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Cited by 538Autism Spectrum Disorder ResearchNeural and Behavioral Psychology StudiesChild and Animal Learning Development

The paradox of cognitive flexibility in autism

Open access
Geurts, Hilde M., Corbett, Blythe, Solomon, Marjorie·2009·Trends in Cognitive Sciences
DOI 10.1016/j.tics.2008.11.006PMC PMC5538880
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Abstract

We present an overview of current literature addressing cognitive flexibility in autism spectrum disorders. Based on recent studies at multiple sites, using diverse methods and participants of different autism subtypes, ages and cognitive levels, no consistent evidence for cognitive flexibility deficits was found. Researchers and clinicians assume that inflexible everyday behaviors in autism are directly related to cognitive flexibility deficits as assessed by clinical and experimental measures. However, there is a large gap between the day-to-day behavioral flexibility and that measured with these cognitive flexibility tasks. To advance the field, experimental measures must evolve to reflect mechanistic models of flexibility deficits. Moreover, ecologically valid measures are required to be able to resolve the paradox between cognitive and behavioral inflexibility.

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Claims the paper makes

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  • Findingcitation

    It has been difficult to clearly articulate the links between cognitive flexibility deficits and observed behavioral rigidity in autism.

    “Despite the strong face-validity of this relationship (Table 1), it has proven difficult to clearly articulate the links between them [6,7]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Joseph, 2004, The relationship of theory of mind and executive functions to symptom type and severity in children with autism, Dev. Psychopathol. source

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    • cites [7] Landa, 2005, Language, social, and executive functions in high functioning Autism: a continuum of performance, J. Autism Dev. Disord. source

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  • Findingcitation

    Correlations between executive function task performance and autism characteristics are aspecific because working memory and inhibition also relate to autism characteristics.

    “To date, the obtained correlations seem to be aspecific because other executive functions like working memory and inhibition also seem to relate to autism characteristics [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Lopez, 2005, Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic disorder, J. Autism Dev. Disord. source

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  • Findingcitation

    People with autism encounter difficulties performing the WCST.

    “Hence, we do not dispute that people with autism encounter difficulties when performing on this task.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Two studies found no TMT difficulties in children and adults with autism.

    “Two studies showed that children and adults with autism had no difficulties on the TMT [9,29].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Lopez, 2005, Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic disorder, J. Autism Dev. Disord. source

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    • cites [29] Corbett, B.A. et al. Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder, and typical development. Psychiatry Res. (in press)

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  • Findingcitation

    Studies using the Trail Making Test report mixed conclusions.

    “Studies using another clinical neuropsychological measure, the trail making test (TMT), report mixed conclusions [8,9,15–17,29].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [8] Hill, 2006, Executive processes in Asperger syndrome: patterns of performance in a multiple case series, Neuropsychologia source

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    • cites [9] Lopez, 2005, Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic disorder, J. Autism Dev. Disord. source

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    • cites [15] Goldstein, 2001, Attentional processes in autism, J. Autism Dev. Disord. source

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    • cites [16] Goldstein, 2002, High-functioning autism and schizophrenia - A comparison of an early and late onset neurodevelopmental disorder, Arch. Clin. Neuropsychol. source

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    • cites [17] Minshew, 2002, Abstract reasoning in autism: a dissociation between concept formation and concept identification, Neuropsychology source

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    • cites [29] Corbett, B.A. et al. Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder, and typical development. Psychiatry Res. (in press)

      Not checked in the free run.

  • Classified as probably not a substantial claim. 24
  • May combine two claims. 24

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    No other prominent cognitive theory of autism explains the observed inflexibility in autism.

    “So far, none of the other prominent cognitive autism theories gives an explanation for the observed inflexibility in autism.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Using the >3 cutoff, no TMT study provided evidence of cognitive flexibility problems in autism (autism ratios 2.0 or 2.1; schizophrenia >3).

    “If we calculate this ratio (autism groups 2.0 [15,16] or 2.1 [8], schizophrenia groups >3 [16]), none of the studies actually showed evidence for difficulties with cognitive flexibility in autism.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [15] Goldstein, 2001, Attentional processes in autism, J. Autism Dev. Disord. source

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    • cites [16] Goldstein, 2002, High-functioning autism and schizophrenia - A comparison of an early and late onset neurodevelopmental disorder, Arch. Clin. Neuropsychol. source

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    • cites [8] Hill, 2006, Executive processes in Asperger syndrome: patterns of performance in a multiple case series, Neuropsychologia source

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  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Landa and colleagues found that children with high functioning autism had ID-shift problems yet performed better than typically developing children on ED-shifts.

    “By contrast, Landa and colleagues [7] reported that children with high functioning autism had difficulties with ID-shifts, but outperformed typically developing children on ED-shifts.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Landa, 2005, Language, social, and executive functions in high functioning Autism: a continuum of performance, J. Autism Dev. Disord. source

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    Findingcitation

    One D-KEFS study of adults with autism reported no cognitive flexibility deficits, while another study of children with autism reported deficits.

    “One study of adults with autism reported no cognitive flexibility deficits [9], but another study including children with autism reported deficits [29].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Lopez, 2005, Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic disorder, J. Autism Dev. Disord. source

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    • cites [29] Corbett, B.A. et al. Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder, and typical development. Psychiatry Res. (in press)

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    Findingcitation

    Children with ADHD appear mainly challenged by switch paradigms, not by the ID/ED task.

    “However, the discrepancies in cognitive flexibility findings might not be so straight forward because ADHD children seem to be primarily challenged on switch paradigms [70,71] but not on the ID/ED task [29,32,34,35].”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [70] Cepeda, 2000, Task switching and attention deficit hyperactivity disorder, J. Abnorm. Child Psychol. source

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    • cites [71] Smith, 2006, Task-specific hypoactivation in prefrontal and temporoparietal brain regions during motor inhibition and task switching in medication-naive children and adolescents with attention deficit hyperactivity disorder, Am. J. Psychiatry source

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    • cites [29] Corbett, B.A. et al. Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder, and typical development. Psychiatry Res. (in press)

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    • cites [32] Happé, 2006, Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages, Brain Cogn. source

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    • cites [34] Goldberg, 2005, Subtle executive impairment in children with Autism and children with ADHD, J. Autism Dev. Disord. source

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    • cites [35] Sinzig, 2008, Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms, Child Adolesc. Psychiatry Ment. Health source

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    Findingcitation

    In those studies, neither the autism nor the ADHD children failed the ID/ED task.

    “In these studies, neither the children with autism nor the children with ADHD failed the task (see also Box 2).”
    Quote in the paperSubstantial claim

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    Findingcitation

    In Shafritz and colleagues, ASD task-related activation was confined to ventrolateral PFC during response or cognitive set shifts, while typically developing participants activated dorsolateral PFC, anterior cingulate, premotor cortex, and basal ganglia.

    “Task-related activation for individuals with ASD was limited to the ventrolateral PFC when a response shift or shift in cognitive set was required, whereas many other areas including dorsolateral PFC, anterior cingulate cortex, premotor cortex and the basal ganglia were activated in the TYP group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Shafritz, 2008, The neural circuitry mediating shifts in behavioral response and cognitive set in autism, Biol. Psychiatry source

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    Findingcitation

    Two studies reported WCST difficulties in ADHD children, but two others did not.

    “ADHD children showed difficulties with the WCST in two studies [20,68], but not in two other studies [14,69].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [20] Tsuchiya, 2005, Computerized version of the Wisconsin card sorting test in children with high-functioning autistic disorder or attention-deficit/hyperactivity disorder, Brain Dev. source

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    • cites [68] Nyden, 1999, Executive function/attention deficits in boys with Asperger syndrome, attention disorder and reading/writing disorder, Autism source

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    • cites [14] Geurts, 2004, How specific are executive functioning deficits in Attention Deficit Hyperactivity Disorder and autism?, J. Child Psychol. Psychiatry Allied Discip. source

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    • cites [69] Ozonoff, 1999, Brief report: specific executive function profiles in three neurodevelopmental disorders, J. Autism Dev. Disord. source

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    Findingcitation

    Shafritz and colleagues found no group differences in behavioral switching performance, but the ASD group had reduced activation in frontal, striatal, and parietal regions.

    “There were no differences between the groups in behavioral performance for switching, but there was reduced activation in frontal, striatal and parietal regions in the ASD group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Shafritz, 2008, The neural circuitry mediating shifts in behavioral response and cognitive set in autism, Biol. Psychiatry source

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    Findingcitation

    In the largest autism study so far, Ozonoff and colleagues found ED-shift problems but no ID-shift problems; the sample was a well-characterized national group of children with high functioning autism and Asperger syndrome.

    “However, Ozonoff and colleagues [36] reported difficulties with ED-shifts and not with ID-shifts in the largest autism study to date, which included a very well-characterized national sample of children with high functioning autism and Asperger syndrome.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Ozonoff, 2004, Performance on Cambridge neuropsychological test automated battery subtests sensitive to frontal lobe function in people with autistic disorder: evidence from the collaborative programs of excellence in autism network, J. Autism Dev. Disord. source

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  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    Sinzig and colleagues found ID/ED difficulties in children with autism plus comorbid ADHD, but not in children with autism without comorbid ADHD.

    “The findings of Sinzig and colleagues [35] suggest that children with autism with comorbid ADHD show difficulties with the task, whereas children with autism without any comorbid ADHD do not.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Sinzig, 2008, Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms, Child Adolesc. Psychiatry Ment. Health source

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    Findingreasoning

    For clinical neuropsychological measures, clear deficits are reported only by WCST studies; other measures yield inconsistent results that generally do not support deficits.

    “In summary, with respect to clinical neuropsychological measures, only studies using the WCST clearly report deficits (i.e. has high discriminating power), whereas the findings of studies using other measures are inconsistent, but generally do not support these findings.”
    Quote in the paperSubstantial claim

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    Findingcitation

    Schmitz and colleagues found that adults with ASD performed behavioral tasks as well as typically developing adults but had increased activation in right inferior and parietal areas during a task-switching paradigm.

    “In a relatively small study with a wide age range, Schmitz and colleagues [40] reported that adults with ASD, who performed behavioral tasks comparably to typically developing (TYP) adults, showed increased activation in the right inferior and parietal areas associated with performance on a task-switching paradigm in ASD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Schmitz, 2006, Neural correlates of executive function in autistic spectrum disorders, Biol. Psychiatry source

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    Findingcitation

    To our knowledge, just four studies have examined task-switching in autism, and none found performance deficits.

    “To our knowledge, only four studies have investigated task-switching in people with autism and none of them reported performance deficits [40–43].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [40] Schmitz, 2006, Neural correlates of executive function in autistic spectrum disorders, Biol. Psychiatry source

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    • cites [41] Shafritz, 2008, The neural circuitry mediating shifts in behavioral response and cognitive set in autism, Biol. Psychiatry source

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    • cites [42] Stahl, 2002, Joint attention and set-shifting in young children with autism, Autism source

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    • cites [43] Whitehouse, 2006, Inner speech impairments in autism, J. Child Psychol. Psychiatry Allied Discip. source

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  • May combine two claims.

    Findingreasoning

    The review's synthesis shows that cognitive flexibility deficit findings in autism from clinical neuropsychology (except WCST) and experimental cognitive psychology paradigms are inconsistent, even though behavioral inflexibility is evident in many respects.

    “This qualitative literature overview shows that the findings regarding cognitive flexibility deficits in individuals with autism as assessed by either clinical neuropsychology (other than the WCST) or experimental cognitive psychology paradigms, are rather inconsistent, despite exhibiting behavioral inflexibility in many respects.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Autism involves pervasive cognitive and behavioral rigidity across functional domains.
    • Rests on an assumption: Individuals with autism encounter difficulties changing strategy during daily activities and adapting their perspective during social interactions.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Findingnone given

    The field lacks clear mechanistic hypotheses about autism-related deficits that can be tested and validated.

    “The field lacks clear mechanistic hypotheses about the autism related deficits that can be tested and validated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Performance on clinical neuropsychological measures draws on a broad range of cognitive processes.

    “However, we question that failure on these measures is indeed because of cognitive inflexibility because performance on these measures draws upon a broad range of cognitive processes.”
    Quote in the paperNot a substantial claim

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    Interpretationcitation

    WCST failure can result from deficits in multiple cognitive processes, including learning from feedback, maintaining the goal, noticing a needed strategy change, inhibiting a previous response, switching responses, and sustaining responding.

    “Failure on the Wisconsin Card Sorting Task can be because of deficits in various cognitive processes including learning from feedback, keeping the goal of the task in mind, noticing that a change in strategy is necessary, inhibiting a previous motor response, switching to another response and sustaining responding over time.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [24] Barcelo, 1999, Role of dorsolateral prefrontal cortex in attentional set shifting: parsing the cognitive significance of WCST errors with event-related potentials, Psychophysiology

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    • cites [25] Ozonoff, 1995, Reliability and validity of the Wisconsin card sorting test in studies of autism, Neuropsychology source

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    • cites [26] Sergeant, 2002, How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder?, Behav. Brain Res. source

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    Premisecitation

    The MCST warning that the sorting rule needs to change does not ensure participants can change or ascertain the new rule.

    “The MCST includes a warning that the sorting rule needs to be changed, however this does not ensure the participants can do so or ascertain the new sorting rule [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Zelazo, 1996, An age-related dissociation between knowing rules and using them, Cogn. Dev. source

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  • Classified as probably not a substantial claim.

    Premisecitation

    A TMT ratio score (first part relative to second) higher than three indicates cognitive flexibility difficulties.

    “Arbuthnott and Frank [30] showed that a ratio score of the first part of the task in relation to the second part that is higher than three is indicative of cognitive flexibility difficulties.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Arbuthnott, 2000, Trail making test, part B as a measure of executive control: validation using a set-switching paradigm, J. Clin. Exp. Neuropsychol. source

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    Study design and conductreasoning

    The ID/ED task has two potential confounds: those who do not reach the final stages receive the maximum error score automatically, which may obscure findings; and sustained attention difficulties can decrease performance.

    “Nonetheless, there are two potential confounds in this task. First, participants failing to reach the final stages of the task are automatically given the highest error score, which might obscure findings (Box 1). Sustaining attention difficulties, as opposed to cognitive flexibility, can decrease performance on this task, which is the second potential confound.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Before imaging studies can support conclusions about cognitive flexibility, more research is needed with mechanistically plausible hypotheses, well-controlled paradigms, and large samples of children with ASD.

    “This very brief overview of recent neuroimaging findings indicates that more studies based on mechanistically plausible hypotheses using well-controlled experimental paradigms, including large samples of children with ASD, will be required before it is possible to draw conclusions about cognitive flexibility from imaging studies.”
    Quote in the paperNot a substantial claim

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    Interpretationcitation

    ASD and ADHD are both linked to cognitive control difficulties, but they appear to differ on cognitive flexibility.

    “Hence, both ASD and ADHD have been associated with cognitive control difficulties, but ostensibly diverge when we focus on cognitive flexibility.”
    Quote in the paperSubstantial claim

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    Interpretationreasoning

    The WCST has serious problems that prevent concluding that failure reflects cognitive inflexibility, though failure could stem from generalized performance deficits.

    “First, as described in the previous paragraph, there are serious issues with the WCST that makes it impossible to conclude that failure is indeed because of cognitive inflexibility, although failure might be because of generalized performance deficits (i.e. executive functioning deficits).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Doing well on the ID/ED task does not forecast doing well on a task-switch paradigm because other factors, such as level of attention shifting, probably determine performance.

    “Stated simply, success on the ID/ED task does not predict success on a task-switch paradigm because other factors, such as the level of attention shifting (i.e. feature versus dimension) probably have a role in determining performance (Box 1).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Whether ADHD comorbidity in autism validly explains the mixed ID/ED findings remains unclear.

    “Thus, it remains unclear whether comorbidity of ADHD in autism is a valid explanation for mixed findings (Box 3).”
    Quote in the paperSubstantial claim

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    Interpretationcitation

    Subtype differences cannot adequately account for the mixed findings, since Happé included only children with ADHD of the combined subtype.

    “Because Happé [32] only included children with ADHD of the combined subtype, differences related to subtype do not provide a sufficient explanation for these mixed findings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Happé, 2006, Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages, Brain Cogn. source

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  • Classified as probably not a substantial claim.

    Premisecitation

    There is a striking co-occurrence of autism with ADHD.

    “Some argue that attention difficulties are central to autism [37], and there is a striking co-occurrence of autism with attention deficit hyperactivity disorder (ADHD) [38,39].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [38] Gadow, 2005, Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples, Autism source

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    • cites [39] Gadow, 2006, ADHD symptom subtypes in children with pervasive developmental disorder, J. Autism Dev. Disord. source

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    Premisecitation

    ADHD is well established to involve severe cognitive control difficulties, yet cognitive flexibility does not seem to be a core deficit.

    “It is well established that people with ADHD encounter various severe cognitive control difficulties [57], but cognitive flexibility does not seem to be a key deficit [4,12,26,57,67].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [57] Nigg, 2005, An integrative theory of attention-deficit/hyperactivity disorder based on the cognitive and affective neurosciences, Dev. Psychopathol. source

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    • cites [4] Pennington, 1996, Executive functions and developmental psychopathology, J. Child Psychol. Psychiatry Allied Discip. source

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    • cites [12] Willcutt, 2008, Recent developments in neuropsychological models of childhood psychiatric disorders, Adv. Biol. Psychiatry source

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    • cites [26] Sergeant, 2002, How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder?, Behav. Brain Res. source

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    • cites [67] Willcutt, 2005, Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review, Biol. Psychiatry source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The order of trial types in the ID/ED task lacks a validated neural network model of cognitive control as its basis.

    “Second, to our knowledge the sequence of trial types involved in the ID/ED is not based on a validated neural network model of cognitive control.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In typically developing adults, good and poor performance on a cognitive flexibility task were linked to activation of different neural circuits (ventral MPFC and rostral ACC versus DLPFC, MPFC and parietal cortex).

    “For example, Wager and colleagues [48] reported that in typically developing adults, good and poor performance on a cognitive flexibility task were associated with activation of different neural circuits (ventral medial prefrontal cortex [MPFC] and rostral anterior cingulate cortex [ACC], and dorsolateral PFC [DLPFC], MPFC and parietal cortex, respectively).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Wager, 2005, Towards a taxonomy of attention shifting: individual differences in fMRI during multiple shift types, Cogn. Affect. Behav. Neurosci. source

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  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The correlations in those examples may reflect a general executive functioning deficit.

    “Therefore, the correlations obtained in the given examples [8–10] might be because of a general executive functioning deficit”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Other top-down factors and bottom-up mediating variables may explain inflexibility better than the measures discussed so far.

    “Other top down factors and/or mediating variables (bottom up) might better explain inflexibility than the measures discussed so far.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Greater ecological validity always reduces the mechanistic purity of a task.

    “However, increasing ecological validity always comes at the cost of reducing the mechanistic purity of the task.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationcitation

    Comparing clinical groups may help clarify the etiology of each disorder and reveal similarities and differences among neurodevelopmental disorders.

    “Hence, these comparisons between clinical groups might help us to unravel the etiology of each of these disorders and will provide insight into the differences and similarities among various neurodevelopmental disorders [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Casey, 2001, Evidence for a mechanistic model of cognitive control, Clin. Neurosci. Res. source

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    • Rests on an assumption: Neurodevelopmental disorders may differ in the onset of apparent deficits and in the neurobiological substrate where those deficits arise.

  • Classified as probably not a substantial claim.

    Premisereasoning

    ADHD characteristics require careful consideration in research on autism.

    “However, there is considerable evidence that ADHD characteristics need to be carefully considered when studying autism (Box 2)”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Attention difficulties may interact with deficits in other developmental domains in autism.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Failure on the WCST may be due to social-motivational factors.

    “For example, failure on the WCST might be because of social-motivational factors [25,26]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Ozonoff, 1995, Reliability and validity of the Wisconsin card sorting test in studies of autism, Neuropsychology source

      Not checked in the free run.

    • cites [26] Sergeant, 2002, How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder?, Behav. Brain Res. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Failure on the WCST may be due to uncertainty about task expectations, which may evoke stress.

    “or uncertainty regarding the expectations of the task which might evoke stress.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In DSM-IV-TR, a diagnosis of autism and a diagnosis of ADHD cannot be assigned at the same time.

    “In the current diagnostic statistical manual (DSM)-IV-text revision [1], both diagnoses cannot be given simultaneously.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders (4th ed., TR) American Psychiatric Association

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  • Classified as probably not a substantial claim.

    Premisecitation

    Not all switches are equivalent.

    “Ravizza and Carter [49] have argued that all switches are not created equal”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Ravizza, 2008, Shifting set about task switching: behavioral and neural evidence for distinct forms of cognitive flexibility, Neuropsychologia source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A certain level of arousal and/or stress supports optimal performance.

    “It is well-established that a certain level of arousal and/or stress is conducive for optimal performance”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Yerkes, 1908, The relation of strength of stimulus to rapidity of habit-formation, J. Comp. Neurol. Psychol. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Over- or under-arousal may plausibly connect psychobiological factors to cognitive flexibility task performance in autism.

    “Although unstudied, over or under arousal might provide a plausible connection between psychobiological factors and performance on cognitive flexibility tasks in autism.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Task-switching paradigms have been widely studied in typical development, which provides a context for their use in atypical populations.

    “One benefit of task-switching paradigms is that they have been extensively studied in typical development, providing a context for use in atypically developing populations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Going directly from mechanistic tasks to observable behavior may be too large a gap to bridge.

    “To go directly from the mechanistic tasks to observable behavior might be too large a gap to bridge.”
    Quote in the paperNot a substantial claim
44 of 44

  • The paper relies on this without support.

    Autism involves pervasive cognitive and behavioral rigidity across functional domains.

    “Clinical observation indicates that pervasive cognitive and behavioral rigidity across functional domains is diagnostic of autism.”

  • The paper relies on this without support.

    Individuals with autism encounter difficulties changing strategy during daily activities and adapting their perspective during social interactions.

    “They encounter difficulties in changing strategy during daily activities or adapting their perspective during social interactions.”

  • The paper relies on this without support.

    Autism involves deficits in both cognitive and motivational domains.

    “because we know that autism is associated with deficits in both domains.”

  • The paper relies on this without support.

    Neurodevelopmental disorders may differ in the onset of apparent deficits and in the neurobiological substrate where those deficits arise.

    “Moreover, neurodevelopmental disorders might differ in terms of onset of apparent deficits in addition to the neurobiological substrate level in which these deficits arise.”

  • The paper relies on this without support.

    Attention difficulties may interact with deficits in other developmental domains in autism.

    “because attention difficulties might interact with deficits in other developmental domains where people with autism are challenged.”
5 of 5

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?

  • ACT presents a promising alternative to CBT for autistic individuals, as it addresses some of the difficulties associated with core symptoms of autism, including lack of cognitive flexibility and perseveration or rumination.

    “ACT presents a promising alternative to CBT for autistic individuals, as it addresses some of the difficulties associated with core symptoms of autism, including lack of cognitive flexibility (Geurts et al ., 2009) and perseveration or rumination (Gotham et al ., 2014; Patel et al ., 2017).”

    From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Geurts et al., 2009

    The citation is attached to the claim about lack of cognitive flexibility, not the claims about ACT or rumination. In “Why is this important?”, the review describes difficulties adapting behavior in everyday life, but its “Conclusions and future directions” say that findings on cognitive flexibility deficits are inconsistent. It therefore supports observed inflexibility in autism, but not an unqualified claim that a cognitive flexibility deficit is established. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • It is difficult to understand relationships between behavioral data and psychophysiological data.

    “It is likewise difficult to understand relationships between behavioral data and psychophysiological data (Geurts et al., 2009; Watts et al., 2016).”

    From Sensory, emotional and cognitive contributions to anxiety in autism spectrum disorders (2017) · cites this paper as Geurts et al., 2009

    In “Conclusions and future directions” (page not provided), the paper says it has been challenging to link cognitive-flexibility task performance to actual behavior. It also discusses psychobiological factors such as stress, but does not establish the claimed difficulty of relating behavioral data specifically to psychophysiological data. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Well-documented inflexible everyday behaviours in ASD are not necessarily directly related to experimentally assessed cognitive flexibility deficits.

    “It is important to note that well-documented inflexible everyday behaviours in ASD are not necessarily directly related to cognitive flexibility deficits assessed experimentally85.”

    From Cognitive and behavioural flexibility: Neural mechanisms and clinical considerations (2021) · cites this paper as [85]

  • Despite reports of cognitive flexibility deficits in ASD, particularly in younger children, there are conflicting notions regarding the extent, nature, etiology, and neurobiology of these deficits.

    “Despite reports of cognitive flexibility deficits in ASD (70,71), particularly in younger children (72,73), there are conflicting notions regarding the extent, nature, etiology, and neurobiology of these deficits (74).”

    From Brain Mechanisms Supporting Flexible Cognition and Behavior in Adolescents With Autism Spectrum Disorder (2021) · cites this paper as [74]

  • Although individuals with ASD appear behaviorally rigid in daily activities, neuropsychological and laboratory-based measures of cognitive flexibility provide mixed results with respect to patterns of executive function deficits.

    “Although individuals with ASD appear behaviorally rigid in daily activities, neuropsychological and laboratory-based measures of cognitive flexibility provide mixed results with respect to patterns of EF deficits (74).”

    From Brain Mechanisms Supporting Flexible Cognition and Behavior in Adolescents With Autism Spectrum Disorder (2021) · cites this paper as [74]

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Ambery, 2006, Differences in neuroanatomy and their relationship to cognitive functioning in people with Asperger's syndrome and high functioning autism, Biol. Psychiatry, 59
  2. Barcelo, 1999, Role of dorsolateral prefrontal cortex in attentional set shifting: parsing the cognitive significance of WCST errors with event-related potentials, Psychophysiology, 36, S30
  3. Cambridge, 2002

Cited by

Sorted by citations

Related

Authors
Geurts, H. M., Corbett, B., & Solomon, M.
Affiliations
  • University of Amsterdam (NL)
  • University of California, Davis (US)
  • University of California Davis Medical Center (US)
Corresponding author
Geurts, Hilde M.
ORCID
Venue
Trends in Cognitive Sciences
Publisher
Elsevier BV
Published
2009-02
Volume
13
Issue
2
Pages
74-82
ISSN
1364-6613 (ISSN-L)
DOI
10.1016/j.tics.2008.11.006
PMC
PMC5538880
OpenAlex
W2172212100
Semantic Scholar
9cc30d3a092a72fa716448ca4e1e29565e01e55c
Cited by
538
References
71
Citations by year
2026: 34 · 2025: 30 · 2024: 39 · 2023: 36 · 2022: 26 · 2021: 40 · 2020: 43 · 2019: 45 · 2018: 34 · 2017: 33 · 2016: 22 · 2015: 24 · 2014: 31 · 2013: 24 · 2012: 33
FWCI
1.91
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Trends in Cognitive Sciences (publishedVersion)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • University of California, Davis
  • National Institute of Mental Health (K08MH074967)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Developmental and Educational Psychology › Child and Animal Learning Development
Keywords
cognitive flexibility, autism spectrum disorder, behavioral inflexibility, ecological validity, autism subtypes
MeSH terms
Autistic Disorder, Cognition, Humans, Neuropsychological Tests, Psychiatric Status Rating Scales, Psychomotor Performance, Pliability

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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.

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