The Paradox of Cognitive Flexibility in Autism

Background: Researchers and clinicians assume that inflexible everyday behaviors in autism are directly related to cognitive flexibility deficits as assessed by clinical and experimental measures. However, there is a large gap between the day-to-day behavioral flexibility and that measured with so called cognitive flexibility tasks.

Objectives: We question the belief that cognitive flexibility is pathognomonic to autism. We will address why this is important, why cognitive flexibility deficits are considered central to autism spectrum disorder, and why we are skeptical.

Methods: We present an overview of current literature addressing cognitive flexibility in autism spectrum disorders.

Results: Based on recent studies at multiple sites, using diverse methods, and participants of different autism subtypes, ages, and cognitive levels, no consistent evidence for cognitive flexibility deficits was found.

Conclusions: To advance the field, experimental measures must evolve to reflect mechanistic models of flexibility deficits. Moreover, ecologically valid measures are required to be able to resolve the paradox between cognitive and behavioral inflexibility.