Jul 13, 2022

Executive functioning could be key to improving outcomes in children with autism


Many individuals with autism experience mental health symptoms and have difficulties with academic and everyday functioning. The available treatments are few and unreliable. Dr. Stephanie Ameis, Dr. Peter Szatmari, and their team have discovered that improving executive functioning at a young age could help alleviate these difficulties and improve the lives of children with autism in the long-term. We spoke to Dr. Ameis about the findings published in their new paper.

Dr. Stephanie Ameis
Dr. Stephanie Ameis

What is executive function and how does it differ in those with autism? 

SA: Executive functioning (EF) is a set of mental processes that we use to plan, manage tasks, and achieve goals. Executive functions include things like working memory, self control, and directing attention.

EF predicts later academic performance and mental health in typically-developing children. While not all individuals with autism have EF impairment, a recent meta-analysis suggested that many of them struggle with these types of thinking tasks, and have particular difficulty applying EF skills to everyday life situations.

Dr. Peter Szatmari
Dr. Peter Szatmari

What motivated this research? 

SA: Many individuals with autism struggle with mental health symptoms and have difficulties with academic and everyday functioning. EF impairment has been linked to these challenges and with greater autism symptoms. There are few treatments that have been proven to help. 

Before our study, no study had examined whether EF impairment could have an important effect on different outcomes. We didn't know if EF impairment contributes to difficulties at school, in everyday life, and in regulating emotions later on in life.

What was the most important finding of this study, in your opinion?

SA: Our longitudinal study is the first to show that EF in school age children with autism may be one pathway through which preschool autism symptoms influence academic performance, everyday functioning, and challenging behaviours, such as aggression and rule breaking in adolescence. Our work suggests that preschool children with greater autism symptoms may develop more difficulty in EF in middle childhood (i.e., at school-age), which then increases the risk for greater behavior problems, and poorer outcomes in school and everyday life, in adolescence. 

How does this change treatment in the future? 

SA: Our work provides the rationale for developing interventions to improve EF skills in school-age children with autism, and then measuring if these interventions improve development, mental health, and functioning in adolescence. 

Any next steps? 

SA: We are currently developing and testing interventions that target mental health symptoms and EF in teens and young adults with autism.

What is the major take home message for the public?

SA: Clinicians and teachers supporting children with autism need to consider the potential impact of EF on behaviour and functioning. When diagnosing autism in preschool children, clinicians may educate families about how EF impairment can be common in children with autism and become more prominent as they get older. In school-age children, conversations with teachers are needed to improve understanding about how EF difficulties may be influencing school performance and behavioural regulation. There are currently no interventions proven to improve EF skills in individuals with autism, but there are behavioural strategies that can be put in place to help support EF skills. Increased awareness and understanding of how these skills impact other domains are an important starting point to lessen the impact of EF impairment on a variety of domains.


ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod

Ameis SH, Haltigan JD, Lyon RE, Sawyer A, Mirenda P, Kerns CM, Smith IM, Vaillancourt T, Volden J, Waddell C, Zwaigenbaum L, Bennett T, Duku E, Elsabbagh M, Georgiades S, Ungar WJ, Zaidman-Zait A, Lai MC, Szatmari P; Pathways in ASD Study Team. Middle-childhood executive functioning mediates associations between early-childhood autism symptoms and adolescent mental health, academic and functional outcomes in autistic children. J Child Psychol Psychiatry. 2022 May;63(5):553-562. doi: 10.1111/jcpp.13493.