Comparison of Parent- and Teacher-Report of Executive Function Deficits on Adaptive Behavior Skills in Individuals with and without ASD

Background:  The importance of the real-world everyday skills defined by adaptive behavior for successful social functioning and independent living of individuals with ASD has been documented in the literature. There is often a significant gap between IQ and adaptive behavior for individuals with ASD without co-occurring intellectual disability (HFASD). Deficits in executive function (EF) skills have been associated with impaired adaptive functioning. However, most studies have assessed EF skills via parent report on measures such as the Behavior Rating Scale of Executive Function (BRIEF) and have not also included a second source of information such as teacher observations of EF skills in the classroom. Inclusion of another informant could enhance the understanding of previous findings.

Objectives:  The study aim is twofold: 1) Examine the role of teacher-reported EF deficits on adaptive behavior functioning in comparison to parent report among a group of individuals with HFASD and 2) Determine if the relationship between EF deficits and adaptive behavior is transdiagnostic by including a clinical comparison group of individuals referred for an ASD evaluation but not meeting diagnostic criteria.

Methods:  This is an IRB-approved record review study of diagnostic evaluations of a clinically-referred population ages 6-18 years seen at an outpatient clinic. ASD diagnoses were based on ADOS-2 scores and experienced clinical judgment; SRS-2 was used as a measure of ASD symptom severity. Adaptive functioning was measured by parent report on the ABAS-2 and ABAS-3 Practical domain. The BRIEF and BRIEF-2 were used to measure EF skills.

Results:  Data collection and analyses are ongoing with a total anticipated n=60-65. Currently, ASD group n=28 and non-ASD group n=19. The groups are evenly matched for age (ASD M=9.82; non-ASD M=9.63, t(45)=-.25, p>.05) and nonverbal IQ (ASD M=99.11; non-ASD M=94.21, t(45)= -1.09, p>.05). Both groups had significantly impaired functioning on the Practical domain (ASD M=67.54; non-ASD M=70.47). Parent and teacher report of overall EF deficits were not correlated in either group (ASD r=.25, p=.17; non-ASD r=.28, p=.17). Teacher report of EF subscales were not correlated with the Practical domain for the ASD group (r’s<.16, p’s>.27), yet Initiate and Organization of Materials was negatively correlated with Practical domain in the non-ASD group (r’s>.47, p’s<0.4). Per parent report, significant correlations between the Practical domain and Initiate, Working Memory, and Plan/Organize existed for the ASD group (r’s>.32, p’s<.04), while in the non-ASD group Practical skills were correlated with Shift (r=-.42, p=.04).

Conclusions:  While EF and Practical skills deficits were noted across clinical groups, parents tended to report more difficulties. Different relations between EF and Practical skills were found between the ASD and non-ASD groups. A better understanding of the factors that contribute to a more successful outcome for high functioning individuals with ASD is necessary to develop effective interventions. Nearly half of individuals with ASD have average or above cognitive abilities yet do poorly with the practical everyday adaptive behavior skills. Interventions that improve EF skills may be particularly helpful in increasing functional independence for this fastest growing subgroup of individuals with ASD.