Executive Functioning as a Pathway Between Social Skills and Psychopathology: The Moderating Role of Autism Diagnosis.
Samina I Ansari, Lucas A Martin, Kristi C Guest and 1 others
Planning, working memory, and self-regulation skills sit between poor social skills and emotional or behavioral problems in children.
The self-regulation link to behavioral problems is the same for autistic and typically developing kids. The planning-and-working-memory link to emotional problems was found only in autistic children.
Key findings
1Metacognitive functioning (planning, working memory, organization) partially mediated the link between poor social skills and internalizing problems for autistic children (β = 0.17, 95% CI [0.061, 0.280]), but this mediation was not significant for typically developing children.
2Behavioral regulation (inhibition, shifting, emotional control) mediated the link between poor social skills and externalizing problems for both autistic (β = 0.48, 95% CI [0.324, 0.656]) and typically developing (β = 0.76, 95% CI [0.494, 1.080]) children, with no significant difference between the two groups.
3Autistic children had significantly higher internalizing problems (M diff = 17.72), higher externalizing problems (M diff = 12.59), poorer social skills (M diff = 33.38), and lower metacognitive and behavioral regulation scores than typically developing peers, all p < 0.001.
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How it was doneWhat they foundWhat it means for OTs
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What it does not show
Cross-sectional design: the mediation is correlational and cannot establish that EF difficulties cause the emotional or behavioral problems, or that improving EF would reduce them. All measures were parent-reported (SRS, BRIEF, CBCL), so a single rater's expectations or awareness of the child's diagnosis may have shaped the scores; the authors note this could attenuate the autistic group's EF scores. The study could not control for the severity of autistic symptoms, concurrent interventions, or co-occurring conditions such as ADHD, all of which are associated with EF and psychological outcomes. Data came from four distinct samples across three sites, introducing potential variability in assessment procedures and clinical populations. SEM Model 2 (behavioral regulation → externalizing) showed poor fit (CFI = 0.897, TLI = −0.820), and the authors explicitly state those results must be interpreted with caution. 70.75% of participants were male, limiting generalizability to autistic girls and women, who are often under-identified and may present differently. The BRIEF measures everyday EF as perceived by a caregiver and has been found to correlate poorly with performance-based EF tasks, so the construct captured here is not the same as a pure cognitive capacity.
Declared interests
The authors declare no conflicts of interest. The work was funded by the University of Alabama at Birmingham College of Arts and Sciences Faculty Funds.
The easy way to misread this
Do not read the significant mediation as proof that improving a child's planning or self-regulation skills will reduce their anxiety or behavioral problems. This is a cross-sectional snapshot: the three variables were measured at the same time, so the direction of influence is not established. Additionally, all scores came from the same parent, and the study could not account for whether the child was already receiving therapy or had a co-occurring diagnosis like ADHD, both of which would confound the EF-to-problems link.
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