Childhood Executive Function Predicts Later Autistic Features and Adaptive Behavior in Young Autistic People: a 12-Year Prospective Study

Lorcan Kenny,Elizabeth Pellicano,Serena J Cribb

doi:10.1007/s10802-018-0493-8

Abstract

Longitudinal studies of autistic people show that the behavioral features of autism generally endure into adulthood. Yet the prognostic indicators remain far from certain, especially for cognitively able individuals. Here, we test the predictive power of specific cognitive skills, namely theory of mind and executive function, measured in childhood, on young people’s autistic features and adaptive behavior 12 years later. Twenty-eight young autistic people (2 female) were seen twice within the space of 12 years. At Time 1 (M = 5 years; 7 months, SD = 11 months), participants were assessed on components of executive function (planning, inhibition and cognitive flexibility) and theory of mind (false-belief understanding). At Time 2, 12 years later (M = 17 years 10 months, SD = 1 year; 2 months), we measured participants’ autistic features and adaptive behavior. Only Time 1 executive function skills predicted significant variance in autistic adolescents’ autistic features, over and above variance attributable to early age, intellectual ability and theory of mind skills. Furthermore, early EF skills, in addition to early verbal ability and nonverbal ability, predicted significant variance in young people’s adaptive behavior at the 12-year follow-up. These long-term longitudinal findings clearly demonstrate that executive function measured in early childhood has prognostic significance in a sample of young autistic people approaching emerging adulthood and underscore their importance as a key target for early intervention and support.

Highlights

Longitudinal studies of autistic people show that the behavioral features of autism generally endure into adulthood
We conducted hierarchical regression analyses to test whether individual differences in theory of mind’ (ToM) and executive function’ (EF) measured in early childhood predicted autistic features, as indexed by Autism Diagnostic Observation Schedules – 2nd edition (ADOS-2) severity scores, and adaptive functioning, as measured by Vineland-2 scores, 12 years later
This study examined the predictive power of specific cognitive skills measured in childhood for a group of cognitivelyable autistic children followed over a 12-year period

Summary

Introduction

Longitudinal studies of autistic people show that the behavioral features of autism generally endure into adulthood. These studies have repeatedly shown that childhood language ability, especially the acquisition of language before age 5 (Eaves and Ho 2008; Gotham et al 2012; Lotter 1974; Magiati et al 2014; Pickles et al 2014; Szatmari et al 2003; Venter et al 1992) and general intellectual ability (Bal et al 2015; Gillberg and Steffenburg 1987; Howlin et al 2013) are significant predictors of autistic features and adaptive behavior in autistic people This is not necessarily the case, for cognitively-able individuals, whose adult outcomes are notoriously variable and less than straightforward to predict on the basis of early language and intellectual functioning alone (e.g., Anderson et al 2014; Howlin et al 2004). Rival candidate is atypicalities in ‘executive function’ (EF) or difficulties with those skills necessary for flexible, goal-oriented behavior (including planning, cognitive flexibility, inhibition), which were linked in particular to the presence of restricted and repetitive behaviors in autism and problems managing everyday routines (Damasio and Maurer 1978; Ozonoff et al 1991; Turner 1997)

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