Skip to main content

Brief Report: An Exploration of Cognitive Flexibility of Autistic Adolescents with Low Intelligence Using the Wisconsin Card Sorting Task

Abstract

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.

This is a preview of subscription content, access via your institution.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

    Book  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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

    Article  Google Scholar 

  5. 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

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. 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

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cumming, G. (2014). The new statistics: Why and how. Psychological Science, 25(1), 7–29. https://doi.org/10.1177/0956797613504966

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. Gioia, G., Isquith, P., Guy, S., & Kenworthy, L. (2000). BRIEF: Behavior rating inventory of executive function. Psychological Assessment Resources.

    Google Scholar 

  15. 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

  16. Heaton, R. K. (1981). Wisconsin card sorting test manual. Psychological Assessment Resource Incorporation.

    Google Scholar 

  17. 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.

    Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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

    Article  PubMed Central  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. 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

    Article  Google Scholar 

  29. 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

    Article  Google Scholar 

  30. 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

    Article  Google Scholar 

  31. 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

    Article  PubMed  Google Scholar 

  32. 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

    Article  Google Scholar 

  33. 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

    Article  PubMed  PubMed Central  Google Scholar 

  34. 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

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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

    Article  PubMed  PubMed Central  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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

    Article  PubMed  PubMed Central  Google Scholar 

  39. 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

    Article  PubMed  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. 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

    Article  Google Scholar 

  42. 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

    Article  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. 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

    Article  Google Scholar 

  45. Wechsler, D. (1999). Wechsler Abbreviated Scale of intelligence. Psychological Corporation.

    Google Scholar 

  46. 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

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

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.

Funding

No funding was received to assist with the preparation of this manuscript, and for conducting this study.

Author information

Affiliations

Authors

Contributions

Both authors contributed to the study conception and design. Material preparation, data collection and analysis was performed by Stephanie Lung, under the close supervision of Dr. Armando Bertone. The first draft of the manuscript was written by Stephanie, and iterative rounds of edits with Dr. Bertone. Both authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephanie Lock Man Lung.

Ethics declarations

Conflict of interest

Both authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

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 Consent

Informed assent and consent were obtained from all individual participants and their parents/caregivers included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • WCST
  • Cognitive flexibility
  • Low intelligence
  • Autism
  • Adolescents