Cognitive flexibility (CF) is the ability to shift between concepts or rules. Difficulty with CF is associated with autism (i.e., ASD) as it contributes to repetitive behaviours. However, little is known about CF skills of autistic adolescents with low intelligence. This study uses the Wisconsin Card Sorting Task (WCST) to assess the CF of 36 adolescents, all with a Weschler full-scale IQ between 50 and 85, 14 of whom had an ASD diagnosis. The results indicated no statistically significant differences in WCST performance between those with and without ASD. It was also found that performance IQ significantly contributed to the WCST performance in the ASD group only, suggesting an autism-specific role of non-verbal cognitive functioning in CF.
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Berg, E. A. (1948). A simple objective technique for measuring flexibility in thinking. Journal of General Psychology, 39, 15–22. https://doi.org/10.1080/00221309.1948.9918159
Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Development, 81(6), 1641–1660. https://doi.org/10.1111/j.1467-8624.2010.01499.x
Bishop, S. L., Richler, J., & Lord, C. (2007). Association between restricted and repetitive behaviours and nonverbal IQ in children with autism spectrum disorders. Child Neuropsychology, 12(4–5), 247–267. https://doi.org/10.1080/09297040600630288
Buttelmann, F., & Karbach, J. (2017). Development and plasticity of cognitive flexibility in early and middle childhood. Frontiers in Psychology, 8, 1040. https://doi.org/10.3389/fpsyg.2017.01040
Chan, R. C., Shum, D., Toulopoulos, T., & Chen, E. (2008). Assessment of executive functions: Reviews of instruments and identification of critical issues. Archives of Clinical Neuropsychology, 23(2), 201–216.
Chen, S. F., Chien, Y. L., Wu, C. T., Shang, C. Y., Wu, Y. Y., & Gau, S. S. (2016). Deficits in executive functions among youths with autism spectrum disorders: An age-stratified analysis. Psychological Medicine, 46(8), 1625–1638. https://doi.org/10.1017/S0033291715002238
Cumming, G. (2014). The new statistics: Why and how. Psychological Science, 25(1), 7–29. https://doi.org/10.1177/0956797613504966
Dajani, D. R., & Uddin, L. Q. (2015). Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends in Neurosciences, 38(9), 571–578. https://doi.org/10.1016/j.tins.2015.07.003
Dick, A. S. (2014). The development of cognitive flexibility beyond the preschool period: An investigation using a modified flexible item selection task. Journal of Experimental Child Psychology, 125, 13–34. https://doi.org/10.1016/j.jecp2014.01.021
Didden, R., Sigafoos, J., Green, V. A., Korzilius, H., Mouws, C., Lancioni, G. E., O’Reilly, M. F., & Curfs, L. M. (2008). Behavioural flexibility in individuals with Angelman syndrome, Down syndrome, non-specific intellectual disability and autism spectrum disorder. Journal of Intellectual Disability Research, 52, 503–509. https://doi.org/10.1111/j.1365-2788.2008.01055.x
Faja, S., & Darling, L. N. (2018). Variation in restricted and repetitive behaviors and interests relates to inhibitory control and shifting in children with autism spectrum disorder. Autism, 3(5), 1–11. https://doi.org/10.1177/1362361318804192
Fombonne, E., Zakarian, R., Bennett, A., Meng, L., & McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics, 118, 139–150. https://doi.org/10.1542/peds.2005-2993
Gioia, G., Isquith, P., Guy, S., & Kenworthy, L. (2000). BRIEF: Behavior rating inventory of executive function. Psychological Assessment Resources.
Gouvernement du Québec. (2007). Organization of educational services for at-risk students and students with handicaps, social maladjustments or learning difficulties. Retrieved August 1, 2019, from http://www.education.gouv.qc.ca/fileadmin/site_web/documents/dpse/adaptation_serv_compl/19-7065-A.pdf
Heaton, R. K. (1981). Wisconsin card sorting test manual. Psychological Assessment Resource Incorporation.
Heaton, R. K., Chelune, G. J., Talley, J. L., Kay, G. G., & Curtiss, G. (1993). Wisconsin card sorting test manual (revised and expanded). Psychological Assessment Resources Inc.
Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26–32. https://doi.org/10.1016/j.tics.2003.11.003
Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence for executive dysfunction in autism. Neuropsychologia, 32(4), 477–492. https://doi.org/10.1016/0028-3932(94)90092-2
Ionescu, T. (2012). Exploring the nature of cognitive flexibility. New Ideas in Psychology, 30(2), 190–200. https://doi.org/10.1016/j.newideapsych.2011.11.001
Kenny, L., Cribb, S. J., & Pellicano, E. (2019). Childhood executive function predicts later autistic features and adaptive behaviour in young autistic people: A 12-year prospective study. Journal of Abnormal Child Psychology, 47, 1089–1099. https://doi.org/10.1007/s10802-018-0493-8
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442–462. https://doi.org/10.1177/1362361315588200
Kenworthy, L., Yerys, B. E., Anthony, L. G., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18(4), 320–338. https://doi.org/10.1007/s11065-008-9077-7
Kopp, B., Maldonaldo, N., Scheffels, J. E., Hendel, M., & Lange, F. (2019). A meta-analysis of relationships measures of Wisconsin card sorting and intelligence. Brain Sciences, 9(12), 349. https://doi.org/10.3390/brainsci9120349
Kouklari, E. C., Tsermentseli, S., & Monks, C. P. (2018). Hot and cool executive function in children and adolescents with autism spectrum disorder: Cross-sectional developmental trajectories. Child Neuropsychology, 24(8), 1088–1114. https://doi.org/10.1080/09297049.2017.1391190
Landry, O., & Al-Taie, S. (2016). A meta-analysis of the Wisconsin Card Sorting Task in autism. Journal of Autism and Developmental Disorders, 46(4), 1220–1235. https://doi.org/10.1007/s10803-015-2659-3
Leung, R. C., & Zakzanis, K. K. (2014). Brief report: Cognitive flexibility in autism spectrum disorders: A quantitative review. Journal of Autism and Developmental Disorders, 44, 2628–2645. https://doi.org/10.1007/s10803-014-2136-4
Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., Christensen, D. L., Wiggins, L. D., Pettygrove, S., Andrews, J. G., Lopez, M., Hudson, A., Baroud, T., Schwenk, Y., White, T., Rosenberg, C. R., Lee, L. C., Harrington, R. A., Huston, M.,…Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2016. Morbidity and Mortality Weekly Report Surveillance Summaries Centers for Disease Control and Prevention, 69(4), 1–12. https://doi.org/10.15585/mmwr.ss6904a1
Mannion, A., Brahm, M., & Leader, G. (2014). Comorbid psychopathology in autism spectrum disorder. Review Journal of Autism and Developmental Disorders, 1, 124–134. https://doi.org/10.1007/s40489-014-0012-y
Marcovitch, S., Jacques, S., Boseovski, J. J., & Zelazo, P. D. (2008). Self-reflection and the cognitive control of behaviour: Implications for learning. Mind, Brain, and Education, 2(3), 136–141. https://doi.org/10.1111/j.1751-228X.2008.00044.x
Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114. https://doi.org/10.1016/j.ridd.2009.06.003
McLean, R. L., Harrison, A. J., Zimak, E., Joseph, R. M., & Morrow, E. M. (2014). Executive function in probands with autism with average IQ and their unaffected first-degree relatives. Journal of American Academy of Child & Adolescent Psychiatry, 53(9), 1001–1009. https://doi.org/10.1016/j.jaac.2014.05.019
Miller, H. L., Ragozzino, M. E., Cook, E. H., Sweeney, J. A., & Mosconi, M. W. (2015). Cognitive set shifting deficits and their relationship to repetitive behaviors in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(3), 805–815. https://doi.org/10.1007/s10803-014-2244-1
Nouwens, P. J. G., Lucas, R., Smulders, N. B. M., Embregts, P. J. C. M., & van Nieuwenhuizen, C. (2017). Identifying classes of persons with mild intellectual disability or borderline intellectual functioning: a latent class analysis. BMC Psychiatry, 17, 257. https://doi.org/10.1186/s12888-017-1426-8
Panerai, S., Tasca, D., Ferri, R., D’Arrigo, V. G., & Elia, M. (2014). Executive functions and adaptive behaviour in autism spectrum disorders with and without intellectual disability. Psychiatry Journal. https://doi.org/10.1155/2014/941809
Roelofs, R. L., Visser, E. M., Berger, H. J. C., Prins, J. B., Schrojenstei, H. M. J., Van Lantman-De Valk, & Teunisse, J. P. (2015). Executive functioning in individuals with intellectual disabilities and autism spectrum disorders. Journal of Intellectual Disability Research, 59(2), 125–137. https://doi.org/10.1111/jir.12085
Rommelse, N., Langerak, I., van der Meer, J., de Bruijn, Y., Staal, W., Oerlemans, A., & Buitelaar, J. (2015). Intelligence may moderate the cognitive profile of patients with ASD. PLoS ONE, 10(10), e0138698. https://doi.org/10.1371/journal.pone.0138698
Russell, G., Mandy, W., Elliott, D., White, R., Pittwood, T., & Ford, T. (2019). Selection bias on intellectual ability I autism research: A cross-sectional review and meta-analysis. Molecular Autism, 10, 9. https://doi.org/10.1186/s13229-019-0260-x
Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo, P. D., & Burack, J. A. (2007). Deconstructing executive deficits among persons with autism: Implications for cognitive neuroscience. Brain and Cognition, 65(1), 77–86. https://doi.org/10.1016/j.bandc.2006.04.0072
Somsen, R. J. (2007). The development of attention regulation in the Wisconsin Card Sorting Task. Developmental Science, 10(5), 664–680. https://doi.org/10.1111/j.1467-7687.2007.00613.x
Srivastava, A. K., & Schwartz, C. E. (2014). Intellectual disability and autism spectrum disorders: Causal genes and molecular mechanisms. Neuroscience & Behavioural Reviews, 46(2), 161–174. https://doi.org/10.1016/j.neubiorev.2014.02.015
Thurm, A., Farmer, C., Salzman, E., Lord, C., & Bishop, S. (2019). State of the field: Differentiating intellectual disability from autism spectrum disorder. Frontiers in Psychiatry, 10(526), 1–10. https://doi.org/10.3389/fpsyt.2019.00526
Visser, E. M., Berger, H. J. C., Van Schrojenstein Lantman-De Valk, H. M. J., Prins, J. B., & Teunisse, J. P. (2015). Cognitive shifting and externalizing problem behaviour in intellectual disability and autism spectrum disorder. Journal of Intellectual Disability Research, 59(8), 755–766. https://doi.org/10.1111/jir.12182
Wallace, G. I., Yerys, B. E., Peng, C., Dlugi, E., Anthony, L. G., & Kenworthy, L. (2016). Assessment and treatment of executive function impairments in autism spectrum disorder: An update. International Review of Research in Developmental Disabilities, 51, 85–122. https://doi.org/10.1016/bs.irrdd.2016.07.004
Wechsler, D. (1999). Wechsler Abbreviated Scale of intelligence. Psychological Corporation.
Yerys, B. E., Wallace, G. L., Harrison, B., Celano, M. J., Giedd, J. N., & Kenworthy, L. E. (2009). Set-shifting in children with autism spectrum disorders. Autism, 13(5), 523–538. https://doi.org/10.1177/1362361309335716
We would like to thank the Summit Centre for Education, Research, and Training (SCERT) and Ms. Andrea Guzman for facilitating the recruitment of participants. We are also grateful for Ms. Erika Pettorelli for recruiting participants at the Perceptual Neuroscience Laboratory for Autism and Development (PN Lab). Lastly, we would like to thank Dr. Eve-Marie Quintin for her helpful comments on the draft of this manuscript.
No funding was received to assist with the preparation of this manuscript, and for conducting this study.
Conflict of interest
Both authors have no relevant financial or non-financial interests to disclose.
This research has been approved for ethics at McGill University (REBIII368-0118) on February 22nd, 2018 and at SCERT of Summit School of Montreal on November 22nd, 2018.
Informed assent and consent were obtained from all individual participants and their parents/caregivers included in the study.
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Lung, S.L.M., Bertone, A. Brief Report: An Exploration of Cognitive Flexibility of Autistic Adolescents with Low Intelligence Using the Wisconsin Card Sorting Task. J Autism Dev Disord (2021). https://doi.org/10.1007/s10803-021-05134-1
- Cognitive flexibility
- Low intelligence