Executive Functioning in Adults with Autism. Do They Have a Characteristic Brief-a Profile?

Background:

Adults with ASD are known to have executive function (EF) problems, especially with cognitive shifting. EF research in ASD is mainly based on results from neuropsychological tests. However, this way of testing has its limits concerning the ecological validity and takes a considerable amount of time. The Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) does not have these disadvantages. The BRIEF-A screens for potential problems, measured by nine nonoverlapping theoretically and empirically derived clinical scales: Inhibit, Self-monitor, Plan/Organize, Shift, Initiate, Task monitor, Emotional control, Working memory, and Organization of materials.

Various studies have shown that the BRIEF is able to identify EF problems in children with ASD, with the most profound elevation on the scale Shift. This could be considered a ‘characteristic’ ASD profile. Little research has been conducted on the existence of such a profile in adults with ASD. Research using the BRIEF-A informant version shows that adults with ASD have elevated scores on the scales Shift and Plan/Organize. It is unclear whether the same is true for the self-report version.

Objectives:

We want to investigate whether there is a characteristic BRIEF-A-score profile for adults with ASD.

Methods:

The sample consisted of 254 adults (M = 34.28, SD = 12.05 years; 181 men, 73 women). Trained clinicians diagnosed the participants with ASD, using the DSM-IV-TR criteria (N = 14 AD, N = 114 AS, N = 126 PDD-NOS). All participants filled in a BRIEF-A self-report questionnaire. T-scores were calculated for all eight scales. The normative sample of the Dutch BRIEF-A manual was used as a reference group.

Results:

The ASD group has significant higher BRIEF-A scores – indicative of more EF problems – than the normative group, on all nine scales (M >= 50, p < .001, d = 0.75-1.60). The scales Shift, Initiate, Working Memory and Plan/Organize even show a clinical elevation (M > 65, p <= .001, d = 0.25-0.40).

Concerning differences based on sex, women with ASD have significant higher scores than men on the clinical scale Shift (M = 74.27, SD = 11.70, M = 68.41, SD = 12.56 respectively, t(252) = -3.435, p = .001, d = 0.48) and Emotional control (M = 64.15, SD = 11.62, M = 58.97, SD = 12.16 respectively, t(252) = -3.110, p < .002, d = 0.44).

Conclusions:

Adults with ASD report the most profound EF problems with shifting, initiating, working memory, and planning/organizing. Women with ASD report more problems than men concerning shifting and emotional control. Note that the effect sizes are small. More research is warranted before conclusions can be made concerning a possible characteristic BRIEF-A profile for adults with ASD.