Transition to adulthood: Executive functions and independent living skills in autism spectrum disorder

August 2023
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The transition to adulthood is particularly challenging for young adults with autism spectrum disorder (ASD). These challenges exhibit themselves with poor outcomes in independent living, employment, education, and community participation. Broad executive functioning deficits have been indicated as a key factor in the development of independent living skills for young adults with ASD. This study aims to expand the understanding of the impact of executive functions on independent living skills in young adults with ASD and examine (1) differences in independent living and executive functioning skills between young adults with ASD and neurotypical peers and (2) the contribution of executive functions to independent living skills for young adults with ASD. This study utilizes a novel performance-based assessment of executive function, utilizing an everyday activity that challenges the integration of cognitive skills, the Weekly Calendar Planning Activity (WCPA). Eighty-four age-matched participants (52 in the ASD group and 32 neurotypical peers) completed a battery of assessments of independent living and executive functioning skills. These included the Montreal Cognitive Assessment (MoCA), Adaptive Behavior Assessment System (ABAS-3), Daily Living Questionnaire (DLQ), Behavior Rating Inventory of Executive Function (BRIEF-A), and the WCPA. Independent living skills in young adults with ASD, as measured by ABAS-3, were significantly lower than their neurotypical peers (p < .001) and fell 2 standard deviations below the mean. Executive functioning skills, as measured by the BRIEF-A and WCPA were all significantly lower in young adults with ASD. WCPA was able to significantly differentiate young adults with ASD and neurotypical peers; as demonstrated by following fewer rules, utilizing fewer strategies, performing with less accuracy, and stating lower self-awareness of performance than their neurotypical peers. Executive functioning skills as measured by BRIEF-A robustly correlated with independent living skills (ABAS-3 and DLQ). However, WCPA scores did not significantly correlate with independent living skill measures, highlighting the heterogeneity of executive dysfunction within ASD. Though no significant relationships were found between WCPA scores and independent living, WCPA shows promise at providing a window into how the integration of multiple executive functions impact challenges with everyday living.

Occupational Therapy