Exploring the impact of adolescent cognitive inflexibility on emotional and behavioural problems experienced by autistic adults

Autistic young people experience high levels of co-occurring mental health difficulties, including anxiety, depression and behavioural difficulties, across their lifespan. Understanding the neuropsychological mechanisms which underlie these difficulties is vital in developing personalised supports and interventions. Cognitive inflexibility is one candidate mechanism which is associated with co-occurring mental health comorbidities but is also associated with other features of autism such as restricted and repetitive behaviours. This study investigates the distinct longitudinal association between cognitive inflexibility, measured using objective neuropsychological measures and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people from a population-based longitudinal study were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence quotient measured at 16 years. We used structural equation modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the severity of restricted and repetitive behaviours and verbal intelligence quotient. Our results indicate an effect of cognitive inflexibility on increased behavioural problems at 16 years and emotional problems across timepoints, which is distinct from restricted and repetitive behaviours and verbal intelligence quotient. Exploratory mediation analyses suggest that cognitive inflexibility may be one mechanism through which emotional difficulties are maintained longitudinally. Lay abstract Autistic people experience high levels of co-occurring mental health difficulties. To develop more effective treatments, a greater understanding of the thinking processes that may lead to these difficulties is needed. Cognitive inflexibility, defined as a rigid pattern of thoughts and subsequently behaviours, is one possible thinking trait which has previously been associated with both co-occurring mental health difficulties but also other features of autism such as restricted and repetitive behaviours. Restricted and repetitive behaviours include repetitive movements, ritualistic behaviours, and/or highly focused interests. This study investigates the relationship between, cognitive inflexibility, measured using neuropsychological tasks, and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people who were recruited to be representative of the wider autism population were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence measured at 16 years. We used statistical modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the possible relationship with restricted and repetitive behaviours and verbal intelligence quotient. Our results suggest that cognitive inflexibility may be an important factor associated with emotional difficulties across adolescence and early adulthood. This suggests that developing intervention approaches targeting cognitive inflexibility may be an important step in improving the mental health of those with autism.

Intellectual performance profi le of a sample of children and adolescents from Brazil with 22q11.2 Deletion Syndrome (22q11.2DS) based on the Wechsler Scale

The 22q11.2 Deletion Syndrome (22q11.2DS), the most common human chromosome microdeletion syndrome, is associated with a very heterogeneous neurocognitive phenotype. One of the main characteristics of the syndrome spectrum is the intellectual variability, which encompasses average performance and intellectual disability and discrepancies between Verbal Intelligence Quotient and Performance Verbal Intelligence Quotient, with greater impairment in nonverbal tasks. The present study aimed at investigating the intellectual performance aspects of a 21children and adolescents sample from Brazil who had been diagnosed with 22q11.2DS, based on the Wechsler Intelligence Scale for Children - 4th edition. The samples were reviewed considering the differences between indices. The results revealed an Full Scale Intelligence Quotient predominant in the borderline range (42 to 104) and a significant discrepancy between the indices of Verbal Comprehension and Perceptual Reasoning in 42% of the sample. With regard to the performance in the subtests alone, a better performance was found in Similarities, whereas block design, matrix reasoning, digit span and letter-number sequencing subtests were the most challenging. These findings indicate that a comprehensive assessment of intellectual performance aspects covering the different measures of the Wechsler Intelligence Scale may contribute to a broader understanding of the neurocognitive phenotype associated with 22q11.2DS.

The correlation between striatal dopamine D2/D3 receptor availability and verbal intelligence quotient in healthy volunteers

Background. Although a correlation between the central dopaminergic system and intelligence may exist, the results from imaging studies remain inconclusive. The aim of this study was to explore the relationship between striatal dopamine D2/D3 receptor availability and verbal intelligence quotient (VIQ) using single photon emission computed tomography (SPECT).Method. Striatal D2/D3 receptor availability of 64 healthy subjects was determined with the [123I]iodobenzamide ([123I]IBZM) ligand. Intelligence quotients (IQs) of the subjects were measured by the Wechsler Adult Intelligence Scale – Revised (WAIS-R).Results. In addition to age, left striatal D2/D3 receptor availability correlated positively with VIQ. In females, left striatal D2/D3 receptor availability was the only variable that correlated significantly with the similarities subtest of VIQ.Conclusions. There is a relationship between left striatal D2/D3 receptor availability and verbal intelligence, which varies, predominantly in males.

Depression Symptoms and Neuropsychological Function in Children with Learning Difficulties

Objective. The objective of this study was to identify correlations between depression symptoms and cortical functions in children with learning difficulties. Method. A sample of 33 students participated in the study, 25 males and 8 females, with average age of 10.7 years old, recruted from outpatients clinics of Neurology, specialized in learning problems with multidisciplinary evaluation. The participants were evaluated with the following instruments: the Wechsler Intelligence Scale for Children (WISC) and Children’s Depression Inventory (CDI). For data analysis, the Statistical Package for Social Sciences was used for descriptive and inferential statistics. Results. Three students presented depression symptoms. Negative correlations (the more depressive were the children the less scored in WISC) were found between CDI and the WISC verbal subtests: Similarities, Vocabulary, and Comprehension; between the CDI and the WISC Verbal Intelligence Quotient (IQ), Total IQ, and Verbal Comprehension Index; between the CDI and the WISC test of sustained visual attention: Symbol Search and Speed of Processing Index. Conclusions. We observed that the depression symptoms interfered negatively in verbal functions and sustained visual attention. The study demonstrates that it is important to investigate depressive symptoms in children, mainly in those who present learning difficulties.

Children Who are Uncommonly Good: The Comprehension Subtest of the WISC—R

The Comprehension subtest of the WISC—B. was examined from different perspectives. Children who score above average on the subtest also exhibit healthy personality characteristics such as freedom from high anxiety, high depression, and low self-esteem. Upper middle-class children (17 in Grade 3 and 15 in Grade 6) did not show greater moral awareness than would be predicted by their high Verbal Intelligence Quotient. Actively teaching school children moral standards and socially accepted behaviour is given support by the data.