space of 2 years. At baseline (M = 29 months, SD =5.6 months), participants were assessed for EEF, cognitive development, autistic symptoms, and emotional/behavioral problems. At follow-up, we repeated the same assessment except for cognitive development. Results The group with stable difficulties (across 2 years) in EEF during early childhood showed a worsening in the severity of autistic symptoms and emotional and behavioral problems compared with children without EEF difficulties (p < 0.05), and these effects cannot be attributable to cognitive development. Discussion Our results suggest that early and stable EEF plays the role of a modifier by interacting with the core domains of autism, in particular with the social affect domain (SA CSS), influencing social cognition and exacerbating or lessening symptom expression and emotional behavioral problems. These short-term longitudinal and preliminary findings underscore the importance of EEF as necessary target for early intervention in children with autism.
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Affiliation(s)
- Elisabetta Lupi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Tucci
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Laura Casula
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Roberta Lucia Novello
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Silvia Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Leoni M, Vanes LD, Hadaya L, Kanel D, Dazzan P, Simonoff E, Counsell SJ, Happé F, Edwards AD, Nosarti C. Exploring cognitive, behavioral and autistic trait network topology in very preterm and term-born children. Front Psychol 2023; 14:1119196. [PMID: 37187563 PMCID: PMC10176608 DOI: 10.3389/fpsyg.2023.1119196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/30/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Compared to full-term (FT) born peers, children who were born very preterm (VPT; <32 weeks' gestation) are likely to display more cognitive and behavioral difficulties, including inattention, anxiety and socio-communication problems. In the published literature, such difficulties tend to be studied independently, thus failing to account for how different aspects of child development interact. The current study aimed to investigate children's cognitive and behavioral outcomes as interconnected, dynamically related facets of development that influence one another. Methods Participants were 93 VPT and 55 FT children (median age 8.79 years). IQ was evaluated with the Wechsler Intelligence Scale for Children-4th edition (WISC-IV), autism spectrum condition (ASC) traits with the social responsiveness scale-2nd edition (SRS-2), behavioral and emotional problems with the strengths and difficulties questionnaire (SDQ), temperament with the temperament in middle childhood questionnaire (TMCQ) and executive function with the behavior rating inventory of executive functioning (BRIEF-2). Outcome measures were studied in VPT and FT children using Network Analysis, a method that graphically represents partial correlations between variables and yields information on each variable's propensity to form a bridge between other variables. Results VPT and FT children exhibited marked topological differences. Bridges (i.e., the variables most connected to others) in the VPT group network were: conduct problems and difficulties with organizing and ordering their environment. In the FT group network, the most important bridges were: difficulties with initiating a task or activity and prosocial behaviors, and greater emotional problems, such as lower mood. Discussion These findings highlight the importance of targeting different aspects of development to support VPT and FT children in person-based interventions.
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Affiliation(s)
- Marguerite Leoni
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lucy D. Vanes
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Laila Hadaya
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dana Kanel
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, London, United Kingdom
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and King's College London, National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre, London, United Kingdom
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, United Kingdom
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Kim SA, Kasari C. Brief Report: Longitudinal Trajectory of Working Memory in School-Aged Children on the Autism Spectrum: Period of High Plasticity and "Late Bloomers". J Autism Dev Disord 2023:10.1007/s10803-023-05960-5. [PMID: 37022582 DOI: 10.1007/s10803-023-05960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE While working memory (WM) is a powerful predictor for children's school outcomes, autistic children are more likely to experience delays. This study compared autistic children and their neurotypical peers' WM development over their elementary school years, including relative growth and period of plasticity. METHODS Using a nationally-representative dataset, latent growth models were built to examine periods of high plasticity and the relationship between children's performance upon school entry and their relative growth. RESULTS While both groups made steeper gains during the early school years, autistic children's period of highest plasticity was prolonged by 1 year, which suggests a larger window for interventions. Further, autistic children who started kindergarten with poorer WM were more likely to make rapid growth during the last 3 years of elementary school, which is when their neurotypical peers' development started to plateau. CONCLUSION Findings should prompt various stakeholders to examine interventions and instructions to maximize autistic children's growth in WM. Further, the continued support and monitoring by educators throughout autistic children's late childhood can be particularly beneficial for the "late-bloomers."
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Affiliation(s)
- Sohyun An Kim
- Department of Education, University of California, Los Angeles, Moore Hall, 457 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Connie Kasari
- Department of Education, University of California, Los Angeles, Moore Hall, 457 Portola Plaza, Los Angeles, CA, 90095, USA
- Semel Institute for Neuroscience, University of California, Los Angeles, CA, USA
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Heemskerk C, Strand S, Malmberg L. Physical activity predicts task-related behaviour, affect and tiredness in the primary school classroom: A within-person experiment. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2023; 93 Suppl 1:130-151. [PMID: 35661349 PMCID: PMC10952838 DOI: 10.1111/bjep.12523] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
AIM We investigated the dose-response relationship between acute physical activity (PA) intensity during physical education (PE) lessons (dose), and task behaviour and learning experiences in the classroom after PE (response), and mediation effects of acute PA on-task behaviour via learning experiences. METHOD A total of 78 children (Mage = 9.30 years; 43 females) took part. Participants reported learning experiences (tiredness, positive and negative affect) during one afternoon per week for 6 weeks. Their task behaviour was observed (on-task, active off-task and passive off-task) during two classroom lessons. Between the classroom lessons, they took part in a PE lesson, with experimentally induced PA intensity (low, medium and high). Accelerometers were worn for 24 h leading up to and during every intervention afternoon. Participants completed self-reports three times per classroom lesson, both before and after PE. Intra- and interindividual differences in PA, task behaviour and learning experiences were analysed with multilevel structural equation models. RESULTS Moderate PA directly increased on-task behaviour and reduced passive off-task behaviour, whereas light PA increased active off-task behaviour and reduced on-task behaviour. We found no direct effects of vigorous PA or mediated effects of any PA intensity on-task-related behaviour. However, a greater positive affect during PE indirectly led to more on-task and less passive off-task behaviour. Regularly active children reported less tiredness in the classroom. CONCLUSION PE lessons can increase on-task behaviour and reduce both passive and active off-task behaviours. Positive affect and tiredness are indirectly involved in the impact of PA on task-related behaviour. The greatest benefits were found for moderate PA and for PE lessons, which left children feeling positive. Moreover, regular participation in moderate-to-vigorous PA leads children to feel less tired during school lessons.
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Conner CM, Elias R, Smith IC, White SW. Emotion Regulation and Executive Function: Associations with Depression and Anxiety in Autism. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 101:102103. [PMID: 36741741 PMCID: PMC9897310 DOI: 10.1016/j.rasd.2023.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
| | - Rebecca Elias
- University of Southern California, Los Angeles, CA
- Children’s Hospital Los Angeles, Los Angeles, CA
| | - Isaac C. Smith
- University of Connecticut School of Medicine, West Hartford, CT
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Rosello R, Martinez-Raga J, Tomas JM, Rosello B, Berenguer C, Cortese S. Exploring developmental trajectories throughout adolescence of children with autism spectrum disorder without intellectual disability. J Neural Transm (Vienna) 2023; 130:299-312. [PMID: 36385316 DOI: 10.1007/s00702-022-02554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
Characterizing the developmental trajectories of children with autism spectrum disorder (ASD) throughout adolescence and across different domains of functioning offers opportunities to improve long-term outcomes. This prospective study explored, for the first time, the evolution of children with ASD-without intellectual disability (ID) in terms of socio-adaptative skills, learning behaviors, executive functioning (EF), and internalizing/externalizing problems, compared to typically developing (TD) peers. Forty-five children with ASD-without ID and 37 matched TD children (aged 7-11) were assessed at baseline and after 5 years. Parents and teachers completed measures on theory of mind (ToM), socialization, daily living skills, learning style, EF, and emotional/behavioural difficulties at both time points. On all the domains assessed, the ASD group performed significantly worse than the TD group, both in childhood and adolescence. Specific changes were noted between baseline and follow-up assessment on adaptive skills, prosocial behavior, emotional control, inhibit, working memory and monitoring. Group membership (ASD/TD) was influenced by peer relationships and inhibit EF variables. These findings have implications for clinical and school settings.
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Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Imperial College London, London, UK.
- Division of Psychiatry, University of Valencia, Valencia, Spain.
| | - Jose Martinez-Raga
- Division of Psychiatry, University of Valencia, Valencia, Spain
- Doctor Peset Hospital of Valencia, Valencia, Spain
| | - Jose Manuel Tomas
- Division of Methodology and Behavioural Science, University of Valencia, Valencia, Spain
| | - Belen Rosello
- Division of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Carmen Berenguer
- Division of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Samuele Cortese
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Innovation in Mental Health (CIMH), University of Southampton, Southampton, UK
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13
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O’Hearn K, Lynn A. Age differences and brain maturation provide insight into heterogeneous results in autism spectrum disorder. Front Hum Neurosci 2023; 16:957375. [PMID: 36819297 PMCID: PMC9934814 DOI: 10.3389/fnhum.2022.957375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/07/2022] [Indexed: 02/05/2023] Open
Abstract
Studies comparing individuals with autism spectrum disorder (ASD) to typically developing (TD) individuals have yielded inconsistent results. These inconsistencies reflect, in part, atypical trajectories of development in children and young adults with ASD compared to TD peers. These different trajectories alter group differences between children with and without ASD as they age. This paper first summarizes the disparate trajectories evident in our studies and, upon further investigation, laboratories using the same recruiting source. These studies indicated that cognition improves into adulthood typically, and is associated with the maturation of striatal, frontal, and temporal lobes, but these age-related improvements did not emerge in the young adults with ASD. This pattern - of improvement into adulthood in the TD group but not in the group with ASD - occurred in both social and non-social tasks. However, the difference between TD and ASD trajectories was most robust on a social task, face recognition. While tempting to ascribe this uneven deficit to the social differences in ASD, it may also reflect the prolonged typical development of social cognitive tasks such as face recognition into adulthood. This paper then reviews the evidence on age-related and developmental changes from other studies on ASD. The broader literature also suggests that individuals with ASD do not exhibit the typical improvements during adolescence on skills important for navigating the transition to adulthood. These skills include execution function, social cognition and communication, and emotional recognition and self-awareness. Relatedly, neuroimaging studies indicate arrested or atypical brain maturation in striatal, frontal, and temporal regions during adolescence in ASD. This review not only highlights the importance of a developmental framework and explicit consideration of age and/or stage when studying ASD, but also the potential importance of adolescence on outcomes in ASD.
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Affiliation(s)
- Kirsten O’Hearn
- Department of Physiology and Pharmacology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States,*Correspondence: Kirsten O’Hearn,
| | - Andrew Lynn
- Department of Special Education, Vanderbilt University, Nashville, TN, United States
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14
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Gong L, Guo D, Gao Z, Wei K. Atypical development of social and nonsocial working memory capacity among preschoolers with autism spectrum disorders. Autism Res 2023; 16:327-339. [PMID: 36374256 DOI: 10.1002/aur.2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
Individuals with autism spectrum disorders (ASD) have shown impaired performance in canonical and nonsocial working memory (WM). However, no study has investigated social WM and its early development. Using biological motion stimuli, our study assessed the development of social and nonsocial WM capacity among children with or without ASD across the age span between 4 and 6 (N = 150). While typically developing (TD) children show a rapid development from age 5 to 6, children with ASD showed a delayed development for both social and nonsocial WM capacity, reaching a significant group difference at age 6. Furthermore, we found a negative correlation between social (but not nonsocial) WM capacity and the severity of autistic symptoms among children with ASD. In contrast, there is a positive correlation between both types of WM capacity and intelligence among TD children but not among children with ASD. Our findings thus indicate that individuals with ASD miss the rapid development of WM capacity in early childhood and, particularly, their delayed social WM development might contribute to core symptoms that critically depend on social information processing.
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Affiliation(s)
- Linlin Gong
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.,Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing, China
| | - Dong Guo
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Zaifeng Gao
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Kunlin Wei
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.,Key Laboratory of Machine Perception (Ministry of Education), Peking University, Beijing, China
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15
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Yon-Hernández JA, Canal-Bedia R, Wojcik DZ, García-García L, Fernández-Álvarez C, Palacio-Duque S, Franco-Martín MA. Executive functions in daily living skills: A study in adults with autism spectrum disorder. Front Psychol 2023; 14:1109561. [PMID: 37113122 PMCID: PMC10127455 DOI: 10.3389/fpsyg.2023.1109561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/26/2023] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
- Jo A. Yon-Hernández
- Instituto Universitario de Integración en la Comunidad, InFoAutismo, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Ricardo Canal-Bedia
- Instituto Universitario de Integración en la Comunidad, InFoAutismo, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- *Correspondence: Ricardo Canal-Bedia,
| | - Dominika Z. Wojcik
- Instituto Universitario de Integración en la Comunidad, InFoAutismo, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - Clara Fernández-Álvarez
- Instituto Universitario de Integración en la Comunidad, InFoAutismo, Universidad de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Stefanny Palacio-Duque
- Instituto Universitario de Integración en la Comunidad, InFoAutismo, Universidad de Salamanca, Salamanca, Spain
| | - Manuel A. Franco-Martín
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Zamora Hospital (Complejo Asistencial de Zamora), Zamora, Spain
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16
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Lei J, Charman T, Leigh E, Russell A, Mohamed Z, Hollocks MJ. Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis. Autism Res 2022; 15:2265-2295. [PMID: 36196666 PMCID: PMC10092776 DOI: 10.1002/aur.2826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022]
Abstract
Compared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n = 1608) of CI and INT, and 15 studies (n = 1115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n = 833; r = 0.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n = 295; r = 0.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties.
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Affiliation(s)
- Jiedi Lei
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Zameer Mohamed
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew J Hollocks
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
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17
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Powell K, Macari S, Brennan-Wydra E, Feiner H, Butler M, Goncalves Fortes D, Boxberger A, Torres-Viso M, Morgan C, Lyons M, Chawarska K. Elevated symptoms of executive dysfunction predict lower adaptive functioning in 3-year-olds with autism spectrum disorder. Autism Res 2022; 15:1336-1347. [PMID: 35388596 PMCID: PMC9253075 DOI: 10.1002/aur.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Kelly Powell
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Suzanne Macari
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Emma Brennan-Wydra
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Hannah Feiner
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Maureen Butler
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Diogo Goncalves Fortes
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Alexandra Boxberger
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Mariana Torres-Viso
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Chelsea Morgan
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Megan Lyons
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Katarzyna Chawarska
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
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18
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Differences in daily life executive functioning between people with autism and people with schizophrenia. J Autism Dev Disord 2022:10.1007/s10803-022-05547-6. [PMID: 35441913 DOI: 10.1007/s10803-022-05547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
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.
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19
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Aita SL, Holding EZ, Greene J, Carrillo A, Moncrief GG, Isquith PK, Gioia GA, Roth RM. Multivariate base rates of score elevations on the BRIEF2 in children with ADHD, autism spectrum disorder, or specific learning disorder with impairment in reading. Child Neuropsychol 2022; 28:979-996. [DOI: 10.1080/09297049.2022.2060201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stephen L. Aita
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Emily Z. Holding
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Jennifer Greene
- Department of Research and Development, Psychological Assessment Resources, Lutz, FL, USA
| | - Alicia Carrillo
- Department of Research and Development, Psychological Assessment Resources, Lutz, FL, USA
| | - Grant G. Moncrief
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Peter K. Isquith
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Gerard A. Gioia
- Department of Neuropsychology, Children’s National Medical Center, Washington, District of Columbia, USA
| | - Robert M. Roth
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
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20
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Leung FYN, Sin J, Dawson C, Ong JH, Zhao C, Veić A, Liu F. Emotion recognition across visual and auditory modalities in autism spectrum disorder: A systematic review and meta-analysis. DEVELOPMENTAL REVIEW 2022. [DOI: 10.1016/j.dr.2021.101000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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21
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Lynn A, Luna B, O'Hearn K. Visual working memory performance is intact across development in autism spectrum disorder. Autism Res 2022; 15:881-891. [PMID: 35128834 DOI: 10.1002/aur.2683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
Autism spectrum disorder (ASD) is associated with atypical visual processing and deficits in working memory (WM). Visual WM performance typically improves between childhood and adulthood, but such improvement may be atypical in ASD. To better understand how visual WM develops, we used a well-established change detection task across multiple visual features. We examined visual WM for color, shape, and pattern in children, adolescents, and adults with and without ASD. VWM capacity and performance for all visual features improved across age similarly for both the TD and ASD groups. While performance was better on set size 4 trials than set size 8 trials for color, shape, and no change trials, such an effect was not evident for pattern change trials. Overall, the present findings suggest that VWM for different visual features may be intact across development in ASD. The ability to hold multiple objects in mind (WM) improves across typical development, but it remains unclear whether such improvement occurs in ASD. We found that developmental improvements in WM for different types of object details (e.g., color, shape, and pattern) is generally similar for both ASD and typical development.
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Affiliation(s)
- Andrew Lynn
- Department of Psychology & Human Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kirsten O'Hearn
- Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
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22
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Barton H, McIntyre LL. Caregiver-reported executive functioning and associated adaptive and challenging behaviour in children with histories of developmental delay. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:121-132. [PMID: 34213015 DOI: 10.1111/jir.12865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- H Barton
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, Oregon, USA
| | - L L McIntyre
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, Oregon, USA
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23
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Monteiro EM. An ecologically valid understanding of executive functioning. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Elissa M. Monteiro
- Graduate School of Education University of California Riverside Riverside California USA
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24
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Larson C, Gangopadhyay I, Prescott K, Kaushanskaya M, Ellis Weismer S. Planning in Children with Autism Spectrum Disorder: The Role of Verbal Mediation. J Autism Dev Disord 2021; 51:2200-2217. [PMID: 32930893 PMCID: PMC7956912 DOI: 10.1007/s10803-020-04639-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study examined verbal mediation during planning in school-age children with autism spectrum disorder (ASD) relative to age- and nonverbal IQ- matched typically developing peers using a dual-task paradigm. Analyses showed no group differences in performance. However, in the condition intended to disrupt verbal mediation, language skills were associated with planning performance for the TD group, but not the ASD group. Upon examining ASD subgroups with versus without comorbid structural language impairment, children with ASD and normal language appeared to rely on verbal mediation to a greater degree than children with ASD and language impairment, but to a lesser degree than TD peers. Thus, the role of verbal mediation in planning for children with ASD differs depending on language status.
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Affiliation(s)
- Caroline Larson
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Ishanti Gangopadhyay
- Department of Speech, Language and Hearing Sciences Organization Indiana University-Bloomington, 200 South Jordan Avenue, Room C175, Bloomington, IN, 47405, USA
| | - Kathryn Prescott
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Margarita Kaushanskaya
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Susan Ellis Weismer
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA.
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA.
- Waisman Center, University of Wisconsin-Madison, Room 473, 1500 Highland Ave, Madison, WI, 53705, USA.
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25
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Kearney CA, Rede M. The Heterogeneity of Selective Mutism: A Primer for a More Refined Approach. Front Psychol 2021; 12:700745. [PMID: 34177747 PMCID: PMC8222660 DOI: 10.3389/fpsyg.2021.700745] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 01/13/2023] Open
Abstract
Selective mutism is a persistent and debilitating psychiatric disorder in which a child fails to speak in situations where speaking is expected. Although listed as an anxiety disorder, the multifaceted and heterogeneous nature of selective mutism indicates that a more accurate conceptualization may be as a neurodevelopmental disorder. This article serves as a primer of historical and clinical presentations, empirical clinical profiles, clinical distinctions, assessment, and treatment related to the complexity of selective mutism. The article includes a brief discussion of selective mutism within a developmental psychopathology perspective with an eye toward reformed efforts for prevention, assessment, and treatment regarding this population.
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Affiliation(s)
| | - Melanie Rede
- Department of Psychology, University of Nevada, Las Vegas, NV, United States
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26
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Tesfaye R, Wright N, Zaidman-Zait A, Bedford R, Zwaigenbaum L, Kerns CM, Duku E, Mirenda P, Bennett T, Georgiades S, Smith IM, Vaillancourt T, Pickles A, Szatmari P, Elsabbagh M. 'Investigating longitudinal associations between parent reported sleep in early childhood and teacher reported executive functioning in school-aged children with autism'. Sleep 2021; 44:6275587. [PMID: 33987680 DOI: 10.1093/sleep/zsab122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/05/2021] [Indexed: 11/14/2022] Open
Abstract
Up to 80% of children with autism spectrum disorder (ASD) experience sleep disturbance. Poor sleep impairs executive functioning (EF), a lifelong difficulty in ASD. Evidence suggests EF difficulties in ASD are exacerbated by poor sleep. We examine whether early childhood sleep disturbances are associated with worsening EF trajectories in school-aged children with ASD. A subsample (n=217) from the Pathways in ASD longitudinal study was analyzed. The Children's Sleep Habits Questionnaire captured sleep duration, onset, and night awakenings before age 5 (Mean=3.5years). Metacognition (MI) and Behavioral Regulation (BRI) indices, on the Teacher Behavior Rating Inventory of Executive Functioning, were used to measure cognitive and affective components of EF respectively at four time-points (7.8-11.8years). We applied latent growth curve models to examine associations between sleep and EF, accounting for relevant covariates, including school-age sleep (Mean=6.7years). Sleep traits had different age-related impacts on behavioral regulation, but not metacognition. Longer sleep onset at 3.5 years was associated with a worsening BRI difficulties slope (b=2.07, p<0.04), but conversely associated with lower BRI difficulties at 7.7 years (b=-4.14, p=0.04). A longer sleep onset at 6.7 years was related to higher BRI difficulties at 7.7 years (b=7.78, p<0.01). Longer sleep duration at 6.7 years was associated with higher BRI difficulties at age 7.7 (b=3.15, p=0.01), but subscale analyses revealed shorter sleep duration at age 6.7 was linked to a worsening inhibition slope (b=-0.60, p=0.01). Sleep onset is a robust early correlate of behavior regulation in children with ASD, whereas sleep duration is a later childhood correlate.
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Affiliation(s)
- Rackeb Tesfaye
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada
| | - Nicola Wright
- King's College London, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anat Zaidman-Zait
- Tel Aviv University, Department of Educational Sciences, Tel Aviv, Israel
| | - Rachael Bedford
- King's College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,University of Bath, Department of Psychology, Bath, UK
| | | | - Connor M Kerns
- University of British Columbia, Department of Psychology, Vancouver, Canada
| | - Eric Duku
- McMaster University, Psychiatry and Behavioural Neurosciences, Hamilton, Canada
| | - Pat Mirenda
- University of British Columbia, Education and Counseling Psychology, Vancouver, Canada
| | - Teresa Bennett
- McMaster University, Psychiatry and Behavioural Neurosciences, Hamilton, Canada
| | - Stelios Georgiades
- McMaster University, Psychiatry and Behavioural Neurosciences, Hamilton, Canada
| | - Isabel M Smith
- Dalhousie University, IWK Health Centre, Pediatrics, Halifax, Canada
| | | | - Andrew Pickles
- King's College London, Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- University of Toronto, Department of Psychiatry, Toronto, Canada.,Centre for Addiction and Mental Health, Child and Youth Mental Health, Toronto, Canada.,SickKids Department of Psychiatry, child and adolescent psychiatry, Toronto, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada
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27
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Mazzoli E, Salmon J, Pesce C, Teo WP, Rinehart N, May T, Barnett LM. Effects of classroom-based active breaks on cognition, sitting and on-task behaviour in children with intellectual disability: a pilot study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:464-488. [PMID: 33719112 DOI: 10.1111/jir.12826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Classroom-based active breaks can help typically developing children reduce sitting, increase physical activity and improve cognitive functions and on-task behaviour. Yet, this strategy has not been tested in children with intellectual disability (ID) - a population who are insufficiently active. This study aimed to investigate the effects of a 5-week active breaks intervention on cognitive functions and on-task behaviour in schoolchildren with ID. METHODS Twenty-four children, aged between 8 and 12 years (37.5% girls), were recruited. Children's cognitive functions (response inhibition, lapses of attention, interference and working memory) were measured at baseline and end of trial using computer-based tests. Sitting, standing and movement patterns were assessed with inclinometers, and on-task behaviour was directly observed in the classroom before and after active breaks, at baseline, mid-trial and end of trial. Linear mixed models were used to investigate the intervention effects on cognitive functions and sedentary patterns; generalised linear mixed models were used to analyse on-task behaviour data. RESULTS A significant time × group interaction was found for working memory favouring the intervention (B = 11.56, 95% confidence interval [1.92, 21.21]). No significant effects were found in relation to the other measures of children's cognition or on-task behaviour. Stepping time and bouts of sitting were positively affected. CONCLUSIONS Classroom-based active breaks can increase physical activity and reduce sedentary behaviour in children with ID and might also benefit their working memory. Further research is required to clarify the effects on cognition and to investigate whether this strategy has other benefits in this population.
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Affiliation(s)
- E Mazzoli
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - J Salmon
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - C Pesce
- Department of Movement, Human and Health Sciences, University of Rome 'Foro Italico', Rome, Italy
| | - W-P Teo
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Physical Education and Sports Science (PESS) Academic Group, National Institute of Education (NIE), Nanyang Technological University, Singapore
| | - N Rinehart
- Deakin Child Study Centre, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - T May
- Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - L M Barnett
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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28
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Rosello R, Martinez-Raga J, Mira A, Girela B, Cortese S. Developmental outcomes in adolescence of children with autism spectrum disorder without intellectual disability: A systematic review of prospective studies. Neurosci Biobehav Rev 2021; 126:590-603. [PMID: 33872683 DOI: 10.1016/j.neubiorev.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) without intellectual disability (ID) represent approximately two-thirds of the ASD population. Here we focused on prospective research assessing different areas of functioning of children with ASD, without ID, until adolescence. Based on a pre-registered protocol (PROSPERO CRD42020189029), a systematic review of prospective studies (published between 01.01.2010 and 01.01.2020) was conducted. Twenty-eight studies met eligibility criteria. Findings indicated that ASD diagnosis and the Intelligence Quotient were highly stable over time across studies. Executive Functioning, Theory of Mind and Central Coherence processes tended to improve, although deficits remained when compared to typically developed controls. Adaptive difficulties and psychiatric comorbidity were relatively stable over time. We discuss potential implications of the findings for clinicians and educators and suggest recommendations for future research.
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Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Imperial College London, UK.
| | - Jose Martinez-Raga
- Psychiatry Department, University Hospital Doctor Peset of Valencia & University of Valencia, Spain
| | - Alvaro Mira
- Division of Developmental and Educational Psychology, University of Valencia, Spain
| | | | - Samuele Cortese
- Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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29
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Skogli EW, Andersen PN, Isaksen J. An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training. Dev Neurorehabil 2020; 23:439-447. [PMID: 32397778 DOI: 10.1080/17518423.2020.1756499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Erik Winther Skogli
- Innlandet Hospital Trust, Division Mental Health Care, Child and Adolescent Psychiatric Clinic , Lillehammer, Norway
| | - Per Normann Andersen
- Department of Psychology, Inland Norway University of Applied Sciences , Lillehammer, Norway
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30
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Krug MK, Elliott MV, Gordon A, Hogeveen J, Solomon M. Proactive control in adolescents and young adults with autism spectrum disorder: Unimpaired but associated with symptoms of depression. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:517-527. [PMID: 32406696 DOI: 10.1037/abn0000527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although autism spectrum disorder (ASD) is characterized by deficits in cognitive control, our previous work has shown that preparatory, goal-directed cognitive processing (proactive control) may be preserved in children with ASD. We investigated whether proactive control is intact in adolescents and young adults with ASD, as well as how symptoms of ASD (repetitive behaviors) and psychopathology (Depressive, Anxiety, and Attention-Deficit/Hyperactivity Problems) are related to proactive control. Participants were adolescents and young adults with ASD (N = 44) and typical development (TD; N = 44). Proactive control was assessed using a picture-word Stroop paradigm where participants named animals depicted in drawings while ignoring a superimposed written animal word. Interference effects (reaction time (RT) differences between more difficult incongruent trials, where animal pictures and words prompted different responses, and simpler congruent trials, where animal pictures and words prompted the same response) were calculated for two versions of the Stroop Task: a mostly congruent (MC) block, where the majority of trials were congruent, and a mostly incongruent (MI) block, where most trials were incongruent. Proactive control was calculated as the reduction in interference in the MI block in comparison to the MC block. Proactive control did not differ between groups, indicating that proactive control is not impaired in adolescents and young adults with ASD. In ASD, depression symptoms were associated with reduced proactive control. Future research should investigate the effects of interventions targeting depression as well as interventions targeting proactive control processes in individuals with ASD and comorbid depression. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Marie K Krug
- Department of Psychiatry and Behavioral Sciences
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31
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Escolano-Pérez E, Acero-Ferrero M, Herrero-Nivela ML. Improvement of Planning Skills in Children With Autism Spectrum Disorder After an Educational Intervention: A Study From a Mixed Methods Approach. Front Psychol 2019; 10:2824. [PMID: 31920859 PMCID: PMC6930833 DOI: 10.3389/fpsyg.2019.02824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/29/2019] [Indexed: 01/22/2023] Open
Abstract
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.
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