Assessment of Executive Functions and Their Effects on Adaptive Behavior in Children with Autism Spectrum Disorders

Background: Executive functioning is an umbrella term for higher order cognitive functions that include various skills such as inhibition, flexibility, emotional control, initiation, working memory, organization of material, planning, and monitoring. Executive functions (EFs) are involved in the control of action and thought and are crucial in social adaptation process, cognitive development, interpersonal and communication skills. Recently, researchers have stated that the theory of executive dysfunction is the primary cognitive process that best explains Autism core symptoms and behavioral manifestations. Studies from developing countries have shown that individuals with Autism spectrum disorder (ASD) encounter difficulties in wide range of EFs when compared to typically developed children. In Lebanon, as in most countries of the Middle East, studies evaluating EFs in ASD cases are scarce. Their assessment is an important element in identifying profiles of ASD children and to successfully carry out an appropriate course of action.

Objectives: The aim of the current study is the evaluation of Global Executive Functions (GEF) and their components in children with ASD and to identify an EF profile for ASD cases in Lebanon. We also sought to examine their effects on adaptive behavior.

Methods: A total of 30 children aged 5 to 14 years old with ASD were matched by age and gender to 30 normal typically developing (TD) individuals. Teachers were asked to complete the Behavior Rating Inventory of Executive (BRIEF-T) scale assessing children’s Global Executive functions (GEF) and its different domains within everyday contexts. Adaptive behaviors were assessed by Vineland Adaptive Behavior Scales-Second Edition (Vineland-II). Statistical analysis was performed using SPSS version 22.0

Results: Statistically significant differences were found in GEF as well as all EF subdomains assessed in ASD group compared to their TD counterparts with lower performance by the ASD group. The mean VABS score was lower among ASD group compared to the TD group (Mean VABS among ASD 37.3 with a SD of 9 compared to 114.5 and a SD of 13.2 with a P-value ˂0.001) suggesting deficits in adaptive behaviors in ASD cases than their TD counterparts. Inhibition and emotional controls subdomains of the BRIEF-T were positively correlated with VABS suggesting their impact on the adaptive behavior of children with ASD.

Conclusions: ASD cases exhibited impairment in inhibition, flexibility, emotional control, initiation, working memory, organization of material, planning, and monitoring domains of EFs relative to their TD peers. Deficits in adaptive behaviors were also found in ASD individuals than TD children. Finally, deficits in inhibition and emotional controls were associated with decreased adaptive behavior of children with ASD. Considering the low EF profile found in ASD children in Lebanon, educational strategies should be suggested in order to improve their EFs and thus to improve their adaptive behaviors.