ADHD symptoms and learning behaviors in children with ASD without intellectual disability. A mediation analysis of executive functions

Abstract

In spite of its importance for education, the relationship between learning behaviors (LB), attention deficit hyperactivity disorder symptoms (ADHD) and executive functioning (EF) in children with autism spectrum disorder (ASD) has hardly been explored. The first objective of the present study was to compare children with ASD without intellectual disability and children with typical development (TD) on ADHD symptoms and learning behaviors: Motivation/competence, attitude toward learning, persistence on the task, and strategy/flexibility. The second objective was to analyze the mediator role of behavioral regulation and metacognition components of EF between ADHD symptoms and learning behaviors in children with ASD. Participants were 89 children between 7 and 11 years old, 52 with ASD and 37 with TD, matched on age and intelligence. Their teachers filled out questionnaires assessing executive functioning as well as learning behaviors. Parents and teachers reported on inattention and hyperactivity/impulsivity behaviors. Compared to children with TD, children with ASD presented significantly more ADHD symptoms and poorer learning behaviors. In addition, there were significant mediation effects of the behavioral regulation index (BRI) and metacognition index (MI) of EF, indicating that both are part of the route through which ADHD symptoms impact to learning behaviors of children with ASD.

ASD and ADHD Comorbidity: What Are We Talking About?

“…These findings are supported by those of Rosello et al ( 26 ), who reported significantly more ADHD symptoms and poorer learning behaviors in ASD children than in those exhibiting typical development. Furthermore, behavioral regulation problems and impaired executive functioning associated with ADHD symptoms significantly impacted performance for ASD children, objectively demonstrating the effect of ADHD symptoms on these children's learning behaviors.…”

Middle‐childhood executive functioning mediates associations between early‐childhood autism symptoms and adolescent mental health, academic and functional outcomes in autistic children

“…In prior work in ASD, BRIEF metacognitive skills (e.g. monitoring, planning, working memory) have been shown to influence academic/everyday performance (Gardiner & Iarocci, 2018 ; Gilotty et al., 2002 ; McLean, Harrison, Zimak, Joseph, & Morrow, 2014 ; Pugliese et al., 2015 ), potentially by affecting motivation and willingness to engage and persist to task completion (Rosello et al., 2018 ).…”

“…We first tested the hypothesis that middle‐childhood EF would mediate associations between early‐childhood ASD symptoms and early‐adolescent emotional/behavioral, academic, and functional outcomes (Figure 1 ) using mainly parent‐rated measures that were selected a priori based on prior relations found between BRI/MCI and SRS total score (Leung et al., 2016 ; Torske et al., 2017 ), BRI and externalizing/internalizing (Lawson et al., 2015 ), and MCI with learning behaviors (Rosello et al., 2018 ), or adaptive functioning (Pugliese et al., 2016 ). Two models examined the indirect effect of middle‐childhood BRIEF‐BRI (parent‐report) on the associations between early‐childhood SRS and early‐adolescent CBCL‐externalizing (Model 1) or internalizing (Model 2) scores.…”

“…Middle-Childhood T5=7.5-8y T6=8.5-9y T7= 9.5-10y (Leung et al, 2016;Torske et al, 2017), BRI and externalizing/internalizing (Lawson et al, 2015), and MCI with learning behaviors (Rosello et al, 2018), or adaptive functioning (Pugliese et al, 2016). Two models examined the indirect effect of middle-childhood BRIEF-BRI (parent-report) on the associations between early-childhood SRS and early-adolescent CBCL-externalizing (Model 1) or internalizing (Model 2) scores.…”

“…Cross‐sectional studies in ASD have demonstrated associations between BRIEF‐measured EF with: (a) autism symptoms (Leung, Vogan, Powell, Anagnostou, & Taylor, 2016 ; Torske, Naerland, Oie, Stenberg, & Andreassen, 2017 ), (b) adaptive functioning (Gilotty, Kenworthy, Sirian, Black, & Wagner, 2002 ; Pugliese et al., 2015 ), (c) internalizing symptoms (Gardiner & Iarocci, 2018 ; Wallace et al., 2016 ), and (d) learning behaviors (e.g. learning attitudes, task persistence, flexibility; Rosello, Berenguer, Baixauli, Colomer, & Miranda, 2018 ). A retrospective cohort study also found that earlier measurement of metacognitive skills (a BRIEF‐EF sub‐domain) in children with ASD contributed uniquely to the variance in later measured adaptive functioning, beyond IQ effects (Pugliese et al., 2016 ).…”