Demetriou, E. A., DeMayo, M. M., & Guastella, A. J. (2019). Executive Function in Autism Spectrum Disorder: History, Theoretical Models, Empirical Findings, and Potential as an Endophenotype. Frontiers in psychiatry, 10, 753. https://doi.org/10.3389/fpsyt.2019.00753

University of Rochester

Executive function refers to functions such as planning, working memory, impulse control, inhibition, and mental flexibility. Traditionally, these functions have been tied to the frontal lobe, particularly the prefrontal cortex. Many signs of autism that are observed are related to disrupted executive function, causing repeated behaviors and rigid schedules among other behaviors. Executive Dysfunction seems to be a product of differences in the frontal lobe, caused by injury or neurodevelopmental disorders. It can also contribute to difficulties with emotional/behavioral regulation.

Executive Dysfunction

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 

Evaluating the theory of executive dysfunction in autism

Executive Function in Autism Spectrum Disorder: History, Theoretical Models, Empirical Findings, and Potential as an Endophenotype

Planning is a complex and dynamic operation that involves constant monitoring, re-evaluating, and updating, which in turn requires the ability to predict abstract outcomes, assess the current situation accurately, make a choice, and implement a plan properly. Planning deficits have been observed in individuals with ASD, as they have trouble with planning tasks like the Tower of Hanoi/Tower of London.
However, this deficit was not present in all ASD individuals, and was not seen much in easy puzzles, suggesting an ASD problem in complex planning, not just any kind of planning. This deficit may be more related to a learning disability, but it's unclear.

Planning Deficits in ASD

Otherwise known as set-shifting, this refers to the ability to shift to a different thought or action as context shifts. Poor mental flexibility is demonstrated in the inability to change course of thought and action and perseveration- one of the major symptoms of autism spectrum disorder. ASD individuals, for instance, struggle with the Wisconsin Card Sorting Task. 
However, performance is not poor for ASD individuals across the board, seeming to be affected by age, IQ, gender, and ethnic origin. Performance may be highly related to verbal IQ, and errors may not all be perseverative in nature. Some errors may just be random errors. 

Mental Flexibility in Autism

Executive functioning is thought to be centralized in the frontal lobes. Individuals with frontal lobe damage do, in fact, show deficits often seen in ASD, which is where the theory of executive dysfunction in ASD came from. Indeed, there are reported structural abnormalities in the frontal cortices of ASD individuals, but results are inconclusive because results vary by individual. Generally, delayed postnatal maturation of the prefrontal cortex has been reported. However, it is important to keep in mind that developmental and acquired disorders are inherently different and cannot be compared totally equally. Similarly, results are inconclusive about how much of ASD symptoms are related to prefrontal cortex abnormalities. Though there is a potential that these abnormalities are probably a factor, it is unclear if these abnormalities are the root of ASD. 

Autism and the Frontal Lobes in Executive Dysfunction

There is a general lack of consensus as to which executive functioning aspects are problematic in ASD specifically. Symptoms overlap with other disorders, so the source isn’t clear. It cannot be proven if executive dysfunction is the root of ASD symptoms as opposed to a symptom in itself. These difficulties are also not entirely universal, appearing to be affected by IQ and age, with some executive functions more difficult to others. Measurements are imperfect and may be affected by other factors. Perhaps its greatest potential is as an endophenotype. 

Problems With the Executive Dysfunction Hypothesis of ASD

Some relevant psychiatric and developmental populations that struggle with executive dysfunction are the following:
- ADHD
- depression
- anxiety
- schizophrenia
- ASD

Populations affected by Executive Dysfunction

Issues with emotional regulation, aka Emotional Dysregulation (ED), are not diagnostic factors when evaluating people for autism, however many people with ASD struggle with emotional regulation which can manifest in behavioral or social difficulties due to difficulty or inability to apply adaptive emotion regulation strategies

Emotional Regulation and ASD

The left hemisphere deals with working memory, concentration, executive planning, and positive emotions. 

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