Search

Background Executive functioning (EF) varies in children with autism spectrum disorder (ASD) and is associated with clinical symptoms, academic, and adaptive functioning. Here, we examined whether middle-childhood EF mediates associations between early-childhood autism symptoms and adolescent outcomes in children with ASD. Methods The Pathways in ASD Cohort comprising children recruited at the time of ASD diagnosis (at 2-4 years-of-age) and followed prospectively across eight subsequent timepoints over ˜10 years was used. A subset of Pathways participants (n = 250) with Behavior Rating Inventory of Executive Function (BRIEF)-Parent Form data from at least one timepoint when participants were school-aged was analyzed. A mediation framework was used to examine whether BRIEF-measured EF across age 7-10 years (middle-childhood) mediated associations between early-childhood autism symptoms (measured using the parent-report Social Responsiveness Scale across age 2-6 years) and clinical, academic, and functional outcomes, indexed at age >10-11.8 years (early-adolescence) using the Child Behavior Checklist (CBCL)-Internalizing and Externalizing Scales, Academic Performance from the Teacher's Report Form, and Vineland Adaptive Behavior Scales. Models were rerun substituting clinician-rated and teacher-rated measures, where possible. Results Mediation models indicated a significant indirect effect of middle-childhood EF on associations between early-childhood autism symptoms and externalizing behavior, academic performance, or adaptive functioning in early adolescence; kappa squared (κ2 ) effect sizes ranged from large to small. Model findings were stable across raters. Middle-childhood EF did not mediate associations between early-childhood autism symptoms and adolescent internalizing behavior. Conclusions Among children with an ASD diagnosis, middle-childhood EF may be one pathway through which early-childhood autism symptoms influence a variety of outcomes in early-adolescence. An experimental study targeting middle-childhood EF to improve adolescent academic, emotional/behavioral, and adaptive functioning is needed to evaluate the clinical meaningfulness of these findings.

Judgment and decision-making (JDM) skills have been implicated as additional domains of competence in individuals with Attention-Deficit Hyperactivity Disorder (ADHD). Recent cognitive science perspectives suggest that judgment and decision-making skills are conceptually and empirically separable from other domains of cognitive abilities, such as intelligence and executive function tasks. Over the last several years, there has been an increase in the empirical study of JDM tasks in ADHD, including adolescent and adult samples. Specifically, temporal discounting (or delay aversion) and risky decision making have been the most well-studied constructs in ADHD, perhaps because impulsivity and engagement in risky behaviors have been well documented in individuals with ADHD. Overall, individuals with ADHD tend to prefer smaller immediate rewards over larger delayed rewards on temporal discounting paradigms and tend to display lower performance on risky choice tasks than non-clinical samples. In this chapter, we describe this literature and review the associations between judgment and decision-making paradigms and cognitive abilities in individuals with ADHD across the life span. We also review the study of judgment and decision-making skills in other intellectual and developmental disabilities (IDDs), where these paradigms have been less well studied relative to ADHD samples. The correlations between JDM paradigms and cognitive abilities in ADHD samples are small to modest, as has been reported in non-clinical samples, reinforcing the separability of these domains of competence. JDM paradigms in ADHD offer interesting future directions for assessing the difficulties of these individuals that are often described in clinical descriptions.

Highlights • Executive function deficit impairs functional outcome in Autism spectrum (ASD) • ASD showed normal brain activity in a working memory task but abnormal connectivity • A sub-set of the ASD group had highly variable patterns of activity • This may have implications for treatment targeting or diagnostic biotypes, 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.