Theory of Mind and Executive Function in Preschoolers with Typical Development Versus Intellectually Able Preschoolers with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) have difficulties in theory of mind (ToM) and executive function (EF), which may be linked because one domain (EF) affects the other (ToM). Group differences (ASD vs. typical development) were examined in both cognitive domains, as well as EF’s associations and regressions with ToM. Participants included 29 intellectually able preschoolers with ASD and 30 typical preschoolers, aged 3–6 years. EF tasks included planning and cognitive shifting measures. ToM tasks included predicting and explaining affective and location false-belief tasks. The novelty of this study lies in its in-depth examination of ToM explanation abilities in ASD alongside the role of verbal abilities (VIQ). Significant group differences emerged on most EF and ToM measures, in favor of typically developing children. Overall in the study group, EF-planning skills, EF-cognitive shifting and VIQ significantly contributed to the explained variance of ToM measures. Implications are discussed regarding the social-cognitive deficit in ASD.     

Brief Report: Impaired Flexible Item Selection Task (FIST) in School-Age Children with Autism Spectrum Disorders

Cognitive flexibility has been measured with inductive reasoning or explicit rule tasks in individuals with autism spectrum disorders (ASD). The Flexible Item Selection Task (FIST) differs from previous cognitive flexibility tasks in ASD research by giving children an abstract, ambiguous rule to switch. The ASD group (N = 22; Mean age = 8.28 years, SD = 1.52) achieved a lower shift percentage than the typically developing verbal mental-age control group (N = 22; Mean age = 6.26 years, SD = 0.82). There was a significant positive correlation between verbal mental age and shift percentage for children with ASD. Group differences on the FIST converge and extend prior evidence documenting an impaired ability to adapt rapidly to changes in task demands for individuals with ASD.     

Assessment of executive function in young children with and without ASD using parent ratings and computerized tasks of executive function

Objective: The current study investigated executive function (EF) in young children with and without autism spectrum disorder (ASD) using multiple methods of assessment. Method: Young children (M = 63.2 months) with and without ASD, matched on age, IQ, and maternal education, were assessed on computerized measures of working memory, inhibition, flexibility, and planning. Parents completed a behavior rating scale assessing children’s EF within everyday contexts. Results: There were no significant group differences on working memory, inhibition, flexibility, or planning. The mean difference on one aspect of the planning task (number of correct trials), however, approached significance and showed a medium to large effect size. There was also a significant difference between groups on the EF behavior rating scale, indicating that participants with ASD demonstrated greater executive dysfunction, as indexed by parent report. Conclusions: The results suggest that in young children with ASD, EF difficulties may only become apparent when situational demands require coordinating multiple abilities, as assessed with scales indexing children’s abilities to manage their day-to-day EF-related behavior. We suggest that multiple methods are needed to achieve a comprehensive and valid EF assessment in young children with ASD.     

Brief Report: Accuracy and Response Time for the Recognition of Facial Emotions in a Large Sample of Children with Autism Spectrum Disorders

The empirical literature has presented inconsistent evidence for deficits in the recognition of basic emotion expressions in children with autism spectrum disorders (ASD), which may be due to the focus on research with relatively small sample sizes. Additionally, it is proposed that although children with ASD may correctly identify emotion expression they rely on more deliberate, more time-consuming strategies in order to accurately recognize emotion expressions when compared to typically developing children. In the current study, we examine both emotion recognition accuracy and response time in a large sample of children, and explore the moderating influence of verbal ability on these findings. The sample consisted of 86 children with ASD (M _age = 10.65) and 114 typically developing children (M _age = 10.32) between 7 and 13 years of age. All children completed a pre-test (emotion word–word matching), and test phase consisting of basic emotion recognition, whereby they were required to match a target emotion expression to the correct emotion word; accuracy and response time were recorded. Verbal IQ was controlled for in the analyses. We found no evidence of a systematic deficit in emotion recognition accuracy or response time for children with ASD, controlling for verbal ability. However, when controlling for children’s accuracy in word–word matching, children with ASD had significantly lower emotion recognition accuracy when compared to typically developing children. The findings suggest that the social impairments observed in children with ASD are not the result of marked deficits in basic emotion recognition accuracy or longer response times. However, children with ASD may be relying on other perceptual skills (such as advanced word–word matching) to complete emotion recognition tasks at a similar level as typically developing children.     

Impairment in face processing in autism spectrum disorder: a developmental perspective

Findings on face identity and facial emotion recognition in autism spectrum disorder (ASD) are inconclusive. Moreover, little is known about the developmental trajectory of face processing skills in ASD. Taking a developmental perspective, the aim of this study was to extend previous findings on face processing skills in a sample of adolescents and adults with ASD. N = 38 adolescents and adults (13–49 years) with high-functioning ASD and n = 37 typically developing (TD) control subjects matched for age and IQ participated in the study. Moreover, n = 18 TD children between the ages of 8 and 12 were included to address the question whether face processing skills in ASD follow a delayed developmental pattern. Face processing skills were assessed using computerized tasks of face identity recognition (FR) and identification of facial emotions (IFE). ASD subjects showed impaired performance on several parameters of the FR and IFE task compared to TD control adolescents and adults. Whereas TD adolescents and adults outperformed TD children in both tasks, performance in ASD adolescents and adults was similar to the group of TD children. Within the groups of ASD and control adolescents and adults, no age-related changes in performance were found. Our findings corroborate and extend previous studies showing that ASD is characterised by broad impairments in the ability to process faces. These impairments seem to reflect a developmentally delayed pattern that remains stable throughout adolescence and adulthood.     

The Relationship Between Theory of Mind and Executive Function in a Sample of Children from Mainland China

To explore the relationship between theory of mind (ToM) and executive function (EF) in a sample of individuals from mainland China, 20 children with autism spectrum disorders (ASD), 26 children with Attention Deficit Hyperactivity Disorder (ADHD), and 30 normal control subjects were compared on two batteries of ToM tasks and EF tasks. Children with ASD had a significant theory of mind impairment relative to the other controls, while non-verbal IQ removed group differences in executive function. ToM was significantly correlated with inhibitory control. Performance on inhibitory control tasks, however, did not affect performance on ToM tasks.     

Beyond individual differences: are working memory and inhibition informative specifiers within ASD?

Findings on working memory (WM) and inhibition in children with autism spectrum disorders (ASD) are contradictory and earlier studies largely ignored individual differences. As WM and inhibition seem to be related, children who experience WM deficits might also experience inhibition deficits. Moreover, these children possibly form a distinct subgroup, differing on other variables, such as cognitive functioning, symptom severity, behavior, and attention deficit hyperactivity disorder (ADHD) characteristics. We studied a large sample of children with and without ASD (8–12 years, IQ > 80) with classic experimental tasks (n-back task, ASD n = 77, control n = 45; stop task, ASD n = 74, control n = 43), and explored individual differences. The ASD group made more errors on the n-back task with increasing WM load, and had longer stop signal reaction times on the stop task when compared with controls. However, only 6 % of the ASD group showed both WM and inhibition deficits, and 71 % showed no deficits. Parents of children with WM and/or inhibition deficits tended to report more conduct problems on the disruptive behavior disorder rating scale. ADHD characteristics did not influence performance. Some children used medication during testing, which seemingly influenced stop task performance, but excluding these data did not change the main findings. Large individual differences in cognitive functioning are present, even within children with ASD with average or above average intelligence. However, whether individual differences in specific cognitive domains, such as WM and inhibition are as informative as individual differences in diagnosis, comorbidity, and general cognitive functioning, calls for future research.     

Prevalence of Parent-Reported ASD and ADHD in the UK: Findings from the Millennium Cohort Study

The UK prevalence of parent-reported autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) were estimated from the Millennium Cohort Study. Case definition was if a doctor or health care professional had ever told parents that their child had ASD and/or ADHD. Data were collected in 2008/2009 for 14,043 children. 1.7 % of children were reported as having ASD (95 % CI 1.4–2.0) at mean age 7.2 years (SD = 0.2; range = 6.3–8.2). 1.4 % reportedly had ADHD (95 % CI 1.2–1.7), and 0.3 % had both ASD and ADHD (95 % CI 0.2–0.5). After adjusting for socio-economic disadvantage, only male sex (p < 0.001 for both conditions) and cognitive ability, p = 0.004 (ASD); p = 0.01 (ADHD) remained strongly associated. The observed prevalence of parent-reported ASD is high compared to earlier UK and US estimates. Parent-reported ADHD is low compared to US estimates using the same measure.     

Testing the specificity of executive functioning impairments in adolescents with ADHD,ODD/CD and ASD

Current diagnostic systems conceptualise attention deficit hyperactivity disorder (ADHD), oppositional defiant/conduct disorder (ODD/CD) and autism spectrum disorder (ASD) as separate diagnoses. However, all three demonstrate executive functioning (EF) impairments. Whether these impairments are trans-diagnostic or disorder-specific remains relatively unexplored. Four groups of 10–16 year-olds [typically developing (TD; N = 43), individuals clinically diagnosed with ADHD (N = 21), ODD/CD (N = 26) and ASD (N = 41)] completed Go/NoGo and Switch tasks. Group differences were tested using analysis of co-variance (ANCOVA) including age, IQ, sex, conduct problems and ADHD symptoms as co-variates. Results indicated some disorder-specificity as only the ASD group demonstrated decreased probability of inhibition in the Go/NoGo task compared to all other groups. However, shared impairments were also found; all three diagnostic groups demonstrated increased reaction time variability (RTV) compared to the TD group, and both the ODD/CD and the ASD group demonstrated increased premature responses. When controlling for ADHD symptoms and conduct problems, group differences in RTV were no longer significant; however, the ASD group continued to demonstrate increased premature responses. No group differences were found in cognitive flexibility in the Switch task. A more varied response style was present across all clinical groups, although this appeared to be accounted for by sub-threshold ODD/CD and ADHD symptoms. Only the ASD group was impaired in response inhibition and premature responsiveness relative to TD adolescents. The findings suggest that some EF impairments typically associated with ADHD may also be found in individuals with ASD.     

Brief report: Autism spectrum disorder diagnostic persistence in a 10-year longitudinal study

BackgroundThe aim was to examine diagnostic persistence of Autism Spectrum Disorder (ASD) in individuals without intellectual disability from childhood to emerging adulthood.MethodWe assessed 38 children with estimated full-scale intelligence quotient (IQ) >70 who were diagnosed with ASD at baseline (M_age=12.0, SD=2.3, 84% male), and re-assessed two (n=37, M_age=14.2, SD=2.4, 84% male) and 10 years (n=23, M_age=21.7, SD=2.4, 78% male) later.ResultsAt two-year follow-up, all participants still met diagnostic criteria for ASD according to the Diagnostic and Statistical Manual for Mental Disorders – fourth version (DSM-IV). At 10-year follow-up, 65% met diagnostic criteria for ASD according to DSM-IV, 48% met diagnostic criteria according to the Diagnostic and Statistical Manual for Mental Disorders – fifth version (DSM-5), 57% met the ASD cut-off on the Autism Spectrum Quotient 10-item (AQ-10), and 78% met either DSM-IV criteria or cut-off on the AQ-10. Higher IQ in childhood predicted loss of ASD diagnosis according to DSM-IV criteria (Hedges g = 1.30). A higher proportion of girls compared to boys displayed loss of ASD diagnosis according to DSM-IV criteria.ConclusionsThese findings suggest that ASD traits among individuals without intellectual disability may wane into emerging adulthood and that loss of ASD diagnosis is associated with higher IQ and being a girl. Diagnostic re-evaluations may be warranted for some individuals diagnosed with ASD as children or adolescents.     

Emotion-recognition and theory of mind in high-functioning children with ASD: Relationships with attachment security and executive functioning

This study explored the relationships that attachment security and executive functioning (EF) (working memory and inhibition) had with emotion-recognition and theory of mind (ToM) in children with high-functioning Autism Spectrum Disorder (ASD) aged between 6 and 12 years (n = 26), while controlling for cognitive ability. Group differences in attachment security were also explored in this group, compared to a typically-developing group (n = 27) matched on age and cognitive ability. Attachment security was not found to be significantly different between groups, however studies employing larger sample sizes are needed to further clarify this finding. Cognitive processes and attachment insecurity appear to relate to performance on structured behavioural measures of emotion-recognition and ToM differentially in children with high-functioning ASD and typically-developing children. Implications for the mechanisms underlying socio-emotional processes in childhood are discussed.     

Association between autism symptoms and family functioning in children with attention-deficit/hyperactivity disorder: a community-based study

Autism spectrum disorder (ASD) symptoms are elevated in populations of children with attention-deficit/hyperactivity disorder (ADHD). This study examined cross-sectional associations between ASD symptoms and family functioning in children with and without ADHD. Participants were recruited to a longitudinal cohort study, aged 6–10 years (164 ADHD; 198 controls). ADHD cases were ascertained using community-based screening and diagnostic confirmation from a diagnostic interview. ASD symptoms were measured using the Social Communication Questionnaire. Outcome variables were parent mental health, family quality of life (FQoL), couple conflict and support, and parenting behaviours. After adjustment for a range of child and family factors (including other mental health comorbidities), higher ASD symptoms were associated with poorer FQoL across all three domains; emotional impact (p = 0.008), family impact (p = 0.001) and time impact (p = 0.003). In adjusted analyses by subgroup, parents of children with ADHD+ASD had poorer parent self-efficacy (p = 0.01), poorer FQoL (p ≤ 0.05), with weak evidence of an association for less couple support (p = 0.06), compared to parents of children with ADHD only. Inspection of covariates in the adjusted analyses indicated that the association between ASD symptoms and most family functioning measures was accounted forby child internalising and externalising disorders, ADHD severity, and socioeconomic status; however, ASD symptoms appear to be independently associated with poorer FQoL in children with ADHD. The presence of ASD symptoms in children with ADHD may signal the need for enhanced family support.     

Do Parents Model Gestures Differently When Children’s Gestures Differ?

Children with autism spectrum disorder (ASD) or with Down syndrome (DS) show diagnosis-specific differences from typically developing (TD) children in gesture production. We asked whether these differences reflect the differences in parental gesture input. Our systematic observations of 23 children with ASD and 23 with DS (M_ages = 2;6)—compared to 23 TD children (M_age = 1;6) similar in expressive vocabulary—showed that across groups children and parents produced similar types of gestures and gesture-speech combinations. However, only children—but not their parents—showed diagnosis-specific variability in how often they produced each type of gesture and gesture-speech combination. These findings suggest that, even though parents model gestures similarly, the amount with which children produce each type largely reflects diagnosis-specific abilities.     

Using the Autism Detection in Early Childhood (ADEC) and Childhood Autism Rating Scales (CARS) to Predict Long Term Outcomes in Children with Autism Spectrum Disorders

This study evaluated the predictive validity of the Autism Detection in Early Childhood (ADEC; Young, Autism detection in early childhood: ADEC. Australian Council of Educational Research, Camberwell, VIC 2007) and a well-established screening tool, the Childhood Autism Rating Scale (CARS; Schopler et al. The childhood autism rating scale (CARS). Western Psychological Services, Los Angeles 1988), for long term outcomes of children with ASD engaged in an early intervention program. Participants were 55 children (44 male, 11 female) aged 19–42 months (M = 33.5, SD = 5.6) at initial assessment who were followed up 2 and 6 years after their initial assessment. The ADEC and the CARS performed similarly when predicting long term outcomes such as clinical diagnostic outcome and overall adaptive functioning level. However, only the ADEC score was significantly correlated with ASD symptom severity at the 6-year follow up. Although these findings need to be replicated with additional and larger samples, this study extends our understanding of the psychometric properties of both the ADEC and the CARS.     

Effects of Equine Assisted Activities on Autism Spectrum Disorder

Quality of life assessments were used in this study to determine the behavioral changes of children diagnosed with autism spectrum disorder (ASD) who participated in equine assisted activities. Behavioral changes of children with ASD participating in 9 weeks of equines assisted activities (EAA) (N = 10) were compared to behavioral changes of children who participated in a non-equine intervention (N = 8). Parents noted significant improvements in their child’s physical, emotional and social functioning following the first 6 weeks of EAA. The children participating in the non-equine program also demonstrated improvement in behavior, but to a lesser degree. The favorable outcome of this study lends support for continuation of programs utilizing EAA in the treatment of children with ASD.     

Teacher Competence of Delivery of BEST in CLASS as a Mediator of Treatment Effects

This study investigated if training and practice-based coaching in an evidence-based program was associated with higher observed treatment integrity (adherence and competence) and if these treatment integrity components were associated with teacher report of child behavioral outcomes in the BEST in CLASS efficacy trial. Participants were 462 children (M = 4.32 years, SD = 0.53; 65% male; 17.0% Caucasian, 66.0% African-American, 5.0% Hispanic, and 12.0% other) identified as having problem behavior and their 185 teachers (M = 12.09 years teaching experience; 99% female; 47.0% Caucasian, 48.0% African-American, 1.0% Asian/Pacific Islander, 3.0% Hispanic and 1.0% other). Teachers and focal children were randomly assigned to the intervention (teacher n = 92, children n = 230) or control condition (teacher n = 93, child n = 232). Results of a multilevel mediation analysis indicated that the BEST in CLASS intervention had a positive effect on teacher report of child problem behavior (SSIS-RS) and externalizing problems (C-TRF), as well as having a positive effect on teachers’ adherence and competence of delivery of the intervention. There was an indirect effect through competence of delivery for externalizing problems, but not problem behavior. No indirect effects for adherence were found. Implications of these findings and directions for future research are discussed.     

Broad Autism Phenotype in Typically Developing Children Predicts Performance on an Eye-Tracking Measure of Joint Attention

We examined visual attention allocation during a set of social videos that are intended to elicit the coordination of attention with another person, compared to a control condition. Deficits in joint attention are a characteristic of young children with autism spectrum disorder (ASD). Participants included a diverse sample of 50 typically developing school-aged children between 3 and 9 years of age (M = 6:3, SD = 1:8). Results demonstrated that gaze allocation differed significantly between the experimental and control condition. Further, individual differences in gaze allocation were significantly predicted by a parent-report measure evaluating features of the broad autism phenotype. This study contributes to a research program that aims to develop and validate an endophenotype measure of ASD.     

Moderating Effects of Parental Characteristics on the Effectiveness of a Theory of Mind Training for Children with Autism: A Randomized Controlled Trial

This RCT investigated whether the effect of a Theory of Mind (ToM) intervention for children with ASD was moderated by parental education level and employment, family structure, and parental ASD. Children with autism aged 8–13 years (n?=?136) were randomized over a waitlist control or treatment condition. At posttest, children in the treatment condition had more ToM knowledge, showed fewer autistic features, and more ToM-related behavior than children in the control condition. Children who had one or two parents with at least a college degree, and children with parents not diagnosed with/suspected of having ASD themselves benefitted from the training. These findings provide valuable information about family variables that need to be taken into account in treatment design and implementation.     

Age Related Differences of Executive Functioning Problems in Everyday Life of Children and Adolescents in the Autism Spectrum

Numerous studies investigated executive functioning (EF) problems in people with autism spectrum disorders (ASD) using laboratory EF tasks. As laboratory task performances often differ from real life observations, the current study focused on EF in everyday life of 118 children and adolescents with ASD (6–18 years). We investigated age-related and individual differences in EF problems as reported by parents on the Behavioral Rating Inventory Executive Functions (BRIEF: Gioia et al. in Behavior rating inventory of executive function. Psychological Assessment Resources, Odesse 2000), and examined the association with autism severity. Inhibition problems were mostly found in the youngest group (6- to 8-year-olds), whereas problems with planning where more evident for 12- to 14-year-olds as compared to 9- to 11-year-olds. In a subsample of participants meeting the ADOS ASD cut-off criteria the age related differences in planning were absent, while problems with cognitive flexibility were less apparent in 15- to 18-year-olds, compared to 9- to 11-, and 12- to 14-year olds. EF problems surpassing the clinical cutoff were only observed in 20 % (planning) to 51 % (cognitive flexibility) of the children and adolescents, and no relation was found with ASD symptom severity. This underlines the heterogeneous nature of ASD.     

Theory of mind in autism spectrum disorder: Does DSM classification predict development?

It is unclear how theory of mind (ToM; understanding mental states and their influence on behaviour) develops in autism spectrum disorders (ASD). At least two possibilities exist: development is delayed or developmental patterns deviate from normal. We used a cross-sectional design to examine ToM skills in 4–16 year-old children. First, participants were classified in terms of the DSM-IV categories low-functioning autism (n = 21), high-functioning autism (n = 24), Asperger's syndrome (n = 21), and pervasive developmental disorder not otherwise specified (PDD-NOS; n = 20). The high-functioning autism, Asperger's syndrome and PDD-NOS groups displayed delayed ToM onset compared to a typically developing group (n = 30), but normal ToM developmental rates and sequences; supporting delayed development. ToM in low-functioning ASD fit the deviant development model: Age did not predict ToM. A second ToM model using DSM-5 ASD and verbal IQ supported ToM development differences: Greater verbal ability was associated with increased ToM in ASD but not in typical development. As a single explanation for ToM development in ASD is insufficient, it is imperative to report specifiers such as intellectual functioning when using DSM-5 classification. DSM-IV classification contributed little to the prediction of ToM development beyond the influence of intellectual functioning.