Cited by 192Autism Spectrum Disorder ResearchDevelopmental and Educational NeuropsychologyChild Nutrition and Feeding Issues

The DOI matches its Crossref record; 126 of the 127 references it cites were found in a registry or an index.

Brief Report: Cognitive Flexibility in Autism Spectrum Disorders: A Quantitative Review

Leung, Rachel C., Zakzanis, Konstantine K.·2014·Journal of Autism and Developmental Disorders

DOI 10.1007/s10803-014-2136-4

Open this paper in CoChat — free account

Abstract

Impairments in cognitive flexibility have been used to characterize the neuropsychological presentation of persons with autism spectrum disorders (ASDs). Previous studies have yielded mixed results. Our objective was to systematically review the sensitivity of cognitive flexibility measures in ASD using quantitative methods employed by meta-analytic statistical techniques. Seventy-two studies met inclusion criteria for analysis and included a total of 2,137 individuals with ASD and 2,185 healthy controls. Our findings demonstrate that while the shift sub-scale of the self-report version of the Behavioral Rating Inventory of Executive Function (BRIEF) showed approximate absolute discriminability, of all the performance measures that were systematically reviewed and evaluated, none could reliably differentiate between individuals with ASD and controls; this is not surprising given that cognitive flexibility is not a core deficit of ASD. Our findings suggest that while the shift sub-scale of the self-report version of the BRIEF is a promising clinical marker, clinical performance measures of cognitive flexibility may lack ecological validity and lastly, reinforces that impairments in cognitive flexibility do not uniformly characterize all persons with ASD.

Integrity signals

Registry

Crossref · 10.1007/s10803-014-2136-4

Cites

126 of 126 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

We couldn’t retrieve this paper’s full text, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

1 retracted

Cognitive flexibility in autism spectrum disorder: Explaining the inconsistencies?
Van Eylen, L., Boets, B., Steyaert, J., Evers, K., Wagemans, J., & Noens, I. (2011) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2011.01.025 · Cited by 183
Retracted
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,603
Statistical power analysis for the behavioral sciences
Cohen, J. (1990) · Computers Environment and Urban Systems · doi:10.1016/0198-9715(90)90050-4 · Cited by 65,417
Statistical Power Analysis for the Behavioral Sciences (2nd ed.).
Lachenbruch, P. A., & Cohen, J. (1989) · Journal of the American Statistical Association · doi:10.2307/2290095 · Cited by 37,421
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Carter, M. J. (2014) · Therapeutic Recreation Journal · Cited by 15,154
Book Reviews: Statistical Methods for Meta-Analysis Larry V. Hedges and Ingram Olkin New York: Academic Press, 1985. xxii + 369 pp
Wasserman, S. S., Hedges, L. V., & Olkin, I. (1988) · Journal of Educational Statistics · doi:10.2307/1164953 · Cited by 10,377
VALIDITY OF THE TRAIL MAKING TEST AS AN INDICATOR OF ORGANIC BRAIN DAMAGE
Reitan, R. M. (1958) · Perceptual and Motor Skills · doi:10.2466/pms.1958.8.3.271 · Cited by 8,167
Diagnostic and Statistical Manual of Mental Disorders, 3rd ed
Cooper, A. M., & Michels, R. (1981) · American Journal of Psychiatry · doi:10.1176/ajp.138.1.128 · Cited by 7,419

Show all 127 references

Research works printed but not linked: 3

De Sonneville, L. M. J. (1999). Amsterdam neuropsychological tasks: A computer aided assessment program. In B. P. L. M. Den Brinker, P. J. Beek, A. N. Brand, F. J. Maarse, & L. J. M. Mulder (Eds.), Cognitive ergonomics, clinical assessment and computer assisted learning: Computers in psychology (pp. 187–203). Lisse: Swets and Zeitlinger.
Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior Rating of Executive Function. Lutz, FL: Psychological Assessment Resources.
Llorente, A. M., Williams, J., Satz, P., & D’Elia, L. (1998). Children’s color trails test (CCTT). Los Angeles, CA: Western Psychological Services.

Sorted by citations

Autism spectrum disorders: a meta-analysis of executive function
Demetriou, E. A., Lampit, A., Quintana, D. S., Naismith, S. L., Song, Y. J. C., Pye, J. E., Hickie, I., & Guastella, A. J. (2018) · Molecular Psychiatry · doi:10.1038/mp.2017.75 · Cited by 841
Executive Function in Autism Spectrum Disorder: History, Theoretical Models, Empirical Findings, and Potential as an Endophenotype
Demetriou, E. A., DeMayo, M. M., & Guastella, A. J. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00753 · Cited by 274
“A meta-analysis on cognitive flexibility (96) indicated life span impairment in ASD.”
Meta-analysis of neuropsychological measures of executive functioning in children and adolescents with high-functioning autism spectrum disorder
Lai, C. L. E., Lau, Z., Lui, S. S. Y., Lok, E., Tam, V., Chan, Q., Cheng, K. M., Lam, S. M., & Cheung, E. F. C. (2017) · Autism Research · doi:10.1002/aur.1723 · Cited by 250
“Fourth, previous meta-analyses [Geurts et al., 2014; Leung & Zakzanis, 2014] included studies conducted on samples with ASD and comorbid intellectual disability.”
BackgroundMethodResultInfluential
The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis
Westwood, H., Stahl, D. R., Mandy, W., & Tchanturia, K. (2016) · Psychological Medicine · doi:10.1017/s0033291716000581 · Cited by 194
“A recent meta-analysis (Leung & Zakzanis, 2014) comparing neuropsychological performance between patients with ASD and HCs on number of perseverative errors on the computerized WCST, which again pooled both child and adult studies, reported a medium mean effect size (d = 0.68).”
BackgroundMethodInfluential
The Effects of Exercise Interventions on Executive Functions in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-analysis
Liang, X., Li, R., Wong, S. H., Sum, R. K. W., Wang, P., Yang, B., & Sit, C. H. P. (2021) · Sports Medicine · doi:10.1007/s40279-021-01545-3 · Cited by 194
Working memory and cognitive flexibility‐training for children with an autism spectrum disorder: a randomized controlled trial
de Vries, M., Prins, P. J. M., Schmand, B. A., & Geurts, H. M. (2014) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12324 · Cited by 188
PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms.
Haruvi-Lamdan, N., Horesh, D., & Golan, O. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000298 · Cited by 166
Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders
Vaidya, C. J., You, X., Mostofsky, S., Pereira, F., Berl, M. M., & Kenworthy, L. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13114 · Cited by 126
Executive functioning in autism spectrum disorders: Influence of task and sample characteristics and relation to symptom severity
Van Eylen, L., Boets, B., Steyaert, J., Wagemans, J., & Noens, I. (2015) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-015-0689-1 · Cited by 123
“[37] and is consistent with many other reports of increased perseverative errors on the original WCST (for reviews, see [55, 56]).”
Result
A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder
Friedman, L., & Sterling, A. M. (2019) · Seminars in Speech and Language · doi:10.1055/s-0039-1692964 · Cited by 155
“However, the authors reported that the majority of the studies included in the metaanalysis had compared individuals with ASD to age-matched controls, but the authors did not consider group matching status in their inclusionary criteria.(5) Therefore, results from this meta-analysis may not generalize to all individua…”
Result
Can Bilingualism Mitigate Set-Shifting Difficulties in Children With Autism Spectrum Disorders?
Gonzalez-Barrero, A. M., & Nadig, A. S. (2019) · Child Development · doi:10.1111/cdev.12979 · Cited by 114
“This is likely because the DCCS task is not a highly sensitive measure of set-shifting impairment, with a 95% confidence interval of [-1.82, 2.85] pooled over the two studies just mentioned (Leung & Zakzanis, 2014).”
BackgroundMethodResultInfluential
Characterizing the Factor Structure of Parent Reported Executive Function in Autism Spectrum Disorders: The Impact of Cognitive Inflexibility
Granader, Y., Wallace, G. L., Hardy, K. K., Yerys, B. E., Lawson, R. A., Rosenthal, M., Wills, M. C., Dixon, E., Pandey, J., Penna, R., et al. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2169-8 · Cited by 106
“This makes the BRIEF a useful clinical tool in ASD (Leung and Zakzanis 2014; Tunc et al. 2014), but assumptions about the factor structure of the BRIEF in ASD populations should not be premised on findings from TDC.”
Method
A meta-analysis of cognitive flexibility in autism spectrum disorder
Lage, C., Smith, E. S., & Lawson, R. P. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105511 · Cited by 129
“The only quantitative review to date focused specifically on cognitive flexibility in autistic people (Leung and Zakzanis, 2014) reported extensive variation in the magnitude of cognitive flexibility difficulties.”
Background
Effects of Cognitive Training Programs on Executive Function in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review
Pasqualotto, A., Mazzoni, N., Bentenuto, A., Mulè, A., Benso, F., & Venuti, P. (2021) · Brain Sciences · doi:10.3390/brainsci11101280 · Cited by 112
Executive function predicts school readiness in autistic and typical preschool children
Pellicano, E., Kenny, L., Brede, J., Klaric, E., Lichwa, H., & McMillin, R. (2017) · Cognitive Development · doi:10.1016/j.cogdev.2017.02.003 · Cited by 106
Metacognitive Aspects of Executive Function Are Highly Associated with Social Functioning on Parent-Rated Measures in Children with Autism Spectrum Disorder
Torske, T., Nærland, T., Øie, M. G., Stenberg, N., & Andreassen, O. A. (2018) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2017.00258 · Cited by 98
“Meta-analyses and reviews have been written about domains like inhibition and interference control (Geurts et al., 2014b), cognitive flexibility (Leung and Zakzanis, 2014) and working memory in ASD (Barendse et al., 2013; Wang et al., 2017).”
Background
Executive Function Skills in School-Age Children With Autism Spectrum Disorder: Association With Language Abilities
Weismer, S. E., Kaushanskaya, M., Larson, C., Mathée‐Scott, J., & Bolt, D. M. (2018) · Journal of Speech Language and Hearing Research · doi:10.1044/2018_jslhr-l-rsaut-18-0026 · Cited by 92
“Based on a meta-analysis of shifting/cognitive flexibility studies, Leung and Zakzanis (2014) concluded that the Shift subscale of the Behavior Rating Inventory of Executive Functions (BRIEF) is a promising clinical marker for ASD, yet their results also highlighted the fact that cognitive…”
Executive Functions in Older Adults With Autism Spectrum Disorder: Objective Performance and Subjective Complaints
Davids, R. C. D., Groen, Y., Berg, I. J., Tucha, O. M., & van Balkom, I. D. C. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2831-4 · Cited by 75
“This is in line with a previous review on the sensitivity of cognitive flexibility measures in individuals with ASD by Leung and Zakzanis (2014).”
Result
Traumatic Exposure and Psychological Well-Being: The Moderating Role of Cognitive Flexibility
Fu, F., & Chow, A. Y. M. (2016) · Journal of Loss and Trauma · doi:10.1080/15325024.2016.1161428 · Cited by 69
Virtual collaborative gaming as social skills training for high‐functioning autistic children
Ke, F., & Moon, J. (2018) · British Journal of Educational Technology · doi:10.1111/bjet.12626 · Cited by 72
Neuropsychological assessment in autism spectrum disorder and related conditions
Zwick, G. P. (2017) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2017.19.4/gzwick · Cited by 72
Associations Among Symptoms of Autism, Symptoms of Depression and Executive Functions in Children with High-Functioning Autism: A 2 Year Follow-Up Study
Andersen, P. N., Skogli, E. W., Hovik, K. T., Egeland, J., & Øie, M. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2415-8 · Cited by 63
Intelligence May Moderate the Cognitive Profile of Patients with ASD
Rommelse, N. N. J., Langerak, I., van der Meer, J., de Bruijn, Y. G. E., Staal, W., Oerlemans, A. M., & Buitelaar, J. K. (2015) · PLoS ONE · doi:10.1371/journal.pone.0138698 · Cited by 69
“Importantly however, cognitive deficits were not generalized across all domains (particularly set shifting was completely normal in ASD participants across the IQ range, in line with a recent review [63] and were overall of small to moderate size at best, suggesting cognitive deficits not to be the core or sole cause…”
MethodResult
Addressing the autism mental health crisis: the potential of phenomenology in neurodiversity-affirming clinical practices
Pantazakos, T., & Vanaken, G.-J. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1225152 · Cited by 59
“, thinking errors and cognitive distortions); facing demands for unachievable cognitive flexibility and perspective-taking (Minshew et al., 2002; Koenig and Levine, 2011; Leung and Zakzanis, 2014; Cooper et al., 2018); difficulty with interpreting social cues, facial expressions, and nonverbal communication; building…”
Background
Impaired cognitive flexibility across psychiatric disorders
Grant, J. E., & Chamberlain, S. R. (2023) · CNS Spectrums · doi:10.1017/s1092852923002237 · Cited by 67
“Many psychiatric disorders are characterized by repetitive compulsive behaviors (including, for example, alcohol and substance use disorders, schizophrenia, autism spectrum disorders, eating disorders, gambling disorder, trichotillomania, and skin-picking disorder).(1-7) Obsessivecompulsive disorder (OCD) may reflect…”
Background
Diagnóstico de autismo no século XXI: evolução dos domínios nas categorizações nosológicas
Fernandes, C. S., Tomazelli, J. G., & Girianelli, V. R. (2020) · Psicologia USP · doi:10.1590/0103-6564e200027 · Cited by 104
Autism spectrum disorder and schizophrenia: boundaries and uncertainties
Pina‐Camacho, L., Parellada, M., & Kyriakopoulos, M. (2016) · BJPsych Advances · doi:10.1192/apt.bp.115.014720 · Cited by 62
“Both patients with ASD and those with schizophrenia can show odd mannerisms, stereotyped behaviours and a rigid, inflexible pattern of thinking and behaving (Delahunty 1993; Ridley 1994; Leung 2014).”
Same room - different windows? A systematic review and meta-analysis of the relationship between self-report and neuropsychological tests of cognitive flexibility in healthy adults
Howlett, C. A., Wewege, M. A., Berryman, C. F., Oldach, A. M., Jennings, E., Moore, E., Karran, E. L., Szeto, K., Pronk, L., Miles, S., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102061 · Cited by 66
What does it take to be rigid? Reflections on the notion of rigidity in autism
Petrolini, V., Jorba, M., & Vicente, A. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1072362 · Cited by 56
Autism Spectrum Traits Linked with Reduced Performance on Self-Report Behavioural Measures of Cognitive Flexibility
Albein‐Urios, N., Youssef, G. J., Kirkovski, M., & Enticott, P. G. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3503-3 · Cited by 51
“Poorer performance on the BRIEF-A shift subscale has been shown consistently in individuals with ASD (Gioia et al. 2002; Leung and Zakzanis 2014).”
Method
Putative Brain Networks Underlying Repetitive Negative Thinking and Comorbid Internalizing Problems in Autism
Burrows, C. A., Timpano, K. R., & Uddin, L. Q. (2017) · Clinical Psychological Science · doi:10.1177/2167702616683506 · Cited by 43
“There is also ample evidence for reduced cognitive flexibility across development in ASD, both in laboratory assessments (Lopez et al., 2005; Panerai et al., 2014) and on self- and parent-reports (Leung & Zakzanis, 2014).”
Background
Characteristic Executive Dysfunction for High‐Functioning Autism Sustained to Adulthood
Xie, R., Sun, X., Yang, L., & Guo, Y. (2020) · Autism Research · doi:10.1002/aur.2304 · Cited by 54
“…memory, planning, cognitive flexibility, inhibition, and so on [Hill, 2004b], and has long been of interest for its proposed role in specific impairments in ASD in a set of cognitive and behavioral control process [Demetriou et al., 2018; Leung & Zakzanis, 2014; Olde Dubbelink & Geurts, 2017].”
Background
Bilingual language development in autism
Prévost, P., & Tuller, L. (2021) · Linguistic Approaches to Bilingualism · doi:10.1075/lab.21018.pre · Cited by 48
Prospective memory in autism: theory and literature review
Sheppard, D. P., Bruineberg, J. P., Kretschmer-Trendowicz, A., & Altgassen, M. (2018) · The Clinical Neuropsychologist · doi:10.1080/13854046.2018.1435823 · Cited by 44
“…et al., 2004) and switching flexibly between different tasks or foci of attention (Corbett, Constantine, Hendren, Rocke, & Ozonoff, 2009; Kenworthy, Yerys, Anthony, & Wallace, 2008; Leung & Zakzanis, 2014; Ozonoff et al., 2004; but see Geurts, Corbett, & Solomon, 2009 for a critical review).”
Adding the missing voice: How self-report of autistic youth self-report on an executive functioning rating scale compares to parent report and that of youth with attention deficit hyperactivity disorder or neurotypical development
Kenworthy, L. E., Verbalis, A. D., Bascom, J., daVanport, S., Strang, J. F., Pugliese, C. E., Freeman, A. J., Jeppsen, C., Armour, A. C., Jost, G. M., et al. (2021) · Autism · doi:10.1177/13623613211029117 · Cited by 42
“In the case of autism, Leung and Zakzanis (2014) conducted a quantitative review of 72 studies and found that (1) autistic individuals without intellectual disability demonstrated variability in the magnitude of EF impairment depending on the type of assessment measure and (2) parent-report and…”
PSMC3 proteasome subunit variants are associated with neurodevelopmental delay and type I interferon production
Ebstein, F., Küry, S., Most, V., Rosenfelt, C., Scott-Boyer, M.-P., van Woerden, G. M., Besnard, T., Papendorf, J. J., Studencka-Turski, M., Wang, T., et al. (2023) · Science Translational Medicine · doi:10.1126/scitranslmed.abo3189 · Cited by 36
Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta‐analysis
Lei, J., Charman, T., Leigh, E., Russell, A., Mohamed, Z., & Hollocks, M. J. (2022) · Autism Research · doi:10.1002/aur.2826 · Cited by 35
“Previous systematic and literature reviews on the topic of CI have evaluated the psychometric properties of standardized measures, including their discriminability (Leung & Zakzanis, 2014) and ecological validity when completed by autistic individuals (Geurts et al., 2009).”
Background
Bilingualism Effects on the Cognitive Flexibility of Autistic Children: Evidence From Verbal Dual-Task Paradigms
Peristeri, E., Vogelzang, M., & Tsimpli, I. M. (2021) · Neurobiology of Language · doi:10.1162/nol_a_00055 · Cited by 39
“Heterogeneity in EF in autism has been verified by Leung and Zakzanis’ (2014) meta-analysis, which has exhibited considerable variability of effect size in set-shifting performance across autistic populations, further implying that EF deficits do not constitute a uniform characteristic of the…”
Result
Effects of therapeutic recreation on adults with ASD and ID: a preliminary randomized control trial
García-Villamisar, D. A., Dattilo, J., & Muela, C. (2016) · Journal of Intellectual Disability Research · doi:10.1111/jir.12320 · Cited by 40
A mixed methods study of autistic adults' mental health therapy experiences
Mazurek, M. O., Pappagianopoulos, J., Brunt, S., Sadikova, E., Nevill, R., Menezes, M., & Harkins, C. (2023) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2835 · Cited by 33
Real-world executive functioning for autistic children in school and home settings
Tschida, J. E., & Yerys, B. E. (2021) · Autism · doi:10.1177/13623613211041189 · Cited by 34
“While broad executive function impairments characterize autism spectrum disorder (ASD), shifting has been proposed as a promising clinical marker from caregiver informant data given its notable ability to differentiate autistic and typically developing (TD) individuals (Leung & Zakzanis, 2014).”
Influential
Cognitive flexibility in autism: Evidence from young autistic children
Ανδρέου, Μ., Konstantopoulos, K., & Peristeri, E. (2022) · Autism Research · doi:10.1002/aur.2828 · Cited by 36
“…category within a limited period of time, are two common neuropsychological tests used to assess cognitive flexibility in both clinical and typical school-aged child populations (e.g., Koren et al., 2005; Leung & Zakzanis, 2014; Pastor-Cerezuela et al., 2016; Stad et al., 2019; Zhao et al., 2013).”
Background
Mutations in neuroligin-3 in male mice impact behavioral flexibility but not relational memory in a touchscreen test of visual transitive inference
Norris, R. H. C., Churilov, L. P., Hannan, A. J., & Nithianantharajah, J. (2019) · Molecular Autism · doi:10.1186/s13229-019-0292-2 · Cited by 30
Advancing the Personalization of Assessment and Intervention in Autistic Adolescents and Young Adults by Targeting Self-Determination and Executive Processes
Shogren, K. A., Mosconi, M. W., Raley, S. K., Dean, E. E., Edwards, B., Wallisch, A. M., Boyd, B. A., & Kiblen, J. C. (2021) · Autism in Adulthood · doi:10.1089/aut.2021.0010 · Cited by 37
One-Class Support Vector Machines Identify the Language and Default Mode Regions As Common Patterns of Structural Alterations in Young Children with Autism Spectrum Disorders
Retico, A., Gori, I., Giuliano, A., Muratori, F., & Calderoni, S. (2016) · Frontiers in Neuroscience · doi:10.3389/fnins.2016.00306 · Cited by 29
“, 2001), as well as in cognitive flexibility and in the ability to regulate the breadth of attention (Leech and Sharp, 2014), functions frequently impaired in patients with ASD (Bruck et al., 2007; Leung and Zakzanis, 2014; Orekhova and Stroganova, 2014).”
Background
Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults
Ilen, L., Feller, C. M., & Schneider, M. (2023) · Autism · doi:10.1177/13623613231204829 · Cited by 34
“It is possible that executive functioning difficulties (Kenworthy et al., 2008) or cognitive rigidity (Leung & Zakzanis, 2014), associated with autism, could interfere with effective problem-solving and coping with perceived stress related to daily-life activities.”
Background
Feasibility of a school-based mindfulness program for improving inhibitory skills in children with autism spectrum disorder
Juliano, A., Alexander, A., DeLuca, J., & Genova, H. M. (2020) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2020.103641 · Cited by 38
Machine Learning for Differential Diagnosis Between Clinical Conditions With Social Difficulty: Autism Spectrum Disorder, Early Psychosis, and Social Anxiety Disorder
Demetriou, E. A., Park, S. H., Ho, N., Pepper, K. L., Song, Y. J. C., Naismith, S. L., Thomas, E. E., Hickie, I. B., & Guastella, A. J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00545 · Cited by 26
Reading and Writing Skills in Adolescents With Autism Spectrum Disorder Without Intellectual Disability
Baixauli, I., Miranda, B. R., Berenguer, C., Lorenzo, M. T. D. M., & Miranda, A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.646849 · Cited by 36
Developing set‐shifting improvement tasks (SSIT) for children with high‐functioning autism
Saniee, S., Pouretemad, H., & Zardkhaneh, S. A. (2019) · Journal of Intellectual Disability Research · doi:10.1111/jir.12633 · Cited by 26
Broad Cognitive Profile in Children and Adolescents with HF-ASD and in Their Siblings: Widespread Underperformance and its Clinical and Adaptive Correlates
Rosa, M., Puig, O., Lázaro, L., Vallés, V., Lera‐Miguel, S., Sánchez‐Gistau, V., & Calvo, R. M. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3137-x · Cited by 23
“2016) but some mixed results remain in the literature (Geurts et al. 2009; Leung and Zakzanis 2014; May et al. 2013; Oerlemans et al. 2013; Rommelse et al. 2015; Semrud-Clikeman et al. 2014).”
Flexibility in autism during unpredictable shifts of socio-emotional stimuli: Investigation of group and sex differences
Lacroix, A., Dutheil, F., Logemann, A., Cserjesi, R., Peyrin, C., Biro, B., Gomot, M., & Mermillod, M. (2022) · Autism · doi:10.1177/13623613211062776 · Cited by 21
“However, laboratory results on flexibility in autism are inconsistent (for overviews, see Geurts et al., 2009; Leung & Zakzanis, 2014).”
Result
Cholinergic neurons in the pedunculopontine nucleus guide reversal learning by signaling the changing reward contingency
Ruan, Y., Li, K.-Y., Zheng, R., Yan, Y., Wang, Z., Chen, Y., Liu, Y., Tian, J., Zhu, L., Lou, H., et al. (2022) · Cell Reports · doi:10.1016/j.celrep.2022.110437 · Cited by 22
Quantitative prediction of individual cognitive flexibility using structural MRI
Zhu, J., Zhu, D., Zhang, C., Wang, Y., Yang, Y., & Yu, Y. (2018) · Brain Imaging and Behavior · doi:10.1007/s11682-018-9905-1 · Cited by 21
Parahippocampal deactivation and hyperactivation of central executive, saliency and social cognition networks in autism spectrum disorder
Mouga, S., Duarte, I. C., Café, C., Sousa, D., Duque, F., Oliveira, G., & Castelo-Branco, M. S. (2022) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-022-09417-1 · Cited by 24
Autism and Pervasive Developmental Disorders
(2019) · Cambridge University Press eBooks · doi:10.1017/9781108297769 · Cited by 25
Planning in Children with Autism Spectrum Disorder: The Role of Verbal Mediation
Larson, C., Gangopadhyay, I., Prescott, K. E., Kaushanskaya, M., & Weismer, S. E. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04639-5 · Cited by 22
“I have to charge my social battery”: Perspectives from autistic young adults on Quality of Life
Øverland, E., Hauge, Å. L., Orm, S., Øie, M. G., Skogli, E. W., Pellicano, E., & Andersen, P. N. (2024) · Autism · doi:10.1177/13623613241245578 · Cited by 21
“Transitions often involve uncertainty about what is ahead, and uncertainty can be experienced as more challenging for autistic people than non-autistic people (Leung & Zakzanis, 2014).”
Background
Evaluating the feasibility of the NIH toolbox cognition battery for autistic children and adolescents
Jones, D. R., Dallman, A., Harrop, C., Whitten, A., Pritchett, J., Lecavalier, L., Bodfish, J. W., & Boyd, B. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04965-2 · Cited by 18
Dimensional associations between executive function processes and symptoms of ADHD, ASD, oppositional defiance and anxiety in young school-referred children
Anning, K. L., Langley, K., Hobson, C., & Van Goozen, S. H. M. (2023) · Cortex · doi:10.1016/j.cortex.2023.06.005 · Cited by 18
“Previous research has indicated that cognitive flexibility is the most commonly identified EF problem in individuals with ASD (Leung & Zakzanis, 2014); it is also linked to disorder-specific symptoms (Hill & Bird, 2006; South et al., 2007) and challenges (e.g., theory of mind; Jones et al., 2018).”
Background
Psychological Factors in Autism Spectrum Disorders
Vivanti, G., Yerys, B. E., & Salomone, E. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108297769.004 · Cited by 17
The role of executive functions in preschool children with autism spectrum disorder: A short narrative review
Petrolo, E., Guerrera, S., Logrieco, M. G., Casula, L., Vicari, S., & Valeri, G. (2025) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2024.104905 · Cited by 18
The relationships between motor skills and executive functions in children with and without autism spectrum disorder
Pan, C., Sung, M., Tsai, C., Chen, F., Chen, Y., & Chen, C. (2024) · Autism Research · doi:10.1002/aur.3136 · Cited by 16
“However, the current finding regarding the difference of cognitive flexibility performance is not consistent with previous literature (Leung & Zakzanis, 2014; Robinson et al., 2009), which found preserved cognitive flexibility among autistic individuals.”
Result
Ergenlerde İyi Oluşun Yordanmasında Bilişsel Esneklik ve Öz-Şefkatin Rolü
Topkaya, N., Köksal, Z., & BAYRAM, S. (2022) · Batı anadolu eğitim bilimleri dergisi · doi:10.51460/baebd.1084576 · Cited by 14
A systematic review of ecological momentary assessment in autism research
Chen, Y., Xi, Z., Greene, T., & Mandy, W. (2024) · Autism · doi:10.1177/13623613241305722 · Cited by 13
“Although some previous researchers expressed concerns about autistic people’s capacity to transition between activities (Leung & Zakzanis, 2014), autistic participants in Chen et al. (2014) reported that they were able to shift back and forth between responding to signals and daily activities. a…”
Contrasting Views of Autism Spectrum Traits in Adults, Especially in Self-Reports vs. Informant-Reports for Women High in Autism Spectrum Traits
Taylor, S. C., Gehringer, B. N., Dow, H. C., Langer, A., Rawot, E., Smernoff, Z., Steeman, S. L., Almasy, L. A., Rader, D. J., Bućan, M., et al. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05822-6 · Cited by 15
“Additionally, a previous meta-analysis showed that self-report BRIEF scales performed better in terms of clinical ASD discrimination than informant-report BRIEF scales (Leung & Zakzanis, 2014).”
Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: a nation-wide cohort study in Taiwan
Li, S.-T., Chien, W., Chung, C., & Tzeng, N. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1329836 · Cited by 14
Adolescent treadmill exercise enhances hippocampal brain-derived neurotrophic factor (BDNF) expression and improves cognition in autism-modeled rats
King, C., Rogers, L. G., Jansen, J., Sivayokan, B., Neyhard, J., Warnes, E., Hall, S. E., & Plakke, B. (2024) · Physiology & Behavior · doi:10.1016/j.physbeh.2024.114638 · Cited by 16
Cognitive flexibility in autism: How task predictability and sex influence performances
Lacroix, A., Torija, E., Logemann, H. N. A., Baciu, M., Cserjési, R., Dutheil, F., Gomot, M., & Mermillod, M. (2024) · Autism Research · doi:10.1002/aur.3281 · Cited by 18
Adaptive responding to prolonged stress exposure: A binational study on the impact of flexibility on latent profiles of cognitive, emotional and behavioural responses to the COVID‐19 pandemic
Hemi, A., Sopp, M. R., Schäfer, S. K., Michael, T., & Levy‐Gigi, E. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.14053 · Cited by 13
“It enables individuals to shift between discrepant tasks or demands and adapt to different challenges (Koesten et al., 2009; Leung & Zakzanis, 2014).”
Background
Enhanced fear limits behavioral flexibility in Shank2-deficient mice
Yun, M., Kim, E., & Jung, M. W. (2022) · Molecular Autism · doi:10.1186/s13229-022-00518-1 · Cited by 13
“People with ASD often show impairments in tasks requiring cognitive flexibility, such as the Wisconsin card sorting test [11, 12], and impaired cognitive flexibility has been proposed to underlie repetitive and restrictive patterns of behavior in this disorder [13].”
Background
Are preconceptional stressful experiences crucial elements for the aetiology of autism spectrum disorder? Insights from an animal model
Pisu, M. G., Boero, G., Garau, A., Casula, C., Cisci, S., Biggio, F., Concas, A., Follesa, P., Maciocco, E., Porcu, P., et al. (2019) · Neuropharmacology · doi:10.1016/j.neuropharm.2019.107686 · Cited by 14
Mapping the structure of biomarkers in autism spectrum disorder: a review of the most influential studies
Jin, F., & Wang, Z. (2024) · Frontiers in Neuroscience · doi:10.3389/fnins.2024.1514678 · Cited by 12
Intrinsic Structural Connectivity of the Default Mode Network and Behavioral Correlates of Executive Function and Social Skills in Youth with Autism Spectrum Disorders
Blume, J., Kahathuduwa, C. N., & Mastergeorge, A. M. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05460-y · Cited by 14
“…of Laboratory Sciences and Primary Care, Department of Psychiatry, Texas Tech University Health Sciences Center, Lubbock, USA 1 3 skills (e.g., initiation, working memory) in contrast (Freeman et al., 2017; Leung & Zakzanis, 2014; Ozonoff et al., 2004; Pugliese et al., 2015; Torske et al., 2018).”
Using the cognitive rigidity-flexibility dimension to deepen our understanding of the autism spectrum
Cahalan, S., Mitroff, S. R., Subiaul, F., & Rosenblau, G. (2025) · Personality Neuroscience · doi:10.1017/pen.2025.10002 · Cited by 11
“Slower shifts in extra-dimensional reversal learning has been shown to scale with behavioral inflexibility in individuals with an autism diagnosis (D ’ Cruz et al., 2013; Geurts et al., 2009; Leung & Zakzanis, 2014; Yerys et al., 2009).”
Your Need for Cognition, Cognitive Flexibility, and Cognitive Emotion Regulation Strategies Matter! The Path beyond a Satisfied Life
Kaynak, H., Nazlıgül, M. D., & Cengil, B. B. (2024) · The Journal of Psychology · doi:10.1080/00223980.2024.2352730 · Cited by 13
“In addition, people with greater cognitive flexibility are more adaptable and open to change, readily modifying their thought processes, opinions, and problem-solving strategies in response to new information or challenges (Leung & Zakzanis, 2014).”
A Problem-Solving Intervention Using iPads to Improve Transition-Related Task Performance of Students With Autism Spectrum Disorder
Yakubova, G., & Zeleke, W. A. (2016) · Journal of Special Education Technology · doi:10.1177/0162643416650023 · Cited by 10
Attentional Cueing and Executive Deficits Revealed by a Virtual Supermarket Task Coupled With Eye-Tracking in Autism Spectrum Disorder
Mouga, S., Duarte, I. C., Café, C., Sousa, D., Duque, F., Oliveira, G., & Castelo-Branco, M. S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.671507 · Cited by 12
Age-related differences in inhibitory control and memory updating in boys with Asperger syndrome
Weiss, E. M., Gschaidbauer, B., Kaufmann, L., Fink, A., Schulter, G., Mittenecker, E., & Papousek, I. (2016) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-016-0756-8 · Cited by 13
“Some authors suggest that EF deficits in adults with AS and high-functioning autism may not be apparent in standard neuropsychological tests of EFs such as the Wisconsin card sorting test (WCST) which are rather unspecific indicators of brain functions because they confound several cognitive components and processes […”
Background
Associations of autistic traits, executive dysfunction and the FKBP5 gene with emotion regulation in Chinese college students
Gong, J., He, Y., Zhou, L., Mo, Y., Yu, F., Liu, M., Yang, L., & Liu, J. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2021.111293 · Cited by 11
Cognitive flexibility in neurodevelopmental disorders: insights from neuroimaging and neuropsychology
Koithan, E. M., Demeter, D. V., Ali, S. A., Feigelis, M., & Greene, D. J. (2024) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2024.101429 · Cited by 11
Slow but Steady: Similarities and Differences in Executive Functioning Between Autistic and Non‐Autistic Adults
Jertberg, R., Begeer, S., Geurts, H. M., Chakrabarti, B., & der Burg, E. V. (2025) · Autism Research · doi:10.1002/aur.70015 · Cited by 10
Spanish version of the Adult Executive Functioning Inventory (ADEXI): Psychometric properties in adults with Autism Spectrum Disorders and Intellectual Disability
García-Villamisar, D. A., Jodra, M., Sáez‐Suanes, G. P., & Thorell, L. B. (2020) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.26183 · Cited by 9
“In addition, a review of studies of cognitive flexibility showed that ratings, but not tests, could discriminate between individuals with ASD and controls (Leung & Zakzanis, 2014).”
Background
Atypical Neural Responses of Cognitive Flexibility in Parents of Children With Autism Spectrum Disorder
Cheng, X., Li, Y., Cui, X., Cheng, H., Li, C., Fu, L., Jiang, J., Hu, Z., & Ke, X. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.747273 · Cited by 12
Accumbal Adenosine A2A Receptors Enhance Cognitive Flexibility by Facilitating Strategy Shifting
Zhou, J., Wu, B., Lin, X., Dai, Y., Li, T., Zheng, W., Guo, W. M., Vakal, S., Chen, X., & Chen, J. (2019) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2019.00130 · Cited by 9
Heterogeneity of executive functions among preschool children with psychiatric symptoms
Teivaanmäki, S., Huhdanpää, H., Kiuru, N. H., Aronen, E. T., Närhi, V. M., & Klenberg, L. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01437-y · Cited by 12
Successful attentional set-shifting in 2-year-olds with and without Autism Spectrum Disorder
Smith, H., Carter, A. S., Blaser, E., & Káldy, Z. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213903 · Cited by 11
Cognitive flexibility moderates the efficacy of a visuospatial intervention following exposure to analog trauma
Hemi, A., Sopp, M. R., Perel, A., Holmes, E. A., & Levy‐Gigi, E. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101858 · Cited by 8
Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems
Pugliese, C. E., Handsman, R., You, X., Anthony, L. G., Vaidya, C. J., & Kenworthy, L. E. (2024) · Autism · doi:10.1177/13623613241246091 · Cited by 8
“…meta-analyses have identified inconsistency in the magnitude and specificity of EF challenges (Demetriou et al., 2018; C. L. E.Lai et al., 2017; Leung & Zakzanis, 2014), calling for a more nuanced, ground-up investigation of this construct in autism using a multi-dimensional, data-driven…”
Subgroups of Children with Autism Spectrum Disorder without Intellectual Disability: A Longitudinal Examination of Executive and Socio-Adaptive Behaviors in Adolescence
Roselló, R., Berenguer, C., Martı́nez-Raga, J., Miranda, A., & Cortese, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10102220 · Cited by 11
Neural correlates of schema-dependent episodic memory and association with behavioral flexibility in autism spectrum disorders and typical development
Cook, K. M., You, X., Cherry, J. B. C., Merchant, J. S., Skapek, M., Powers, M. D., Pugliese, C. E., Kenworthy, L. E., & Vaidya, C. J. (2021) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-021-09388-9 · Cited by 8
“Moreover, behavioral inflexibility is associated with the two core characteristics of ASD, difficulty in social interaction [25] and engagement in restricted and repetitive behaviors [42, 45], and also predicts socially adaptive outcomes [10, 59, 60], although the direct link between cognitive and behavioral flexibili…”
Background
Olfactory capacity in anorexia nervosa: correlations with set-shifting ability
Karavia, A., Kapsali, F., Gonidakis, F., Koliou, A., Tsigkaropoulou, E., Papageorgiou, C., & Michopoulos, I. (2021) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-021-01188-3 · Cited by 7
An ecologically valid understanding of executive functioning
Monteiro, E. M. (2021) · Psychology in the Schools · doi:10.1002/pits.22627 · Cited by 9
Did you hear? Auditory prospective memory cues are more beneficial for autistic than for non-autistic children and adolescents
Sheppard, D. P., & Altgassen, M. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.104001 · Cited by 7
Brief Report: An Exploration of Cognitive Flexibility of Autistic Adolescents with Low Intelligence Using the Wisconsin Card Sorting Task
Lung, S. L. M., & Bertone, A. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05134-1 · Cited by 7
Cognitive flexibility in schizophrenia: A confirmatory factor analysis of neuropsychological measures
Knížková, K., Siroňová, A., Večeřová, M., Keřková, B., Šustová, P., Jonáš, J., Hrubý, A., & Rodríguez, M. (2023) · Applied Neuropsychology Adult · doi:10.1080/23279095.2023.2230508 · Cited by 6
“;) or in a set of tests (Champagne-Lavau et al., 2012; Leung & Zakzanis, 2014; Zmigrod et al., 2019).”
Attention and sensory integration for gait in young adults with autism spectrum disorder
Bick, N. A., Redfern, M. S., Jennings, J. R., Eack, S. M., Iverson, J. M., & Cham, R. (2024) · Gait & Posture · doi:10.1016/j.gaitpost.2024.04.035 · Cited by 6
Understanding cognitive flexibility in emotional evaluation in autistic males and females: the social context matters
Lacroix, A., Bennetot-Deveria, Y., Baciu, M., Dutheil, F., Magnon, V., Gomot, M., & Mermillod, M. (2024) · Molecular Autism · doi:10.1186/s13229-024-00622-4 · Cited by 8
Tracking Representational Flexibility Development through Speech Data Mining
Ke, F.-F., Moon, J., & Sokolikj, Z. (2020) · Frontiers in Education Conference · doi:10.1109/fie44824.2020.9273818 · Cited by 6
“The literature indicates card sorting, flexible item selection, and insight problems, along with qualitative observation or interviewing are the major methods of flexibility evaluation [9].”
Method
Probing the Neurodynamic Mechanisms of Cognitive Flexibility in Depressed Individuals with Autism Spectrum Disorder
Elmaghraby, R., Blank, E., Miyakoshi, M., Gilbert, D. L., Wu, S. W., Larsh, T., Westerkamp, G., Liu, Y., Horn, P. S., Erickson, C. A., et al. (2025) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2024.0109 · Cited by 5
“Among EF impairments, dif ﬁ culties in cognitive ﬂ exi-bility are frequently cited as the most impactful and are related to core ASD features (D ’ Cruz et al., 2016; D ’ Cruz et al., 2013; Dirks et al., 2020; Van Eylen et al., 2011; Hoofs et al., 2018; Leung and Zakzanis, 2014; Lage et al., 2022).”

Authors: Leung, R. C., & Zakzanis, K. K.
Affiliations: University of Toronto (CA)
Corresponding author: Leung, Rachel C.
ORCID: Leung, Rachel C.
Zakzanis, Konstantine K.
Venue: Journal of Autism and Developmental Disorders
Publisher: Springer Science and Business Media LLC
Published: 2014-05-27
Volume: 44
Issue: 10
Pages: 2628-2645
ISSN: 0162-3257 (ISSN-L)
1573-3432
DOI: 10.1007/s10803-014-2136-4
OpenAlex: W1981575082
Cited by: 192
References: 127
Citations by year: 2026: 11 · 2025: 20 · 2024: 28 · 2023: 19 · 2022: 18 · 2021: 32 · 2020: 11 · 2019: 16 · 2018: 11 · 2017: 8 · 2016: 10 · 2015: 5 · 2014: 3
FWCI: 0.84
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Autism and Developmental Disorders (publishedVersion)
PubMed (publishedVersion)
Funders: Sick Kids Foundation
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords: cognitive flexibility, autism spectrum disorder, executive function, neuropsychological assessment, discriminability, ecological validity, clinical biomarkers
MeSH terms: Child, Child Development Disorders, Pervasive, Cognition, Female, Humans, Neuropsychological Tests, Executive Function, Self Report

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Brief Report: Cognitive Flexibility in Autism Spectrum Disorders: A Quantitative Review

Abstract

Overview

Integrity signals

Verification

Claims the paper makes

Claims other papers make about this one

Citations

Cites

Cited by

Related

Metadata

Record

About these checks