Childhood Executive Function Predicts Internalizing and Externalizing Symptoms in Emerging Adults With and Without Autism: A 10-Year Longitudinal Study

Figures & data

Table 1. Demographic and clinical characteristics.

	M	SD	Range	M	SD	Range	χ2/F	P	Hedges’ g
T1 – baseline	ASD (n = 38)			TD (n = 50)			Group comparison
Age	12.03	2.34	9–17	11.56	1.99	8–17	1.016	.316	0.22
% boys/girls	84/16			64/36			4.446	.035
Full-scale IQ	98.26	17.82	70–137	103.78	12.95	77–133	2.830	.096	0.36
Mothers’ education	12.79	2.67	9–17	14.58	2.37	9–18	11.014	.001	0.72
ASSQ	21.47	9.27	4–49	1.62	1.85	0–8	218.657	<.001	3.18
Executive function^a	2.93	3.18	−3.76–10.91	0.00	2.57	−4.50–5.66	21.738	<.001	1.03
Internalizing symptoms^b	65.53	10.63	34–82	42.43	8.65	33–66	124.919	<.001	2.42
Externalizing symptoms^b	59.08	10.59	40–79	40.78	7.52	33–58	88.852	<.001	2.04
T2–2-year follow-up	ASD (n = 37)			TD (n = 50)
Sample retention %	97%			100%
Age	14.21	2.35	11–19	13.62	1.95	10–19	1.673	.199	0.27
% boys/girls	84/16			64/36			4.166	.041
Executive function^c	1.39	3.06	−4.58–7.93	−1.81	2.35	−5.90–5.70	29.977	<.001	1.21
Internalizing symptoms^d	59.82	10.86	34–76	41.10	8.26	33–62	80.451	<.001	1.99
Externalizing symptoms^d	50.18	8.85	33–69	39.74	5.59	34–51	43.909	<.001	1.47
T3–10-year follow-up	ASD (n = 26)			TD (n = 40)
Sample retention (%)	68%			80%
Age	22.15	2.62	18–27	20.88	1.88	17–26	5.325	.024	0.58
% boys/girls	81/19			65/35			1.911	.167
Executive function^e	−0.73	3.04	−4.92–5.47	−4.02	1.97	−8.44–0.22	26.274	<.001	1.37
Internalizing symptoms^f	56.71	11.72	35–78	45.85	10.38	25–68	14.898	<.001	1.00
Externalizing symptoms^f	50.04	11.89	29–74	43.33	8.81	29–68	6.681	.012	0.67

Note. ASD = autism spectrum disorder, TD = typically developing. Full-scale IQ estimated from Wechsler Abbreviated Scale of Intelligence; Mother’s education in years. ASSQ = Autism Spectrum Screening Questionnaire; Executive function (higher scores indicate more problems) = composite score calculated from results on the Letter-Number Sequencing Test from Wechsler Intelligence Scale for Children-IV, the Color-Word Interference Test, Condition 3, and the Trail Making Test, Condition 4, both from Delis-Kaplan Executive Function System. Internalizing and externalizing symptoms from Achenbach System of Empirically Based Assessment; Children Behavior Checklist at T1 and T2, Adult Self-Report at T3. ^an = 34 ASD, ^bn = 49 TD, ^cn = 33 ASD, ^dn = 34 ASD, ^en = 22 ASD, n = 39 TD, ^fn = 24 ASD.

Table 2. Bivariate correlations between study variables.

Baseline (T1)

2-year follow-up (T2)

10-year follow-up (T3)

Age

ASSQ

EF

INT

EXT

EF

INT

EXT

EF

INT

EXT

T1

Age

-

ASSQ

.24*

-

.

EF

−.36**

.36***

-

INT

.06

.77***

.39***

-

EXT

.10

.73***

.35**

.77***

-

T2

EF

−.18

.42***

.85***

.38***

.50***

-

INT

.09

.69***

.39***

.81***

.58***

.29**

-

EXT

.12

.59***

.28**

.63***

.75***

.35**

.70***

-

T3

EF

.11

.56***

.66***

.49***

.52***

.76***

.39**

.41**

-

INT

.16

.39***

.39**

.45***

.23

.42**

.52***

.24

.38**

-

EXT

−.03

.28*

.47***

.19

.25*

.54***

.25*

.22

.36**

.54***

-

Note. T1 = baseline, T2 = 2-year follow-up, T3 = 10-year follow-up. ASSQ = Autism Spectrum Screening Questionnaire. EF = Executive function, composite score calculated from results on the Letter-Number Sequencing Test from Wechsler Intelligence Scale for Children-IV, the Color-Word Interference Test, Condition 3, and the Trail Making Test, Condition 4, both from Delis-Kaplan Executive Function System. INT = Internalizing and EXT = externalizing symptoms, from Achenbach System of Empirically Based Assessment; Children Behavior Checklist at T1 and T2, Adult Self-Report at T3. Statistically significant correlations are identified by *p < .05, ** p < .01, *** p < .001.

Table 3. Baseline predictors of internalizing symptoms at baseline, 2-year follow-up, and 10-year follow-up.

	Baseline (T1) N = 83				2-year follow-up (T2) N = 81				10-year follow-up (T3) N = 62
Predictors from T1	B	95% CI	SE	ΔR^2	B	95% CI	SE	ΔR^2	B	95% CI	SE	ΔR^2
Step 1				.007				.012				.024
Age	.573	[−.986, 2.133]	.784		.705	[−.737, 2.148]	.725		.914	[−.603, 2.431]	.758
Step 2				.587				.452				.144
Age	−.742	[−1.776, .292]	.520		−.129	[−1.218, .960]	.547		.383	[−1.068, 1.835]	.725
Autism symptoms	.991***	[.808, 1.175]	.092		.763***	[.576, .951]	.094		.424**	[.159, .689]	.133
Step 3				.004				.033				.125
Age	−.481	[−1.657, .695]	.591		.624	[−.634, 1.881]	.631		1.634*	[.074, 3.194]	.779
Autism symptoms	.942***	[.729, 1.154]	.107		.650***	[.441, .859]	.105		.223	[−.054, .499]	.138
Executive function	.385	[−.439, 1.209]	.414		.946*	[.101, 1.791]	.424		1.847**	[.693, 3.002]	.577

Note. Dependent variable = internalizing symptoms, Achenbach System of Empirically Based Assessment; Children Behavior Checklist at T1 and T2, Adult Self-Report at T3. Autism symptoms = Autism Spectrum Screening Questionnaire. Executive function = composite score calculated from results on the Letter-Number Sequencing Test from Wechsler Intelligence Scale for Children-IV, the Color-Word Interference Test, Condition 3, and the Trail Making Test, Condition 4, both from Delis-Kaplan Executive Function System. T1 N = 83, T2 N = 81, T3 N = 62. *p < .05, **p < .01, ***p < .001.

Table 4. Baseline predictors of externalizing symptoms at baseline, 2-year follow-up, and 10-year follow-up.

	Baseline (T1) N = 83				2-year follow-up (T2) N = 81				10-year follow-up (T3) N = 62
Predictors from T1	B	95% CI	SE	ΔR^2	B	95% CI	SE	ΔR^2	B	95% CI	SE	ΔR^2
Step 1				.010				.011				.001
Age	.601	[−.697, 1.899]	.652		.434	[−.502, 1.369]	.470		−.139	[−1.468, 1.189]	.664
Step 2				.535				.324				.108
Age	−.447	[−1.358, .464]	.458		−.024	[−.810, .761]	.395		−.537	[−1.837, .763]	.650
Autism symptoms	.789***	[.628, .951]	.081		.419***	[.284, .554]	.068		.317**	[.080, .555]	.119
Step 3				.002				.008				.154
Age	−.290	[−1.329, .749]	.522		.217	[−.713, 1.147]	.467		.663	[−.716, 2.042]	.689
Autism symptoms	.760***	[.572, .947]	.094		.383***	[.228, .537]	.078		.124	[−.120, .369]	.122
Executive function	.231	[−.497, .960]	.366		.304	[−.322, .929]	.314		1.772***	[.752, 2.793]	.510

Note. Dependent variable = externalizing symptoms, Achenbach System of Empirically Based Assessment, Children Behavior Checklist at T1 and T2, Adult Self-Report at T3; Autism symptoms = Autism Spectrum Screening Questionnaire. Executive function composite score calculated from results on the Letter-Number Sequencing Test from Wechsler Intelligence Scale for Children-IV, the Color-Word Interference Test, Condition 3, and the Trail Making Test, Condition 4, both from Delis-Kaplan Executive Function System. T1 N = 83, T2 N = 81, T3 N = 62. *p < .05, **p < .01, ***p < .001.

short-legendFigure 1.

Figure 2. Internalizing and externalizing symptoms as predictors of later executive function.