Social Communication Difficulties in Children with Autism Spectrum Disorder (ASD Level 1): The Mediating Role of Cognitive Disengagement Syndrome.
Adults with high-functioning autism show solid, medium-size executive deficits, with flexibility and planning hit hardest.
01Research in Context
What this study did
Karaca et al. (2026) pooled 42 earlier studies of adults with high-functioning autism.
They looked at five executive skills: stopping impulses, holding facts in mind, switching tasks, planning ahead, and quick idea flow.
The team used meta-analysis to find the size of each weakness compared to typical adults.
What they found
All five skills were weaker in the autism group. The biggest gaps were in switching tasks and planning.
The overall effect was medium, meaning the difference is clear enough to matter in daily life.
How this fits with other research
Tonizzi et al. (2022) showed that adding ADHD to autism makes inhibition and memory worse. The new data say the core autism profile already shows medium deficits even without ADHD.
Bramham et al. (2009) mapped adult ADHD versus autism and found planning problems mainly in autism. The meta-analysis now confirms planning as one of the two weakest spots.
Walley et al. (2005) saw inhibition deficits disappear once language and attention were counted out. This looks like a clash, but their child sample used tighter controls. The adult meta-analysis kept language differences in, so both can be true: inhibition drops when verbal skill is leveled.
Why it matters
When you assess an adult with ASD, expect trouble with flexibility and planning first. Build supports such as written step lists, visual schedules, and extra switch cues. If inhibition seems poor, check language and attention before blaming autism alone.
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02At a glance
03Original abstract
The comprehensiveness and severity of executive dysfunction in high-functioning autism (HFA) spectrum disorder have not reached a unified conclusion especially in patients in adulthood. Clarifying this issue is critical for guiding clinical diagnosis and targeted intervention. The primary objective of the present meta-analysis was to study the characteristics of executive function (EF) in adults with HFA compared to typically developing (TD) adults, by taking five key components into consideration, including inhibition, working memory, flexibility, planning, and fluency. The PubMed and Embase databases were searched to identify peer-reviewed studies that compared EF in adults with and without HFA from 1980 to November 2018. Hedges' g effect sizes were computed to measure the primary outcome. Moderators like age, sex, and diagnostic tools were controlled using meta-regressions. Forty-two studies satisfying the selection criteria were included, which resulted in a large sample size of 2419 participants. A moderate overall effect size for reduced EF across domains was found in adults with HFA, compared with TD (g = 0.57, 95% confidence interval 0.47-0.66). Subsequently, a broad executive dysfunction was found in adults with HFA in this study (flexibility [g = 0.69], planning [g = 0.64], inhibition [g = 0.61], working memory [g = 0.48], fluency [g = 0.42]), with the predominated impairment on flexibility and planning. Taken together, these results provide evidence for the executive dysfunction hypothesis and may assist in the clinical diagnosis and targeted intervention, suggesting the necessity of sustained intervention on EF for individuals with HFA from childhood to adulthood. LAY SUMMARY: The meta-analysis explored the characteristics of EF in adults with high-functioning autism (HFA) comparing to typically developing controls. Moderate effect sizes for reduced EF across domains were found in adults with HFA, with the flexibility and planning being the most predominately impaired. A comprehensive measurement of EF in adults with HFA has important clinical implications for the diagnosis, treatment, prognosis, and a fundamental understanding for developmental trajectory of these patients.
Journal of autism and developmental disorders, 2026 · doi:10.1002/aur.2304