The Connection Between Autism Spectrum Disorder (ASD) and Executive Function Difficulties

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Two hands holding puzzle pieces that symbolize autism spectrum disorder in the shape of a heart

Adults with Autism Spectrum Disorder (ASD) often face significant challenges with executive function, which affect their ability to plan, organize, and regulate emotions. Learned coping mechanisms can mask these difficulties, complicating the assessment process.

The newly updated Behavior Rating Inventory of Executive Function®, Second Edition-Adult Version (BRIEF2A) offers several enhanced features that provide clinicians with a comprehensive tool to identify executive function deficits in adults with ASD, leading to more accurate diagnoses and tailored intervention strategies.

Understanding Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition marked by difficulties in social communication and interaction, along with restricted, repetitive behaviors (American Psychiatric Association, 2013). Although symptoms are usually recognized in childhood, they often continue into adulthood, affecting various aspects of functioning.

Core Symptoms of ASD

  • Communication and Interaction Difficulties: Struggling to understand social cues, maintain conversations, and form relationships.
  • Restricted Interests and Repetitive Behaviors: Includes repetitive movements, rituals, and intense focus on specific topics or activities.
  • Functional Impacts: Symptoms that affect performance in school, work, and other aspects of daily life.

How ASD Manifests in Adults

While diagnosed in childhood, ASD symptoms often evolve and become more noticeable in adulthood, particularly in work, social, and independent living contexts. An estimated 5.4 million U.S. adults, or 2.21% of the population, are affected by autism spectrum disorder (ASD) (Centers for Disease Control and Prevention, 2024).

  • Social Communication Challenges: Difficulty interpreting social cues, maintaining conversations, and forming relationships can lead to isolation or strained interactions.
  • Restricted Interests and Repetitive Behaviors: Rigid routines or intense focus on specific hobbies can limit flexibility in daily life.
  • Difficulty with Change and Transitions: Struggles with adjusting to changes in routine or new situations, particularly in work or personal settings.
  • Sensory Sensitivities: Heightened or reduced sensitivity to stimuli like light, sound, or textures can cause discomfort and impact functioning.
  • Mental Health Concerns: Anxiety, depression, and obsessive-compulsive disorder (OCD) are common, with these conditions often exacerbated by social, sensory, and executive function challenges.

The Connection Between Executive Function and Autism Spectrum Disorder

Executive functions are a set of interrelated control processes that govern behavior, emotion, cognition, and aspects of motor and sensory functioning. These self-regulatory functions organize, direct, and manage behaviors, emotional responses, and cognitive activities (Stuss & Alexander, 2000).

In individuals with ASD, EF difficulties are closely linked to challenges in adaptive skills, which impact daily functioning. Improving EF in this population could enhance daily task management and overall adaptive functioning (Yon-Hernández, 2023).

Although specific prevalence data on EF impairments in adults with ASD are limited, a study of 110 adults found that about 64% exhibited EF impairments (Johnston, 2019).

Executive Function Deficits in ASD

  • Working Memory: Individuals with ASD struggle to retain and apply information, which impedes their ability to follow instructions or complete tasks. They also perform worse than typically developing individuals in working memory (Townes, 2023; Hou, 2024; Southon, 2022).
  • Cognitive Flexibility: Adapting to changes in routine or shifting between tasks proves difficult, making it challenging to navigate unexpected situations. Additionally, individuals with ASD and ADHD show worse performance in cognitive flexibility compared to typically developing individuals (Townes, 2023; Hou, 2024; DiSarro, 2021).
  • Inhibitory Control: Regulating responses and managing emotions in social situations can be a major challenge. Both ASD and ADHD groups show deficits in inhibitory control compared to typically developing individuals (Townes, 2023; Hou, 2024; Burroughs, 2024).
  • Social Functioning: Executive function deficits hinder social interactions, complicating communication and behavior regulation in social contexts (Burroughs, 2024).
  • Age-Related EF Decline: As individuals with ASD age, executive function difficulties, especially memory decline, worsen and impair decision-making and daily functioning (Pagni, 2022; Saulnier, 2022).

Evaluating ASD and EF Deficits with the BRIEF2A

The BRIEF2A is a standardized tool that assesses executive function (EF) deficits in adults with Autism Spectrum Disorder (ASD). It collects self-reported and informant-reported perspectives, offering a comprehensive view of an individual’s EF strengths and challenges. Clinicians can apply the BRIEF2A in various settings, such as private practices, hospitals, and rehabilitation clinics, making it a versatile resource for improving assessment accuracy and guiding intervention strategies for adults with ASD.

Key features of the BRIEF2A include:

  • Updated normative sample: Based on the 2021 US census, enhancing the representativeness and reliability of the results across diverse populations.
  • 3-factor structure: Assesses behavioral, emotional, and cognitive regulation for a more precise characterization of EF deficits.
  • Extended age range: Designed for adults aged 18 to 99, allowing for a thorough evaluation of executive function challenges across the lifespan, including older populations who may experience different manifestations of EF deficits.
  • Multirater reports: The informant forms allow clinicians to compare information from multiple external observers, revealing discrepancies that provide valuable insights.
  • Progress monitoring reports: These new reports track changes over time and highlight differences between raters, enabling clinicians to monitor intervention effectiveness and assess progress in real-world contexts.
  • Validity scales: Updated embedded validity scales improve the accuracy of the assessment, ensuring that results are reliable and reflect the individual’s true executive function abilities.
  • Reduced item count: With 70 items (down from 75), the BRIEF2A streamlines the assessment process while providing comprehensive data on executive function.
  • New Spanish forms: Expands utility for Spanish-speaking adults, making the tool more inclusive and accessible for diverse populations.

With the BRIEF2A, clinicians can assess ASD and EF deficits through a structured, reliable evaluation of real-world functioning. The tool gathers data from multiple sources to uncover symptoms, track changes, and provide a clearer understanding of executive function, supporting accurate diagnoses and tailored interventions for adults with ASD.

Who Can Use the BRIEF2A?

The BRIEF2A is a standardized tool designed for a range of mental health professionals, including clinical, neuro, and counseling psychologists in settings like private practices, hospitals, and rehabilitation clinics. It’s also valuable for school psychologists working with K-12 students, particularly in developing transition plans for those with IEPs preparing for life after high school.

Qualifications to Use the BRIEF2A

The BRIEF2A is classified as a Level B assessment tool, meaning that professionals must meet specific qualifications to purchase and use it. To be eligible, individuals must have:

  • A degree from an accredited 4-year college or university in psychology, counseling, speech-language pathology, or a closely related field.
  • Completion of coursework in test interpretation, psychometrics, measurement theory, or educational statistics.
  • Alternatively, professionals who hold a license or certification that requires training and experience in the ethical and competent use of psychological tests are also eligible to purchase the BRIEF2A.

These requirements ensure that the BRIEF2A is used by qualified professionals with the expertise to administer and interpret the tool accurately and ethically.

Unlock a Deeper Understanding of Executive Function in Adults with ASD

Discover how the Behavior Rating Inventory of Executive Function®, Second Edition-Adult Version (BRIEF2A) can transform your assessments and improve outcomes for adults with ASD.

 

Sources

  1. American Psychiatric Association. (2013). Neurodevelopmental disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., pp. 31-86).
  2. Burroughs, C., Muscatello, R. A., & Corbett, B. A. (2024). The Role of Everyday Executive Function in Observed Social Symptoms of Autism Spectrum Disorder. Journal of autism and developmental disorders, 10.1007/s10803-024-06351-0. Advance online publication. https://doi.org/10.1007/s10803-024-06351-0
  3. Centers for Disease Control and Prevention. (2024, May 16). Key findings: Estimated number of adults living with autism spectrum disorder in the United States, 2017. https://www.cdc.gov/autism/publications/adults-living-with-autism-spectrum-disorder.html
  4. Di Sarro, R., Di Santantonio, A., Desideri, L., & Varrucciu, N. (2021). Profiling planning skills and cognitive flexibility of adults with autism spectrum disorders: Preliminary results from an exploratory service-based study. International journal of developmental disabilities, 68(5), 651–657. https://doi.org/10.1080/20473869.2020.1871311
  5. Hou, Y., Wang, Y., Deng, J., & Song, X. (2024). Effects of different exercise interventions on executive function in children with autism spectrum disorder: a network meta-analysis. Frontiers in psychiatry, 15, 1440123. https://doi.org/10.3389/fpsyt.2024.1440123
  6. Johnston, K., Murray, K., Spain, D., Walker, I., & Russell, A. (2019). Executive Function: Cognition and Behaviour in Adults with Autism Spectrum Disorders (ASD). Journal of autism and developmental disorders, 49(10), 4181–4192. https://doi.org/10.1007/s10803-019-04133-7
  7. Pagni, B. A., Walsh, M. J. M., Ofori, E., Chen, K., Sullivan, G., Alvar, J., Monahan, L., Guerithault, N., Delaney, S., & Braden, B. B. (2022). Effects of age on the hippocampus and verbal memory in adults with autism spectrum disorder: Longitudinal versus cross-sectional findings. Autism research : official journal of the International Society for Autism Research, 15(10), 1810–1823. https://doi.org/10.1002/aur.2797
  8. Saulnier, C. A., Klaiman, C., & McQueen, E. (2022). Adaptive Behavior Profiles in Autism Spectrum Disorder. Current psychiatry reports, 24(12), 749–756. https://doi.org/10.1007/s11920-022-01381-w
  9. Southon C. (2022). The relationship between executive function, neurodevelopmental disorder traits, and academic achievement in university students. Frontiers in psychology, 13, 958013. https://doi.org/10.3389/fpsyg.2022.958013
  10. Stuss, D. T., & Alexander, M. P. (2000). Executive functions and the frontal lobes: A conceptual view. Psychological Research, 63(3-4), 289–298. https://doi.org/10.1007/s004269900007
  11. Townes, P., Liu, C., Panesar, P., Devoe, D., Lee, S. Y., Taylor, G., Arnold, P. D., Crosbie, J., & Schachar, R. (2023). Do ASD and ADHD Have Distinct Executive Function Deficits? A Systematic Review and Meta-Analysis of Direct Comparison Studies. Journal of attention disorders, 27(14), 1571–1582. https://doi.org/10.1177/10870547231190494
  12. Yon-Hernández, J. A., Canal-Bedia, R., Wojcik, D. Z., García-García, L., Fernández-Álvarez, C., Palacio-Duque, S., & Franco-Martín, M. A. (2023). Executive functions in daily living skills: A study in adults with autism spectrum disorder. Frontiers in psychology, 14, 1109561. https://doi.org/10.3389/fpsyg.2023.110956
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