Improved Executive Function over Time in Children with ASD and Relations with Mental Health and Functional Outcomes

Poster Presentation
Thursday, May 2, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
R. Lyon1, J. D. Haltigan1, A. Sawyer2, P. Mirenda3, I. M. Smith4, T. Vaillancourt5, J. Volden6, C. Waddell7, L. Zwaigenbaum6, S. E. Bryson8, W. Roberts9, E. Fombonne10, T. Bennett11, E. Duku12, M. Elsabbagh13, S. Georgiades12, W. J. Ungar14, A. Zaidman-Zait15, M. C. Lai16, P. Szatmari16 and S. Ameis17, (1)The Centre for Addiction and Mental Health, Toronto, ON, Canada, (2)Centre for Addiction and Mental Health, Toronto, ON, Canada, (3)University of British Columbia, Vancouver, BC, Canada, (4)Dalhousie University / IWK Health Centre, Halifax, NS, CANADA, (5)University of Ottawa, Ottawa, ON, Canada, (6)University of Alberta, Edmonton, AB, Canada, (7)Simon Fraser University, Vancouver, BC, Canada, (8)Dalhousie University, Halifax, NS, Canada, (9)isand, Toronto, ON, Canada, (10)Psychiatry, Pediatrics & Behavioral Neurosciences, Oregon Health & Science University, Portland, OR, (11)Offord Centre for Child Studies, McMaster University, Hamilton, ON, CANADA, (12)McMaster University, Hamilton, ON, Canada, (13)McGill University, Montreal, PQ, Canada, (14)University of Toronto / The Hospital for Sick Children, Toronto, ON, Canada, (15)Tel-Aviv University, Tel-Aviv, Israel, (16)The Hospital for Sick Children, Toronto, ON, Canada, (17)The Margaret and Wallace McCain Centre for Child, Youth, & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
Background: Executive function (EF) is a high-order cognitive function including a number of subcomponents, such as set-shifting, response inhibition and working memory. Executive dysfunction is prevalent in children diagnosed with autism spectrum disorder (ASD) and may be an important predictor of functional independence in adulthood. Relationships between EF and adaptive functioning and mental health symptoms have been shown. However, little is known about the development of EF skills over time in children with ASD.

Objectives: We aimed to examine: 1) how EF skills change over time in a large longitudinal sample of children with ASD followed across school age; and (2) whether EF skills in school-age predict functional outcomes in pre-adolescence.

Methods: Our sample included data from 202 children prospectively followed in a large Canadian multisite longitudinal study (Pathways in ASD Study) from the time of clinical diagnosis of ASD in early childhood (2-4 years of age, T1) across 7 additional timepoints (T2-7). Data collected when children were age 6 (T4), and every 1-2.5 years thereafter (T5-8) was used (sample age=10-11.8 years at T8). The Behavior Rating Inventory of Executive Function(BRIEF) Behavioral Regulation (BRI) and Metacognitive Index (MCI) Subscales (T5-8), Vineland Adaptive Behavior Scale(VABS) Adaptive Behavior Composite Score (T8), Child Behavior Checklist(CBCL) Internalizing/Externalizing Scores (T8), teacher-report of academic performance (Teacher Report Form) (T8), and Wechsler Preschool and Primary Scale of Intelligence-measured full scale IQ (T4) were used. Repeated measures analysis was used to examine change in BRI and MCI T scores collected in participants across school-age (T5-8). Hierarchical regressions were used to examine whether BRI and MCI scores (collected at T5-7) predicted VABS composite, CBCL internalizing/externalizing and academic performance scores at T8 (N=71-88). FSIQ was entered in the first step for each model to control for effects of general intelligence.

Results: Repeated measures analysis showed a significant decline for both BRI (F3, 279= 4.88, p = .003) and MCI T-scores (F3, 250= 5.56, p = .001) across T5 to 8. Hierarchical regressions indicated that: BRI predicted both internalizing (β=.46, p<0.01) and externalizing (β=.37, p<0.01) behaviours in models controlling for MCI, FSIQ and internalizing or externalizing behaviours; and BRI (β=-.37, p<0.01), MCI (β=.17, p<0.05), and FSIQ (β=.26, p<0.01) were all significant predictors of academic performance. Only FSIQ was a significant predictor of VABS composite scores.

Conclusions: Our preliminary findings indicate that in children with ASD, EF skills improve across school age. Parent-reported EF skills collected across school age are also predictive of parent-reported mental health symptoms, and teacher-reported academic performance in the same children in pre-adolescence. EF skills may be an important cognitive domain to track in children with ASD as well as a novel treatment target with the potential for positive downstream effects on academic performance and mental health symptoms.