Exploring the impact of adolescent cognitive inflexibility on emotional and behavioural problems experienced by autistic adults.
Matthew J Hollocks, Tony Charman, Gillian Baird and 3 others
PMID 34579554WHAT IT FOUND
In autistic adults, cognitive inflexibility measured in adolescence predicted higher anxiety and depression at age 23.
This effect remained after accounting for restricted behaviours and verbal IQ. Clinicians should assess thinking style, not just autism severity, when addressing mental health.
Key findings
01Reduced cognitive flexibility at age 16 significantly predicted greater behavioural problems, anxiety and depression at age 23.
02The association between cognitive inflexibility and emotional symptoms remained significant and was stronger than the effect of restricted and repetitive behaviours.
03Cognitive inflexibility mediated the stability of anxiety and depression symptoms from adolescence to early adulthood.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample size was relatively small (n=81), which limits the ability to analyse subgroups based on intellectual disability levels. Cognitive flexibility was only measured at one time point (age 16), so the direction of causality and potential bidirectional effects with anxiety could not be determined. Mental health outcomes were based on parent-report questionnaires, which may introduce bias compared to self-report or clinical interview. The study lacked a non-autistic comparison group, so it is unclear if these associations are specific to autism or present in the general population. Neuropsychological tests used to measure flexibility also tap into other executive functions, making it difficult to isolate 'flexibility' as a distinct construct.
Declared interests
The authors declared no potential conflicts of interest. Funding was provided by Autism Speaks (project grant 7729), the UK Medical Research Council (grant G0400065), and the Biomedical Research Centre at South London and Maudsley Foundation Trust.
The easy way to misread this
Do not assume that targeting cognitive flexibility will improve mental health outcomes based on this study alone. The research shows an association and predictive link, but it did not test an intervention. Improving flexibility is a hypothesis for future research, not a proven treatment effect.