J Autism Dev Disord
DOI 10.1007/s10803-012-1650-5
ORIGINAL PAPER
The Specificity of Inhibitory Impairments in Autism
and Their Relation to ADHD-Type Symptoms
Charlotte Sanderson • Melissa L. Allen
Ó Springer Science+Business Media, LLC 2012
Abstract Findings on inhibitory control in autism have
been inconsistent. This is perhaps a reflection of the different
tasks that have been used. Children with autism (CWA) and
typically developing controls, matched for verbal and non-
verbal mental age, completed three tasks of inhibition, each
representing different inhibitory subcomponents: Go/No-Go
(delay inhibition), Dog-Pig Stroop (conflict inhibition), and
a Flanker task (resistance to distractor inhibition). Behav-
ioural ratings of inattention and hyperactivity/impulsivity
were also obtained, as a possible source of heterogeneity in
inhibitory ability. CWA were only impaired on the conflict
inhibition task, suggesting that inhibitory difficulty is not a
core executive deficit in autism. Symptoms of inattention
were related to conflict task performance, and thus may be an
important predictor of inhibitory heterogeneity.
Keywords Autism  Inhibition  ADHD 
Executive function
Introduction
A dominant cognitive theory of autism links the social and
non-social features of the disorder to deficits in ‘executive
C. Sanderson  M. L. Allen
Department of Psychology, Lancaster University,
Lancashire, UK
Present Address:
C. Sanderson (&)
Behavioural and Brain Sciences Unit, University College
London (UCL) Institute of Child Health, 30 Guilford Street,
London WC1N 1EH, UK
e-mail: charlotte.sanderson107@gmail.com;
charlotte.sanderson.10@ucl.live.ac.uk
function’ (EF) (Hill 2004a; Russell 1997). This umbrella
term refers to a range of higher-order cognitive abilities
that together permit an individual to plan and carry out
non-automatic, flexible and goal-directed actions (Welsh
and Pennington 1988). However, executive impairments
have been linked to various developmental disorders,
including attention-deficit/hyperactivity disorder (ADHD)
(Ozonoff and Jensen 1999) and Tourette syndrome
(Leckman et al. 1987). It is thus difficult for an executive
account, in its simplest form, to explain the differential
clinical outcomes in each disorder (Pennington 1997).
Some have argued that autism may thus be distinguish-
able by a unique executive profile or pattern of strength and
weakness across various subcomponents of EF (e.g. working
memory, planning, inhibitory control) (Pennington 1997;
Happé et al. 2006; Hill 2004a). A specific suggestion is that
inhibitory control may be ‘‘intact’’ in children with autism
(CWA), which would in particular help to discriminate the
disorder from ADHD—where inhibition is often considered
a core cognitive deficit (e.g. Happé et al. 2006; Sinzig et al.
2008; Bramham et al. 2009; Lijffijt et al. 2005). However,
the evidence for intact inhibitory control in autism remains
equivocal (Christ et al. 2007; Adams and Jarrold 2009; Hill
2004a, b). Though many studies have failed to identify any
deficit relative to controls, a notable number have reported
impairments in CWA on both verbal and non-verbal inhi-
bition tasks (see Table 1).
Inhibitory Control
Inhibitory control is defined as the ability to suppress
information or a response that may interfere with the
attainment of a cognitive or behavioural goal (Nigg 2000;
Dagenbach and Carr 1994). However, like EF, it is argu-
ably not a unitary construct (e.g. Friedman and Miyake
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 Table 1 Summary of previous findings on inhibitory ability in children with autism and typically developing (TD) and/or moderate learning difficulty (MD) controls
Study Sample characteristics Inhibitory control task ASD impaired?

123
ASD Comparisons Matching criteria

Adams and Jarrold (2009) Autism TD NVMA (RCPM)/Word Reading (BAS) Colour-word Stroop No
Chimeric Animal Stroop No
Ames and Jarrold (2007) Autism/AS/PDD-NOS TD/MLD VMA/NVMA (BPVS/RCPM) Dog-Pig Stroop (Card-version) Yes
Biro and Russell (2001) Autism TD/MLD VMA Detour Reaching Task Yes
Bishop and Norbury (2005) HFA TD NVMA Opposite-Worlds Yes
Walk-Don’t Walk Yes
Christ et al. (2007) Autism/AS/PDD TD/ASD siblings Statistically controlled for IQ (WASI) & CA Colour-word Stroop No
Go/No-Go No
Flanker Task Yes
Eskes et al. (1990) Autism TD Reading Speed Colour-word Stroop No
Goldberg et al. (2005) HFA TD CA Colour-word Stroop No
Geurts et al. (2004) HFA TD CA Opposite Worlds No
Change Task Yes
Circle Drawing Task Yes
Happé et al. (2006) HFA TD CA/IQ (FSIQ, PIQ, VIQ) Go/No-Go No
AS
Henderson et al. (2006) HFA TD CA/MA Flanker No
Hughes and Russell (1993)
Study 1 Autism MLD VMA Windows Task Yes
Study 2 Autism MLD/TD VMA Detour Reaching Task
Switch Yes
Knob No
Lemon et al. (2011) HFA/AS TD CA/FIQ Stop-task
Female Participants Yes
Male Participants No
Minshew et al. (1999) HFA TD CA/IQ (Ammons) Anti-Saccade Task Yes
Noterdaeme et al. (2001) Autism TD CA/PIQ Directional conflict task Yes
Go/No-Go No
Ozonoff and Jensen (1999) Autism TD CA (FIQ used as Covariate). Colour-word Stroop No
Ozonoff and Strayer (1997) HFA TD CA/Gender/VIQ/PIQ/FSIQ Stop-task No
Ozonoff et al. (1994) Autism/PDD-NOS Tourette syndrome CA/Gender/VIQ/PIQ/FSIQ Go/No-Go
TD Neutral response set No
Prepotent response set Yes
Russell et al. (1991) Autism Down Syndrome Word Reading (BAS) Windows task Yes
J Autism Dev Disord

Russell et al. (1999) Autism TD/MLD VMA Day/Night Stroop No

J Autism Dev Disord

mental age, NVMA non-verbal mental age, CA chronological age, WASI Wechsler Abbreviated Scale of Intelligence, BPVS British Picture Vocabulary Scale, RCPM Ravens coloured
N.B. In some studies listed, additional clinical groups and/or other executive tasks (not detailed here) were included. FSIQ Full-scale IQ, VIQ verbal IQ, PIQ performance IQ, VMA verbal
ASD impaired?
2004), and there may be fundamental distinctions between
different tasks in terms of the cognitive processes they
draw upon. It may thus be that some types of inhibition
task are more problematic for CWA than others, which
Yes
No
No
could fuel inconsistency between studies. In this study,
three types of inhibitory paradigm that have been used are
considered, which we refer to as delay, conflict and resis-
Classic (colour-word) Stroop
Automated Windows Task

tance to distractor inhibition.

Delay paradigms require children to ‘‘delay, temper, or
Inhibitory control task

altogether suppress an impulsive response when a task calls

for it’’ (Carlson and Moses 2001, p. 103). Examples
include the Go/No-Go task (e.g. Christ et al. 2007; Happé
Go/No-Go

et al. 2006; Noterdaeme et al. 2001; Ozonoff et al. 1994;

and Sinzig et al. 2008), the stop-Signal task (Ozonoff and
Strayer 1997; Lemon et al. 2011) and the TEA-Ch Walk-
Don’t Walk subtest (Manly et al. 1999). In the widely used
Go/No-Go task, participants are typically presented with a
sequence of visual stimuli (e.g. shapes or letters), and they
must make a speeded motor response to the majority of
stimuli (‘‘Go’’) but withhold responding to one or more
pre-specified shapes/letters. These ‘‘No-Go’’ stimuli appear
only on a minority (e.g. 25 %) of trials, thus generating a
CA/IQ corrected z-scores

prepotent response tendency. Inhibitory performance is

gauged by the number of ‘false positive’ responses made.
Matching criteria

The core cognitive process in these tasks is the active

VMA (BPVS)

suppression of a habitual response, and thus they are often

construed as simple tests of the supervisory attentional
CA/FIQ

system (SAS) (Norman and Shallice 1986). Indeed, per-

formance declines with concurrent cognitive load (e.g.
Mitchell et al. 2002) and with age (e.g. Butler et al. 1999)
indicating a limited-capacity executive process. Neuroim-
aging points towards widespread activation across the
Comparisons

frontal cortex with delay inhibition, particularly in right

TD/MLD

inferior (ventrolateral) regions (Aron and Poldrack 2005),

TD
TD

and patients with right inferior frontal damage show dis-

rupted performance (Aron et al. 2003).
Conflict inhibition paradigms share functional similari-
Sample characteristics

ties with delay tasks, in that they too test individuals’

ability to hold in mind task rules/goals and actively sup-
press prepotent responses (Carlson and Moses 2001).
progressive matrices, BAS British Ability Scales

However, importantly, conflict tasks also require partici-

HFA/AS
Autism

pants to replace that suppressed response with an opposing

ASD

AS

one—which may explain why the two task-types load onto

distinct factors in factor analysis (Carlson and Moses
Semrud-Clikeman et al. (2010)

2001). The classic conflict task is the colour-word Stroop

task (Stroop 1935). In this, participants are shown colour-
words printed in different coloured ink (e.g. BLUE printed
Russell et al. (2003)

in red ink) and are asked to name the ink-colour instead of

Sinzig et al. (2008)
Table 1 continued

the written word. Yet, although widely used, it is thought

that this task may systematically overestimate inhibitory
abilities in ASD populations (Adams and Jarrold 2009).
Study

This is because as the ‘to-be-inhibited’ information is the

semantic meaning of written words (MacLeod 1991)—and

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Table 2 Participant background/matching measures
Autism group (N = 31)
M SD
CARS autism rating 32.60 5.97
CA (months) 164.03 24.80
BPVS age (months; max. 160) 91.87 20.36
Raven’s CPM score (max. 36) 28.10a 4.98
Inattentiveness (VADTRS total score) 14.29 4.89
Hyperactivity/Impulsivity (VADTRS total score) 11.26 5.92
* p \ 0.05; ** p \ 0.01, *** p \ 0.001
a
Raven’s CPM score of 28–30 is equivalent to a standardised score (UK) of 9.5–10 years (Raven et al. 1990)
CWA appear to access the semantic meaning of written
words less automatically (Nation 2006).
Other conflict inhibition tasks avoid this confound
however, and are thus more suitable for ASD samples—for
instance, the Windows (Russell et al. 1991), detour
reaching (Russell et al. 1999), TEA-Ch Opposite World
(Manly, et al. 1999), Day/Night (Gerstadt et al. 1994) and
Dog/Pig Stroop (Ames and Jarrold 2007) tasks. Like the
colour-word Stroop, each of these requires the suppression
of a prepotent response and the replacement of that
response with a conflicting and less salient one. This
additional process undoubtedly augments both working
memory and conflict resolution demands, which may
explain why conflict tasks better predict working memory
(and Theory of Mind) ability than delay tasks (Carlson and
Moses 2001; Carlson et al. 2002, 2004; Hala et al. 2003).
Nonetheless, the executive processes involved are still
thought to be largely frontal lobe mediated, with lateral
prefrontal lesions again known to be detrimental to task
accuracy (Vendrell et al. 1995; Perret 1974).
Resistance to distractor paradigms require participants to
select targets presented alongside irrelevant distractors, or
more broadly, resist ‘‘interference from information in the
external environment that is irrelevant to the task’’ (Fried-
man and Miyake 2004, p. 104). One such task is the com-
puterised Eriksen flanker task (Eriksen and Eriksen 1974).
Here, participants identify a target (e.g. letter/shape/arrow)
that is presented either on its own, or flanked by response-
incompatible stimuli. Performance is thought to be associ-
ated with the ability to actively suppress distracting infor-
mation (e.g. Tipper 1985) and/or capacities for focussed and
selective attention. These tasks arguably therefore involve
earlier (i.e. perceptual) stages of information processing and
preattentive sensory gating. But again, aging (Earles et al.
1997) and frontal lesions (Stuss et al. 1999) are both detri-
mental to performance, indicating the recruitment of
domain-general executive processes. Neuroimaging studies
suggest particularly important roles for the dorsolateral PFC,
ventrolateral PFC and ACC (Wager and Smith 2003).
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J Autism Dev Disord
TD group (N = 28) F value p value Effect-size (g2p)
M SD
15.66 1.12 218.22*** \0.001 0.793
106.71 16.24 117.56*** \0.001 0.673
93.79 12.38 0.186 0.668 0.003
29.46a 3.89 1.362 0.248 0.023
2.86 3.62 102.463*** \0.001 0.643
2.29 3.91 46.123*** \0.001 0.447
Inhibitory Control in Autism
Existing research indicates that some inhibition task-types
might be more problematic for CWA than others (Christ
et al. 2007). For delay inhibition, the majority of evidence
has come from the Go/No-Go task, and these have typically
found no evidence of impairment. Indeed, the one study
that did report impaired Go/No-Go performance (Ozonoff
et al. 1994) has since been contested due to a set-shifting
confound. Corroborating findings from the Go/No-Go,
Ozonoff and Strayer (1997) found equivalent error-rates
and stop-signal reaction times (SSRTs) in CWA and TD
controls on the Stop-task. Although another study (Lemon
et al. 2011) did find significantly slower SSRTs in CWA
(females only), mean full-scale IQ was considerably lower
than that of the controls, probably only failing to reach
significance due to low power. Yerys et al. (2009) found no
evidence of impairment amongst CWA on the TEA-Ch
Walk-Don’t Walk task. Together these indicate that simple
delay tasks of behavioural inhibition are not problematic
for CWA.
Regarding conflict inhibition, the most dominant task in
ASD research has been the classic colour-word Stroop—and
these typically suggest no evidence of impairment (e.g.
Ozonoff and Jensen 1999). However, due to the earlier
discussed confound, findings using this particular paradigm
should be interpreted with caution in CWA. This is partic-
ularly true given the less favourable picture painted by other
conflict paradigms. Russell and colleagues (1991; Hughes
and Russell 1993) reported that CWA persistently failed on
both the Windows and Detour reaching tasks, making more
errors than TD/MLD children of matched verbal mental age.
Similarly, CWA have been shown to make more inhibitory
errors than controls on the Opposite World task (Bishop and
Norbury 2005) and the Dog/Pig Stroop task (Ames and
Jarrold 2007). Russell et al. (1999) found no evidence of
impairment on the Day/Night task, despite structural simi-
larities to the Dog/Pig Stroop—but this study notably only
matched groups on non-verbal mental age (Jarrold and
J Autism Dev Disord
Brock 2004). This can leave CWA at a disadvantage, as
verbal ability is often poorer than non-verbal ability in this
population (Joseph et al. 2002).
Finally, findings on resistance to distractor inhibition have
been both scarce and inconsistent. Whereas one study
reported clear inhibitory impairments in CWA (Christ et al.
2007), two others found no such evidence (Dichter and
Belger 2007; Henderson et al. 2006). This again may relate to
a non-inhibitory confound. The flanker task in Christ et al.
required children to maintain online numerous arbitrary
response mappings, which arguably augments working
memory demands compared to the simpler designs used
elsewhere (i.e. arrows flanker tasks). Nonetheless, it is
notable that both Dichter and Belger (2007) and Henderson
et al. (2006) used adult samples. It is therefore conceivable
that delays in resistance to distraction development are
observable amongst CWA, but that typical functioning is
reached by adulthood. No study has implemented a simple,
arrows flanker task with a child ASD sample to address this
possibility.
Overall, existing research suggests that conflict tasks of
inhibition may be most problematic for CWA, perhaps
owing to greater working memory and conflict demands—
although evidence on resistance to distractor evidence is
limited and difficult to decipher. However, without
administering all three paradigm types to the same sample
of CWA, it is hard to rule out the possibility that disparate
findings are cohort, rather than task related (Christ et al.
2007)—especially given the known heterogeneity in the
autism population. Therefore the first aim of this study was
to administer three different tasks to CWA and a control
group matched for verbal and non-verbal mental age: one
delay, one conflict, and one resistance to distractor. These
tasks, respectively, were a Go/No-Go task, the Dog/Pig
Stroop task and an arrows Flanker task. These are all well
established in the inhibitory literature, have been applied
successfully in ASD research and avoid various known
confounds. We expected that impairment was most likely
to emerge on the Dog-Pig Stroop (conflict) task.
ASD, Inhibitory Control and the Role of ADHD-Type
Symptoms
A further aim of our investigation was to address a poten-
tially important source of heterogeneity in inhibitory ability
in this population. At least 30 % of CWA meet diagnostic
criteria for ADHD, and many more show elevated symptoms
of inattention and hyperactivity (Leyfer et al. 2006; see also
Sinzig et al. 2009). Associations between autism and
attentional disorders have been suggested at a genetic (e.g.
Rommelse et al. 2010), functional (e.g. Brieber et al. 2007)
and behavioural level (Sinzig et al. 2008). This overlap is of
particular relevance to studies of inhibition in autism
because inhibitory control is often considered the core def-
icit in ADHD, with children with the disorder almost
invariably exhibiting broad-ranging inhibitory impairments
(Barkley 1997; Nigg 2001; Aron and Poldrack 2005; Will-
cutt et al. 2005). Given symptomatic overlaps, it may be that
covarying ADHD-type symptoms are more important pre-
dictors of inhibitory ability in CWA than core autistic
symptoms themselves. Indeed, ADHD-type symptoms may
be a significant driver of group differences (Castellanos and
Tannock 2002).
In high-functioning groups, the presence and severity of
both inattentive and hyperactive traits have already been
shown to predict performance on a Go/No-Go task (Sinzig
et al. 2008) and ‘‘change’’ task (a conflict variant of the
Stop-task) (Verté et al. 2006). Notably, in both studies this
was despite overall group differences between CWA and
TD controls failing to reach significance. Bishop and
Norbury (2005) also found symptoms of inattention and
hyperactivity/impulsivity to be moderately predictive of
inhibitory impairment on the Opposite World and Walk/
Don’t Walk tasks in CWA (high-functioning), pragmatic
language impairment (PLI) and specific language impair-
ment (SLI). It appears therefore that ADHD symptom-
presence may be an important predictor of individual dif-
ferences in inhibitory ability amongst CWA.
Thus, for each child taking part, an objective measure of
inattention and hyperactivity/impulsivity was obtained to
gauge the importance of ADHD-type symptoms in any
observed group differences. The Vanderbilt ADHD Diag-
nostic Teacher Rating Scale (VADTRS; Wolraich et al.
1998) was used as it provides separate estimates for
symptoms of inattention and hyperactivity/impulsivity
based upon DSM-IV (American Psychiatric Association
[APA] 1994) criteria. Given that associations between both
inattention (e.g. Bishop and Norbury 2005) and overac-
tivity (e.g. Ames and White 2010; Verté et al. 2006) and
inhibitory performance in CWA have been reported across
various inhibition tasks, we expected that both ADHD-
symptom types might predict inhibitory deficits, and no
task specific predictions were made.
Together, the two overarching predictions of this
research have various implications for our understanding of
inhibition in autism. First, uneven patterns of performance
across different tasks would help to explain a record of
inconsistency in the field. Impairment on the Dog/Pig
Stroop only would suggest that inhibitory control is not a
core or pervasive deficit in CWA, but also that generalist
claims of ‘‘intact’’ inhibition are misguided. Crucially, this
notion would help to differentiate the executive profile of
autism from that of other developmental disorders with
known executive dysfunction (particularly ADHD). Sec-
ond, if symptoms of inattention and/or hyperactivity help
predict which children demonstrate inhibitory difficulties,
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it would highlight the importance of considering overlap-
ping symptoms between developmental disorders.
Method
Participants
Written informed consent was obtained from a parent/
guardian of all children taking part. Children also provided
verbal consent prior to commencing sessions.
ASD Group
All CWA who participated were enrolled in a specialist
school for autism and had formal diagnoses of an ASD made
by a qualified clinical or educational psychologist using
DSM criteria (e.g. ADOS/ADI). A teacher/teaching assis-
tant completed the Childhood Autism Rating Scale (CARS)
to confirm that clear ASD symptomatology was still present.
The CARS was selected as it provides a cut-off for symptom
severity. Thirty-one participants (5 female, 26 male) with
CARS scores of \27 points (Mesibov et al. 1989) and who
completed all tasks successfully were included in the final
sample (Mean Age = 163 months, SD = 22.8 months).
Control Group
Twenty-eight typically developing (TD) children, aged
6–11 years, were recruited from three local primary
schools. No child had any clinical diagnosis or was on the
school register for special educational needs. On the
CARS, all TD children scored between 15 (the minimum
score) and 19 points. Thus, all twenty-eight children (17
female, 11 male) were included in the final sample (Mean
Age = 106 months, SD = 16.2 months).
ASD and TD groups were matched on estimated verbal
and non-verbal mental age (MA), according to perfor-
mance on the BPVS (Dunn et al. 1997) and the Raven’s
Coloured Progressive Matrices (Raven’s CPM) (Raven
et al. 1990). For all children, a teacher completed the first
19-items of the 35-item Vanderbilt AD/HD Diagnostic
Teacher Rating Scale (VADTRS). The VADTRS assesses
symptoms of attention-deficit/hyperactivity disorder based
upon DSM-IV (1994) criteria, with 19-items rated on a
four-point frequency scale (0 = Never; 1 = Occasionally;
2 = Often; 3 = Very Often). A child is indicated as above
the DSM-IV threshold for AD/HD Inattentive-Type if they
receive a rating of 2 or 3 on six or more from Items 1–9.
AD/HD-Hyperactive/Impulsive Type is indicated by six or
more ratings of 2 or 3 on Items 10–19. AD/HD Combined
type is indicated by six or more ratings of 2 or 3 on both
dimensions. For normative data, see Wolraich et al. (1998).
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J Autism Dev Disord
Procedure and Task Design(s)
Participants were tested individually in a well-lit, quiet, and
distraction-free room. Each completed the three inhibitory
control tasks (Go/No-Go; Dog-Pig Stroop; Flanker) and
two standardised measures (RCPM; BPVS) in counterbal-
anced order. Sessions lasted 40–60 min. Inhibition tasks
were written in Psyscript, and run on a computer using an
OS X 10.6 operating system.
Go/No-Go Task
Task Design
On each trial, a shape (O, D, h, or e) appeared centrally
on the computer screen. Children were instructed to
respond to three of the shapes by pressing a large external
‘‘star’’ button (i.e. ‘‘Go’’ stimuli), but to resist responding
to a fourth shape (i.e. the ‘‘No-Go’’ stimulus). The shape
designated as the ‘‘No-Go’’ stimulus was counterbalanced
between participants. To generate a prepotent response,
75 % of trials were ‘‘Go’’ trials requiring a button press,
and 25 % of trials were ‘‘No-Go’’ trials where the response
should be withheld.
The maximum inter-stimulus interval (ISI) was
2,500 ms. At the start of each trial, a fixation-cross
appeared at the centre of the screen for 200 ms. The
stimulus then appeared for 200 ms. After stimulus offset,
participants had a further 1,000 ms to respond before the
trial automatically terminated. There was then a 1,100 ms
pause before the next trial commenced. An error tone
(‘‘bleep’’) was played immediately if the child made an
omission error (i.e. failed to respond on a ‘‘Go’’ trial), or a
false positive (i.e. pressed the star button on a ‘‘No-Go’’
trial). A positive feedback-noise (‘‘ping’’) was played for
correct responses.
Procedure
A warm-up session was initially conducted to familiarize
participants with the stimuli. Training was terminated only
when the child could correctly identify the required
response for each shape (i.e. Go vs. No-Go). Children then
completed a short practice block of eight trials containing
all four stimuli presented in a fixed but superficially ran-
dom order. 144 experimental trials then followed, split into
three 48-trial blocks separated by short breaks. Stimulus
presentation was randomised throughout each half block.
Four measures of task performance were obtained: False
positive rate (‘‘No-Go’’ trials on which the button was
pressed); hit rate (‘‘Go’’ trials on which the child respon-
ded); hit trial reaction time (RT); and task sensitivity. The
latter differentiates participants who make fewer false
J Autism Dev Disord
positives despite a good hit rate (good sensitivity) from
those who make fewer false positives but fewer hits as well
(poor sensitivity) (see Grier 1971).
Dog-Pig Stroop Task
Task Design
Stimuli were two simple line drawings of a dog and a pig,
which were presented centrally on a computer screen. Two
experimental conditions, each containing 32 trials were
administered. In the control (baseline) condition, children
were instructed to say ‘‘dog’’ when they see the dog image
and ‘‘pig’’ when they see a pig, as quickly and accurately as
possible. In the Stroop (i.e. inhibition) condition, children
were instructed to say ‘‘dog’’ to pig images, and ‘‘pig’’ to
dog-images.
Children’s responses were recorded online during the
task and audiotaped for subsequent checking. If a child
made a mistake on a trial but then corrected him/herself,
the initial response was recorded. To estimate response
latency on each trial, the experimenter pressed a large
external button in time with the child’s initial response.
Although this measure of reaction time is relatively crude,
many of the children would not have been testable with
throat microphones that measure voice-onset due to inter-
ference from task irrelevant movements and vocalisations.
Notably, any additional error introduced via the reaction-
time estimate was constant across groups.
On each trial, the stimulus remained centrally on-screen
until a response had been registered. After 3,000 ms had
elapsed without a response, the trial automatically termi-
nated and the message ‘‘Too Slow’’ was presented for
500 ms. Stimulus presentation was followed by a 2,000 ms
pause before the next trial commenced. The maximum ISI
was 5,500 ms.
Procedure
All children completed the control condition first to obtain
baseline picture naming speed and accuracy, followed by
Stroop training slides. After completing four Stroop prac-
tice trials successfully, children commenced the 32-trial
Stroop condition block.
Flanker Task
Task Design
Children were presented with two large arrow-shaped
buttons—one pointing left and one pointing right. There
were three conditions in this task. In all conditions, chil-
dren were asked to press the button pointing the same way
as a white target arrow that would appear (centrally) on-
screen. On baseline trials, the target arrow was presented
alone. On congruent trials, the target arrow was flanked by
four red distractor arrows (two either side) pointing the
same way as the target (e.g. ). On incongruent trials,
the target arrow was flanked by distractor arrows facing in
the opposite direction to the target (e.g. ).
The maximum ISI was 2,900 ms. On each trial, a fixa-
tion cross appeared centrally on-screen for 200 ms. This
was replaced by the stimulus (neutral, congruent or
incongruent), which remained on-screen until a button-
press was registered. If no response had been registered
after 1,200 ms, the trial automatically terminated and a
‘‘Too-Slow’’ message was briefly displayed accompanied
by an error tone (‘‘bleep’’). The error-tone also sounded if
the participant responded incorrectly. A positive feedback-
noise was played (‘‘ping’’) for correct responses. There was
a 1,100 ms pause (inter-trial interval) between trials.
Procedure
Familiarisation trials were followed by three blocks of 30
trials, each separated by a short break (90 trials in total).
Each block contained ten baseline, ten congruent and ten
distractor trials, which were distributed randomly. Error-
rates and mean RTs were recorded for all trials.
Planned Comparisons
A MANOVA with group as the between-group factor was
used to assess group differences in chronological age (CA),
BPVS, Raven’s CPM, CARS and VADTRS scores. Dif-
ference in gender-distribution between groups was esti-
mated using a Chi-square test. Regarding task
performance, a series of Pearson correlations were imple-
mented between the three inhibitory measures (all partici-
pants included). To permit these correlations, single-figure
estimates of inhibitory performance had to be calculated
for the Dog-Pig Stroop and Flanker task by subtracting
participants’ baseline RT and error-rates from their Stroop/
incongruent trial RT and error-rates. False positive rate was
used to represent inhibitory performance on the Go/No-Go.
Between task correlations (N = 59) could detect large
effect sizes (r = 0.5) at a = 0.05 (2-tailed) at 99 % power,
and medium effect sizes (r = 0.3) at approximately 66 %
power. Simple bivariate correlations were also performed
to highlight any associations between CA, MA (BPVS/
RCPM) and CARS rating and inhibitory outcome measures
(see Table 3). As these were carried out separately for each
group (N = *30), we only had sufficient power (80 %) to
detect large effect sizes (r = 0.5) at a = 0.05 (2-tailed).
Although CA was not matched between groups, CA was
not used as a covariate for group comparisons of inhibitory
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Table 3 Pearson (r) correlations between CA, BPVS, Raven’s CPM pair-wise comparisons (using Bonferroni correction) clar-
and CARS (ASD only) and inhibitory performance ified group differences across conditions (no-distractor,
CA BPVS Raven’s congruent, incongruent).
Associations between inhibitory performance and
TD group (N = 28)
ADHD-like symptoms were assessed in the ASD group
Flanker only as TD children scored very low (mostly zero) on both
Inhibitory RT -0.174 -0.072 0.019 dimensions. For this, subgroups of high and low scoring
Inhibitory error -0.311 0.039 0.010 CWA were identified for both inattentiveness and hyper-
Dog Pig Stroop activity/impulsivity scales. ‘‘High Scorers’’ were children
Inhibitory errors -0.139 -0.179 -0.136 scoring six or more ratings of 2 (often) or 3 (very often) on
Inhibitory RT -0.095 -0.334 -0.405* relevant items. This is cut-off flags children who may meet
Go/No-Go the diagnostic criteria for ADHD-Inattentive type (n = 9),
False positives -0.031 -0.033 -0.083 or ADHD-Hyperactive/Impulsive type (n = 7) (APA
CA BPVS Raven’s CARS 1994). ‘‘Low scorers’’ received no more than one rating of
2 (often) or 3 (very often) on items for ADHD-Inattentive
Autism group (N = 31)
type (n = 11) and ADHD-Hyperactive/Impulsive type
Flanker (n = 12). Performance of high/low scoring groups was
Inhibitory RT -0.429* -0.394* 0.042 0.012 compared via one-way multiple ANOVAs with the key
Inhibitory error -0.096 -0.175 -0.435* 0.012 inhibitory performance measures as dependent variables.
Dog Pig Stroop This subgroup approach was used to maintain the thresh-
Inhibitory errors 0.037 -0.374* -0.299 0.156 old-based scoring method on which the VADTRS was
Inhibitory RT -0.482** -0.127 -0.207 -0.357 validated.
Go/No-Go For all comparisons, an alpha level of 0.05 was used and
False positives 0.060 -0.161 -0.456** 0.315 exact p values and effect sizes are provided where appro-
* p \ 0.05; ** p \ 0.01 (2-tailed)
priate to make results as transparent and easily comparable
to previous findings as possible. Although a number of
statistical tests were performed, Howell (2002) argues that
performance. This is because covariates have been ill correction for multiple comparisons is not warranted where
advised for the control of non-trivial groups differences a priori predictions are made. However, we caution readers
(Miller and Chapman 2001), as it can cause observed to interpret non-corrected results conservatively, particu-
means to be adjusted for spurious reasons (Jarrold and larly where strong a priori predictions were not made (e.g.
Brock 2004). Pearson’s correlations were used, however, to ADHD-symptom effects).
estimate any influence CA may have had on inhibitory
performance and possible implications for group differ-
ences. However, again, there was only sufficient power to Results
detect large (i.e. r = 0.5) effect sizes at a = 0.05.
Group differences in Go/No-Go task performance were As shown in Table 2, CARS ratings were higher amongst
assessed via a one-way MANOVA. Group was the CWA than TD controls, as were VADTRS inattention and
between-participants factor, and false alarms, hits, A’ (task hyperactivity scores. VADTRS inattention ratings and
sensitivity), Go-trial RT and No-Go-trial RT were the CARS-rating were positively correlated in CWA,
dependent variables. The main measure of inhibition was r(29) = 0.384, p = 0.033 (2-tailed). The two groups were
false alarm rate. Group differences in Dog-Pig Stroop task satisfactorily matched on BPVS and Raven’s score.
performance were investigated using a 2 9 2 mixed MA- Although the ASD group was significantly older than the
NOVA. Trial-type was the within-participants factor, group TD group, Pearson’s correlations indicated few associations
was the between-participants factor, and error-rate and RT between CA and inhibitory performance: in the ASD group
were the dependent variables. Errors were classified as any only, higher CA was predictive of faster inhibitory RTs on
trial on which the child either said the wrong animal name the flanker task (p = 0.016) and the Dog-Pig Stroop
(i.e. Incorrect Response Errors) or failed to make a (p = 0.007). In terms of MA, higher RCPM scores were
response before the trial terminated (i.e. Too Slow Errors). predictive of better inhibitory performance (faster RT)
Group differences on the Flanker task were assessed using amongst TD children in the Dog-Pig Stroop (p = 0.033).
a 3 9 2 mixed MANOVA, with trial-type as a within- Amongst CWA, higher Raven’s scores predicted more
participants factor, group as a between-participants factor, inhibitory errors on the Flanker task (p = 0.014) and more
and error-rate and RT as the dependent variables. Post hoc false-positives (p = 0.010) on the Go/No-Go. Higher BPVS

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J Autism Dev Disord

Table 4 Pearson correlations (N) between inhibitory performance on the three inhibitory control tasks
Flanker (errors) Dog-Pig Stroop (errors) Flanker (RT) Dog-Pig Stroop (RT)

Go/No Go (false alarms) 0.193 (59) -0.030 (58) -0.075 (59) 0.169 (58)
Flanker (errors) 0.248 (58) 0.043 (59) 0.032 (58)
Dog-Pig Stroop (errors) 0.152 (58) 0.262 (58)
Flanker (RT) 0.149 (58)
* p \ 0.05; ** p \ 0.01 (2-tailed)

Table 5 Group effects (ASD/TD) for Go/No-Go task measures

ASD group (N = 31) TD group (N = 28) F value p value Effect-size (g2p)
M SD M SD

False alarms (/36 No-Go trials) 17.74 8.05 22.71 6.35 6.830 0.011* 0.107
Hits(/108 Go-trials) 104.4 4.43 106.3 2.00 4.629 0.036* 0.075
Task sensitivity (A0 ) (0.5 = random; 0.623 0.118 0.561 0.061 6.275 0.015* 0.099
1.0 = perfect sensitivity)
Go-trial RT (ms) 0.422 s 0.112 s 0.410 s 0.064 s 0.262 0.611 0.005
No-Go-trial RT (ms) 0.341 s 0.081 s 0.343 s 0.043 s 0.004 0.950 0.000

scores were associated with slower inhibitory RTs on the
Flanker Task, and more inhibitory errors on the Dog-Pig
Stroop. Notably, there were no significant correlations
between inhibitory performance on any task and CARS
score (all r \ 0.357, p [ 0.05).
Inhibitory Control Measures
There were no significant correlations between any of the
main inhibitory measures between tasks, although the
association between inhibitory error-rates on the Flanker
and Dog-Pig Stroop tasks did approach significance,
r(56) = 0.248, p = 0.061 (2-tailed) (see Table 4).
On the Go/No-Go task, CWA made significantly fewer
false positives than TD children (p = 0.01) (see Table 5).
Logistic regression showed that false alarm rate still helped
to differentiate between CWA and TD participants after the
higher hit-rate in the ASD group has been taken into
account (v2(1, N = 59) = 5.078, p = 0.024). CWA also
showed better task sensitivity (A0 ) than TD children
(p \ 0.05). Together these indicate better overall accuracy
on the task, rather than just a tendency to press the button
less ‘across the board’.
On the Dog-Pig Stroop Task, there was a significant
within-participants effect of trial-type on error-rate,
F(1,56) = 58.970, p \ 0.001, g2p = 0.513, and on RT,
F(1,56) = 147.544, p \ 0.001, g2p = 0.725, with children
making more errors and responding slower on Stroop trials
than on baseline trials. This indicates that Stroop trials did
impose additional inhibitory demands.
There was a marginally significant effect of group upon
error-rate, F(1,56) = 3.264, p = 0.076, g2p = 0.055, with
CWA making more total errors (M = 3.3; SE = 0.445)
than TD children (M = 2.1; SE = 0.461) across both
baseline and Stroop trials. The main effect of group upon
RT was also significant, F(1,56) = 4.576, p = 0.037,
g2p = 0.076, with CWA tending to respond significantly
slower (M = 0.881 s; SE = 0.036) than TD children
(M = 0.772; SE = 0.037).
Figure 1 illustrates a significant trial-type h group
interaction for error-rate, F(1,56) = 7.425, p = 0.009,
g2p = 0.117. Post hoc exploration indicated that this was
due to CWA making more errors on Stroop trials than con-
trols, t(59) = 2.277, p = 0.027, despite an equivalent error-
rate on baseline trials t(59) = -0.287, p = 0.775. However,
there was no significant trial-type h group interaction for RT
on this task, F(1,56) = 0.396, p = 0.532, g2p = 0.007.
For the Flanker Task, the main effect of trial-type was
significant for both error-rate, F(1.60,116) = 41.763,
p \ 0.001, g2p = 0.419, and RT, F(1.54,116) = 218.595,
p \ 0.001, g2p = 0.790. Post hoc exploration showed that
this was because children made significantly more errors on
incongruent distractor trials (M = 4.44, SD = 2.334) than
on baseline (M = 2.00, SD = 2.147) or congruent distractor
trials (M = 1.90, SD = 2.147) (both, p \ 0.001). Children
also responded significantly slower on incongruent distrac-
tor trials (M = 0.675 s, SD = 0.128 s) than on both base-
line (M = 0.560 s, SD = 0.111 s) and congruent distractor
trials (M = 0.584 s, SD = 0.117 s) (both, p \ 0.001).
Children were still significantly slower on congruent than

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 J Autism Dev Disord

Fig. 1 Mean and SE of a error

rate and b reaction time on the
Dog-Pig Stroop task

8
baseline trials though (p \ 0.001), suggesting that even non-
conflicting peripheral stimuli cause some interference.

Number of Inhibition Errors

7
There was no main effect of group on error-rate, 6

(Dog-Pig Stroop)
F(1,57) = 0.780, p = 0.381, g2p = 0.014, but there was a
5
significant group effect on RT, F(1,57) = 5.316,
p = 0.018, g2p = 0.085, with CWA tending to respond 4

significantly faster (M = 0.575; SE = 0.020) than TD 3

children (M = 0.642; SE = 0.021). However, the trial-type 2
h group interaction was insignificant for error-rate,
1
F(1.605, 114) = 0.882, p = 0.417, g2p = 0.015, and RT,
F(1.534,114) = 0.049, p = 0.914, g2p = 0.001, implying 0
High Low
no inhibitory advantage in CWA (see Fig. 2).
Symptoms of Inattention

Symptoms of Inattention and Hyperactivity/Impulsivity
There were no significant differences between the high and
low hyperactivity/impulsivity subgroups of CWA on any
inhibitory measure (all p [ 0.3). The high inattention sub-
group did, however, show significantly poorer inhibitory
performance on the Dog-Pig Stroop task than the low inat-
tention subgroup, F(1,18) = 4.273, p = 0.05, g2p = 0.192
(see Fig. 3). No differences between inattention subgroups
were observed on the Go/No-Go and Flanker (all p [ 0.1).
Two further one-way ANOVAs were performed to
gauge whether overall group-differences in Dog-Pig Stroop
error-rate were driven by poor performance in the high-
inattention ASD subgroup. These demonstrated that the
high inattention CWA made significantly more inhibitory
errors than a random subgroup of TD children (N = 10),
Fig. 3 Mean and SE of error rate for the high and low inattention
subgroups of CWA on the Dog-Pig Stroop
F(1,17) = 6.322, p = 0.022, g2p = 0.659, but that the low
inattentive subgroup did not, F(1,17) = 0.383, p = 0.543,
g2p = 0.091.
Discussion
Overall, the present research suggests that children do not
perform equivalently on different tasks of ‘‘inhibitory con-
trol’’, and that some tasks may be more likely to reveal
impairments in CWA than others. It is possible to make this
statement with confidence because this study administered
multiple measures of inhibitory control to the same cohort of

Fig. 2 Mean and SE of a error

rate and b reaction time on the
Flanker task for no distractor,
congruent and incongruent
distractor trials

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J Autism Dev Disord
children (Christ et al. 2007). Impairments in inhibitory
control were seen on the Dog/Pig Stroop task, but not on two
other tasks thought to tap into ‘inhibitory function’. We
propose that this selective impairment might relate to dis-
parities in the cognitive and executive demands imposed by
the tasks. In particular, conflict tasks of inhibition might be
more problematic for CWA because of the considerable (and
simultaneous) working memory demands they exert.
On the Go/No-Go task, our measure of delay inhibition,
CWA actually demonstrated better inhibitory performance
than TD controls. They made fewer false positives and
showed better task sensitivity, which indicates a genuine
inhibitory advantage (i.e. CWA did not just response less
across both Go and No-Go stimuli, which would more
indicate sustained attentional difficulties). Although
‘intact’ inhibitory performance amongst CWA has been
documented on numerous occasions on this task (e.g.
Christ et al. 2007; Geurts et al. 2004; Noterdaeme et al.
2001; Sinzig et al. 2008), superior performance has not. It
is thus conceivable the CA difference between the two
groups was influential. Although no significant correlation
between inhibitory performance and CA was observed in
either group on this task, voluntary inhibitory functions are
known to develop and improve throughout childhood
(Diamond and Taylor 1996; Levin et al. 1991) and into
adolescence (Ridderinkhof et al. 1999).
For this reason, the observed superiority of CWA on our
Go/No-Go task should be interpreted with some caution.
However, this result is still relatively strong evidence that
autism is not associated with Go/No-Go task impairments,
adding to a growing body of research from tasks tapping
simple delayed response inhibition like the Go/No-Go task,
Stop-task (Ozonoff and Strayer 1997) and TEA-Ch Walk-
Don’t Walk task (Yerys et al. 2009; although see Bishop
and Norbury 2005). Particularly notable here is that these
children showed ‘‘spared’’ performance on the Go/No-Go
despite showing an inhibitory deficit on another task—the
Dog/Pig Stroop (Gerstadt et al. 1994). This is a powerful
indication that something about the tasks themselves is
driving differential ‘inhibitory’ performance.
The Dog-Pig Stroop task has been used once previously
to measure inhibitory capacities in CWA (Ames and Jarrold
2007), and similar inhibitory impairments were observed.
However, the single-trial computerised version used here is
arguably more sensitive to group-based differences in per-
formance, providing separate trial-by-trial measures of
accuracy and response time (Perlstein et al. 1998). These
results corroborate a number of previous studies that have
observed difficulties amongst CWA on other tasks of con-
flict inhibition, including the Windows (Hughes and Russell
1993; Russell et al. 2003), detour reaching (Biro and Russell
2001), and the TEA-Ch Opposite Worlds tasks (Bishop and
Norbury 2005, although see Geurts et al. 2004).
The CWA’s performance on the conflict inhibition task
suggests that inhibition is not completely ‘‘spared’’ in autism
(cf. Pennington 1997). However, it is perhaps more inter-
esting to ask why CWA might have more difficulty with this
paradigm compared to others. One argument is that these
tasks impose considerable working memory as well as
inhibitory demands—by necessitating the suppression of an
inappropriate (yet prepotent) response, whilst also simulta-
neously activating and implementing a conflicting and novel
response (Carlson and Moses 2001; Carlson et al. 2002).
This additional requirement is absent in the Go/No-Go task
and Flanker task, in which children need only suppress either
a prepotent response or distracting information. Supporting
this conjecture, Carlson et al. demonstrated that perfor-
mance on conflict inhibition tasks was significantly corre-
lated with working memory abilities in young TD children,
but performance on delay inhibition tasks was not. Thus it
may be this simultaneous strain on two core executive
components that it problematic for CWA.
Our measure of resistance to distractor inhibition, the
arrows Flanker task, measured participants’ ability to
suppress interference from distracting information in the
external environment that is irrelevant to the task at hand.
Both CWA and TD children had difficulty suppressing
irrelevant distractors. Further, although incongruent dis-
tractors were most problematic, children in both groups
experienced some interference even from non-conflicting
distractors, illustrating the sensitivity of the task to low-
level attentional processes. However, CWA showed no
greater inhibitory difficulty than controls, corroborating
two previous studies that administered a similar arrows
Flanker task to adults with autism (Henderson et al. 2006;
Dichter and Belger 2007). The results do conflict with
another study, however, that reported clearly impaired
performance amongst CWA using a slightly different
Flanker task (Christ et al. 2007)—which may point towards
subtle non-inhibitory differences between the two task-
versions (see Friedman and Miyake 2004). For instance, in
Christ et al., children had to hold in mind four different
arbitrary response mappings throughout the task, whereas
an arrows paradigm only requires participants to hold in
mind two logical stimulus–response mappings. Thus, it
may be that elevated working memory demands make
Christ et al.’s task more problematic for CWA, as opposed
to the central inhibitory components. Given this, we would
argue that our task is the purer measure. However, before
generalising to claims of ‘‘intact’’ resistance to distractor
inhibition, it is important to undertake further research with
different task variants.
The lack of any strong correlation between tasks and the
disparate group-differences across paradigms arguably
point towards separate inhibitory functions that are in turn
differentially affected in autism. However, it is critical to
123

recognise other factors may have influenced task perfor-
mance differences. One possibility is that the strength or
potency of the ‘‘to be inhibited’’ information or impulse
varies between tasks. That is, the Dog-Pig Stroop may
simply be more sensitive to group differences because of
its inhibitory difficulty, and performance on the three tasks
may not correlate well simply because the prepotent-
response strengths are not equivalent. Indeed, through
computational modelling using various task parameters,
Davelaar and Cooper (2010) showed that the strongest (and
in fact only) mediator of correlation between two inhibitory
tasks (a Stop-task and a Stroop task) was the prepotent
response potency channel. Although more extensive com-
putational modelling using a numerous delay, resistance to
distractor and conflict tasks would be required to
strengthen this argument, it is important to remember that
shared/non-shared executive processes are not the only
possible mediators of group differences and between-task
correlations. Regardless of the interpretation of group dif-
ferences, however, the current findings are still a relatively
strong indication that inhibitory function is not a core
deficit in ASD (e.g. Yerys et al. 2009, although see
Simpson and Riggs 2005). This message is particularly
clear if one considers that children with AD/HD almost
invariably show inhibitory impairments irrespective of the
task choice (e.g. Happé et al. 2006).
Our second objective was to consider the role of symp-
toms of inattention and/or hyperactivity/impulsivity in pre-
dicting inhibitory impairments in CWA. As expected, these
symptoms were far more common in CWA than TD children
(see Lee and Ousley 2006)—with approximately one-third
of CWA scoring above the clinical cut-off for AD/HD-
inattentive type, and one quarter above cut-off for hyper-
active/impulsive type on the VADTRS. This corroborates a
recent large-scale study that estimated that 31 % of indi-
viduals with autism meet diagnostic criteria for AD/HD
(Leyfer et al. 2006). In contrast, no TD child came close to
either cut-off and the majority scored extremely low on both
scales.
We found no link between symptoms of hyperactivity/
impulsivity and inhibitory performance in CWA (unlikely
due to low power because the observed effect sizes were
relatively small). This is perhaps somewhat surprising
given that correlations between inhibitory performance on
various different tasks and these symptoms in CWA have
been reported (e.g. Ames and White 2010; Bishop and
Norbury 2005; Sinzig et al. 2008; Verté et al. 2006). One
plausible explanation is that VADTRS is a less sensitive
measure of hyperactive/impulsive symptoms as those used
in previous studies, because although based upon DSM-IV
criteria, the VADTRS is a relatively new scale backed by
relatively limited validity and normative data. However, a
review of the psychometric properties of various ADHD
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J Autism Dev Disord
rating scales, Collett et al. (2003) did conclude that the
VADTRS is ‘‘psychometrically strong’’ despite its relative
youth (p. 1027). Therefore, it seems unlikely that insensi-
tivity of the VADTRS is responsible for the null hyper-
activity/impulsivity findings.
In contrast, CWA who scored over the diagnostic cut-off
for AD/HD inattentive-type made more inhibitory errors on
the Dog/Pig Stroop than those with low inattentiveness
ratings. Furthermore, whereas the high-inattention sub-
group of CWA performed more poorly on the task than a
randomly selected TD subgroup, the low-inattention sub-
group of CWA did not. One possible implication here is
that the ASD group impairment on the Dog/Pig Stroop may
have been driven primarily by the poor performance of this
highly inattentive subgroup of CWA.
Although this finding corroborates others studies linking
symptoms of inattention to inhibitory control in autism
(Bishop and Norbury 2005; Chhabildas et al. 2001), why
would attentional-deficits in CWA predict inhibitory
impairments on some, but not all, tasks of inhibitory con-
trol? One possibility, again, is the fact that conflict tasks
draw heavily (and simultaneously) upon both inhibitory
control abilities and working memory (Carlson and Moses
2001; Carlson et al. 2002): the two domains of executive
function that have most consistently been shown to be
impaired in attentional disorders (Castellanos and Tannock
2002; Gioia et al. 2002; Semrud-Clikeman et al. 2010).
Indeed, in a meta-analysis of 83 studies, Willcutt et al.
(2005) reported that the most robust and consistent exec-
utive impairments amongst children with ADHD are
response inhibition and working memory (verbal and spa-
tial), as well as vigilance and planning. The Dog/Pig Stroop
task may thus be particularly sensitive to attentional
impairments because it draws upon not one, but two, of the
key areas of executive dysfunction associated with atten-
tional difficulties. That is, in these children, the need to
actively maintain rule-bound processes may divert (lim-
ited) attentional resources away from the inhibitory ele-
ment of the task, leading to poorer inhibitory performance.
Explicit measures of working memory capacity would be
needed to explore this hypothesis further.
Again, the fact that inattention only predicted poorer
performance on the Dog-Pig Stroop is particularly poignant
if we consider that inhibitory impairments in AD/HD
populations are far less dependent on the task measurement
used (Barkley 1997). Indeed, the specificity of inhibitory
difficulties in these CWA compared to AD/HD groups
shows some support for executive accounts of autism,
because it suggests that different profiles of executive
ability may indeed be observable in different disorders
(Pennington 1997). It is perhaps rather unrealistic to expect
disorders to be characterised by impaired subcomponents
of EF alongside completely spared ones, as subcomponents
J Autism Dev Disord
are inherently intertwined (Welsh and Pennington 1988).
The results we obtained here, however, support the notion
that disorders differ in terms of where their core or most
pervasive executive difficulties lie.
Although speculative, our findings also point to a more
fundamental issue. When differences are found between
individuals with autism and control groups, there is often
an assumption that they relate to the core symptoms of the
autistic disorder. For instance, authors readily link
observed impairments in inhibitory function to restricted or
repetitive behaviours (e.g. Turner 1997; Lopez et al. 2005).
However, it might be that group differences are more
closely associated with a ‘‘covariate’’ of the disorder or
underlying endophenotypes (e.g. symptoms of inattention),
rather than core autistic symptoms themselves. It is thus
important that studies of autism take into account symp-
toms of ADHD in their sample (and vice versa for ADHD-
related studies)—particularly when investigating impair-
ments, like executive dysfunction, that have been impli-
cated in both disorders.
Several methodological limitations of the study should be
noted. First, whilst ASD and TD groups were matched for
non-verbal and verbal mental age, they were not matched for
chronological age. Although a CA difference is expected
when comparing TD and ASD groups, future studies would
benefit from ensuring sufficient age overlap between com-
parison groups. This would permit the use of CA as a
covariate and additional CA-matched subgroup analyses
(Jarrold and Brock 2004). Correlational analyses indicated
that between-group differences were if anything more con-
servative as a result of the CA disparity, as older CWA
showed faster inhibitory reaction times on the Flanker and
Stroop task than younger CWA. The fact that this relation-
ship was observed in the ASD group only may have reflected
the wide age range of the group. We also note that we only
had sufficient power (80 %) to identify relatively large effect
sizes. Secondly, it is notable that the two groups had non-
equivalent gender distributions. Although we confirmed no
sex-related differences in inhibitory performance in either
group on any task, gender differences have been observed in
brain activation on inhibition tasks (Garavan et al. 2006). It
should be stressed, however, that studies have typically
found no evidence of sex differences in behavioural per-
formance on inhibition tasks including the Stop task
(Williams et al. 1999), the Go/No-Go (Garavan et al. 2006)
and the Stroop task (MacLeod 1991). Finally, although all
children in the ASD group had received a formal diagnosis of
an ASD using DSM criteria and their current symptoms were
clearly suggested by the CARS, confirmation of current
symptomology using the ADOS-G/ADI-R would have per-
mitted more detailed analysis of the autistic symptom-profile
of the ASD group, and would describe current symptomol-
ogy according to DSM-IV most appropriately.
Acknowledgments Many thanks to the staff and students of Pe-
terhouse School, Presfield School, Larkfield Primary School, Trinity
St. Peters C of E Primary School and Holy Trinity, Southport.
Conflict of interest The authors declare that they have no conflict
of interest.
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