Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-018-3813-5

ORIGINAL PAPER

Gender Difference in the Association Between Executive Function

and Autistic Traits in Typically Developing Children
Meixia Dai1 · Lizi Lin1,2 · Jingjing Liang1 · Zengjian Wang1 · Jin Jing1

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract
Autistic traits and executive function (EF) were assessed in 413 typically developing children aged 6–9 years. The children
were divided into the high- autistic-trait (HAT) and low-autistic-trait (LAT) groups based on their total autistic traits. Results
suggested that there were gender differences in specific autistic traits in children with LAT. There were gender-specific
associations between EF and autistic traits in children with HAT: the set shifting of EF predicted difficulties in social aware-
ness in boys; whereas all the EF components predicted difficulties in social communication and social cognition in girls.
These findings may have implications for developing customized interventions that are targeted at specific autistic deficits
in males and females.

Keywords  Gender difference · Autistic trait · Executive functions · Children

Introduction
Autism spectrum disorder (ASD) is a neurodevelopmental
disorder characterized by impaired social communication
and interaction, as well as restricted and repetitive pattern of
behaviors (American Psychiatric Association 2013). One of
the important features of ASD is the skewness in gender dis-
tribution that ASD is more prevent in males than in females
(Baxter et al. 2015; Christensen et al. 2016; Schaafsma and
Pfaff 2014). Recent examinations of autistic traits in general
population have shown a similar pattern of gender difference
in high autistic traits (Posserud et al. 2006; Sun et al. 2014).
Moreover, numerous studies have suggested that females
with ASD are different from males with regard to behavioral
Electronic supplementary material  The online version of this
article (https​://doi.org/10.1007/s1080​3-018-3813-5) contains
supplementary material, which is available to authorized users.
* Zengjian Wang
wangzj27@mail.sysu.edu.cn
* Jin Jing
jingjin@mail.sysu.edu.cn
1
Faculty of Maternal and Child Health, School of Public
Health, Sun Yat-sen University, 74 Zhong‑shan Road 2,
Guangzhou 510080, China
2
School of Public Health, Peking University Health Science
Center, Beijing 100191, China
symptoms. For instance, it was found that females with ASD
exhibit fewer restricted and repetitive behaviors but greater
communication deficits than males with ASD (Frazier et al.
2014; Jamison et al. 2017; Rynkiewicz et al. 2016; Wang
et al. 2017). Although many studies have reported higher
total autistic traits in typically developing (TD) males than
females (Ruzich et al. 2015), few studies have compared the
autistic phenotypes between genders in the general popu-
lations. In one previous study, researchers found that TD
boys exhibited more restricted and repetitive behaviors and
social interaction than girls (Hsiao et al. 2013). However,
another study found no significant difference in autistic traits
between TD boys and girls (Solomon et al. 2012). Despite
being a topic of great interest, gender differences in autistic
traits in general populations and the underlying mechanisms
remains unclear (Lai et al. 2015).
It has been proposed that cognitive impairments, espe-
cially the executive function (EF), have distinct interactions
with various autistic behavioral symptoms (Happé et al. 2006;
Happé and Ronald 2008; Hill 2004). Therefore, an important
consideration in understanding gender differences in autistic
behaviors is the role of EF. EF refers to a set of purposeful
higher-order neuropsychological domains, including planning,
working memory, inhibition, mental flexibility, as well as the
control and shifting of attention (Johnson 2012). EF impair-
ments are commonly reported in ASD. A recent meta-analysis
showed the occurrence of executive dysfunction in ASD such

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 Journal of Autism and Developmental Disorders

as conception formation and cognitive flexibility (Demetriou Method

et al. 2017). Another meta-analysis found that ASD is asso-
ciated with impaired performances on measures of the Wis- Participants
consin Card Sort Test, including the categories completed,
the failure-to-maintain-set and the non-perseverative errors We recruited typically developing children from primary
(Landry and Al-Taie 2016). EF impairments have been linked schools in Guangzhou. The inclusion criteria included: (1)
to autistic behavioral symptoms both in the areas of social aged 6–9 years old; (2) Full-Scale IQ > 70; (3) with normal
communication and restricted and repetitive behaviors pattern naked vision or corrected-vision; (4) without color blind-
(Jones et al. 2018; Kenworthy et al. 2009; Leung et al. 2016; ness and color amblyopia; (5) free from physical disabilities,
Torske et al. 2018). medical illness, and developmental or behavioral disorders
In recent years, increasing evidences have suggested that EF based on parent-report (e.g., ASD, attention deficit hyperac-
may have a different impact on autistic traits between males tivity disorder, developmental delay and depression). A total
and females (Lai et al. 2017; Lehnhardt et al. 2016; White et al. of 451 children were recruited. Thirty-eight children were
2017). For example, Lehnhardt et al. (2016) found that females excluded due to missing data, of whom 22 did not complete
with ASD have better EF than males with ASD using a late- Social Responsiveness Scale (SRS) and 16 did not complete
diagnosed sample. They suggested that EF may enable females the Wisconsin Card Sorting Test (WCST). A sample of 413
with ASD to camouflaging their deficits in social communica- participants (91.6%) was included in the final analysis. The
tions hence lead to missing early diagnosis. Lai et al. (2017) flow chart of the present study is shown in Fig. 1.
defined camouflaging in autism as the discrepancy between
the individual’s external behavioral symptoms in social-inter- Procedure
personal contexts and self-reported dispositional traits. They
found that better camouflaging was associated with EF only The study was approved by the Ethical Committee of the
in females with ASD. These studies suggested that the impact School of Public Health, Sun Yat-sen University. All the
of EF on the manifestation of autism may vary with gender, children and their parents voluntarily participated in this
pointing to the need to explore the gender-specific role of EF study with informed consents. The tests were performed at
in autistic traits. the Research Center for Child and Adolescent Psychologi-
Autistic traits, which are defined as behaviors associated cal and Behavioral Development, Sun Yat-sen University.
with ASD, are known to be distributed continuously across the Each child was tested individually by qualified technicians
general and clinical populations and share a common etiology
(Constantino and Charman 2016; Robinson et al. 2011). EF
deficits were also found in TD individuals with high autis-
tic traits (Ferraro et al. 2016; Gokcen et al. 2009). In light of
these findings, research on autistic traits in the general popu-
lation could be beneficial in understanding ASD as a clinical
disorder.
The aim of the current study was to investigate the associa-
tions between EF and autistic traits in boys and girls using
a school-based sample of children. The autistic traits were
measured using the Social Responsiveness Scale (SRS; scores
of total scale and the subscales including Social Awareness,
Social Cognition, Social Communication, Social Motivation
and Autistic Mannerisms), and EF was assessed with the Wis-
consin Card Sort Test, which is regarded as the quintessential
executive functioning task that is sensitive for the measure-
ment of control and shifting attention, and mental flexibility.
We hypothesized that the manifestation of EF may be different
in boys and girls with high autistic traits.

Fig. 1  The flow chart of the study

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Journal of Autism and Developmental Disorders
in a quiet room without distractions. In addition to testing
the children, SRS was also completed by parents within
15–20 min under the supervision of investigators. Any ques-
tion or confusion from parents was clarified to ensure that
they understood all of the items. The completed question-
naires were checked for quality control.
Measures
Autistic Traits
Autistic traits were assessed using the Chinese version of
SRS (Cen et al. 2017). The SRS is a 65-item questionnaire
designed to measure autistic symptomatology (mainly
involving reciprocal social behavior) with five specific
symptom domains: Social Awareness, Social Cognition,
Social Communication, Social Motivation and Autistic
Mannerisms (Constantino and Gruber 2012). The SRS has
good internal consistency, high test–retest reliability and
good discriminative validity (Cen et al. 2017; Constantino
et al. 2003). The SRS is rated on 4-point Likert scales (0–3)
for each item, with the total raw score ranging from 0 to
195. A higher total score indicates greater levels of autistic
traits. A total raw score of ≥ 56.5 is recommended as a cut-
off for screening ASD in general population in mainland
China (Cen et al. 2017). Accordingly, we classified children
who met cut-off score for SRS as having high-autistic-trait
(HAT), and the rest as having low-autistic-trait (LAT).
Executive Function
The WCST is a quintessential and widely used executive
functioning test. We used the computerized version of 128-
cards WCST to examine executive function (EF), because it
helps to reduce confounding influences on task performance
of examiners (Shan et al. 2008; South et al. 2007). Partici-
pants were asked to sort cards in accordance with one of
the three rules (color, shape and number) via mouse click-
ing. The card sorting rules were not revealed to the exami-
nees, but must be inferred from the feedback provided by
the computer. Computer screen displayed ‘√’ for a correct
card sorted and ‘×’ for an incorrect card sorted. After 10
consecutive correct responses, card sorting rules changed
without announcement. This task procedure continued until
participants completed six sorting categories (color, shape,
number, color, shape, number) or when all 128 cards were
sorted.
Four WCST indices were used for analysis: number of
completed categories (CC), failure to maintain set (FMS),
non-preservative errors (NPE) and shifting efficiency
(SE). CC was the number of sets of 10 consecutive cor-
rect responses. NPE comprised all errors except persevera-
tive errors. FMS was the number of incorrect responses
after 2–9 consecutive correct responses. SE was cal-
culated as proposed by Cianchetti et al. (2005): score of
SE = CC*6 + [128 − (the number of cards that had been
used)]. This method of scoring takes efficiency in achieving
CC into account by rewarding unused cards which helps
to detect differences in task performance (Cianchetti et al.
2005). CC indicates the ability of set shifting, FMS reflects
difficulties in sustained attention, NPE may simply reflect
the efficiency of discovering rules and the SE indicates the
cognitive flexibility (Landry and Al-Taie 2016).
Intelligence
Intelligence was measured using the Wechsler Intelligence
Scale for Children-Fourth Edition Chinese version (WISC-
IV) (Houcan 2009). WISC-IV is an individually adminis-
tered and norm-referenced instrument, which consists of 10
core and four supplemental subtests. The WISC-IV gener-
ates a full-scale Intelligence Quotient (FSIQ), representing
overall cognitive ability. In addition, four other composite
quotients can be derived: the Verbal Comprehension Index
(VCI), the Perceptual Reasoning Index (PRI), the Work-
ing memory Index (WMI) and the Processing Speed Index
(PSI). The norm mean values of FSIQ and the four com-
posite quotients are 100, and the standard deviations are 15.
The norm of WISC-IV has been established in China. The
validity and reliability of the WISC-IV have been examined
and shown to be satisfactory (Chen et al. 2010).
Statistical Analysis
We divided all the participants into HAT and LAT groups
according to the SRS cut-off of 56.5. Gender differences in
age, FSIQ and autistic traits were examined in the whole
sample, as well as in the HAT group and LAT group respec-
tively. Two-sample t-tests were used to investigate the gen-
der differences in age and FSIQ. Analysis of covariance
(ANCOVA) was used to examine gender differences in
autistic traits after controlling for age and FSIQ. A false
discovery rate (FDR) of 0.05 was used to correct for multi-
ple comparisons of autistic traits (total autistic traits, social
awareness, social cognition, social communication, social
motivation and autistic mannerisms) for the whole sample,
the HAT group and the LAT group (Benjamini and Hoch-
berg 1995, 2000).
Pearson correlation analysis was conducted to explore
the correlations between EF and autistic traits in HAT
boys, HAT girls, LAT boys and LAT girls separately. Fur-
thermore, linear regression models were used to explore
the contributions of EF in predicting autistic traits in boys
and girls with HAT respectively, with age and FSIQ as
covariates. For all the Pearson correlation and linear
regression analyses, FDR corrections were applied within
13

each domain (total autistic traits, social awareness, social
cognition, social communication, social motivation and
autistic mannerisms) to maintain a Type 1 error rate at
0.05 (Benjamini and Hochberg 1995, 2000). The results
of linear regression models were reported with unstand-
ardized regression coefficients (β), 95% confidence inter-
(val (CI) )and the proportions of variance explained
R2(adjusted)  . Analyses were performed using SAS version
9.2 (SAS Institute, Cary, NC, USA). For all the analyses
involving multiple comparisons, results were reported
after correction using FDR procedure.
Results
Sample Characteristics and Gender Difference
in Autistic Trait
A total of 413 children (239 boys and 174 girls) were
included in the data analysis. Table 1 shows the charac-
teristics of the sample. There was no significant difference
in age (t(1,411) = 0.45, P = 0.655) and FSIQ (t(1,411) = 1.93,
P = 0.055) between boys and girls. The ANCOVA analysis
showed that boys scored significantly higher than girls on
Social Awareness (F(1,411) = 7.01, P = 0.024, η2 = 0.02) and
Autism Mannerisms (F(1,411) = 16.92, P < 0.001, η2 = 0.04)
after controlling for age and FSIQ.
We also divided the participants into the HAT group
and LAT group using a cut-off value of 56.5 for SRS. Two-
sample t-test analysis showed that there were no signifi-
cant gender differences in age (t (1,103) = 1.67, P = 0.098;
t (1,306)  = 0.34, P = 0.734) and FSIQ (t (1,103)  = 0.48,
P = 0.635; t(1,306) = 1.36, P = 0.176) in the HAT group and
LAT group, respectively. In the children with HAT, the
ANCOVA analysis showed that there were no significant
gender differences in all SRS variables (all Ps > 0.05).
However, in children with LAT, boys scored significantly
higher on Autism Mannerisms (F(1,306) = 12.00, P = 0.006,
η2 = 0.038), but scored significantly lower on Social Cog-
nition (F(1,306) = 8.56, P = 0.012, η2 = 0.027) compared to
girls.
Additionally, we compared age, FSIQ and SRS scores
between HAT and LAT groups within each gender. Two-
sample t-test analysis showed that boys and girls with
HAT had significantly lower FSIQ than boys and girls with
LAT (boys: t(1,237) = 4.25, P < 0.001; girls: t(1,172) = 3.52,
P < 0.001). The ANCOVA analysis showed that boys with
HAT had significantly higher scores on SRS total scale and
all subscales than boys with LAT (all Ps < 0.001). Similar
results were obtained for girls with HAT compared to girls
with LAT (all Ps < 0.001).
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Journal of Autism and Developmental Disorders
Gender Differences in Associations Between Autistic
Traits and EF
Table 2 shows the correlation patterns between SRS and
WCST variables at two levels of SRS total score (HAT and
LAT) from boys and girls. For the boys with HAT, there was
a significant negative correlation between CC and the Social
Awareness scores (r = − 0.309, P = 0.036). For the girls with
HAT, CC-Social Cognition scores (r = − 0.456, P = 0.012)
and SE-Social Cognition scores (r = − 0.539, P = 0.004)
were negatively correlated; while the NPE-Social Cogni-
tion scores was positively correlated (r = 0.423, P = 0.015).
As for the boys with LAT and the girls with LAT, there was
no significant correlation between SRS and WCST variables
(all Ps > 0.05).
We further performed force-entry linear regression mod-
els of each SRS score in the boys and girls with HAT. Each
EF component was used as a predictor, and age and FSIQ
were covariates (Table  3). The proportions of variance
( )
explained R2(adjusted) by the models are shown in Fig. 2. The
results indicated that for the boys with HAT, CC signifi-
cantly predicted Social Awareness scores (β = − 0.45,
P = 0.039) and CC together with age and FSIQ explained
(11.0% of the variances in Social Awareness scores
)
R2(adjusted) = 0.110 .
In girls with HAT, CC, NPE, SE and FMS were signifi-
cantly associated with SRS scores. CC, NPE and SE signifi-
cantly predicted variance of scores on SRS total scale (CC:
β = − 3.25, P = 0.011; R2(adjusted) = 0.274; NPE: β = 0.22,
P = 0.011; R2(adjusted) = 0.269; SE: β = − 0.28, P = 0.002;
R2(adjusted) = 0.382) and Social Communication (CC:
β = − 1.70, P = 0.010; R2(adjusted) = 0.294; NPE: β = 0.12,
P = 0.007; R2(adjusted) = 0.325; SE: β = − 0.13, P = 0.007;
R2(adjusted) = 0.330). CC, NPE, SE and FMS significantly pre-
dicted variance of Social Cognition scores (CC: β = − 0.81,
P = 0.012; R2(adjusted) = 0.239; NPE: β = 0.05, P = 0.044;
R2(adjusted) = 0.220; SE: β = − 0.07, P = 0.012; R2(adjusted) = 0.324;
FMS: β = 0.74, P = 0.004; R2(adjusted) = 0.145).
Discussion
This study explored the gender difference in the associations
between executive function (EF) and autistic traits in a large
sample of typically developing children. We found that: (1)
there were gender differences in autistic traits in children
with LAT; (2) the association patterns of EF and autistic
 Table 1  Differences of SRS and WCST scores between boys and girls (mean ± SD)
Measures All children Children with HAT Children with LAT Difference between Difference between
HAT and LAT boys HAT and LAT Girls
Boys (n = 239) Girls (n = 174) Pa Boys (n = 70) Girls (n = 35) Pa Boys (n = 169) Girls (n = 139) Pa Pa Pa
Journal of Autism and Developmental Disorders

Ageb 7.61 ± 0.96 7.65 ± 0.95 0.655 7.56 ± 0.96 7.89 ± 0.93 0.098 7.63 ± 0.96 7.59 ± 0.95 0.734 0.608 0.102
FSIQb 107.40 ± 13.27 109.93 ± 13.01 0.055 101.93 ± 13.5 103.23 ± 12.54 0.635 109.67 ± 12.53 111.62 ± 12.61 0.176 < 0.001 < 0.001
SRS
 TS 48.95 ± 16.03 45.80 ± 14.82 0.163 68.87 ± 10.28 67.14 ± 10.57 0.555 40.70 ± 9.32 40.42 ± 10.16 0.942 < 0.001 < 0.001
 SA 8.43 ± 2.33 7.75 ± 2.40 0.024 9.89 ± 2.26 9.20 ± 2.27 0.516 7.83 ± 2.09 7.39 ± 2.29 0.149 < 0.001 < 0.001
 SCog 10.71 ± 3.74 11.09 ± 3.66 0.156 14.36 ± 2.39 14.94 ± 2.51 0.555 9.20 ± 3.11 10.12 ± 3.25 0.012 < 0.001 < 0.001
 SCom 14.49 ± 6.66 13.16 ± 6.15 0.163 22.14 ± 4.83 21.80 ± 5.61 0.888 11.31 ± 4.32 10.98 ± 3.99 0.796 < 0.001 < 0.001
 SM 8.70 ± 3.65 8.71 ± 3.35 0.575 12.23 ± 3.46 12.43 ± 3.4 0.932 7.24 ± 2.58 7.77 ± 2.61 0.080 < 0.001 < 0.001
 AM 6.63 ± 3.71 5.09 ± 3.18 < 0.001 10.26 ± 3.74 8.77 ± 3.65 0.324 5.13 ± 2.44 4.17 ± 2.26 0.006 < 0.001 < 0.001
WCST
 CC 4.30 ± 1.70 4.78 ± 1.50 4.13 ± 1.73 4.54 ± 1.77 4.37 ± 1.68 4.84 ± 1.43
 FMS 2.15 ± 1.52 1.82 ± 1.54 2.07 ± 1.64 1.54 ± 1.46 2.19 ± 1.47 1.88 ± 1.56
 NPE 41.23 ± 21.55 37.51 ± 22.72 41.34 ± 21.55 41.06 ± 28.06 41.19 ± 21.61 36.61 ± 21.19
 SE 33.44 ± 20.99 40.45 ± 22.83 33.10 ± 22.99 39.57 ± 24.56 33.58 ± 20.17 40.67 ± 22.46

SRS Social Responsiveness Scale, WCST Wisconsin Card Sorting Test, TS total score, SA social awareness, SCog social cognition, SCom social communication, SM social motivation, AM autis-
tic mannerism, CC categories completed, FMS failure to maintain set, NPE non-perseverative errors, SE shifting efficiency
a
 Adjusted for age and IQ, and after false-discovery-rate correction for multiple comparisons of SRS scores
b
 Comparison using Two-sample t test

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 Journal of Autism and Developmental Disorders

Table 2  Pearson correlation coefficients of SRS and EF from different SRS levels of boys and girls
EF SRS SRS
TS SA SCog SCom SM AM TS SA SCog SCom SM AM

HAT boys (n = 70) HAT girls (n = 35)

 CC − 0.290 − 0.309* − 0.166 − 0.270 − 0.107 − 0.057 − 0.237 − 0.072 − 0.456* − 0.255 0.161 − 0.085
 FMS − 0.022 − 0.017 − 0.003 − 0.027 0.048 − 0.0571 0.334 0.232 0.265 0.354 − 0.048 0.140
 NPE 0.131 0.163 0.140 0.151 − 0.079 0.051 0.185 0.084 0.423* 0.230 − 0.171 − 0.003
 SE − 0.091 − 0.179 − 0.043 − 0.097 − 0.052 0.059 − 0.373 − 0.213 − 0.539* − 0.339 0.117 − 0.163
LAT boys (n = 169) LAT girls (n = 139)
 CC 0.011 0.013 − 0.046 0.050 − 0.001 − 0.000 0.028 0.052 0.053 0.018 − 0.060 0.035
 FMS − 0.012 0.125 − 0.003 0.063 − 0.141 − 0.112 0.056 0.017 0.016 0.079 0.020 0.051
 NPE 0.045 − 0.049 0.072 − 0.004 0.078 0.048 0.049 − 0.029 0.036 0.030 0.142 − 0.018
 SE − 0.075 − 0.051 − 0.111 − 0.037 − 0.007 − 0.029 − 0.092 0.039 − 0.080 − 0.092 − 0.159 0.009

EF executive function, SRS Social Responsiveness Scale, TS total score, SA social awareness, SCog social cognition, SCom social communica-
tion, SM social motivation, AM autistic mannerism, CC categories completed, FMS failure to maintain set, NPE non-perseverative errors, SE
shifting efficiency, HAT high-autistic-trait, LAT low-autistic-trait
*P < 0.05 after false-discovery-rate correction within each SRS score

traits were different in boys and girls with HAT; (3) for the
boys with HAT, CC predicted the individual differences of
difficulties in social awareness; (4) for the girls with HAT,
the CC, NPE, FMS and SE predicted variances of difficulties
in social cognition and social communication; (5) there were
no significant associations between EF and autistic traits in
boys and girls with LAT.
In the present study, all the participants were from main-
stream schools. Compared to the girls with LAT, boys with
LAT scored significantly higher on Autistic Mannerisms and
lower on Social Cognition, although there were no signifi-
cant differences in autistic traits between boys and girls with
HAT. These findings indicate that boys with LAT have more
repetitive/restricted behaviors, while girls with LAT have
more difficulties in social interaction. In line with our find-
ing, previous researches consistently reported more repeti-
tive/restricted behaviors in boys than girls from general child
population (Hsiao et al. 2013; Nowack et al. 2015). Similar
to the findings of Hsiao et al (2013) in which TD boys and
girls scored 6.20 and 5.08 points, respectively, on SRS sub-
scale measuring repetitive/restricted behaviors, boys and
girls with LAT scored 6.63 and 5.13 points, respectively, in
our study. This result suggests that the SRS measurements of
autistic traits obtained from different studies are similar. The
differences in restricted/repetitive behaviors between boys
and girls with LAT may be due to the normative sex differ-
ence in dimorphic brain structure (Lai et al. 2012; Supekar
and Menon 2015). For example, gray matter morphometry
in the right putamen was different between TD boys and
girls and was related with repetitive/restricted behaviors
measured with ADI-R (Supekar and Menon 2015). Fewer
difficulties in social interaction in boys with LAT may link
to their preferences for attention to detail (Nebot 1988).
Valla and colleagues (Valla et al. 2010, 2013) found that
attention to detail was positively related to face recogni-
tion and facial emotion reading ability in general males but
not in females, thus may lead to better social interaction in
males than females. We observed no difference in autistic
traits between boys and girls with HAT. Inconsistent to this
finding, Dworzynski et al. (2012) found that compared to
boys with high autistic traits (measured with The Childhood
Autism Spectrum Test), girls with high autistic traits had
more communication difficulties. Baron-Cohen and col-
leagues (2014) investigated gender difference in total autistic
traits using the largest sample size to date, 811 adults (454
females) with autism and 3,906 age-matched typical controls
(2,562 females). They found that the gender differences in
total autistic traits were smaller in the autism group than in
the control group (indicated by the significant ordinal inter-
action between gender and diagnosis) (Baron-Cohen et al.
2014). This finding may suggest that increased statistical
power is required to detect gender differences in samples
with ASD or high autistic traits. Further studies with larger
and gender-balanced sample sizes are warranted to clarify
the phenotypic gender difference in children with high level
of autistic traits.
We further investigated the relationship between EF
and autistic traits in boys and girls with LAT and HAT
separately. We found gender-specific associations between
EF and autistic traits in children with HAT, although we
observed no significant associations between EF and autis-
tic traits in boys and girls with LAT. Regression analysis
revealed that in boys with HAT, CC could explain the 11.0%
of the individual differences in Social Awareness. For girls
with HAT, the CC, NPE, SE and FMS predicted variances
of autistic traits related to Social Cognition (23.9%, 22.0%,

13
 Table 3  Multiple regression analysis of executive functions predicting autistic traits in HAT boys and girls a
EF SRS
Journal of Autism and Developmental Disorders

TS SA SCog SCom SM AM
b b b b b
β (95% CI) P β (95% CI) P β (95% CI) P β (95% CI) P β (95% CI) P β (95% CI) Pb

HAT boys (n = 70)

 CC − 1.73 (− 3.27, − 0.20)
 FMS − 0.21 (− 1.74, 1.31)
 NPE 0.05 (− 0.07, 0.17)
 SE − 0.02 (− 0.14, 0.09)
HAT girls (n = 35)
 CC − 3.25 (− 5.50, − 1.01)
 FMS 2.01 (− 0.89, 4.92)
 NPE 0.22 (0.06, 0.37)
 SE − 0.28 (− 0.42, − 0.13)
0.068 − 0.45 (− 0.78, − 0.11)
0.783 − 0.04 (− 0.37, 0.30)
0.667 0.02 (− 0.01, 0.04)
0.783 − 0.02 (− 0.04, 0.01)
0.011 − 0.12 (− 0.66, 0.43)
0.168 0.31 (− 0.32, 0.94)
0.011 0.01 (− 0.02, 0.05)
0.002 − 0.02 (− 0.06, 0.01)
0.039 − 0.24 (− 0.59, 0.10)
0.837 − 0.07 (− 0.41, 0.27)
0.263 0.02 (− 0.01, 0.04)
0.263 < 0.00 (− 0.03, 0.02)
0.665 − 0.81 (− 1.36, − 0.27)
0.633 0.74 (0.05, 1.42)
0.633 0.05 (0.02, 0.09)
0.633 − 0.07 (− 0.10, − 0.03)
0.350 − 0.74 (− 1.47, − 0.01)
0.866 − 0.08 (− 0.81, 0.64)
0.350 0.03 (− 0.03, 0.09)
0.878 − 0.01 (− 0.07, 0.04)
0.012 − 1.70 (− 2.88, − 0.52)
0.044 1.03 (− 0.50, 2.55)
0.012 0.12 (0.05, 0.20)
0.004 − 0.13 (− 0.21, − 0.05)
0.188 − 0.21 (− 0.75, 0.34) 0.753 − 0.10 (− 0.69, 0.49) 0.764
0.820 0.10 (− 0.42, 0.62) 0.775 − 0.13 (− 0.69, 0.44) 0.764
0.552 − 0.02 (− 0.06, 0.02) 0.753 0.01 (− 0.04, 0.05) 0.764
0.786 − 0.01 (− 0.04, 0.03) 0.775 0.01 (− 0.03, 0.06) 0.764
0.010 − 0.05 (− 0.82, 0.72) 0.911 − 0.58 (− 1.44, 0.29) 0.460
0.180 − 0.28 (− 1.18, 0.62) 0.911 0.22 (− 0.83, 1.27) 0.673
0.007 < 0.01 (− 0.05, 0.05) 0.911 0.03 (− 0.03, 0.09) 0.597
0.007 − 0.01 (− 0.06, 0.04) 0.911 − 0.05 (− 0.11, 0.01) 0.440

EF executive function, SRS Social Responsiveness Scale, TS total score, SA social awareness, SCog social cognition, SCom social communication, SM social motivation, AM autistic mannerism,
CC categories completed, FMS failure to maintain set, NPE non-perseverative errors, SE, shifting efficiency, HAT, high-autistic-trait
a
 Adjusted for age and IQ
b
 After false-discovery-rate correction within each SRS score

13

Fig. 2  Variances of autistic traits predicted by each executive function
index in boys and girls with HAT. Proportions indicate variances pre-
dicted by( each executive
) function indicators with age and FSIQ
together R2(adjusted)  . HAT, high-autistic-trait; SRS Social Respon-
siveness Scale; CC categories completed; FMS failure to maintain
set; NPE non-perseverative errors; SE shifting efficiency
32.4% and 14.5% respectively), while CC, NPE and SE pre-
dicted variances in Social Communication(29.4%, 32.5%
and 33.0% respectively). In previous studies, researchers
reported that there is association between EF and social
cognition in samples with and without ASD. For example,
Jones et al. (2018) found a significant association between
cognitive flexibility and social communication symptoms
in adolescents with ASD. Leung et al. (2016) found that the
behavioral regulation of the executive processes (i.e., inhibi-
tion, shifting, and emotional control) could predict the total
autistic traits (SRS total scores) in children with ASD as
well as in TD children. Gokcen et al. (2009) found a signifi-
cant negative association between cognitive flexibility and
total autistic traits in adults and adolescents with sub-clinical
high autistic traits. Our study extends the findings of these
studies by incorporating the gender factor. We show that
the associations between EF and specific autistic traits are
different in boys and girls. Contrary to our findings, Torske
et al. (2018) found similar patterns of correlation between
EF and total autistic traits (SRS total scores) in boys and
girls with ASD. It should be noted that Torske et al. (2018)
assessed EF using the composite indices (i.e., the Behavioral
Regulation Index, the Metacognition Index and the Global
13
Journal of Autism and Developmental Disorders
Executive Composite) of a parent-report measurement (the
Behavior Rating Inventory of Executive Function). But in
the present study, we used EF indicators from a behavioral
task. Therefore, the discrepancy of these findings may due
to the difference in the measurements methods used. Torske
et al. (2018) did not focus on the associations between EF
and specific autistic traits in boys and girls. Further inves-
tigations are needed to clarify whether the EF components
(e.g., Shift and Inhibit) assessed with questionnaires will
show gender-specific associations with autistic traits.
Recent research has shown that EF in children may play
a role in the development of social cognition (Morigu-
chi 2014). In our study, the different association patterns
between EF and autistic traits in boys and girls may result
from the gender differences in social cognition skills, such
as perception of gaze direction and empathy. Gaze cuing
effect, the tendency of orienting to other individuals’ gaze
direction, determines the ability of individuals to capture the
information related to the attention and emotional state of
the individuals they interact with (Frischen et al. 2007). Ear-
lier research found weaker gaze cuing effects in TD males
than females (Deaner et al. 2007). Gender difference was
also reported in empathy (the ability to understand a person’s
metal states and to respond with an appropriate emotion) in
which TD females had higher empathy than males (Baron-
Cohen et al. 2014). Both gaze cuing effects and empathy
were associated with EF. Gaze cuing effect involves a flex-
ible shift of attention (Frischen et al. 2007). While empathy
requires simultaneous processing of multiple information
streams, inhibition of one’s own emotional states and shift-
ing flexibly between one’s own and others’ perspectives and
motional states (Singer and Lamm 2009). Thus we speculate
that attention shifting is more related to difficulties in per-
ceiving social cues and social interaction in boys with HAT,
which may be due to their weaker gaze cuing effects. We
speculate that globe EF (all EF components) is more related
with abilities in processing social information and reciprocal
communication in girls with HAT, which may be due to their
higher empathy response.
It is noteworthy that in children with LAT, EF showed
no significant association with autistic traits. We speculate
that there may be other more important factors, for example,
Theory of Mind (ToM), that affect autistic traits in this popu-
lation. Previous studies have demonstrated a link between
EF and ToM (Lukito et al. 2017; Miranda et al. 2017). For
instance, Jones et al. (2018) found that EF had no direct
association with autistic behaviors but had an indirect effect
through the association with ToM. Further studies are advo-
cated to test the effect of ToM on gender-specific associa-
tions between EF and autistic traits.
High autistic traits appear to cause emotional and behav-
ioral problems (Lundstrom et al. 2011; Saito et al. 2017).
Our findings that EF components have a gender-dependent
Journal of Autism and Developmental Disorders
relation to specific autistic traits in children with HAT may
be relevant for developing gender-specific interventions for
autistic deficits. EF components, such as flexibility and mon-
itoring are thought to facilitate the ability to engage in social
interactions (van Lier and Deater-Deckard 2016). Interven-
tions that target EF components, such as flexibility, insist-
ence to sameness and planning, have been shown to reduce
social impairment (total SRS scores) in children with ASD
(Kenworthy et al. 2014). Our study showed that shifting can
negatively predict difficulties in perceiving social cues and
social communication in boys with HAT; while in girls with
HAT, all EF components were linked to the ability to process
social cues and social communication. This indicates that
boys with difficulties in perceiving social cues and social
communication might benefit from interventions designed
to improve EF in terms of shifting, whereas girls with dif-
ficulties in processing social cues and social communication
might benefit from interventions designed to improve EF
in general. Further studies are warranted to test the clinical
implication of these findings.
Our study has the following limitations. First, we did
not clinically preclude the possibility of children with HAT
being diagnosed with ASD. However, this limitation could
not have had a significant impact on the current findings
given that the autistic traits appear to distribute continuously
and share a common pathogenesis throughout the continuum
(Constantino and Charman 2016; Robinson et al. 2011). Fur-
ther studies involving participants across the whole autistic
traits continuum are warranted to test whether the gender-
differential relationships persist in clinical samples. Second,
the SRS specifically target autistic traits involving reciprocal
social behaviors. Given that autistic traits are supposed to be
fractionable (Brunsdon and Happe 2014), the associations
we found may not generalize to other domains of autistic
traits, such as restricted/repetitive behaviors and interests.
Finally, due to the cross-sectional nature of this study design,
we could not speculate the causality in the relationships
we have observed. Longitudinal studies are necessary to
advance our understanding of the relationship between EF
and autistic traits.
To conclude, our study demonstrated that in TD children
with LAT, boys had more repetitive/restricted behaviors but
fewer difficulties in social interaction than girls. Specific EF
components had gender-differential relationships to the sub-
domains of autistic traits in TD children with HAT. In the
boys with HAT, the categories completed of EF predicted
autistic-like difficulties in social awareness. For the girls
with HAT, the categories completed, the non-perseverative
errors, the failure to maintain set and the shifting efficiency
predicted autistic-like difficulties in social cognition and
communication. Our findings may have implications for
developing gender-specific interventions related to specific
autistic deficits.
Acknowledgments  Jin Jing was supported by National Natural Science
Foundation of China (Grant No. 81573169). Zengjian Wang was sup-
ported by Guangdong medical science and technology research fund
Project (A2018190) and the PhD Start-up Fund of Natural Science
Foundation of Guangdong Province (2018A030310336). We thank
all the participating children and their families. We acknowledge the
relevant staffs and students for their contributions to data collection.
Author Contributions  MD, LL and JL contributed to the data collec-
tion. MD designed the current study, performed the statistical anal-
ysis and drafted the manuscript. ZW guided the statistical analysis
and revised the manuscript. JJ supervised the analysis and revised the
manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards 
Conflict of interest  The authors declare no conflicts of interest in this
work.
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