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Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders
Abstract
OBJECTIVE: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) both have psychiatric comorbidities and distinctive profiles of executive dysfunction. Although there is evidence that executive function (EF) plays a role in the expression of specific behaviors and psychiatric symptoms, it is not known whether specific EF deficits in ASD and ADHD may be pathways to comorbidities in the disorders. This study examines whether parent reported problems with flexibility in ASD and inhibition in ADHD mediate the disorders' associations with anxiety/depression and oppositional/aggressive behavior, respectively. METHOD: Parent report data from the Behavior Rating Inventory of Executive Function (BRIEF) and the Child Behavior Checklist (CBCL) were obtained for 125 children (70 ASD, 55 ADHD Hyperactive/Impulsive or Combined type) as part of a neuropsychological assessment. Diagnostic status, BRIEF Shift (shifting/flexibility) and Inhibit (behavioral inhibition) scale scores, and CBCL Anxious/Depressed (anxiety/depression) and Aggressive Behavior (oppositionality/aggression) scale scores were analyzed with a path analysis to investigate the relation of flexibility and inhibition to comorbid symptoms in children with ASD and ADHD. RESULTS: In a path model with good fit ASD predicted greater inflexibility which predicted greater anxiety/depression, while ADHD predicted greater disinhibition that predicted greater aggression, consistent with our mediational hypotheses. Unexpectedly, the greater inflexibility associated with ASD also predicted greater aggression. CONCLUSIONS: Findings support the importance of everyday EF problems in ASD and ADHD as predictors of comorbid psychopathology and as crucial intervention targets for potential prevention and mitigation of comorbid symptoms.
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“set-shifting and inhibition predicted internalizing and externalizing psychopathology in ASD and ADHD (Lawson et al., 2015).”
From Data‐driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders (2020) · cites this paper as Lawson et al., 2015
In the citing paper
“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 Lawson et al., 2015
In the citing paper
“as several studies have found CI to be associated with self and parent-reported depression in autistic individuals (Gabrys et al., 2018; Hollocks et al., 2014, 2022a, 2022b; Lawson et al., 2015).”
From Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. (2025) · cites this paper as Lawson et al., 2015
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“These indicated that a wide variety of EF skills were improved in child’s real daily life, which were very important since the everyday EF problems were predictors of comorbid psychopathology.[54,59]”
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“…vulnerability factors (e.g. attentional difficulties, selective attention bias, or negative memory bias to all emotional cues; Antshel et al., 2016; Lawson et al., 2015) serve as a symptom cluster bridging symptoms related to MDD with those related to neurodevelopmental disorders, making ASD…”
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“…for primary hypertension in adolescents resulted in changes between baseline and 12-month follow-up on the BRIEF but not on the CBCL. Finally, Lawson et al. (2015) present evidence that BRIEF ratings of inflexibility mediate the relationship between autism spectrum disorder and anxiety/…”
BackgroundExecutive Function in High-Functioning Autism Spectrum Disorder: A Meta-analysis of fMRI Studies
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Mice lacking cyclin-dependent kinase-like 5 manifest autistic and ADHD-like behaviors
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“[30] However, the importance of everyday EF problems in ADHD was emphasized since they were predictors of comorbid psychopathology[31]”
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“Overall, many studies found that the parent/teacher reported CI significantly correlated with greater symptoms of anxiety (Dieckhaus et al., 2021; Lawson et al., 2015; Uljarevi c et al., 2022; Vogan et al., 2018), depression (Gardiner & Iarocci, 2018; Lawson et al., 2015; Lieb & Bohnert, 2017) and…”
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ResultAutonomic and Electrophysiological Evidence for Reduced Auditory Habituation in Autism
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“Research has also found that comorbid anxiety may mitigate some EF problems by increasing cortical arousal and alertness (Arnsten, 2009), but can worsen performance on more complex EF tasks (e.g., Castagna et al., 2019; Lawson et al., 2015).”
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BackgroundBergman, M. A., Schene, A. H., Vissers, C., Vrijsen, J. N., Kan, C. C., & van Oostrom, I. (2019) · Research in Autism · doi:10.1016/j.rasd.2019.101455 · Cited by 20
Liu, C., Liu, R., Tao, R., Feng, J., Liang, X., Yang, Y., & Sit, C. H. P. (2025) · Preventive Medicine · doi:10.1016/j.ypmed.2025.108246 · Cited by 16
Kenny, L., Remington, A., & Pellicano, E. (2024) · Autism · doi:10.1177/13623613231224093 · Cited by 22
“This is despite EF challenges regularly being reported in questionnaire measures of real-world EF (e.g. Kenworthy et al., 2005; R. A. Lawson et al., 2015), and regularly described by autistic people (Cribb et al., 2019; DePape & Lindsay, 2016; Livingston et al., 2019; Pellicano et al., 2021).”
BackgroundSmith, T. F., Kaczorowski, J. A., & Acosta, M. T. (2020) · Child s Nervous System · doi:10.1007/s00381-020-04745-w · Cited by 16
“Difficulty with cognitive flexibility is also observed in NF1-related comorbidities, like ASD [95, 96] and anxiety [97, 98].”
BackgroundAnxiety relates to classroom executive function problems in students with ASD, but not ADHD
Dieckhaus, M. F. S., Hardy, K. K., Anthony, L. G., Verbalis, A. D., Kenworthy, L. E., & Pugliese, C. E. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101739 · Cited by 17
Self-citationFitzgerald, B., McCusker, C. G., Dempsey, M., & DunnGalvin, A. (2023) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-023-00385-3 · Cited by 17
Vaidya, C. J., & Klein, C. (2022) · Current topics in behavioral neurosciences · doi:10.1007/7854_2022_334 · Cited by 15
Lupi, E., Tucci, F., Casula, L., Novello, R. L., Guerrera, S., Vicari, S., & Valeri, G. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1092164 · Cited by 16
“, 2014) and emotional and behavioral problems over time (Hollocks et al., 2014; Lawson et al., 2015).”
BackgroundDevelopment and Psychometric Evaluation of the Open-Source Challenging Behavior Scale (OS-CBS)
Frazier, T. W., Khaliq, I. N., Scullin, K. M., Uljarević, M., Shih, A. J., & Karpur, A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05750-5 · Cited by 13
“For the present study, the general executive composite raw score was expected to show a moderate association with the OS-CBS total score (.30 > r > .50), as poor executive function may contribute to psychopathology and challenging behavior (Lawson et al., 2015).”
Barnes, G. L., Ozsivadjian, A., Baird, G., Absoud, M., & Hollocks, M. J. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06246-0 · Cited by 12
Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive–Compulsive Disorder
Thomas, K. S., Birch, R. E., Jones, C. R. G., & Vanderwert, R. E. (2022) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2022.841633 · Cited by 14
“with a neurodevelopmental condition, such as autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), may represent a clear “at-risk” group for the development of AN and OCD, as studies commonly report executive functioning impairments in these samples (e.g., Ozonoff and Jensen, 1999; Lawson…”
BackgroundGodoy, P. B. G., Shephard, E., Milosavljevic, B., Johnson, M. H., Charman, T., The BASIS Team, Baron‐Cohen, S., Bedford, R., Bolton, P., Chandler, S., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04732-9 · Cited by 12
Wong, O. W. H., Barzilay, R., Lam, A. M. W., Chan, S. S. M., Calkins, M. E., Gur, R. E., & Gur, R. C. (2022) · Psychological Medicine · doi:10.1017/s0033291722001787 · Cited by 15
“Studies have demonstrated that executive dysfunction in ASD could be related to psychopathology such as anxiety (Hollocks et al., 2014), depressive disorders (Wallace et al., 2016), aggressive behaviors (Lawson et al., 2015), and ADHD (Craig et al., 2016).”
BackgroundDoyle, L. R., Glass, L., Wozniak, J. R., Kable, J. A., Riley, E. P., Coles, C. D., Sowell, E. R., Jones, K. L., Mattson, S. N., & CIFASD, T. (2019) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.14036 · Cited by 12
Ng, R., Bjornsson, H. T., Fahrner, J. A., & Harris, J. R. (2023) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acad060 · Cited by 11
Fossum, I. N., Orm, S., Andersen, P. N., Geurts, H. M., Øie, M. G., & Skogli, E. W. (2023) · Developmental Neuropsychology · doi:10.1080/87565641.2023.2206663 · Cited by 12
“EF difficulties are one potential mechanism underlying the development and maintenance of co-occurring symptoms among individuals with ASD (Andersen et al., 2017; R. A. Lawson et al., 2015).”
BackgroundFlynn, R. M., & Colon-Acosta, N. (2016) · Games for Health Journal · doi:10.1089/g4h.2016.0053 · Cited by 15
Skogli, E. W., Andersen, P. N., Orm, S., Hovik, K. T., & Øie, M. G. (2022) · International Journal of Disability Development and Education · doi:10.1080/1034912x.2022.2095360 · Cited by 10
“…to typically developing children (TDC) (Gioia, Isquith, Kenworthy, & Barton, 2002; Hovik et al., 2017; Kouklari, Tsermentseli, & Monks, 2018; Lawson et al., 2015; Mahone et al., 2002; Rosenthal et al., 2013; Semrud-Clikeman, Walkowiak, Wilkinson, & Butcher, 2010; Sergeant, Geurts, &…”
“The Videos Made Me Feel Less Alone”: Feasible Executive Function Supports For Families
Smith, J. V., Dahlman, T., Holmes, J., Armour, C. A., Verbalis, A. D., Ratto, A. B., Hardy, K. K., Gunn, M., Decker, K., Brown, D., et al. (2024) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02768-w · Cited by 9
“EF challenges predict lower quality of life (de Vries & Geurts, 2015, Snyder et al., 2015), co-occurring psychiatric conditions or symptoms (Lawson et al., 2015; Wallace et al. 2016), and poorer adaptive functioning (Pugliese et al., 2014, 2016).”
Self-citationDickson, K. S., Galligan, M. R. L., Holt, T., Kenworthy, L. E., Anthony, L. G., Roesch, S. C., & Brookman-Frazee, L. I. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06365-8 · Cited by 10
“Executive dysfunction is related to concurrent and enduring negative outcomes, including increased co-occurring mental health symptoms in autistic children (Lawson et al., 2015; Pugliese et al., 2020).”
Self-citationHollocks, M. J., McQuaid, G. A., Yerys, B. E., Strang, J. F., Anthony, L. G., Kenworthy, L. E., Lee, N., & Wallace, G. L. (2023) · Autism Research · doi:10.1002/aur.3025 · Cited by 10
“…cognitive flexibility are a common experience for autistic people and have been associated with a range of difficulties including reduced adaptive skills (Bertollo et al., 2020) and greater emotional and behavioral challenges (Hollocks et al., 2021; Lawson et al., 2015; Ozsivadjian et al., 2021).”
Self-citationSchippers, E. E., Hoogsteder, L. M., & Stams, G. J. J. M. (2020) · Journal of Forensic Sciences · doi:10.1111/1556-4029.14539 · Cited by 9
“lem behaviors, since not only aggression, but many psychiatric problems relate to poor EF (21,22).”
BackgroundBerenguer, C., Miranda, B. R., & Leader, G. (2018) · Journal of Educational and Developmental Psychology · doi:10.5539/jedp.v8n2p107 · Cited by 9
“Flexibility involves transitioning from one thought to another, shifting successfully from one task to another, and using flexible problem solving in a variety of contexts (Lawson et al., 2015).”
BackgroundPugliese, C. E., Handsman, R., You, X., Anthony, L. G., Vaidya, C. J., & Kenworthy, L. E. (2024) · Autism · doi:10.1177/13623613241246091 · Cited by 8
“Specifically, we expect an EF profile characterized by inflexibility will be uniquely associated with anxiety, depression, and aggression (e.g. Hollocks et al., 2014; Lawson et al., 2015).”
Self-citationCapp, S., Burca, A. D., Aydın, Ü., Agnew‐Blais, J. C., Lautarescu, A., Ronald, A., Happe, F. G. E., & McLoughlin, G. (2025) · JCPP Advances · doi:10.1002/jcv2.70003 · Cited by 9
“Better - informed interventions may also target executive function demands in early adulthood to mitigate their effects on mental health in individuals with high autistic or ADHD traits (Aydin et al., 2022; Lawson et al., 2015).”
Dickson, K. S., Kenworthy, L. E., Anthony, L. G., & Brookman-Frazee, L. I. (2022) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2021.2013142 · Cited by 7
“However, further work examining this possibility is needed, especially for additional mental health conditions beyond ASD and ADHD.”
BackgroundInfluentialSelf-citationRodgers, J., & South, M. (2020) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13340 · Cited by 7
“There are a few studies linking cognitive inflexibility in autism to anxiety symptoms (Hol-locks, Howlin, Papadopoulos, Khondoker, & Simon-off, 2014) and externalising difficulties (Lawson et al., 2015).”
BackgroundChien, Y., Tai, Y., Chiu, Y., Tsai, W., & Gau, S. S. (2023) · Autism · doi:10.1177/13623613231184733 · Cited by 10
“Several studies have adopted the BRIEF to investigate everyday executive functions in autism (Blijd-Hoogewys et al., 2014; Gilotty et al., 2002; Gioia et al., 2002; Kenworthy et al., 2005; Lawson et al., 2015; Rosenthal et al., 2013; Smidts & Huizinga, 2009; van den Bergh et al., 2014).”
BackgroundBrookman-Frazee, L. I., Baker-Ericzén, M. J., Chan, J., Dickson, K. S., Rieth, S. R., Haine‐Schlagel, R., Stadnick, N. A., Stahmer, A. C., & Suhrheinrich, J. (2022) · Autism and child psychopathology series · doi:10.1007/978-3-030-88538-0_26 · Cited by 6
Do executive functions buffer against COVID-19 stress?
Ng, T. L. Y., Majeed, N. M., Lua, V. Y. Q., & Hartanto, A. (2023) · Current Psychology · doi:10.1007/s12144-023-04652-8 · Cited by 7
“For instance, greater proficiency in executive function tasks has been associated with better mental (Lawson et al., 2015 ; Paelecke-Habermann et al., 2005 ; Penadés et al., 2007) and physical health (Crescioni et al., 2011; Ng & Hartanto, 2022; Riggs et al., 2010 ), stronger social relationships…”
Nakua, H., Hawco, C. S., Forde, N. J., Jacobs, G. R., Joseph, M. J. E., Voineskos, A. N., Wheeler, A. L., Lai, M., Szatmári, P., Kelley, E. A., et al. (2022) · Brain Structure and Function · doi:10.1007/s00429-022-02483-0 · Cited by 7
Hamilton, A., Tallberg, P., Ilahi, F., Hoff, E. V., Ahmadi, B., & Daukantaité, D. (2024) · Child Neuropsychology · doi:10.1080/09297049.2024.2434736 · Cited by 5
“This study recognizes the utility of the Swedish translation of the BRIEF-2’s in assessing day-to-day behavioral manifestations of EF, while exploring differences between youth with NDDs (specifically ADHD and ASD) and those with non-NDD psychiatric comorbidities as well as community controls in terms of parent-rated…”
InfluentialRanjbar, F., Dadgar, H., Azizi, M., & Dalvand, H. (2024) · Advances in Autism · doi:10.1108/aia-06-2024-0040 · Cited by 5
Cid-Duarte, S., Departamento de Psicología, U. D. O. (., Areces, D., Departamento de Psicología, U. D. O. (., Núñez, J. C., & Departamento de Psicología, U. D. O. (. (2022) · Revista de Psicología y Educación - Journal of Psychology and Education · doi:10.23923/rpye2023.01.232 · Cited by 6
Narzisi, A., Barbetti, F., Fabbri‐Destro, M., Berloffa, S., Fantozzi, P., Viglione, V., Muccio, R., Valente, E., Accorinti, I., Foti, E., et al. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1765698 · Cited by 5
“This dissociation may re fl ect a breakdown in the cognitive-emotional integration mechanisms that typically support adaptive functioning in neurodevelopmental populations (18, 40, 55).”
Hollocks, M. J., McQuaid, G. A., Lee, N., & Wallace, G. L. (2025) · Autism Research · doi:10.1002/aur.70061 · Cited by 4
“…lower levels of cognitive flexibility when compared to those without an autism diagnosis (Bertollo et al. 2020), and this has been associated directly with increased symptoms of both anxiety and depression (Hollocks et al. 2022; Lawson et al. 2015; Ozsivadjian et al. 2021; Wallace et al. 2016).”
Self-citation
Metadata
- Authors
- Lawson, R. A., Papadakis, A. A., Higginson, C. I., Barnett, J. E., Wills, M. C., Strang, J. F., Wallace, G. L., & Kenworthy, L.
- Affiliations
- Loyola University Maryland (US)
- Children's National (US)
- George Washington University (US)
- ORCID
- Venue
- Neuropsychology
- Published
- 2015-05
- Volume
- 29
- Issue
- 3
- Pages
- 445-453
- ISSN
- 0894-4105 (ISSN-L)
- 1931-1559
- OpenAlex
- W2084269933
- Cited by
- 169
- References
- 68
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 16 · 2023: 20 · 2022: 19 · 2021: 14 · 2020: 18 · 2019: 16 · 2018: 8 · 2017: 13 · 2016: 10 · 2015: 6
- FWCI
- 5.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Isadore and Bertha Gudelsky Foundation
- Frederick and Elizabeth Singer Foundation
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- executive function, autism spectrum disorder, attention deficit hyperactivity disorder, psychiatric comorbidity, flexibility, behavioral inhibition, inflexibility, disinhibition, anxiety and depression, mediation, children
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Child, Depression, Female, Humans, Inhibition, Psychological, Male, Models, Psychological, Neuropsychological Tests, Executive Function
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