"I have to charge my social battery": Perspectives from autistic young adults on Quality of Life.

LAY ABSTRACT: In this study we have asked a group of autistic young adults to describe what is important for their quality of life. The 14 participants (aged 21-29 years) were recruited from a 10-year follow-up study of autistic people. During interviews, our participants described the importance of having relationships with family, friends and pets. Having meaningful activities and being able to immerse themselves in particular interests was also reported to be important for a good quality of life. Interests had also guided their choice of what to study and what to do for work. They also spoke of how communication problems with professionals, bullying and sensory and emotional overload could have a negative impact on quality of life. Future interventions should focus on how professionals can help autistic people to connect to people/animals and meaningful activities, as the participants described this as important for having a good quality of life. These findings may be helpful in enhancing how passions and interests can be seen as opportunities for both academic and work careers for autistic people. Future research and interventions should also look at the communication barriers between autistic people and professionals, and how two-way understanding can be improved.

Executive functions and ADHD symptoms predict educational functioning in children with ADHD: A two-year longitudinal study.

The aim of this two-year longitudinal study was to investigate whether deficits in executive functions (EF) predict impaired everyday functioning after two years in children and adolescents with ADHD. A sample of 135 participants with and without ADHD were assessed with neuropsychological tests of EF and parent ratings of everyday functioning with the Child Behavior Checklist at baseline (Mage = 11.6, SD = 2.0), and after two years (Mage = 13.6, SD = 2.1). Results showed that ADHD symptoms and impaired EF at baseline predicted lower educational functioning when controlling for general cognitive ability (i.e. "IQ") at two-year follow-up. Furthermore, the results indicated that increased ADHD symptoms predicted problems both with social functioning and functioning in leisure activities (i.e. sport/hobbies/chores/jobs), whereas higher IQ predicted better functioning in leisure activities. The current study primarily highlights the importance of detecting and treating ADHD symptoms in order to prevent reduced functional outcomes, and that EF tests may contribute to identify children in need of educational interventions targeting EF deficits.

Childhood Executive Function Predicts Internalizing and Externalizing Symptoms in Emerging Adults With and Without Autism: A 10-Year Longitudinal Study.

Individuals with autism spectrum disorder (ASD) and typically developing individuals were assessed on three neuropsychological tests of executive function (EF) and on scales of autism symptoms and co-occurring internalizing and externalizing symptoms at baseline (T1; N = 88, Mage = 11.8 years, 73% males), 2-year (T2; 99% retention, Mage = 13.9 years), and 10-year follow-ups (T3; 75% retention, Mage = 21.4 years). An EF composite score from T1 significantly predicted internalizing symptoms at T2 (ß = .228) and internalizing and externalizing symptoms at T3 (ß = .431 and .478, respectively), when controlling for age and autism symptoms. OThe findings suggest that EF difficulties are a long-term risk factor for more co-occurring symptoms. .

Adolescence internalizing problems as a mediator between autism diagnosis in childhood and quality of life in emerging adults with and without autism: a 10-year longitudinal study.

BACKGROUND: Individuals with autism tend to have a reduced quality of life across their lifespan. This reduced quality of life may be a result of autism traits, mental distress, and poor person/environment fit. In this longitudinal study, we looked at the role of adolescence internalizing and externalizing problems in mediating the relationship between having an autism diagnosis from childhood and perceived quality of life as emerging adults. METHODS: A total of 66 participants in a group of emerging adults with autism (mean age 22.2 years), and without autism (mean age 20.9 years) were assessed in three assessment waves (T1 at 12 years, T2 at 14 years, and T3 at 22 years of age). Parents filled out the Child Behavior Checklist at T2 and participants filled out the Perceived Quality of Life Questionnaire at T3. Total and indirect effects were tested in serial mediation analysis. RESULTS: The results showed that internalizing problems fully mediated the association between childhood autism diagnosis and the quality of life in emerging adulthood, while externalizing problems did not. CONCLUSION: Our findings suggest that attention to adolescent internalizing problems is important to improve the later quality of life for emerging adults with autism.

Predictors of Quality of Life and Functional Impairments in Emerging Adults With and Without ADHD: A 10-Year Longitudinal Study.

OBJECTIVE: We tested the hypotheses that (1) a diagnosis of ADHD in childhood or adolescence is associated with reduced quality of life (QoL) and everyday functioning in emerging adulthood, and (2) executive function (EF) deficits, internalizing difficulties, and ADHD symptoms predict reduced QoL and more functional impairments. METHOD: We assessed 85 children and adolescents with ADHD and 50 typically developing (TD) peers at baseline (Mage = 11.6 years, 58% males), 2-year follow-up, and 10-year follow-up with neuropsychological tests of EF and self-reports. RESULTS: Individuals with ADHD reported lower QoL and functional impairments in emerging adulthood compared to TD peers. More internalizing difficulties and ADHD symptoms at baseline and 2-year follow-up significantly predicted lower QoL and more functional impairments at the 10-year follow-up. CONCLUSION: ADHD and internalizing difficulties in childhood or adolescence have a negative impact on QoL and everyday functioning in emerging adulthood.

Childhood executive functions and ADHD symptoms predict psychopathology symptoms in emerging adults with and without ADHD: a 10-year longitudinal study.

Deficits in executive functions (EFs) are theorized to play an important role in causing functional impairment and associated psychopathology in individuals with ADHD. The objective of this study was to examine the role of EFs and ADHD symptoms as longitudinal predictors of psychopathology symptoms in individuals with ADHD and typically developing individuals. We assessed individuals with and without ADHD (N = 135) with neuropsychological tests of EFs and scales of ADHD symptoms and psychopathology symptoms at baseline (T1; Mage = 11.59, 57.8% boys), 2-year follow-up (T2; Mage = 13.63, 97% retention), and 10-year follow-up (Mage = 21.18, 75% retention). Baseline EFs predicted psychopathology symptoms at the 2- and the 10-year follow-up, explaining 17% and 12% of the variance, respectively. Baseline EFs predicted both internalizing and externalizing symptoms, and the predictive value of EFs on psychopathology symptoms at 10-year follow-up was accounted for by cognitive flexibility. Baseline ADHD symptoms were a significant predictor of all symptom domains at all time points. Thus, childhood EFs, in particular cognitive flexibility, can predict psychopathology symptoms in emerging adulthood beyond the effect of ADHD symptoms. This supports dominating theories of ADHD stating that executive dysfunction contributes to the observed phenotype, including associated psychopathology symptoms, and suggests that EFs are important targets of interventional efforts.

Exploring life with autism: Quality of Life, daily functioning and compensatory strategies from childhood to emerging adulthood: A qualitative study protocol.

Introduction: This study aims to investigate self-perceived quality of life, daily functioning, and the use of compensatory strategies in emerging adults with autism. Methods and analysis: Participants will be recruited from the Lillehammer Neurodevelopmental 10-year follow-up study (LINEUP), with the aim of 15 individual in-depth interviews. Subsequently, two focus groups with clinicians will be invited to reflect on the themes found in the individual interviews. All interviews will be recorded and analyzed using reflexive thematic analysis. Ethics and dissemination: The study is approved by the Regional Committee for Medical Research Ethics in South-East Norway. The findings will be disseminated to academic and clinical audiences through journal articles and conference presentations. To reach the broader autistic and autism communities, the findings will be shared with the Autism Society at national and local meetings, in their membership magazine, and on their social media channel.

Attention-deficit/hyperactivity disorder persistence from childhood into young adult age: a 10-year longitudinal study.

INTRODUCTION: The aim of this study was to estimate ADHD persistence in a European clinical sample of children diagnosed with ADHD and followed prospectively for 10 years into young adulthood. METHODS: We assessed 85 children with ADHD at baseline (Mage = 11.6, SD = 2.1, 54% male) and re-assessed 59 at 10-year follow-up (Mage = 21.4, SD = 2.3, 54% male). ADHD symptoms at baseline were assessed with a semi-structured clinical interview (Kiddie-Schedule for Affective Disorders and Schizophrenia/Present and lifetime version) and parent rating scales (ADHD Rating Scale IV, Child Behavior Checklist). ADHD symptoms at 10-year follow-up were assessed with a semi-structured clinical interview (MINI-Plus) and self-report scales (ADHD Self-Report Scale version 1.1 screener, Adult Self Report). Functional impairment at 10-year follow-up was assessed with the Global Assessment of Functioning scale. RESULTS: At 10-year follow-up, 39% met ADHD symptom thresholds based on clinical evaluation using MINI-Plus or the ADHD Self-Report Scale version 1.1 screener or the Adult Self Report together with clinicians' rating of functional impairment. CONCLUSION: ADHD persistence rates in this European clinical sample match previous estimates and indicate that a significant proportion of those diagnosed with ADHD as children still exhibit clinical levels of ADHD symptoms in adulthood.

Decision-making and Risky Behavior in Individuals with Attention-Deficit/Hyperactivity Disorder: A 10-year Longitudinal Study.

We assessed 85 children with Attention-Deficit/Hyperactivity Disorder (ADHD) and 50 typically developing children (TD) (Mage = 11.59, 57.8% boys) with the Hungry Donkey Task (HDT) at baseline and 2-year follow-up, and the Iowa Gambling Task at 10-year follow-up (75% retention). Improvement in the proportion of advantageous choices was observed from two- to 10-year follow-up, but the ADHD group improved less and was outperformed by the TD group at the 10-year follow-up. More advantageous choices on the HDT at baseline predicted less risky behavior at 10-year follow-up. Male sex and more inattentive or externalizing symptoms at baseline predicted more risky behavior.

Declining Trajectories of Co-occurring Psychopathology Symptoms in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A 10-Year Longitudinal Study.

Objective: Our objective was to examine developmental trajectories of co-occurring psychopathology symptoms from childhood to young adulthood in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), individuals with Autism Spectrum Disorder (ASD), and typically developing (TD) individuals. Method: We assessed co-occurring psychopathology symptoms in 61 individuals with ADHD, 26 with ASD, and 40 TD individuals at baseline (T1; Mage = 11.72, 64% boys), 2-year follow up (T2; Mage = 13.77), and 10-year follow up (T3; Mage = 21.35). We analyzed trajectories of internalizing behaviors, externalizing behaviors, and total problems with linear mixed models. Results: From T1 to T3, the ADHD group displayed a small decline in internalizing behaviors (d = -0.49) and large declines in externalizing behaviors (d = -0.78) and total problems (d = -0.71). The ASD group displayed large declines in internalizing behaviors (d = -0.79), externalizing behaviors (d = -0.80), and total problems (d = -0.89). From T1 to T2, the decline in externalizing behaviors and total problems were significantly smaller in the ADHD group compared with the ASD group. The ADHD and the ASD group displayed more co-occurring symptoms compared with the TD group at T3. Conclusion: Individuals with ADHD and ASD, respectively, displayed declines in co-occurring symptoms from childhood to young adulthood. Individuals with ASD displayed an earlier decline compared with individuals with ADHD. Compared with TD individuals, individuals with ADHD and ASD, respectively, continued to display elevated levels of co-occurring symptoms in young adulthood.

Development of executive functioning from childhood to young adulthood in autism spectrum disorder and attention-deficit/hyperactivity disorder: A 10-year longitudinal study.

OBJECTIVE: This 10-year longitudinal study investigated the developmental trajectories of executive functioning (EF) in individuals with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD), compared to typically developing (TD) individuals from childhood into young adulthood. METHOD: There were 173 participants at baseline (T1; ASD = 38 (eight with co-occurring ADHD), ADHD = 85, TD = 50; Mage = 11.7 years, SD = 2.1), 168 at 2-year follow-up (T2) and 127 at 10-year follow-up (T3). Participants were assessed with three neuropsychological tests aimed at capturing central components of EF: working memory/Letter-Number Sequencing Test (LNS), inhibition/Color-Word Interference Test, Condition 3 (CWIT3), and flexibility/Trail Making Test, Condition 4 (TMT4). Test results were analyzed using linear mixed models (LMM). RESULTS: At baseline, the TD participants outperformed the ASD and ADHD participants on all three tests. From T1 to T2, the ASD participants had less improvement than the ADHD and TD participants on the LNS test (p = .007 and .025, respectively), while having more improvement on the CWIT3 relative to the TD participants (p = .027). From T2 to T3, the ADHD participants had less improvement on the LNS test than the ASD and TD participants (p = .004 and .021, respectively). CONCLUSIONS: The ASD and ADHD groups mainly displayed similar maturation on the neuropsychological measures, and displayed continuous impairment relative to the TD group. The need for support and facilitation of EF in school, workplace, and social arenas might continue into young adulthood among certain individuals with ASD and ADHD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training.

Objective: To examine the development of executive functions, in preschool children with autism spectrum disorders (ASD), receiving early intensive behavioral training (EIBI). Method: Executive functions (EF) were assessed with The Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P), by parents and preschool teachers at the time of diagnostic assessment and after 15 months of EIBI intervention. Ten children with ASD (M = 2.9 years, nine males) participated in the study. Reliable Change Index scores were computed for each of the participants in order to investigate any significant change in BRIEF-P T-scores. Results: Three children showed a significant improvement in EF, based on parent ratings. Four children showed a significant improvement in EF based on preschool teacher ratings. Conclusion: Findings indicating a reliable improvement in one third of preschool children with ASD receiving EIBI are encouraging but need to be replicated in larger scale controlled studies.

Similar impairments shown on a neuropsychological test battery in adolescents with high-functioning autism and early onset schizophrenia: a two-year follow-up study.

Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizophrenia, but it is unclear whether the pattern of difficulties is similar or different in the two disorders. This cross-sectional and longitudinal study compared the neuropsychological functioning in adolescents with ASD with adolescents with Early Onset Schizophrenia (EOS).Methods: At baseline and at two-year follow-up, participants were assessed with a brief neuropsychological test battery measuring executive functions, visual and verbal learning, delayed recall and recognition and psychomotor speed.Results: We found similar levels of neuropsychological impairment across groups and over time in the adolescents with ASD or EOS. Adolescents in both groups did not improve significantly on verbal learning, verbal delayed recall, visual learning, visual delayed recall or visual delayed recognition, and both groups performed poorer on verbal recognition. Both groups improved on measures of psychomotor processing and executive functions.Conclusion: The findings suggest that it may be difficult to differentiate adolescents with EOS and ASD based on neuropsychological task performance. An implication of the results is that adolescents with either disorder may benefit from a similar approach to the treatment of cognitive impairment in the disorders.

Art of Learning - An Art-Based Intervention Aimed at Improving Children's Executive Functions.

Executive functions (EFs) can be conceptualized as a mean of behavioral self-regulation, and difficulties with EFs may adversely affect school success, social function, and cognitive and psychological development. Research about EFs and how they are affected by various educational and psychosocial factors is sparse. EFs are of great importance to understand how children can handle the challenges that they meet at various stages of development. There has been an increased focus on programs aimed at improving EFs, either as a primary outcome, or as a supplemental result of a specific activity. In this randomized controlled study, 66 children (31 girls, mean age 7:1 years) were given an arts and culture rich intervention (Art of Learning) aimed at improving EFs. EFs were assessed with the Behavior Rating Inventory of Executive Functioning-teacher version (BRIEF-teacher form) before, immediately after, and 6 months after intervention. Outcome in the intervention group was compared to children from two schools serving as controls (n = 37, 18 girls, mean age 7:3 years). In addition, teachers from intervention schools were also interviewed both individually and in focus groups. The results reveal that both groups improved their EFs, as measured with BRIEF, over time on the global executive composite (GEC) score, the metacognition index, and on behavioral regulation index (BRI). However, the intervention group displayed a significantly greater improvement than the control group on GEC and BRI. The teacher interviews reveal positive effects for the children when it comes to several aspects: collaboration, conflict management, inclusion, vocabulary, and confidence. These factors are regarded as important for EFs development and academic outcome. The results support the notion of best training transfer effects for tasks addressing global executive functioning and specifically behavioral regulation skills (BRI).

Gender Differences in the Relationship Between Changes in ADHD Symptoms, Executive Functions, and Self- and Parent-Report Depression Symptoms in Boys and Girls With ADHD: A 2-Year Follow-Up Study.

OBJECTIVE: This study was conducted to investigate the association between changes in ADHD symptoms, executive functions (EFs), and depression symptoms in girls and boys with ADHD over a 2-year period. METHOD: Thirty-six girls and 39 boys with ADHD, 18 typically developing (TD) girls and 29 TD boys (ages 9-16) were included. Assessments of EFs, ADHD symptoms, and self- and parent-report of depression symptoms were carried out. RESULTS: For girls, a reduction of inattention symptoms was associated with a decline in parent-rated depression symptoms. A reduction in hyperactivity/impulsivity was associated with a reduction in self-rated depression symptoms in boys, and an increase in girls. A reduction in inattention symptoms was associated with a modest increase in self-rated depression symptoms in both boys and girls. CONCLUSION: Gathering information from both the parents and the child with ADHD is important in determining how gender may be influencing symptom profiles.

Distinct Patterns of Everyday Executive Function Problems Distinguish Children With Tourette Syndrome From Children With ADHD or Autism Spectrum Disorders.

OBJECTIVE: The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC). METHOD: Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF). RESULTS: TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I. CONCLUSION: Paired BRIEF scales dissociated EF problems in children with TS from children with ADHD-C, ADHD-I, or ASD. Clinical relevance is discussed.

Development of Hot and Cold Executive Function in Boys and Girls With ADHD.

OBJECTIVE: To investigate the development of executive function with pronounced emotional salience (hot EF) and less pronounced emotional salience (cold EF) in boys and girls with ADHD relative to typically developing (TD) children. METHOD: Seventy-five children with ADHD and 47 TD children were assessed with hot and cold EF tests at baseline and after 2 years. RESULTS: Despite considerable maturation, the ADHD group remained impaired on all cold EF tests relative to TD children after 2 years. There was no effect of gender on cold EF test results. Females with ADHD outperformed TD counterparts on hot EF at baseline. Females with ADHD showed deteriorating hot EF performance, while TD counterparts showed improved hot EF performance across time. CONCLUSION: Enduring cold EF impairments after 2 years may reflect stable phenotypic traits in children with ADHD. Results indicate divergent developmental trajectories of hot EF in girls with ADHD relative to TD counterparts.

Dissociable Response Inhibition in Children With Tourette's Syndrome Compared With Children With ADHD.

OBJECTIVE: This study investigates whether performance in a verbal response task (Color-Word Interference Test [CWIT]) and a motor response task (Conners' Continuous Performance Test [CCPT]) discriminates children with Tourette's Syndrome (TS), ADHD, and typically developing children (TDC). METHOD: Nineteen children with TS, 79 with ADHD, and 50 with TDC participated (8-17 years). RESULTS: Children with TS committed significantly fewer errors in the verbal response task than those with ADHD. Moreover, children with TS but without ADHD performed better than TDC. Errors in motor task and speed of response did not distinguish between groups. A cautious tendency of response correlated positively with rates of tics in children with TS. CONCLUSION: Children with TS were superior in inhibiting a prepotent verbal response; however, comorbidity with ADHD in those children negatively influenced performance. Results support the hypothesis that levels of inhibitory control distinguish children with TS, ADHD, and TDC.

Cognition, Emotion and Behavior in Children with Tourette's Syndrome and Children with ADHD-Combined Subtype-A Two-Year Follow-Up Study.

OBJECTIVE: This two-year follow-up study investigates the course of and association among measures of cognitive control, focused attention, decision-making and symptom severity (anxiety, depression and behavior) in children and adolescents with Tourette's Syndrome (TS) or Attention-Deficit/Hyperactivity Disorder-Combined subtype (ADHD-C). METHOD: 19 children with TS, 33 with ADHD-C, and 50 typically developing children (TDC) were examined with a battery of psychometric measures and rating forms at baseline and two-years later. RESULTS: All three groups improved likewise in measures of cognitive control over time, whereas only the TDC improved in focused attention. The group of children with TS with comorbidities performed more similar to the children with ADHD-C in cognitive control at T1 and T2, whereas the children with TS without comorbidities performed more similar to the TDC in cognitive control at T1 and T2. In the decision-making task, the children with TS (with or without comorbidities) preferred a safer strategy in selecting advantageous choices than the children with ADHD-C and the TDC at T2. Children with TS and children with ADHD-C showed higher symptoms of anxiety and depression and more problems with emotional control compared with TDC at both time points. Finally, children with ADHD-C self-reported more depression symptoms than those with TS at both assessments. For the TS group, safer decision-making was related to better emotional control, and this relationship was stronger for the TS subgroup without comorbidities. CONCLUSION: This study emphasizes the importance of addressing symptoms of anxiety and depression in children with TS or ADHD-C, identifying the effect of comorbidities in children with TS, and that children with TS or ADHD-C likely differ in their sensitivity to reinforcement contingencies.

Associations Among Symptoms of Autism, Symptoms of Depression and Executive Functions in Children with High-Functioning Autism: A 2 Year Follow-Up Study.

This study investigated the course of and association among changes in autism symptoms, depression symptoms and executive functions (EF) in children with high-functioning autism (HFA). Thirty-four children with HFA and 45 typically developing children (age 9-16) were assessed at baseline and after 2 years. Children with HFA had impaired scores on all measures at both time points. According to parent reports, depressive symptoms decreased over time, while EF improved and autism symptoms were stable. Children's reports did not reveal less depressive symptoms over time. A positive association was found only between changes in autism symptoms and changes in symptoms of depression. A possible implication is that interventions aimed at either autism symptoms or symptoms of depression may improve the other.