Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA.
Autism Res. 2022 Jul;15(7):1336-1347. doi: 10.1002/aur.2715. Epub 2022 Apr 6.
Executive functioning (EF) deficits co-occur frequently with autism spectrum disorder (ASD) and have a long-term detrimental impact on quality of life of children and their families. Timely identification of risk for EF vulnerabilities may hasten access to early intervention and alleviate their long-term consequences. This study examines (1) if EF deficits are elevated in toddlers with ASD compared to nonautistic siblings of children with ASD, typically developing (TYP) toddlers, and toddlers with atypical developmental presentation; and (2) if EF deficits have a detrimental effect on adaptive functioning in ASD. Participants were recruited between September 2014 and October 2019 and included 73 toddlers with ASD, 33 nonautistic siblings of children with ASD, 35 toddlers with atypical development, and 28 TYP toddlers matched on chronological age (M = 39.01 months, SD = 3.11). EF deficits were measured using the BRIEF-P; adaptive skills were measured using the VABS-II. Whenever appropriate, analyses were controlled for MSEL verbal and nonverbal developmental quotient, ADOS-2 autism severity scores, and sex. Analyses revealed that toddlers with ASD exhibited elevated BRIEF-P scores across all domains compared to each of the three comparison groups. Higher BRIEF-P scores were associated with lower adaptive social, communication, and daily living skills while controlling for symptom severity, verbal and nonverbal functioning, and sex. In conclusion, marked vulnerabilities in EF are already present in 3-year-old toddlers with ASD and are predictive of the level of adaptive functioning in ASD. EF vulnerabilities in toddlers should be targeted for intervention to improve long-term outcomes in ASD. LAY SUMMARY: Many children with autism experience vulnerabilities in executive functioning (EF), which may include challenges with inhibition, working memory, cognitive flexibility, and planning. The study shows that these vulnerabilities can already be detected at age three and that their presence is linked with lower social, communication, and daily living skills. Screening children with ASD for EF challenges and helping those who have difficulties may improve their long-term outcomes.
执行功能（EF）缺陷常与自闭症谱系障碍（ASD）同时发生，并对儿童及其家庭的生活质量产生长期的不利影响。及时发现 EF 脆弱性的风险可能会加速早期干预的机会，并减轻其长期后果。本研究考察了：（1）与 ASD 非自闭症同胞儿童、典型发育（TYP）幼儿和发育异常的幼儿相比，ASD 幼儿是否存在 EF 缺陷升高；（2）EF 缺陷是否对 ASD 中的适应功能有不利影响。参与者于 2014 年 9 月至 2019 年 10 月期间招募，包括 73 名 ASD 幼儿、33 名 ASD 非自闭症同胞儿童、35 名发育异常的幼儿和 28 名年龄匹配的 TYP 幼儿（M=39.01 个月，SD=3.11）。EF 缺陷使用 BRIEF-P 进行测量；适应技能使用 VABS-II 进行测量。在适当的情况下，分析控制了 MSEL 言语和非言语发育商数、ADOS-2 自闭症严重程度评分和性别。分析显示，与每个对照组相比，ASD 幼儿在所有领域均表现出 BRIEF-P 评分升高。在控制症状严重程度、言语和非言语功能以及性别后，较高的 BRIEF-P 评分与较低的适应社交、沟通和日常生活技能相关。总之，3 岁 ASD 幼儿已经存在明显的 EF 脆弱性，并且可预测 ASD 中的适应功能水平。应针对幼儿的 EF 脆弱性进行干预，以改善 ASD 的长期结果。
