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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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Margari, L., Craig, F., Margari, F., Legrottaglie, A., Palumbi, R., & De Giambattista, C. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s104620 · Cited by 557
“included in this review support for more deficit in cognitive flexibility in ASD than in ADHD, reporting for the ASD group a slower mean reaction time and a higher percentage of perseverative responses.(42) Additionally, the ASD + ADHD group showed difficulty with test duration of flexibility task compared to the cont…”
InfluentialSensory, emotional and cognitive contributions to anxiety in autism spectrum disorders
South, M., & Rodgers, J. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00020 · Cited by 270
“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).”
BackgroundWallace, G. L., Kenworthy, L., Pugliese, C. E., Popal, H. S., White, E. I., Brodsky, E., & Martin, A. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2655-7 · Cited by 261
“However, it should be noted that adding ADHD symptomatology as an additional nuisance variable in the present analyses abolished the significant associations between real-world EF and adaptive functioning.”
BackgroundResultInfluentialAn update on the comorbidity of ADHD and ASD: a focus on clinical management
Antshel, K. M., Zhang‐James, Y., Wagner, K. E., Ledesma, A., & Faraone, S. V. (2016) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.2016.1146591 · Cited by 276
“cognitive disinhibition that predicts to greater externalizing symptoms [94].”
BackgroundAnxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis
van Steensel, F. J. A., & Heeman, E. J. (2017) · Journal of Child and Family Studies · doi:10.1007/s10826-017-0687-7 · Cited by 269
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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