Executive Function in More-Able Kindergartners with ASD Predicts Concurrent Academic, Social, and Behavioral Outcomes

Background: Impairments in executive function (EF) in ASD may emerge as early as preschool years, but studies examining EF skills in young children with ASD are limited. More in-depth examinations of EF skills as predictors of academic and social outcomes in young children with ASD will help us examine when and how impairments in school readiness skills emerge prior to school entry and build treatment programs targeting these skills beginning as early as the preschool years.

Objectives: We used innovative, recently-validated EF tasks in order to examine the association between EF skills and concurrent academic achievement, peer connections, and externalizing/internalizing problem behaviors in more-able kindergarteners with ASD.

Methods: Participants included 42 more-able children with ASD (no cognitive and structural language delays; mean age =63.7 months; SD=6.0). Working memory (Pick the Picture [PTP]), inhibitory control (Arrows [ARR]), and attention shifting (Something’s the Same [STS]) were assessed based on child-friendly, tablet-based EF tasks, EF Touch (Willoughby et al., 2010) and behavioral regulation was assessed based on a well-established, highly engaging, Head Toes Knees Shoulders (HTKS) task (Ponitz et al., 2008; n=28). Academic achievement was measured based on the Woodcock Johnson achievement test (WJ), internalizing/externalizing behaviors based on the Child Behavior Checklist (CBCL), and peer connections based on the Penn Interactive Peer Play Scale (PIPPS). Regression analyses were conducted to examine whether EF skills significantly predicted subsections of WJ–letter word identification (LW), passage comprehension (PC) and applied problem (AP), CBCL internalizing, and externalizing behaviors and PIPPS interaction and disconnection during peer play, while controlling for age, gender, race and maternal education. For a subset of children (n=27, mean age = 60.6 months; SD=3.8); analyses were repeated while controlling for FSIQ as an additional covariate.

Results: Regression analyses indicated significant effects for following variables (p<0.05). Accuracy for attention shifting (STS) from EF Touch significantly predicted performance on the WJ math achievement (AP) the PIPPS interaction and CBCL internalizing problem sub-scores. Accuracy for working memory (PTP) was significantly associated with performance on all three sections from WJ as well as interaction and disconnection sub-scores from the PIPPS. Accuracy for inhibitory control (ARR) from EF Touch significantly predicted WJ reading achievement (PC) and CBCL internalizing problems. Response time for the EF ARR task was also a significant predictor of WJ AP and the PIPPS play interaction. Last, behavioral regulation (HTKS) was significantly predictive of scores for reading (WJ-LW). When IQ was controlled, the effects of attention shifting (STS) on WJ-AP and inhibitory control (ARR) on CBCL internalizing behaviors remained significant.

Conclusions: Our results demonstrate the potential link between impairments in EF skills and academic and social success as well as other clinical features in more-able kindergarteners with ASD. The most robust effects were found for one’s ability to shift attention and inhibit responses on math achievement and internalizing problems respectively. These findings provide preliminary evidence of EF deficits in children with ASD and implications for incorporating EF training into intervention prior to school entry.