The Relationship Between Executive and Social Functioning in Children with Autism Spectrum Disorders on Parent-Rated Measures

Background:  Executive function (EF) deficits are common in children with Autism Spectrum Disorders (ASD), but not part of the diagnostic criteria. While both social and EF deficits in ASD have been extensively studied separately, there has been limited research on the relationship between EF and social function. Most research has focused on neuropsychological assessment of EF and/or how EF impairment is related to a diagnosis of ASD.

Objectives: The aim of the present study was to explore the relationship between social functioning and EF on parent-rated measures in a clinical sample of children with ASD. Furthermore we wanted to investigate how IQ, gender and age influence the relation between EF and social problems. Most research within the ASD field is done on males, but some evidence suggests that females exhibit greater EF and social impairments than their male counterparts and we would like to examine this further.

Participants and Methods: The current sample comprised 86 children with ASD recruited from outpatient clinics between 2013 and May 2016 and assessed at age 6-18 years. Thirteen of the children (15.1%) had childhood autism, 1 had atypical autism (1.2%), 41 (47.7%) had Asperger syndrome and 31 (36%) had unspecified pervasive developmental disorder. Male:female ratio was 2.7:1. Twenty-eight of the participants (32.6%) had an attention deficit/hyperactivity disorder (ADHD) diagnosis in combination with their ASD. Autistic symptoms were evaluated using Autism Diagnostic Interview-Revised (ADI-R) and/or Autism Diagnostic Observation Schedule (ADOS). In addition, the assessment included a full medical and developmental history, physical examination, and IQ assessment. For measurement of social function the parent version of the Social Responsiveness Scale (SRS) was used. In order to assess executive function parents completed the Behavior Rating Inventory of Executive Function (BRIEF).

Results:  A multiple regression analysis was conducted to identify the relations between SRS total score and age, gender, total IQ, BRIEF Behavior Regulation Index (BRI) and BRIEF Metacognitive Index (MI). This model significantly explained SRS total; F(5, 80)=12.57, p<.001, R² =.440. Only BRIEF MI had a significant independent contribution to the prediction, p=.001. This result remained when the children with comorbid ADHD where removed from the analysis. For the children with ASD without ADHD (n=58) the regression model with age, gender, total IQ, BRIEF BRI and BRIEF MI significantly explained SRS total; F(5, 52)=10.31, p< .001, R²=.498. Only BRIEF MI had a significant independent contribution to the prediction, p=.003.

Conclusions: We report a relationship between parental reports of EF and social function in an everyday setting in children with ASD. We found that the metacognitive domain of EF has a significant association to many aspects of social function. These results may have implications for understanding the cognitive components in the social deficits that define ASD. The findings suggest that studies are needed to clarify if children with ASD will improve their social function through intervention programs designed to enhance EF in general and metacognitive function in particular.