The paradox of cognitive flexibility in autism

doi:10.1016/j.tics.2008.11.006

Trends in Cognitive Sciences

Volume 13, Issue 2, February 2009, Pages 74-82

https://doi.org/10.1016/j.tics.2008.11.006 Get rights and content

We present an overview of current literature addressing cognitive flexibility in autism spectrum disorders. Based on recent studies at multiple sites, using diverse methods and participants of different autism subtypes, ages and cognitive levels, no consistent evidence for cognitive flexibility deficits was found. Researchers and clinicians assume that inflexible everyday behaviors in autism are directly related to cognitive flexibility deficits as assessed by clinical and experimental measures. However, there is a large gap between the day-to-day behavioral flexibility and that measured with these cognitive flexibility tasks. To advance the field, experimental measures must evolve to reflect mechanistic models of flexibility deficits. Moreover, ecologically valid measures are required to be able to resolve the paradox between cognitive and behavioral inflexibility.

Section snippets

Focus of this review

Both clinicians and researchers widely believe that cognitive flexibility deficits are pathognomonic of autism spectrum disorders. Here, we question this belief. We address why this is important, why cognitive flexibility deficits are considered central to autism spectrum disorders (ASD) and why we are skeptical.

Why is this important?

Autism spectrum disorders, including autistic disorder, high functioning autism (HFA), Asperger syndrome and pervasive developmental disorder not otherwise specified (PDDNOS), are neurodevelopmental disorders involving social and communication impairments combined with restricted, stereotypical patterns of behavior and interests 1, 2. We employ the term autism to refer collectively to these disorders. Clinical observation indicates that pervasive cognitive and behavioral rigidity across

Why are such cognitive flexibility deficits considered central to autism?

First, the cognitive flexibility construct seems to map easily onto the observed behavior (Table 1). Parents and clinicians alike will see inflexibility as one of the most troubling, consistent and difficult-to-intervene characteristics of the disorder. Second, many cognitive flexibility autism studies using clinical neuropsychological measures indicate that there are cognitive flexibility deficits. However, we question that failure on these measures is indeed because of cognitive inflexibility

Why the skepticism?

First, as described in the previous paragraph, there are serious issues with the WCST that makes it impossible to conclude that failure is indeed because of cognitive inflexibility, although failure might be because of generalized performance deficits (i.e. executive functioning deficits). Second, as described later, studies in autism using experimental cognitive psychology measures that are developed to examine the function of specific cognitive systems, often do not report cognitive

Conclusions and future directions

This qualitative literature overview shows that the findings regarding cognitive flexibility deficits in individuals with autism as assessed by either clinical neuropsychology (other than the WCST) or experimental cognitive psychology paradigms, are rather inconsistent, despite exhibiting behavioral inflexibility in many respects. Besides the differences in the applied cognitive flexibility tasks among the studies, there is considerable heterogeneity in age, cognitive level and autism subtype

Acknowledgements

We want to thank Joel Nigg for his helpful suggestions, Mark Broeders for assistance with the literature review, and we thank the Center for Mind and Brain and the M.I.N.D. Institute of University of California Davis as H.M.G wrote this review during her sabbatical at these institutes.

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Executive function (EF) difficulties are implicated in Neurodevelopmental Disorders (NDDs), such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Because NDDs are highly comorbid and frequently co-occur with additional clinical problems, it is unclear how specific EF problems are associated with symptoms of ASD and ADHD, whilst accounting for co-occurring anxiety or oppositional defiance disorder (ODD) symptoms. The current study utilised a large sample of young children (n = 438, aged 4–8) referred to Cardiff University's Neurodevelopment Assessment Unit (NDAU) by teachers for cognitive and/or socio-emotional problems. As part of the referral process, the teachers completed the Strengths and Difficulties Questionnaire (SDQ), which revealed that most children displayed moderate to high hyperactivity (86%) and prosocial (73%) problems, as well as high levels of symptoms in other clinical domains (41% emotional, 61% conduct and 68% peer problems). Children completed tasks to assess episodic memory, cognitive inhibition, cognitive flexibility and visuomotor control, whilst parents completed questionnaires to measure symptoms of ASD, ADHD, anxiety and ODD. Dimensional analyses showed that poorer cognitive inhibition and visuospatial episodic memory were significantly associated with ADHD symptoms, whereas cognitive flexibility was negatively associated with ODD symptoms. Having more ASD symptoms was associated with fewer cognitive inhibition problems, whereas anxiety was associated with better cognitive flexibility. Our approach to assessment and analysis shows that specific cognitive processes are associated with distinct neurodevelopmental and clinical symptoms, which is ultimately relevant to early identification of and intervention for young children at risk of cognitive and/or socio-emotional problems.
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Trends in Cognitive Sciences

ReviewThe paradox of cognitive flexibility in autism

Section snippets

Focus of this review

Why is this important?

Why are such cognitive flexibility deficits considered central to autism?

Why the skepticism?

Conclusions and future directions

Acknowledgements

Dev. Rev.

Trends Cogn. Sci.

Neuropsychologia

Brain Cogn.

Arch. Clin. Neuropsychol.

Brain Dev.

Behav. Brain Res.

Cogn. Dev.

Brain Cogn.

Biol. Psychiatry

Biol. Psychiatry

Clin. Neurosci. Res.

Neuropsychologia

Biol. Psychiatry

Psychoneuroendocrinology

Physiol. Behav.

Brain Cogn.

Cognit. Psychol.

J. Am. Acad. Child Adolesc. Psychiatry

Neuroimage

Neuropsychologia

Biol. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

Autism and pervasive developmental disorders

J. Child Psychol. Psychiatry Allied Discip.

Executive functions and developmental psychopathology

J. Child Psychol. Psychiatry Allied Discip.

The relationship of theory of mind and executive functions to symptom type and severity in children with autism

Dev. Psychopathol.

Language, social, and executive functions in high functioning Autism: a continuum of performance

J. Autism Dev. Disord.

Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic disorder

J. Autism Dev. Disord.

The relationship between executive functions, central coherence, and repetitive behavior in the high-functioning autism spectrum

Autism

Recent developments in neuropsychological models of childhood psychiatric disorders

Adv. Biol. Psychiatry

Differences in neuroanatomy and their relationship to cognitive functioning in people with Asperger's syndrome and high functioning autism

Biol. Psychiatry

How specific are executive functioning deficits in Attention Deficit Hyperactivity Disorder and autism?

J. Child Psychol. Psychiatry Allied Discip.

Attentional processes in autism

J. Autism Dev. Disord.

Abstract reasoning in autism: a dissociation between concept formation and concept identification

Neuropsychology

Multiple cognitive capabilities/deficits in children with an autism spectrum disorder: “Weak” central coherence and its relationship to theory of mind and executive control

Dev. Psychopathol.

Review
The paradox of cognitive flexibility in autism