Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder

Abstract

Executive function deficits have been reported in both autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). However, little is known regarding which, if any, of these impairments are shared in children with ADHD and those with ASD. In this Review, we provide an overview of the current literature with a critical eye toward diagnostic, measurement and third-variable considerations that should be leveraged to provide more definitive answers. We conclude that the field’s understanding of executive function profiles in ASD and ADHD is highly limited because most research on each of these disorders has failed to account for the possible co-occurrence and the presence of symptoms of the other disorder. A vast majority of studies have relied on traditional neuropsychological tests and informant-rated executive function scales that have poor specificity and construct validity, and most studies have been unable to account for the well-documented between-person heterogeneity within and across disorders. At present, the most parsimonious conclusion is that children with ADHD and/or ASD tend to perform moderately worse than neurotypical children on a broad range of neuropsychological tests. However, the extent to which these difficulties are unique to one of these disorders or shared, or are attributable to impairments in specific executive functions, remains largely unknown. We end with focused recommendations for future research. Children with attention-deficit/hyperactivity disorder and/or autism spectrum disorder show executive function deficits compared to neurotypical peers. In this Review, Kofler et al. question the evidence to examine whether these deficits are shared across both conditions and provide recommendations for future work.