Identifying Neurodevelopmental Domain Subgroups in Autism and ADHD.
Big EF gaps show up by age three in autism and directly track with daily-living delays.
01Research in Context
What this study did
The team looked at three-year-olds with autism. They gave each child short thinking games that test executive function. These games check skills like holding a rule in mind and switching tasks.
Parents also filled out forms about daily living skills such as dressing and helping at home. The study then asked: do toddlers who score low on the games also score low on daily skills?
What they found
Children with autism scored much lower on the thinking games than typical peers. Lower game scores went hand in hand with lower daily-living scores. In short, EF troubles are already big at age three and they map onto real-world independence.
How this fits with other research
Iversen et al. (2021) pooled data from almost 3,000 kids and found the same link: weaker EF goes with more repetitive behaviors. The new toddler data fit that pattern, just measured two years earlier.
Pitchford et al. (2019) followed similar toddlers for ten years. They showed that low adaptive skills at age three foreshadow worse ADHD symptoms in adolescence. Krakowski et al. (2026) now tell us EF is the likely driver inside those early adaptive scores.
Faja et al. (2015) and Leezenbaum et al. (2019) both saw self-control gaps in slightly older children with autism. The toddler findings push the timeline back, hinting that EF lags begin soon after diagnosis.
Why it matters
You now have evidence to screen EF before preschool. A brief game battery at intake can flag kids who will struggle with dressing, toileting, and following group directions. Pair those results with adaptive goals and consider adding EF drills to early-intervention plans. Targeting these core skills at three may smooth the path to kindergarten and cut later ADHD risk.
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02At a glance
03Original abstract
Executive functioning (EF) deficits co-occur frequently with autism spectrum disorder (ASD) and have a long-term detrimental impact on quality of life of children and their families. Timely identification of risk for EF vulnerabilities may hasten access to early intervention and alleviate their long-term consequences. This study examines (1) if EF deficits are elevated in toddlers with ASD compared to nonautistic siblings of children with ASD, typically developing (TYP) toddlers, and toddlers with atypical developmental presentation; and (2) if EF deficits have a detrimental effect on adaptive functioning in ASD. Participants were recruited between September 2014 and October 2019 and included 73 toddlers with ASD, 33 nonautistic siblings of children with ASD, 35 toddlers with atypical development, and 28 TYP toddlers matched on chronological age (M = 39.01 months, SD = 3.11). EF deficits were measured using the BRIEF-P; adaptive skills were measured using the VABS-II. Whenever appropriate, analyses were controlled for MSEL verbal and nonverbal developmental quotient, ADOS-2 autism severity scores, and sex. Analyses revealed that toddlers with ASD exhibited elevated BRIEF-P scores across all domains compared to each of the three comparison groups. Higher BRIEF-P scores were associated with lower adaptive social, communication, and daily living skills while controlling for symptom severity, verbal and nonverbal functioning, and sex. In conclusion, marked vulnerabilities in EF are already present in 3-year-old toddlers with ASD and are predictive of the level of adaptive functioning in ASD. EF vulnerabilities in toddlers should be targeted for intervention to improve long-term outcomes in ASD. LAY SUMMARY: Many children with autism experience vulnerabilities in executive functioning (EF), which may include challenges with inhibition, working memory, cognitive flexibility, and planning. The study shows that these vulnerabilities can already be detected at age three and that their presence is linked with lower social, communication, and daily living skills. Screening children with ASD for EF challenges and helping those who have difficulties may improve their long-term outcomes.
Journal of autism and developmental disorders, 2026 · doi:10.1016/j.jaac.2018.08.017