Heterogeneity of executive functions among comorbid neurodevelopmental disorders

Abstract

Executive functions (EFs) are used to set goals, plan for the future, inhibit maladaptive responses, and change behavior flexibly. Although some studies point to specific EF profiles in autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) — prevalent and often highly comorbid neurodevelopmental disorders — others have not differentiated them. The objective of the current study was to identify distinct profiles of EF across typically developing (TD) children and children with ASD and ADHD. We employed a latent profile analysis using indicators of EF (e.g., working memory, inhibition, and flexibility) in a mixed group of 8–13 year-olds including TD children (n = 128), children with ASD without ADHD (n = 30), children with ADHD (n = 93), and children with comorbid ASD and ADHD (n = 66). Three EF classes emerged: “above average,” “average,” and “impaired.” EF classes did not reproduce diagnostic categories, suggesting that differences in EF abilities are present within the ASD and ADHD groups. Further, greater EF dysfunction predicted more severe socioemotional problems, such as anxiety/depression. These results highlight the heterogeneity of current diagnostic groups and identify an “impaired” EF group, consisting of children with both ASD and ADHD, which could specifically be targeted for EF intervention.

Autism spectrum disorder polygenic scores are associated with every day executive function in children admitted for clinical assessment

“…Comorbidity is common in ASD, and about 30% also meet the diagnostic criteria for ADHD [Lord, Elsabbagh, Baird, & Veenstra-Vanderweele, 2018]. Cognitive difficulties are also observed in ADHD [Craig et al, 2016], and particularly executive dysfunctions are present across diagnostic categories like ASD and ADHD as well as many other psychiatric disorders [Dajani, Llabre, Nebel, Mostofsky, & Uddin, 2016;Snyder, Miyake, & Hankin, 2015]. Executive function is a heritable cognitive domain and deficits are found in unaffected ASD family members at higher rates than in the general population [Benca et al, 2017].…”

A Review of Executive Functions in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder

“…Moreover, examining different attentional constructs, children with ASD+ADHD differed from TD children especially on sustained attention and alertness (Adamo et al, 2014;Andersen et al, 2013;Sinzig et al, 2008a;Lundervold et al, 2016;Tye et al, 2014). Some studies evidence that the comorbid group is the group with the most pronounced brain function abnormalities (Chantiluke et al, 2014) and more impaired on daily-life executive functioning (Dajani et al, 2016). Similarly, studies that had focused on response inhibition report that ADHD and ASD+ADHD patients show more dysfunction on inhibitory control compared to the ASD patients (Bühler et al, 2011;Sinzig et al, 2008b;Tye et al, 2014).…”

“…Analyzing a wide range of EF domains, Dajani, Llabre, Nebel, Mostofsky and Uddin (2016) identified distinct profiles of EF across ADHD, ASD, ASD+ADHD and TD children using a latent profile analysis with indicators of EF. The EF was examined using The Behavior Rating Inventory of Executive Function (BRIEF-parent form) and neuropsychological measures such as "statue subtest" (inhibit responses) from The Developmental Neuropsychological Assessment (NEPSY-II) and backward digit span test (working memory).…”

Parsing heterogeneity in autism spectrum disorder and attention-deficit/hyperactivity disorder with individual connectome mapping

“…For example, subgroups have been shown to exist within children who have ADHD based on differences in functional connectivity of fronto-parietal and reward-related networks (Gates, Molenaar et al 2014, Costa Dias, Iyer et al). Subgroups within both ADHD and ASD categories have been demonstrated based on disorder-specific symptoms (Georgiades, Szatmari et al), neuropsychological task performance (Rommelse, van der Meer et al 2016, Feczko, Balba et al 2017, and parent-reports of children's executive functions (Dajani, Llabre et al 2016 On the other hand, the traditional categorical approach has recently been challenged by mounting evidence for a dimensional taxonomy of psychopathology (Lahey, Krueger et al 2017). Studies focusing on parent-report and neuropsychological measures of ADHD symptoms consistently conclude that inattention and hyperactivity/impulsivity are dimensional by nature (Haslam, Williams et al 2006, Frazier, Youngstrom et al 2007, Lubke, Hudziak et al 2009, Marcus and Barry 2011.…”