Middle-childhood executive functioning mediates associations between early-childhood autism symptoms and adolescent mental health, academic and functional outcomes in autistic children

Stephanie H Ameis; John D Haltigan; Rachael E Lyon; Amanda Sawyer; Pat Mirenda; Connor M Kerns; Isabel M Smith; Tracy Vaillancourt; Joanne Volden; Charlotte Waddell; Lonnie Zwaigenbaum; Teresa Bennett; Eric Duku; Mayada Elsabbagh; Stelios Georgiades; Wendy J Ungar; Anat Zaidman-Zait; Meng-Chuan Lai; Peter Szatmari; Pathways in ASD Study Team

doi:10.1111/jcpp.13493

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. Epub 2021 Aug 12.

Authors

Stephanie H Ameis^{1

2

3}, John D Haltigan^{1

2

4}, Rachael E Lyon¹, Amanda Sawyer^{1

2}, Pat Mirenda⁵, Connor M Kerns⁶, Isabel M Smith^{7

8}, Tracy Vaillancourt⁹, Joanne Volden¹⁰, Charlotte Waddell¹¹, Lonnie Zwaigenbaum^{12

13}, Teresa Bennett^{14

15}, Eric Duku^{14

15}, Mayada Elsabbagh¹⁶, Stelios Georgiades^{14

15}, Wendy J Ungar^{17

18}, Anat Zaidman-Zait^{19

20}, Meng-Chuan Lai^{1

2

3}, Peter Szatmari^{1

2

3}; Pathways in ASD Study Team

Affiliations

¹ Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
³ Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
⁴ Department of Applied Psychology and Human Development, University of Toronto, Toronto, ON, Canada.
⁵ Department of Educational and Counselling Psychology and Special Education, University of British Columbia, Vancouver, BC, Canada.
⁶ Department of Psychology, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁸ Autism Research Centre, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.
⁹ Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
¹¹ Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
¹² Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
¹³ Autism Research Centre, Edmonton, AB, Canada.
¹⁴ Offord Centre for Child Studies, Hamilton, ON, Canada.
¹⁵ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
¹⁶ Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
¹⁷ Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
¹⁸ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of School Counseling and Special Education, Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel.
²⁰ School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: Executive functioning (EF) varies in children with autism spectrum disorder (ASD) and is associated with clinical symptoms, academic, and adaptive functioning. Here, we examined whether middle-childhood EF mediates associations between early-childhood autism symptoms and adolescent outcomes in children with ASD.

Methods: The Pathways in ASD Cohort comprising children recruited at the time of ASD diagnosis (at 2-4 years-of-age) and followed prospectively across eight subsequent timepoints over ~10 years was used. A subset of Pathways participants (n = 250) with Behavior Rating Inventory of Executive Function (BRIEF)-Parent Form data from at least one timepoint when participants were school-aged was analyzed. A mediation framework was used to examine whether BRIEF-measured EF across age 7-10 years (middle-childhood) mediated associations between early-childhood autism symptoms (measured using the parent-report Social Responsiveness Scale across age 2-6 years) and clinical, academic, and functional outcomes, indexed at age >10-11.8 years (early-adolescence) using the Child Behavior Checklist (CBCL)-Internalizing and Externalizing Scales, Academic Performance from the Teacher's Report Form, and Vineland Adaptive Behavior Scales. Models were rerun substituting clinician-rated and teacher-rated measures, where possible.

Results: Mediation models indicated a significant indirect effect of middle-childhood EF on associations between early-childhood autism symptoms and externalizing behavior, academic performance, or adaptive functioning in early adolescence; kappa squared (κ² ) effect sizes ranged from large to small. Model findings were stable across raters. Middle-childhood EF did not mediate associations between early-childhood autism symptoms and adolescent internalizing behavior.

Conclusions: Among children with an ASD diagnosis, middle-childhood EF may be one pathway through which early-childhood autism symptoms influence a variety of outcomes in early-adolescence. An experimental study targeting middle-childhood EF to improve adolescent academic, emotional/behavioral, and adaptive functioning is needed to evaluate the clinical meaningfulness of these findings.

Keywords: Executive function; academic performance; adaptive functioning; autism spectrum disorder; internalizing/externalizing behavior; longitudinal studies; mental health.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Autism Spectrum Disorder*
Autistic Disorder* / complications
Child
Executive Function
Humans
Mental Health
Parents

Abstract

Publication types

MeSH terms

Grants and funding