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Executive Dysfunction in Children with Autism


Executive function is a collective term for critical functions such as planning, working memory, impulse control, inhibition, initiation, and monitoring of tasks or actions. Executive functioning is mediated by the frontal lobe, meaning any developmental delay that implicates the frontal lobe typically results in executive dysfunction. 

Executive Dysfunction in Children with Autism http://autismparentingmagazine.com/executive-dysfunction-autism

Executive dysfunction is observed in conditions such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), Tourette syndrome, schizophrenia, and autism spectrum disorder (ASD). This article will look at the cognitive theory of executive dysfunction in ASD.

Autism spectrum disorder is characterized by difficulties in social interaction and social communication, restricted interests, and repetitive behaviors. These autism traits make general functioning much more challenging, and many scientists argue that executive dysfunction explains these traits.

What is executive dysfunction?

The frontal lobe is known as the seat of cognition and higher-order processing. It plays a role in neuropsychological functioning and, during the development of children and adults, it’s also involved in regulating higher-order cognitive functions that help to perform complex tasks. These higher-order cognitive functions are what we know as “executive functions”. According to Otero, et al. (2014), these higher-order functions include psychological processes such as selection and perception of important information, maintenance and retrieval of information in working memory; self-directed behavior, planning, and organization; regulation of behaviors, and ability to control response to an invariable environment; decision making.

Through neuropsychology research, scientists have found that any damage to the frontal lobe results in difficulties such as social awkwardness or inappropriate social behavior, lack of initiation, impulsivity, lack of focus and engagement in tasks, and disinhibition. Consequently, damage to the frontal lobe equates to executive dysfunction.

Executive dysfunction describes a variety of cognitive, behavioral, and emotional difficulties that are either caused by neurodevelopmental disorders or as a result of a traumatic frontal lobe injury. Challenges due to executive dysfunction include difficulty planning, organizing, problem-solving, and time management

Executive dysfunction in autism

The link between executive dysfunction and autism lies in the presentation of behaviors, in relation to key areas that executive function encompasses. For example, some traits of autism include difficulty initiating new tasks and tendency to fixate on specific tasks, the occurrence of repetitive behaviors that make it difficult to engage in other tasks, and difficulties in controlling impulses or self-regulating. 

Often, some children with autism benefit from the guidance of others to initiate and terminate tasks, or require consistent prompts so that routines become more frequent. Of these, one of the strengths of many autistic children is that they benefit from a routine and organized/structured form of lifestyle; unfortunately, for some, adopting these lifestyles requires external support.

Executive functioning is therefore a self-empowered ability to engage in the various tasks in our environment that require executive functioning without the guidance or prompt of another person. To understand which areas most children show signs of executive function deficits, let’s look at the domains that encompass executive functioning separately.

Areas impacted by executive dysfunction in autism

Planning

Planning is dynamic, and requires that the individual understands the concept of change, adapting to those changes, the ability to make choices, and implementing and revising a plan accordingly. Planning requires us to be flexible and aware that some things don’t follow a linear format and we therefore need to be able to adjust accordingly. 

Hill (2004) found that planning difficulties vary across every autistic individual and challenges occur most when planning is complex. Our everyday lives require constant planning and readjustment to plans which makes planning a complex task. Hill states that this complexity in planning is perhaps the reason why some autistic individuals find daily planning difficult. 

In addition, planning difficulties may not be due to the symptoms of autism—there could be underlying learning disabilities for some autistic individuals.

Cognitive flexibility

Cognitive flexibility is the ability to shift thoughts or actions according to the situation, i.e. your ability to adapt to a change. For example, when you see what you’re doing isn’t working, you make changes to adapt to new situations. 

Cognitive flexibility makes learning and problem solving possible. A person with good cognitive flexibility is able to tolerate changes, i.e. tolerate alternative plans, move from one activity to the next, is able to see different points of views, and find different solutions to the same problem.  

Looking at everyday situations, here are some examples of cognitive flexibility:

  • When you are running late for work and don’t have time to drop the kids off at school, do you make alternative plans at work? Do you ask a close friend or relative to take the kids to school? Cognitive flexibility helps you find alternative solutions to the problem
  • When you’re making breakfast and run out of eggs, do you think of alternative things you could eat or make, or do you get angry and leave for school or work? Cognitive flexibility helps make alternative options when the original plan changes unexpectedly

Some children with autism spectrum show signs of perseveration (behavior that is repetitive and continuous), and have difficulty regulating motor behaviors. Perseveration in autism is a result of poor mental flexibility, a consequence of poor executive function. Examples of this are the inability to stop tasks, or continuously repeating the same patterns instead of considering other ways to do a task. Hill (2004) says that perseveration among autistic children does not occur in every aspect of their lives, but mostly in certain activities that would require making alternative decisions.

Inhibition

Inhibition is the ability to stop an impulse or behavior, whether consciously or unconsciously.

Some children with autism find it difficult to respond to go/no-go tasks—the go signal directs you to respond, whereas the no-go signal directs you to not respond. In testing, the Go/No-Go test is a neurological test for assessing inhibitory control.

A form of inhibition test that is found to be consistent among autistic participants, is the inhibition of a prepotent response. A prepotent response is the natural response to either positive or negative reinforcement, for example, when I am offered a sweet, I am naturally inclined to accept it. A prepotent response inhibition occurs when I reject my desire to accept the sweet and turn down the offer.

In relation to autism, a prepotent response inhibition test was conducted in a study by Hughes and Russell, (1993) where two boxes were placed in front of the child, one had a chocolate and the other did not. For the child to get the chocolate, he/she needed to point to the box without the chocolate. The result of the test was that the child did not inhibit the prepotent desire to point to the chocolate and therefore did not receive the chocolate.

The above study shows the inability to resist certain urges or behaviors occurring in some autistic children.

Self-monitoring

Self-monitoring is the ability to monitor your own thoughts and actions.

Difficulties in self-monitoring work closely with perseverative behavior and inhibition (as highlighted perseveration is continuous or repetitive behaviors). When a person isn’t able to monitor his/her behavior on his/her own, perseveration is bound to take place. Self-monitoring helps to control our behaviors and determine how excessive something is and when inhibition should take place.

Self-monitoring is the cognitive ability to know when to disengage in a task, action, or thought in relation to the context or environment. This is found to be challenging for some autistic children.

However, we need to be careful of what we categorize an executive function deficit in the context of self-monitoring ability. When we look at the traits of autism, behaviors such as stimming may appear to others as a lack of self-monitoring ability, however, stimming is a form of self-regulation.


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Helping autistic children with executive dysfunction

Our ability to perform tasks and respond to the environment is both innate and taught. Executive functions help us to achieve these tasks with ease, while helping us to be functional. Executive dysfunctions lead to many challenges and can impact an autistic child’s ability to be functional, adaptable, and “conform” to social standards. 

Scientists look at executive dysfunctions from a theoretical point of view, but when we bring it down to the level of the child and his/her individual capacity, we become aware of the child’s individual abilities. There may be some form of “dysfunction” that distinguishes an autistic child from a “neurotypical” child, but that does not mean that those domains of executive functions do not exist. 

Therefore, to help autistic children improve their executive functions, it is important to consider their strengths and which form of executive function is impacted. Many therapies and interventions are child-centered and are aimed at teaching and improving the skills of the child.

Tips to improve executive function

1. To improve inhibition/impulse control

The five-second rule is very popular when it comes to food. At some point we dropped food and yelled “five-second rule!” This rule says that if I pick this up in five seconds or less, I can still eat it. Whether it is scientifically correct or not!

The five-second rule can also be used to teach impulse control. This involves teaching your child to count to five before responding to any verbal input or something that may trigger your child’s impulsive response.

It can be helpful to teach this in the presence of a trigger. For example, say your child tends to get triggered when a loud sound occurs, as you introduce the sound, tell your child to count to five. Eventually, the child will learn that, when that trigger occurs, he/she has to count to five. Counting to five helps the child to control his/her response as it happens.

2. To improve cognitive flexibility

Change routines! This is a golden rule when teaching your child to be flexible. Often autistic children are locked in the mindset of doing a task the same way.

  • When doing tasks, if he/she is set on using a particular stationery type, try introducing different materials
  • When going to the store, if he/she is used to a particular route, change the route. It may cause some anxiety at first but, he/she will get used to it
  • Teach your child to prepare different meals so that he/she learns to make a variety of foods. If you run out of milk you could say: “Milk is finished—what else can we make?” Your child needs to be flexible and think of an alternative meal that does not require milk

3. To improve planning and organization

  • Teach your child to plan his/her day daily
  • Teach your child to use vision boards or a schedule. Allow him/her to plan his/her own tasks; you could assist in this but allow the child to use his/her initiate to take the first step
  • Set a target for the day or week. Ask the child what needs to be done before accomplishing the task. If by the end of the day or week this target isn’t met, encourage the child to reorganize his/her schedule

4. To improve working memory

  • Memory games help improve working memory
  • At the end of the day, ask your child about his/her day. This is good practice to improve your child’s memory

5. To improve initiation

  • Create tasks with your child and set times to do each task. It would benefit your child if he/she understood the concept of time. As he/she follows the schedule and time for each task, it could encourage your child begin tasks on his/her own 
  • Asking questions such as “where do we start?” helps to teach your child the order of how a task should be completed using his/her own initiate

6. To improve self-monitoring

  • Teach your child to check in with how he/she feels. Engaging with your feelings is good practice for self-monitoring behavior
  • If your child is triggered by something or is uncomfortable, ask your child to communicate his/her feelings
    • The child can do this by either describing how he/she feels or using pictures or mood board
    • When that happens, the parents can then teach the child how to best deal with those emotions in a more efficient way

Executive dysfunction is a neurodevelopmental disability. However, the aspects that encompass executive functioning can be taught. Three key components are crucial when teaching a child on the spectrum: consistency, organization, and routine. Parents therefore need to adopt a child-centered mindset and teaching strategy that acknowledges their child’s strengths instead of the general standard.

In conclusion

When we seek to improve the executive functioning of autistic children, we need to level the playing field, so that we do not generalize dysfunction to a group of individuals. Autism is a spectrum and therefore symptoms associated with it will differ across every autistic individual. 

Some dysfunctions may occur that do not meet the “neurotypical” standard. However, early intervention, as well as an Individualized Educational Plan (IEP) can certainly help the child improve those areas so that he/she becomes more adaptable and functional.

References

Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24(2), 189–233. https://doi.org/10.1016/j.dr.2004.01.001

Hill E. L. (2004). Executive dysfunction in autism. Trends in cognitive sciences, 8(1), 26–32. https://doi.org/10.1016/j.tics.2003.11.003

Hughes, C., & Russell, J. (1993). Autistic children’s difficulty with mental disengagement from an object: Its implications for theories of autism. Developmental Psychology, 29(3), 498–510. https://doi.org/10.1037/0012-1649.29.3.498 

Otero T.M., Barker L.A. (2014) The Frontal Lobes and Executive Functioning. In: Goldstein S., Naglieri J. (eds) Handbook of Executive Functioning. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8106-5_3 

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