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Article ; Online: Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems.

Pugliese, Cara E / Handsman, Rebecca / You, Xiaozhen / Anthony, Laura Gutermuth / Vaidya, Chandan / Kenworthy, Lauren

Autism : the international journal of research and practice

2024 , Page(s) 13623613241246091

Abstract: Lay abstract: Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk ... ...

Abstract	Lay abstract: Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.
Language	English
Publishing date	2024-04-20
Publishing country	England
Document type	Journal Article
ZDB-ID	1338513-6
ISSN	1461-7005 ; 1362-3613
ISSN (online)	1461-7005
ISSN	1362-3613
DOI	10.1177/13623613241246091
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Article ; Online: Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings.

Dickson, Kelsey S / Galligan, Megan / Holt, Tana / Kenworthy, Lauren / Anthony, Laura / Roesch, Scott / Brookman-Frazee, Lauren

Journal of autism and developmental disorders

2024

Abstract: The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for ... ...

Abstract	The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.
Language	English
Publishing date	2024-04-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	391999-7
ISSN	1573-3432 ; 0162-3257
ISSN (online)	1573-3432
ISSN	0162-3257
DOI	10.1007/s10803-024-06365-8
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Article: Mental Health Therapist Perspectives on the Role of Executive Functioning in Children's Mental Health Services.

Dickson, Kelsey S / Kenworthy, Lauren / Anthony, Laura / Brookman-Frazee, Lauren

Evidence-based practice in child and adolescent mental health

2022 Volume 8, Issue 1, Page(s) 39–54

Abstract: Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in ... ...

Abstract	Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspectives regarding addressing executive functioning within community-based mental health services. The current mixed-methods study aims to characterize mental health therapist perspectives regarding the role of executive functioning in youth clinical presentation and the psychotherapy process and outcomes as well as their experience and training related to executive functioning. Forty-three therapists completed a survey about their perspectives about executive functioning and 14 participated in subsequent focus groups to expand survey results. Results indicated that therapists perceive executive functioning challenges as impacting a large portion of children on their caseload, present across multiple mental health conditions, and that executive functioning is frequently a focus of psychotherapy. Therapists also identified executive functioning challenges as a barrier to therapy engagement and effectiveness. However, therapists reported limited knowledge and training as well as significant motivation for executive functioning training, including executive functioning interventions. Findings confirm the significant role of executive functioning in youth presenting for mental health services and the psychotherapy process and outcomes. Findings also highlight the need for further translation of evidence-based interventions and tools. Challenges as well as potential solutions to inform ongoing and future work seeking to translate and implement evidence-based executive functioning interventions in community mental health services are discussed.
Language	English
Publishing date	2022-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2842149-8
ISSN	2379-4933 ; 2379-4925
ISSN (online)	2379-4933
ISSN	2379-4925
DOI	10.1080/23794925.2021.2013142
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Article ; Online: Still Left Behind: Fewer Black School-Aged Youth Receive ASD Diagnoses Compared to White Youth.

Habayeb, Serene / Kenworthy, Lauren / De La Torre, Andrea / Ratto, Allison

Journal of autism and developmental disorders

2021 Volume 52, Issue 5, Page(s) 2274–2283

Abstract: Prior research suggests that Black children are at risk for delays in diagnosis of autism, but factors that influence diagnostic timing across races remain unclear. This study analyzed data from Black and White children who received a first-time autism ... ...

Abstract	Prior research suggests that Black children are at risk for delays in diagnosis of autism, but factors that influence diagnostic timing across races remain unclear. This study analyzed data from Black and White children who received a first-time autism diagnosis at a specialty clinic. Black youth were under-represented in the group who received a first diagnosis in middle/late childhood (i.e., after age six). Receiving a diagnosis later in childhood was related to higher IQ (trend level) and more internalizing problems for White children whereas it was related to lower IQ (trend level) and higher ASD symptom intensity for Black children. Findings suggest racial disparities in early identification of autism may be diminishing but persist among those diagnosed later in childhood..
MeSH term(s)	Adolescent ; Autism Spectrum Disorder/diagnosis ; Blacks ; Child ; Humans ; Population Surveillance ; Prevalence ; Racial Groups
Language	English
Publishing date	2021-06-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	391999-7
ISSN	1573-3432 ; 0162-3257
ISSN (online)	1573-3432
ISSN	0162-3257
DOI	10.1007/s10803-021-05118-1
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Article ; Online: Gender, assigned sex at birth, and gender diversity: Windows into diagnostic timing disparities in autism.

McQuaid, Goldie A / Ratto, Allison B / Jack, Allison / Khuu, Alexis / Smith, Jessica V / Duane, Sean C / Clawson, Ann / Lee, Nancy Raitano / Verbalis, Alyssa / Pelphrey, Kevin A / Kenworthy, Lauren / Wallace, Gregory L / Strang, John F

Autism : the international journal of research and practice

2024 , Page(s) 13623613241243117

Abstract: Lay abstract: Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism ... ...

Abstract	Lay abstract: Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0-18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3-25.4 years) from a clinic-based sample; and 244 people (18.2-30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed.
Language	English
Publishing date	2024-04-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1338513-6
ISSN	1461-7005 ; 1362-3613
ISSN (online)	1461-7005
ISSN	1362-3613
DOI	10.1177/13623613241243117
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Article ; Online: Time is of the essence: Age at autism diagnosis, sex assigned at birth, and psychopathology.

Smith, Jessica V / McQuaid, Goldie A / Wallace, Gregory L / Neuhaus, Emily / Lopez, Andrea / Ratto, Allison B / Jack, Allison / Khuu, Alexis / Webb, Sara J / Verbalis, Alyssa / Pelphrey, Kevin A / Kenworthy, Lauren

Autism : the international journal of research and practice

2024 , Page(s) 13623613241249878

Abstract: Lay abstract: Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been ... ...

Abstract	Lay abstract: Previous research has shown that girls/women are diagnosed later than boys/men with autism. Individuals who are diagnosed later in life, especially girls/women, have greater anxious and depressive symptoms. Previous research has been limited due to narrow inclusionary criteria for enrollment in studies. The present study uses two samples-one clinic-based, large "real-world" sample and another research-based sample with strict criteria for autism diagnosis-to understand the relationships between diagnostic age, sex assigned at birth, and symptoms of anxiety/depression. In both samples, those who were diagnosed later had greater anxious/depressive symptoms, and anxiety was not predicted by sex. In the clinic-based but not research-based sample, those assigned female at birth were diagnosed later than those assigned male at birth. In the clinic-based sample only, individuals assigned female at birth and who were later diagnosed experienced greater symptoms of anxiety/depression compared to those assigned male who benefited from earlier diagnostic timing. Within the research-based sample, those assigned female at birth had greater depressive symptoms than those assigned male. These findings highlight the importance of timely identification of autism, especially for girls/women who are often diagnosed later. Community-based samples are needed to better understand real-world sex-based and diagnostic age-based disparities in mental health.
Language	English
Publishing date	2024-05-09
Publishing country	England
Document type	Journal Article
ZDB-ID	1338513-6
ISSN	1461-7005 ; 1362-3613
ISSN (online)	1461-7005
ISSN	1362-3613
DOI	10.1177/13623613241249878
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Article ; Online: Brief Report: Performance-Based Executive Functioning Abilities are Associated with Caregiver Report of Adaptive Functioning in Autism Spectrum Disorder.

Udhnani, Manisha D / Kenworthy, Lauren / Wallace, Gregory L / Yerys, Benjamin E

Journal of autism and developmental disorders

2020 Volume 50, Issue 12, Page(s) 4541–4547

Abstract: Executive functioning is thought to contribute to adaptive behavior skills development in individuals with autism spectrum disorder (ASD). However, supporting data are largely based on caregiver reports of executive functioning. The current study ... ...

Abstract	Executive functioning is thought to contribute to adaptive behavior skills development in individuals with autism spectrum disorder (ASD). However, supporting data are largely based on caregiver reports of executive functioning. The current study evaluated whether performance-based measures of executive functioning (working memory and inhibition) explained unique variance in parent-reported adaptive functioning among youth with ASD without an intellectual disability. Both spatial and verbal working memory were associated with adaptive functioning, particularly communication and daily living skills. Our findings demonstrate a robust relationship between working memory and adaptive functioning that translates across different measurement modalities. This preliminary study highlights that targeting executive functioning may be a critical component of an adaptive function training program.
MeSH term(s)	Activities of Daily Living/psychology ; Adaptation, Psychological/physiology ; Adolescent ; Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/psychology ; Caregivers/psychology ; Child ; Executive Function/physiology ; Female ; Humans ; Male ; Memory, Short-Term/physiology
Language	English
Publishing date	2020-04-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	391999-7
ISSN	1573-3432 ; 0162-3257
ISSN (online)	1573-3432
ISSN	0162-3257
DOI	10.1007/s10803-020-04505-4
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Zs.A 765: Show issues

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Article ; Online: Cingulate-Prefrontal Connectivity During Dynamic Cognitive Control Mediates Association Between p Factor and Adaptive Functioning in a Transdiagnostic Pediatric Sample.

Kaminski, Adam / You, Xiaozhen / Flaharty, Kathryn / Jeppsen, Charlotte / Li, Sufang / Merchant, Junaid S / Berl, Madison M / Kenworthy, Lauren / Vaidya, Chandan J

Biological psychiatry. Cognitive neuroscience and neuroimaging

2022 Volume 8, Issue 2, Page(s) 189–199

Abstract: Background: Covariation among psychiatric symptoms is being actively pursued for transdiagnostic dimensions of psychopathology with predictive utility. A superordinate dimension, the p factor, reflects overall psychopathology burden and has support from ...

Abstract	Background: Covariation among psychiatric symptoms is being actively pursued for transdiagnostic dimensions of psychopathology with predictive utility. A superordinate dimension, the p factor, reflects overall psychopathology burden and has support from genetic and neuroimaging correlates. However, the neurocognitive correlates that link an elevated p factor to maladaptive outcomes are unknown. We tested the mediating potential of dynamic adjustments in cognitive control rooted in functional connections anchored by the dorsal anterior cingulate cortex (dACC) in a transdiagnostic pediatric sample. Methods: A multiple mediation model tested the association between the p factor (derived by principal component analysis of Child Behavior Checklist syndrome scales) and outcome measured with the Vineland Adaptive Behavior Scale-II in 89 children ages 8 to 13 years (23 female) with a variety of primary neurodevelopmental diagnoses who underwent functional magnetic resonance imaging during a socioaffective Stroop-like task with eye gaze as distractor. Mediators included functional connectivity of frontoparietal- and salience network-affiliated dACC seeds during conflict adaptation. Results: Higher p factor scores were related to worse adaptive functioning. This effect was partially mediated by conflict adaptation-dependent functional connectivity between the frontoparietal network-affiliated dACC seed and the right dorsolateral prefrontal cortex. Post hoc follow-up indicated that the p factor was related to all Vineland Adaptive Behaviors Scale-II domains; the association was strongest for socialization followed by daily living skills and then communication. Mediation results remained significant for socialization only. Conclusions: Higher psychopathology burden was associated with worse adaptive functioning in early adolescence. This association was mediated by weaker dACC-dorsolateral prefrontal cortex functional connectivity underlying modulation of cognitive control in response to contextual contingencies. Our results contribute to the identification of transdiagnostic and developmentally relevant neurocognitive endophenotypes of psychopathology.
MeSH term(s)	Adolescent ; Humans ; Child ; Female ; Gyrus Cinguli/physiology ; Mental Disorders ; Magnetic Resonance Imaging ; Neuroimaging ; Cognition/physiology
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2879089-3
ISSN	2451-9030 ; 2451-9022
ISSN (online)	2451-9030
ISSN	2451-9022
DOI	10.1016/j.bpsc.2022.07.003
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Article ; Online: Parents report fewer executive functioning problems and repetitive behaviors in young dual-language speakers with autism.

Ratto, Allison B / Potvin, Deborah / Pallathra, Ashley A / Saldana, Laura / Kenworthy, Lauren

Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence

2020 Volume 26, Issue 7, Page(s) 917–933

Abstract: More dual language learners (DLLs) are being identified early with autism spectrum disorder (ASD). However, many families are still being advised against dual language exposure, despite a lack of evidence of negative impacts on language development in ... ...

Abstract	More dual language learners (DLLs) are being identified early with autism spectrum disorder (ASD). However, many families are still being advised against dual language exposure, despite a lack of evidence of negative impacts on language development in ASD. Research in typically developing children has noted advantages for bilinguals in domains such as executive functioning and social skills, but less is known about the effects in ASD. The present study evaluated differences in executive functioning and social communication in young children (n = 55) with ASD. Dual-language learners with ASD had significantly fewer parent reported executive functioning problems and repetitive behaviors; parent-reported social communication skills were generally comparable across groups. Our findings indicate that the bilingual advantage in executive functioning may extend to children with neurodevelopmental conditions.
MeSH term(s)	Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/psychology ; Autistic Disorder ; Child ; Child, Preschool ; Communication ; Executive Function/physiology ; Female ; Humans ; Language ; Language Development ; Male ; Multilingualism ; Parents/psychology ; Social Skills
Language	English
Publishing date	2020-03-11
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1262599-1
ISSN	1744-4136 ; 0929-7049
ISSN (online)	1744-4136
ISSN	0929-7049
DOI	10.1080/09297049.2020.1733512
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Article ; Online: Measuring flexibility in autistic adults: Exploring the factor structure of the flexibility scale self report.

Hollocks, Matthew J / McQuaid, Goldie A / Yerys, Benjamin E / Strang, John F / Anthony, Laura G / Kenworthy, Lauren / Lee, Nancy R / Wallace, Gregory L

Autism research : official journal of the International Society for Autism Research

2023 Volume 16, Issue 11, Page(s) 2208–2219

Abstract: Cognitive flexibility differences are common for autistic individuals and have an impact on a range of clinical outcomes. However, there is currently a lack of well validated measurement tools to assess flexibility in adulthood. The Flexibility Scale was ...

Abstract	Cognitive flexibility differences are common for autistic individuals and have an impact on a range of clinical outcomes. However, there is currently a lack of well validated measurement tools to assess flexibility in adulthood. The Flexibility Scale was originally designed as a parent-report measure of real-world flexibility challenges in youth. The original Flexibility Scale provides a total score and five subscales: Routines and Rituals, Transitions and Change, Special Interests, Social Flexibility, and Generativity. In this study, we evaluate the factorial validity of the Flexibility Scale as a self-report (Flexibility Scale Self Report) measure of cognitive flexibility, adapted from the original Flexibility Scale, for use by autistic adults. This study includes both a primary sample (n = 813; mean age = 40.3; 59% female) and an independently recruited replication sample (n = 120; mean age = 32.8; 74% female) of individuals who completed the Flexibility Scale Self Report. The analysis consisted of an initial confirmatory factor analysis (CFA) of the original Flexibility Scale structure, followed by exploratory factor analysis (EFA) and factor optimization within a structural equation modeling framework to identify the optimal structure for the questionnaire in adults. The identified structure was then replicated through CFA in the replication sample. Our results indicate an alternative optimal scale structure from the original Flexibility Scale, which includes fewer items, and only three (Routines/Rituals, Transitions and Change, Special Interests) of the five subscales contributing to the flexibility total score. Comparisons revealed no structural differences within the scale based on sex assigned at birth. Here the Generativity and Social Flexibility scales are treated as independent but related scales. The implications for measurement of cognitive flexibility in clinical and research settings, as well as theoretical underpinnings are discussed.
MeSH term(s)	Adolescent ; Infant, Newborn ; Humans ; Adult ; Female ; Male ; Self Report ; Autistic Disorder ; Autism Spectrum Disorder/psychology ; Surveys and Questionnaires ; Mental Processes ; Reproducibility of Results ; Psychometrics
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2481338-2
ISSN	1939-3806 ; 1939-3792
ISSN (online)	1939-3806
ISSN	1939-3792
DOI	10.1002/aur.3025
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