Real-world executive functions in adults with autism spectrum disorder: profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression

Wallace, Gregory L.; Kenworthy, Lauren; Pugliese, Cara E.; Popal, Haroon S.; White, Emily I.; Brodsky, Emily; Martin, Alex

doi:10.1007/s10803-015-2655-7

Cited by 261Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesDevelopmental and Educational Neuropsychology

Real-world executive functions in adults with autism spectrum disorder: profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression

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Wallace, Gregory L., Kenworthy, Lauren, Pugliese, Cara E., Popal, Haroon S., White, Emily I., Brodsky, Emily, Martin, Alex·2016·Journal of Autism and Developmental Disorders

DOI 10.1007/s10803-015-2655-7PMC PMC5111802

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Abstract

Although executive functioning (EF) difficulties are well documented among children and adolescents with autism spectrum disorder (ASD), little is known about real-world measures of EF among adults with ASD. Therefore, this study examined parent-reported real-world EF problems among 35 adults with ASD without intellectual disability and their correlations with adaptive functioning and co-morbid anxiety and depression symptomatology. A variable EF profile was found with prominent deficits occurring in flexibility and metacognition. Flexibility problems were associated with anxiety-related symptoms while metacognition difficulties were associated with depression symptoms and impaired adaptive functioning (though the metacognition-adaptive functioning relationship was moderated by ADHD symptoms). These persistent EF problems are predictors of broader functioning and therefore remain an important treatment target among adults with ASD.

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Difficulties with habituation and flexibility, associated with disrupted integration between mPFC and limbic regions, can be treated directly with benefits for anxiety and depression.
“Difficulties with habituation and flexibility, associated with disrupted integration between mPFC and limbic regions, can also be treated directly with benefits for anxiety and depression (Kenworthy et al., 2014; Lawson et al., 2015; Wallace et al., 2016).”
From Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders (2017) · cites this paper as Wallace et al., 2016
The Results and Discussion report an association between inflexibility and anxiety in adults with ASD, and identify executive-function difficulties as a potential treatment target (page numbers unavailable). But the Discussion explicitly says whether such treatment benefits anxiety or depression remains unknown. The paper does not establish habituation difficulties or disrupted mPFC–limbic integration as the mechanism. (LLM, conf=0.90)
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“…memory, inhibition, or planning) often impair the ability to cope with daily hassles and reach long-term goals (Bednarz et al., 2020; Uddin, 2021; Wallace et al., 2016) and affect essential life areas, such as social relationships, work, and independent living (Bishop-Fitzpatrick et al., 2017;…”
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Executive Functioning Is Linked to Mental Health Challenges Among Autistic Adults with Higher Support NeedsPreprint
Greenstein, E., Lee, N., McQuaid, G. A., & Wallace, G. L. (2025) · doi:10.31234/osf.io/7rheu_v1
Executive Functioning Is Linked to Internalizing Symptoms in Autistic Adults With Higher Support Needs
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Everyday executive function predicts adaptive and internalizing behavior among children with and without autism spectrum disorder
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Associations between executive function and core symptoms of attention-deficit/hyperactivity disorder in adults with autism spectrum disorder: Controlling for theory of mind, and age
Baamer, M. Y. I. (2026) · Applied Neuropsychology Adult · doi:10.1080/23279095.2026.2737793
Executive Function: Cognition and Behaviour in Adults with Autism Spectrum Disorders (ASD)
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Authors: Wallace, G. L., Kenworthy, L., Pugliese, C. E., Popal, H. S., White, E. I., Brodsky, E., & Martin, A.
Affiliations: George Washington University (US)
Children's National (US)
National Institute of Mental Health (US)
Corresponding author: Wallace, Gregory L.
ORCID: Wallace, Gregory L.
Kenworthy, Lauren
Pugliese, Cara E.
Popal, Haroon S.
White, Emily I.
Martin, Alex
Venue: Journal of Autism and Developmental Disorders
Publisher: Springer Science and Business Media LLC
Published: 2015-11-16
Volume: 46
Issue: 3
Pages: 1071-1083
ISSN: 0162-3257 (ISSN-L)
1573-3432
DOI: 10.1007/s10803-015-2655-7
PMC: PMC5111802
OpenAlex: W2172314818
Cited by: 261
References: 49
Citations by year: 2026: 13 · 2025: 21 · 2024: 23 · 2023: 30 · 2022: 29 · 2021: 44 · 2020: 32 · 2019: 20 · 2018: 17 · 2017: 23 · 2016: 9
FWCI: 9.82
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Journal of Autism and Developmental Disorders (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Mental Health (1-ZIA-MH002920)
National Institutes of Health (HD046388-01A2)
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
Keywords: executive function, autism spectrum disorder, autistic adults, adaptive behavior, anxiety, depression, metacognition, cognitive flexibility, ADHD comorbidity, real-world functioning
MeSH terms: Autism Spectrum Disorder, Adaptation, Psychological, Adolescent, Adult, Anxiety, Depression, Female, Humans, Male, Neuropsychological Tests, Comorbidity, Young Adult, Executive Function

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Real-world executive functions in adults with autism spectrum disorder: profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression

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