Executive function and functional and structural brain differences in middle-age adults with autism spectrum disorder.
Middle-aged autistic men still have executive trouble and smaller hippocampi, so lifelong support is needed.
01Research in Context
What this study did
Braden et al. (2017) compared middle-aged men with autism to same-age men without autism.
They gave everyone tests of memory, executive function, and visual search.
Each man also had an MRI scan to measure brain structure and activity during a task.
What they found
The autistic group scored lower on planning and flexible thinking tests.
Their hippocampus was smaller and their cortico-striatal network showed less activity.
Memory and visual search scores were the same in both groups.
How this fits with other research
Granieri et al. (2020) pooled 16 imaging studies and saw the same pattern: autistic adults use the prefrontal cortex but miss parietal “team-mates.” Blair’s smaller hippocampus and weaker cortico-striatal signal line up with that view.
Pedrahita et al. (2026) followed adults past 50 and found resting-state brain signals decline faster in autism. Blair’s 2017 data now look like the first hint of this earlier neural aging.
Padmanabhan et al. (2015) showed teens with autism fail to gain inhibitory control with age. Blair shows the gap is still there in mid-life, confirming the problem does not fade.
Why it matters
Your adult clients may look competent on daily tasks yet still struggle with planning and shifting plans. Do not drop executive-function supports at 30 or 40. Instead, add brief cognitive screens to yearly care plans and teach compensatory strategies such as written checklists or visual schedules. These small tools can protect independence as the brain continues to age faster than expected.
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02At a glance
03Original abstract
UNLABELLED: There is a rapidly growing group of aging adults with autism spectrum disorder (ASD) who may have unique needs, yet cognitive and brain function in older adults with ASD is understudied. We combined functional and structural neuroimaging and neuropsychological tests to examine differences between middle-aged men with ASD and matched neurotypical (NT) men. Participants (ASD, n = 16; NT, n = 17) aged 40-64 years were well-matched according to age, IQ (range: 83-131), and education (range: 9-20 years). Middle-age adults with ASD made more errors on an executive function task (Wisconsin Card Sorting Test) but performed similarly to NT adults on tests of delayed verbal memory (Rey Auditory Verbal Learning Test) and local visual search (Embedded Figures Task). Independent component analysis of a functional MRI working memory task (n-back) completed by most participants (ASD = 14, NT = 17) showed decreased engagement of a cortico-striatal-thalamic-cortical neural network in older adults with ASD. Structurally, older adults with ASD had reduced bilateral hippocampal volumes, as measured by FreeSurfer. Findings expand our understanding of ASD as a lifelong condition with persistent cognitive and functional and structural brain differences evident at middle-age. Autism Res 2017, 10: 1945-1959. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We compared cognitive abilities and brain measures between 16 middle-age men with high-functioning autism spectrum disorder (ASD) and 17 typical middle-age men to better understand how aging affects an older group of adults with ASD. Men with ASD made more errors on a test involving flexible thinking, had less activity in a flexible thinking brain network, and had smaller volume of a brain structure related to memory than typical men. We will follow these older adults over time to determine if aging changes are greater for individuals with ASD.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1842