By Dr. Eric Lai, Associate Consultant, Child and Adolescent Psychiatry, Castle Peak Hospital, Hong Kong
In short, what is the study about?
Executive functioning has received a lot of attention as an essential aspect of child development in recent decades. Executive functioning is shown to predict school readiness and academic success especially math and reading competence. It is also shown to closely relate to adult outcomes such as career, marriage, and mental as well as physical wellbeing. It predicts adaptive behavior in daily living skills and socialization. There is growing evidence that supports the presence of executive dysfunction in individuals with autism spectrum disorder. It is also suggested that instead of being globally impaired, the deficits exist in only certain sub-components of executive functioning in these individuals. Therefore our study attempted to explore the profile of deficits in children and adolescents with autism spectrum disorder through summarizing the current literature in a sophisticated and statistical manner. We also tried to tease out the impact of co-occurring ADHD and intellectual disability on the profile of deficits as these disorders often exist together in individuals with ASD.
What are the most important take-home messages from the study?
We found that children and adolescents do exhibit deficits in executive functioning. In particular, they showed more deficits in working memory, flexibility and generativity, i.e. the ability to generate novel behaviors in times of changes. These deficits are evident even without co-occurring ADHD or intellectual disability.
How are these findings important in practice?
These findings enable carers of individuals with autism spectrum disorder to be informed of the difficulties these individuals encounter in daily living. We should bear in mind these individuals do not merely encounter social difficulties which were the area where most attention was lavished on. These individuals are also beset with more general and broader difficulties in executive functioning, as tasks entailing adequate executive functioning are ubiquitous in daily activities, from carrying out basic activities of daily living, to learning and working, and to achieving life goals. After acknowledging the presence of such deficits, the next step would be to accommodate such deficits and provide training to alleviate the deficits. Furthermore, as most of the development of executive functioning takes place in childhood to early adolescence, it is crucial that training targeting at these deficits are delivered in an appropriate developmental stage.
What other studies can be recommended to further an understanding/application of the findings?
There is extensive research on interventions that either accommodate deficits in executive functioning or directly train them in the general population. They are usually in the form of strategies-based interventions that increase the efficiency of executive functioning, such as some cognitive behavioral strategies, or process-based interventions that increase the capacity of executive functioning, such as computerized training. Both of them show promising results. Moreover, in particular, there is also growing body of research targeting at deficits in executive functioning in the clinical population of autism spectrum disorder, such as executive skills “Unstuck and on Target” by Kenworthy and colleagues in 2014, a form of behavioural intervention by Baltruschat and colleagues in 2011, neurofeedback by Kouijzer and colleagues in 2009, etc. Interested readers can refer to the respective articles for further understanding.