Internalizing Psychopathology: Relations to Executive Functions in Young Children with Autism Spectrum Disorder

Background: Children with ASD exhibit significantly higher rates of internalizing psychopathology including anxiety and depression than typically developing (TD) peers (Solomon et al., 2012). Psychiatric comorbidity in ASD increases with age and is associated with more negative outcomes overall. There is a paucity of research examining neurocognitive factors that may impact psychological outcomes for this population (Hollocks et al., 2014). Deficits in executive functioning (EF) are present in children with ASD (Hill, 2004) and associated with internalizing problems in TD populations (Koenigs & Grafman, 2009; Price & Drevets, 2012) and children with other neurodevelopmental disorders (Kelly et al., 2012). Neuropsychological deficits may partially explain the higher incidence of internalizing psychopathology in children with ASD and undermine children’s adaptive responses to stress imparting greater vulnerability to poor mental health outcomes.

Objectives: The current study examines whether EF mediates the relation between developmental status and internalizing problems in young children.

Methods: Participants included 66 children ages 36 to 85 months with 40 children in the TD group (57.5% male) and 26 children in the ASD group (84.6% male). EF measures included an ecologically valid rating scale and performance-based neuropsychological task. Children completed the Tower of Hanoi-Revised (TOH-R; Welsh, Pennington, & Groisser, 1991) and parents completed the BRIEF (Goia, Isquith, Guy, & Kenworthy, 2000) or BRIEF-P (Gioia, Espy, & Isquith, 2003) Plan and Shift subscales measuring planning skills and cognitive flexibility. Parents reported on children’s internalizing problems on the BASC-2-PRS (Reynolds & Kamphaus, 2004).

Results: Analyses utilized Hayes and Preacher’s macro (2013), PROCESS, to test a multiple mediation model in which developmental status is associated with internalizing problems through EF with Shift, Plan, and ToH-R variables as parallel mediators. Bootstrapping results (5,000 resamples and 95% bias-corrected and accelerated CIs) supported our model (R²= .470, F(5,55) = 9.741, p< 0.001) and indicated the predictor variables jointly accounted for 47% of the variance in internalizing problems. Significant indirect effects were found for Shift (point estimate= 1.215, SE = .301, 95% CIs[.652, 1.837]) and Plan (point estimate= .526, SE = .171, 95% CIs[.194, .869]). No significant indirect effect was found for ToH-R (point estimate= -.101, SE=.094, 95% CIs[-.340, .035]). Results indicate BRIEF Plan and Shift are significant mediators of the association between developmental status and internalizing problems whereas ToH-R did not play a mediational role.

Conclusions: The current study found a substantial indirect effect of parent reported child planning skills and cognitive flexibility on the association between ASD and internalizing problems. Performance on a neuropsychological task did not play a significant mediational role suggesting ecologically valid measures of EF may have more significance in the mechanisms underlying the association between internalizing symptoms and ASD. Research exploring the impact of neurocognitive factors on internalizing problems in individuals with ASD is limited and this is the first study to explore these relations in young children. These findings may inform interventions and potentially improve psychiatric outcomes for these children.