How Can Executive Function Training Help Autistic Children with ADHD Features?

What you need to know

• Executive function (EF) training may be particularly beneficial for autistic children who also have attention-deficit/hyperactivity disorder (ADHD) features.
• The study found that EF training improved inhibition skills only for autistic children with significant ADHD features.
• Changes in brain activity related to EF were associated with reductions in repetitive behaviors for children who received the training.

Executive Function Training for Autistic Children

Executive function (EF) refers to a set of cognitive skills that help us manage complex information and engage in goal-oriented behaviors. These skills include inhibition (the ability to control impulses), working memory (holding and manipulating information in mind), and flexibility (the ability to switch between tasks or perspectives). Many autistic children experience challenges with EF, which can impact various aspects of their lives, including social interactions, academic performance, and daily functioning.

This study explored the effectiveness of a computer-based EF training program for autistic children. The researchers were particularly interested in understanding whether certain characteristics of the children, such as co-occurring ADHD or anxiety features, affected how much they benefited from the training.

The Executive Function Training Program

The training program consisted of up to ten 1-hour sessions, usually conducted once a week. During each session, children played four computer games designed to improve different aspects of EF:

1. Two games targeting inhibition
2. Two games targeting visual working memory
3. All games required set-shifting (flexibility)

In addition to the computer games, the program included metacognitive coaching. This coaching involved:

• Providing education about EF
• Increasing awareness of one’s own thinking processes
• Supporting emotion regulation during challenging parts of the training
• Offering problem-solving strategies and coping techniques

The coaching component was designed to help children apply the skills they learned during the training to real-life situations.

ADHD Features and Training Effectiveness

One of the most significant findings of this study was that the EF training appeared to be particularly effective for autistic children who also had ADHD features. Specifically, the training improved inhibition skills (measured by a task called the Change task) only for children with clinically significant ADHD features.

This finding is important because:

1. Many autistic children also have ADHD features (about 21% of the children in this study).
2. Children with both autism and ADHD often face more significant challenges with EF than children with autism alone.
3. The combination of autism and ADHD may create a unique profile of EF difficulties that responds well to targeted training.

For children with significant ADHD features who received the EF training, their ability to inhibit responses improved by an average of 98 milliseconds compared to similar children who didn’t receive the training. While this may seem like a small difference, in the realm of cognitive processing, it represents a meaningful improvement in inhibition skills.

Anxiety Features and Training Effectiveness

Interestingly, the researchers found that anxiety features did not affect how well children responded to the EF training. This was contrary to their initial hypothesis that children with anxiety might benefit more from the training due to its inclusion of emotion regulation strategies.

There are a few possible explanations for this finding:

1. The anxiety symptoms measured in the study might not have been severe enough to impact training effectiveness.
2. The EF training tasks themselves may have been engaging and low-stress, minimizing the impact of anxiety on performance.
3. The emotion regulation components of the training might not have been specifically tailored to address anxiety-related challenges.

Brain Changes and Behavioral Improvements

The study also examined whether changes in brain activity related to EF were associated with improvements in behavior. They found an interesting connection between brain activity and repetitive behaviors, but only for children who received the EF training:

• Children who showed greater improvements in a brain measure of EF (called N2 incongruent amplitude) also showed greater reductions in repetitive behaviors.
• This relationship was not found in children who didn’t receive the training.

This finding suggests that the EF training may be changing brain function in a way that leads to behavioral improvements, particularly in reducing repetitive behaviors. However, the researchers caution that more research is needed to confirm this connection and understand how it works.

Conclusions

• Executive function training may be particularly beneficial for autistic children who also have ADHD features, especially in improving inhibition skills.
• The training’s effectiveness does not appear to be influenced by anxiety features, at least in this study.
• Changes in brain activity related to executive function may be associated with reductions in repetitive behaviors for children who receive the training.

This study provides valuable insights into how EF training might be tailored to better support autistic children, particularly those with co-occurring ADHD features. However, the researchers emphasize that these findings are preliminary and need to be replicated in larger studies. Future research should continue to explore how different characteristics of autistic children may influence their response to interventions, with the ultimate goal of providing more personalized and effective support.