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Meta-Analysis
. 2023 Dec;27(14):1571-1582.
doi: 10.1177/10870547231190494. Epub 2023 Aug 11.

Do ASD and ADHD Have Distinct Executive Function Deficits? A Systematic Review and Meta-Analysis of Direct Comparison Studies

Parker Townes  1 , Chunlin Liu  2 , Prabdeep Panesar  2 , Daniel Devoe  3 , Soo Youn Lee  2 , Gracie Taylor  3 , Paul D Arnold  1 , Jennifer Crosbie  2 , Russell Schachar  2
Affiliations
Meta-Analysis

Do ASD and ADHD Have Distinct Executive Function Deficits? A Systematic Review and Meta-Analysis of Direct Comparison Studies

Parker Townes et al. J Atten Disord. 2023 Dec.

Abstract

Objective: To evaluate if children and adolescents with a diagnosis of ASD or ADHD have distinct executive function (EF) profiles.

Methods: Peer-reviewed articles comparing ASD, ADHD, and typically developing individuals under 19 years of age were identified. The domains evaluated were: working memory, response inhibition, planning, cognitive flexibility, attention, processing speed, and visuospatial abilities.

Results: Fifty-eight articles met inclusion criteria. Analyses were performed on 45 performance metrics from 24 individual tasks. No differences in EF were found between individuals diagnosed with ASD and ADHD. Individuals diagnosed with ASD and ADHD exhibited worse performance in attention, flexibility, visuospatial abilities, working memory, processing speed, and response inhibition than typically developing individuals. Groups did not differ in planning abilities.

Conclusion: Children and adolescents with ASD and ADHD have similar EF profiles. Further research is needed to determine if comorbidity accounts for the commonality in executive dysfunction between each disorder.

Keywords: ADHD; adolescence; autism spectrum disorders (ASD); children; executive function.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow diagram. Note. Articles were reviewed in duplicate by two reviewers blind to each other’s decision following a two level screening process. Discrepancies were settled through consensus between the entire study team.
Figure 2.
Figure 2.
Forest plot of response inhibition meta-analysis. Note. Standardized Mean Difference (SMD) estimates are reported using Hedge’s g. I2 estimates are only relevant for analyses of five or more articles. Significance has been reached when the Subtotal does not cross 0. Positive values indicate greater scores in the ASD group. SSRT = stop signal response time; CPT = continuous performance test; VRCQ = visual response control quotient; ARCQ = auditory response control quotient; D-KEFS = Delis-Kaplan executive function system; CWIT = color-word interference test; SST = stop signal task.
Figure 3.
Figure 3.
Forest plot of working memory meta-analysis. Note. Standardized Mean Difference (SMD) estimates are reported using Hedge’s g. I2 estimates are only relevant for analyses of five or more articles. Significance has been reached when the Subtotal does not cross 0. Positive values indicate greater scores in the ASD group. CANTAB = cambridge neuropsychological test automated battery; SSP = spatial span; SWM = spatial working memory; SOPT = self-ordered pointing task; WISC = Wechsler intelligence scale for children.
Figure 4.
Figure 4.
Forest plot of cognitive flexibility/set-shifting meta-analysis. Note. Standardized Mean Difference (SMD) estimates are reported using Hedge’s g. I2 estimates are only relevant for analyses of five or more articles. Significance has been reached when the Subtotal does not cross 0. Positive values indicate greater scores in the ASD group. ID/ED = CANTAB intra-dimensional/extra-dimensional set shifting; TTC = number of trials needed to reach criterion; D-KEFS = Delis-Kaplan executive function system; WCST = Wisconsin card sorting task; WJ Cog = Woodcock-Johnson tests of cognitive abilities.
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