Executive functioning in children with ASD + ADHD and ASD + ID: A systematic review.
This journal article was sourced to inform clinical practice for an existing case with details as follows:
Diagnoses;
- Autism Spectrum Disrdoer (ASD)
- Attention deficit hyperactivity disorder (ADHD)
- Intellectual Disability (ID)
Impairments;
- Executive Functioning deficits – presenting as difficulty completing schoolwork, and difficulty with domestic Activities of Daily Living (ADLs) such as cleaning and tidying.
Summary
Executive Functioning (EF) in general comprises of higher-level cognitive processes which allow an individual to adapt to situations in their environment. It includes volition, planning and decision-making, purposive action (taking steps to implement a plan) and effective performance.
Individual body functions include:
- Working memory.
- Inhibition.
- Cognitive flexibility and shifting.
- Planning and organisation.
- Attention.
- Self-regulation.
EF allows a person to independently complete daily tasks including domestic, academic, work-related, social skills, etc. ASD, ADHD, ID are all associated with EF deficits which in turn makes these occupations more difficult.
Methodology Review
Systematic Review with 24 articles meeting inclusion criteria – however, there were no date restrictions (2 studies from prior to 2000 and others that are 20 years and older). Evidence continues to grow and evidence from studies 20+ years older could be outdated.
Practical Application and Take Home
Co-occurring diagnoses can have a significant impact compared to children with a sole ASD/ADHD/ID diagnosis and affects Executive functioning to a greater extent than just a sole diagnosis of ASD.
- ASD + ADHD seemed to have more difficulty with working memory, inhibition, planning and organizing as well as attention as a relative weakness. This may manifest itself as difficulty cleaning a room, a schoolbag and other domestic tasks for example.
- ASD + ID seemed to present with relative strengths in attention and weaknesses with metacognition (problem-solving and decision making), flexibility and shifting.
Image Description: The child is playing with magnets at a school setting. They have brown short hair, and are wearing a collared, short-sleeve blue shirt and bright blue glasses.
Researchers suggest performance-based and indirect assessments of Executive Functioning as each can offer different insights.
- Performance-based assessments can evaluate efficiency in problem-solving.
- Indirect measures can evaluate this ability based on the individual’s unique goals and values.
- For example, a client may have significant difficulty problem-solving in a clinical setting/scenario or question posed to them. But if they are given an example which is relevant to them, problem-solving may be much easier.
Lack of evidence in early childhood where Executive Functioning undergoes critical development and is associated with academic outcomes and progression. The average age of the study was 10.3 years.
Clients with ASD/ADHD/ID are much more likely to have other developmental disorders/comorbidities. Informed intervention is necessary in order to target the specific client group.
Journal Article: Benallie, KJ, McClain, MB, Bakner, KE, Roanhorse, T & Ha, J 2021, ‘Executive functioning in children with ASD + ADHD and ASD + ID: A systematic review’, Research in Autism Spectrum Disorders, vol. 86, August 2021, https://doi.org/10.1016/j.rasd.2021.101807.
