Executive Function Improves Over Time Among Children, Adolescents With Autism

Although children and adolescents with autism spectrum disorder (ASD) experience delayed executive function development, individuals with ASD are able to improve their executive functioning over time to a similar degree as their neurotypical peers. These study findings were published in Autism Research.

Previous evidence has established that children and adolescents with ASD experience neurodevelopmental delays across multiple domains, including executive functioning. However, studies that evaluate autism and executive function over time have produced mixed results.

To clarify this relationship, investigators conducted a systematic review and meta-analysis of longitudinal studies that examined executive function among individuals with ASD and neurotypical peers over time. The investigators included studies that collected data on executive function at more than 1 time point, had a baseline measure of executive function, and compared individuals with ASD to age-matched, neurotypical peers.

A total of 14 studies were included in the analyses, for a pooled sample of 518 children and adolescents with ASD and 3558 neurotypical peers. The mean age of participants at baseline ranged from 5.7 to 12.0 years. The studies used a variety of measures to evaluate multiple elements of executive function among the ASD vs neurotypical groups. Most studies measured working memory (k=11), followed by inhibition (k=9), shifting and/or planning (k=6), initiation (k=3), organization (k=3), monitoring (k=3), emotion control (k=3), verbal fluency (k=1), decision-making (k=1), and delay discounting (k=1).

At baseline, the investigators found that children and adolescents with ASD had worse working memory (Hedges g =1.31; P =.002), inhibition (Hedges g =1.11; P =.018), shifting (Hedges g =1.59; P =.020), planning (Hedges g =1.57; P =.022), and other executive function processes than their neurotypical peers.

At follow-up, children and adolescents with ASD also had worse scores on working memory (Hedges g =1.29; P =.001), inhibition (Hedges g =1.01; P =.018,), shifting (Hedges g =1.62; P =.010), planning (Hedges g =1.39; P =.020), and other executive function processes than their neurotypical peers.

However, the investigators observed no significant difference in the longitudinal changes in working memory (Hedges g = 0.02; P =.90), inhibition (Hedges g = -0.22; P =.31,), shifting (Hedges g = -0.05; P =.71), planning (Hedges g = -0.15; P =.33), and other executive function processes between the groups. The results indicate that the age-related trajectories of executive function in ASD are similar to those of neurotypical children and adolescents.

“[D]espite falling behind in [executive function] development, autistic children and adolescents showed similar [executive function improvements over time compared with their [neurotypical] peers,” the investigators concluded. “As a result, parents and educators are encouraged to take early actions to facilitate these individuals to catch up with their [executive function] development.”

The main limitations of the study include the relatively small number of studies and the limited amount of executive function skills assessed.

This article originally appeared on Psychiatry Advisor