A Review of Language, Executive Function, and Intervention in Autism Spectrum Disorder

Abstract

Difficulties with both executive functions and language skills are common but variable in autism spectrum disorder (ASD). Executive functions and language skills are related to one another, such that vocabulary, syntax, and pragmatics are related to domains of working memory, shifting, and inhibition in ASD, although the directionality of these relationships remains unclear. Moreover, interventions that target pragmatic ability have been found to improve executive function skills, and conversely, executive function interventions are linked with improvements in social skills in children with ASD. We review the literature on executive functions, language skills, and their relationship in ASD; discuss factors that may be driving inconsistent findings; and explore clinical applications from the research thus far.Learning Outcomes: As a result of this activity, the reader will be able to (1) explain the relationship between executive functions and language in ASD; (2) describe how targeted interventions may impact executive function or language performance in ASD; and (3) explain how various executive function task features and inclusion of different comparison groups may yield distinctive findings.Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is behaviorally diagnosed and is characterized by deficits in social communication and the presence of restricted and repetitive patterns of behavior. 1 Recent estimates from the Centers for Disease Control and Prevention indicate that this disorder affects approximately 1 in 59 children. 2

The Role of Inner Speech in Executive Functioning Tasks: Schizophrenia With Auditory Verbal Hallucinations and Autistic Spectrum Conditions as Case Studies

“…This theory also purported to account for theory of mind deficits within ASC, as EF difficulties would make it harder for a subject to simultaneously hold two representations in mind, i.e., one about reality and the other about the other person's representation of reality. Overall, a recent meta-analysis of EF in ASC confirms a broad executive dysfunction (Demetriou et al, 2018), although EF deficits are not currently regarded as core symptoms of ASC (Friedman and Sterling, 2019).…”

“…However, experimental research on EF has been said to suffer from the so-called "task impurity problem" (Snyder et al, 2015), which appears when the administration of a certain task prompts the use of several different cognitive processes within the whole construct, thus leading to potentially conflated results regarding specific EFs (e.g., a subject's score on the WCST might depend on the recruitment of task-switching, planning, and working memory: Geurts et al, 2009). 2 The different components of EF are related to different areas in the brain (Vivanti et al, 2019) and may even belong to different "systems" or ways of processing information (Friedman and Sterling, 2019). Several researchers distinguish between core EF and higher-order EF as follows:…”

“…Higher-order executive functions (HO-EF), on the other hand, relate to cognitive processes and abilities that arise later in development, involve concepts, can be explicitly taught, and appear in fewer species. Some authors link these abilities to System-2 (i.e., conscious, serial, and effortful) processing (Friedman and Sterling, 2019). HO-EF routinely include reasoning and planning.…”

“…The different components of EF are related to different areas in the brain ( Vivanti et al, 2019 ) and may even belong to different “systems” or ways of processing information ( Friedman and Sterling, 2019 ). Several researchers distinguish between core EF and higher-order EF as follows:…”

Youths with autism and working memory

“…Previous studies have reported WM deficits in ASD relative to typically developing (TD) populations (Barendse et al 2013). Although a number have reported primarily visuo-spatial WM impairment, with verbal WM being relatively intact in individuals with ASD (Boucher et al 2008;Minshew et al 2001;Steele et al 2007), more recent papers also find verbal WM difficulties (e.g., Friedman et al 2019). Visual WM has been shown, however, to be a sensitive marker of developmental disability (Alloway et al 2016).…”