RESEARCH ARTICLE

Meta-Analysis of Neuropsychological Measures of Executive

Functioning in Children and Adolescents With High-Functioning
Autism Spectrum Disorder
Chun Lun Eric Lai, Zoe Lau, Simon S. Y. Lui, Eugenia Lok, Venus Tam, Quinney Chan, Koi Man Cheng,
Siu Man Lam, and Eric F. C. Cheung

Existing literature on the profile of executive dysfunction in autism spectrum disorder showed inconsistent results.
Age, comorbid attention-deficit/hyperactivity disorder (ADHD) and cognitive abilities appeared to play a role in con-
founding the picture. Previous meta-analyses have focused on a few components of executive functions. This meta-
analysis attempted to delineate the profile of deficit in several components of executive functioning in children and
adolescents with high-functioning autism spectrum disorder (HFASD). Ninety-eight English published case-control
studies comparing children and adolescents with HFASD with typically developing controls using well-known neuro-
psychological measures to assess executive functions were included. Results showed that children and adolescents
with HFASD were moderately impaired in verbal working memory (g 5 0.67), spatial working memory (g 5 0.58), flexi-
bility (g 5 0.59), planning (g 5 0.62), and generativity (g 5 0.60) except for inhibition (g 5 0.41). Subgroup analysis
showed that impairments were still significant for flexibility (g 5 0.57–0.61), generativity (g 5 0.52–0.68), and working
memory (g 5 0.49–0.56) in a sample of autism spectrum disorder (ASD) subjects without comorbid ADHD or when
the cognitive abilities of the ASD group and the control group were comparable. This meta-analysis confirmed the
presence of executive dysfunction in children and adolescents with HFASD. These deficits are not solely accounted
for by the effect of comorbid ADHD and the general cognitive abilities. Our results support the executive dysfunction
hypothesis and contribute to the clinical understanding and possible development of interventions to alleviate these
deficits in children and adolescents with HFASD. Autism Res 2016, 0: 000–000. V C 2016 International Society for

Autism Research, Wiley Periodicals, Inc.

Keywords: executive function; high-functioning autism spectrum disorder; Asperger’s syndrome; meta-analysis

Introduction and actions in new or complex situations in which

Autism spectrum disorder (ASD) is a neurodevelopmen-
tal disorder characterised by persistent deficits in social
communication and social interaction across multiple
contexts, and is associated with restricted, repetitive
patterns of behaviour, interests or activities [American
Psychiatric Association, 2013]. Executive dysfunctions
are believed to contribute to the behavioural character-
istics of autism [Hill, 2004], and might interact with
other cognitive dysfunctions, such as theory of mind
impairment [Baron-Cohen, Leslie, & Frith, 1985] and
weak central coherence [Frith, 1989], to constitute a
“multiple-deficit model”, accounting for the core symp-
toms of autism [Pellicano, 2011].
Executive functions are higher cognitive processes
that underlie purposeful and goal-directed behaviour
[Ozonoff, Pennington, & Rogers, 1991]. These functions
are essential for individuals to control their thoughts
automatic or impulsive responses are not adaptive
[Miyake & Friedman, 2012]. Executive function is a
multi-faceted rather than a unitary construct, and typi-
cally consists of the following components: inhibition,
working memory, flexibility, planning and generativity
[Hill, 2004]. Inhibition refers to the ability to suppress
or avoid a prepotent response to make a less automatic
but task-relevant response [Miyake et al., 2000]. Work-
ing memory is defined as the capacity to actively main-
tain or manipulate information across a short delay,
and can be divided into two domains, i.e., the phono-
logical loop and the visuospatial sketchpad [Baddeley,
1992]. Flexibility is defined as switching between task
sets or response rules [Miyake et al., 2000]. Planning is
defined as identifying and organising a sequence of
steps to achieve a goal [Lezak, 2012]. Generativity is
defined as the ability to generate spontaneously appro-
priate novel responses [Lezak, 2012].

From the Castle Peak Hospital, Tuen Mun, Hong Kong (C.L.E.L., S.S.Y.L., E.L., V.T., Q.C., K.M.C., S.M.L., E.F.C.C.)
Received March 11, 2016; accepted for publication October 15, 2016
Address for correspondence and reprints: Chun Lun Eric Lai, Castle Peak Hospital, No 15 Tsing Chung Koon Road, Tuen Mun, Hong Kong.
E-mail: lai_eric@yahoo.com
Published online 00 Month 2016 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.1723
C 2016 International Society for Autism Research, Wiley Periodicals, Inc.
V

INSAR Autism Research 00: 00–00, 2016 1

 It is believed that executive dysfunctions could con-
tribute to the typical behavioural characteristics of ASD
patients. For instance, inflexibility in applying social
rules and shifting social behaviours or conversational
topics to meet changing contextual demands could
result in social deficits [Geurts, Corbett, & Solomon,
2009], and lack of generativity could limit one’s ability
to generate ideas relevant to the context in conversa-
tion with others, resulting in communication impair-
ment [Bishop & Norbury, 2005a]. Inflexibility in
shifting attention could also result in stereotyped
behaviour [Mosconi et al., 2009].
There is empirical evidence to support that ASD is
associated with executive dysfunctions. Geurts, van den
Bergh, and Ruzzano [2014]’s meta-analysis examined
the executive function component of inhibition and
concluded that individuals with ASD exhibited impair-
ments in prepotent response inhibition (with an effect
size of 0.55) and interference control (with an effect
size of 0.31), both of which are domains of inhibition.
Leung and Zakzanis [2014]’s meta-analysis demonstrat-
ed a considerable variability in the effect sizes of vari-
ous measures of the executive function component of
flexibility in previous studies. The latest meta-analysis
performed by Landry and Al-Taie [2016] summarised
the various measures of the Wisconsin Card Sorting
Test (WCST) and yielded weighted mean effect sizes
ranging from 0.30 (failure to maintain set) to 0.74 (per-
severative errors). They also demonstrated that there
was no evidence of reduced impairment when the
WCST was administered by a computer.
However, these meta-analyses failed to adequately
address a number of factors which are highly relevant
to executive dysfunctions in ASD. First, the majority of
previous meta-analytic literature in this area only
focused on one component of executive functions in
ASD, namely inhibition [Geurts et al., 2014] and flexi-
bility [Landry & Al-Tale, 2016; Leung & Zakzanis,
2014]. Second, attention-deficit/hyperactivity disorder
(ADHD) is a common comorbidity in individuals with
ASD [Lee & Ousley, 2006]. Importantly, Willcutt, Doyle,
Nigg, Faraone, and Pennington [2005]’s meta-analysis
demonstrated that ADHD itself is associated with
marked executive dysfunctions, across different compo-
nents. However, no previous meta-analyses on execu-
tive dysfunctions in ASD had taken the confounding
effect of ADHD comorbidity into account. Third, an
individual’s executive function follows a protracted
course of development [Romine & Reynolds, 2005], but
many previous studies examining the executive func-
tions in ASD individuals recruited samples with a wide
age range. Although Geurts et al. [2014] had examined
the effect of age on both interference control and pre-
potent response inhibition using meta-regression, no
previous meta-analysis had focused on executive
2 Lai et al./Meta-analysis of executive functioning in ASD
dysfunctions in children and adolescents. Fourth, previ-
ous meta-analyses [Geurts et al., 2014; Leung & Zakza-
nis, 2014] included studies conducted on samples with
ASD and comorbid intellectual disability. Although
Geurts et al. [2014]’s meta-analysis suggested that IQ is
a significant moderator for interference control but not
prepotent response inhibition, this finding was con-
founded by the fact that a proportion of subjects failed
to comprehend the task instructions competently
because of intellectual disability.
Therefore, we conducted the first meta-analysis to
explore all components of executive dysfunction [Hill,
2004; Pennington & Ozonoff, 1996] in individuals with
ASD using a high-functioning sample with a narrower age
range. We also explored the impact of comorbid ADHD.
Methodology
Identification of Studies
MEDLINE, Embase, PsycINFO, and Web of Science were
utilised to search for articles from 1978 to 31 December
2015. The year 1978 was used because it was the year
when the World Health Organisation officially listed
infantile autism as a diagnosis in the International Clas-
sification of Disease 9th edition [World Health Organi-
sation, 1978]. Keywords of “Autis*”, “Asperger*”,
“Pervasive Development*”, “ASD” or “PDD” were paired
up with “Executive function*”, “Inhibit*”, “Cognitive
control”, “Interference control”, “Working memory”,
“Visual memory”, “Verbal memory”, “Visuospatial
memory”, “Spatial memory”, “Flexibility”, “Shifting”,
“Planning”, “Generativity” or “Fluency”. Reference lists
of the included articles and previous reviews were
searched for additional articles (Appendix A). Titles and
abstracts were screened for preliminary inclusion. The
search was further refined according to the inclusion
and exclusion criteria as described below. The process
of identification and selection was done independently
by two authors (EL and ZL). Any discordance was
resolved by consensus.
Selection of Studies
Studies were included if (1) they were primary case-
control studies comparing individuals with ASD and
controls on executive function with neuropsychological
tests, (2) the ASD groups were diagnosed according to
the International Classification of Disease (the 9th,
10th version) or Diagnostic and Statistical Manual of
Mental Disorders (III, III-R, IV, IV-TR, V), (3) the partici-
pants were children and adolescents (younger than or
equal to 18 years of age), (4) the comparison group
comprised healthy individuals, (5) there was sufficient
information for computation of effect sizes, namely the
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mean, standard deviation, the number of subjects, or
the t value when the mean and standard deviations
were not provided; and (6) the neuropsychological
assessments were carried out using valid and reliable
tests with reference to Lezak [2012] and Strauss, Sher-
man, and Spreen [2006]. Due to the large number of
different experimental paradigms on executive func-
tions, we pre-defined which tasks would be included in
this meta-analysis based on these two authoritative
texts. Studies were excluded if (1) they were not
reported in English, (2) they were unpublished, (3) they
used questionnaires to quantify the deficits, and (4) the
ASD participants were not all high-functioning
(IQ < 70). We contacted authors of the original studies
for clarification whenever necessary.
Data Extraction
Data such as the mean age, gender, mean IQ, the diag-
nostic method, the number of participants with comor-
bid ADHD, the number of medicated ASD participants
as well as data regarding the neuropsychological mea-
sures were extracted. The different tests employed in
each of the study were first classified according to com-
ponents of executive function they purported to mea-
sure. The most representative variable of each test was
used for data synthesis. These were conducted by two
expert neuropsychologists independently, with refer-
ence to Lezak [2012] and Strauss et al. [2006]. If more
than one test were considered to be capturing the same
component, they were combined by taking the mean.
Similar strategy was employed for the digit span task
and verbal fluency task, where forward and backward
digit span were combined for the former, and semantic
and phonemic fluency test were combined for the lat-
ter. Batteries, such as the Delis-Kaplan Executive Func-
tioning System, were tackled as multiple tests. In
longitudinal studies, only baseline neuropsychological
results were used to circumvent practice effects. If the
results were reported separately according to clinical
subtypes, such as autistic disorder, Asperger’s syndrome
and pervasive developmental disorder – not otherwise
specified, they were pooled together to calculate a gross
mean and standard deviation according to the method
suggested by Borenstein, Hedges, Higgins, and Roth-
stein [2009]. Similar strategies were employed for stud-
ies stratifying ASD participants into two groups with or
without comorbid ADHD. Weissman and Bates [2010]
divided ASD participants into two groups with or with-
out bipolar disorder. Only the group without bipolar
disorder was included.
Data Synthesis and Analysis
Data-analysis was conducted with Comprehensive
Meta-analysis Version 2.0. The random effect model
INSAR Lai et al./Meta-analysis of executive functioning in ASD
was used as the population varied across studies
[Hedges & Olkin, 1985]. Effect sizes were first calculated
in Hedges’s g [Hedges & Olkin, 1985] for individual
studies. They were then pooled together first according
to the types of tests to calculate the synthesised g, and
then according to the components of executive func-
tions they purported to measure to calculate a compos-
ite Hedges’s g for each component of executive
function. A positive Hedges’s g indicates poorer perfor-
mance in individuals with ASD relative to the controls.
It was interpreted as: g 5 0.20 is small; g 5 0.50 is medi-
um; g 5 0.80 is large [Cohen, 1988]. A P-value was also
calculated for each synthesised g and composite
Hedges’s g. The P-value was used to determine whether
a finding was significant and from there, the effect size
was used to determine the strength of the effect.
Assessment of Heterogeneity
Heterogeneity refers to the variability of effect sizes of
individual studies beyond that expected from chance
alone [Engels, Schmid, Terrin, Olkin, & Lau, 2000]. Het-
erogeneity was evaluated using the Cochran’s Q statis-
tic, with its P-value less than 0.10 indicating significant
heterogeneity [Higgins, Green, & Cochrane, 2008]. In
addition, the I2 statistic describes the percentage of the
variability in effect estimates that is due to heterogenei-
ty rather than sampling error (i.e., by chance alone),
and it was interpreted as follows: I2 5 25% is low;
I2 5 50% is moderate; I2 5 75% is high.
Publication Bias
Publication bias was assessed by visual examination of
the funnel plots, Duval and Tweedie’s trim and fill
method [Duval & Tweedie, 2000] and Rosenthal’s fail-
safe N test [Rosenthal, 1979]. With the trim and fill
method, any studies causing asymmetry of the funnel
plot were identified and an adjusted pooled effect size
was calculated. With the fail-safe N test, the number of
hypothetical missing negative studies required to nulli-
fy the findings was calculated. The number of missing
studies was generally regarded as acceptable if it was
less than five times the included studies plus ten
(N < 5k 1 10) [Mullen, Muellerleile, & Bryant, 2001].
Subgroup Analyses
Subgroup analyses were performed twice. First, we iden-
tified studies that explicitly described exclusion of indi-
viduals with ASD with comorbid ADHD either in the
text or through subsequent contacts. We also identified
studies that reported separately the performance data of
groups of participants with ASD with or without comor-
bid ADHD such that the group without comorbid
ADHD can be isolated. These studies and groups were
pooled together to examine the profile of executive
3
dysfunction in a ‘pure’ ASD sample. Next, again from
the 98 articles, we identified the studies that used an
IQ-matched typically developing controls, be it full-
scale IQ, performance IQ or verbal IQ. The results were
pooled together to evaluate the profile of deficits in
such a matching condition.
Meta-Regression
Simple regression was performed for mean age, mean
IQ, percentage of males and percentage of medicated
participants in the ASD group. Only studies that did
not demonstrate significant differences in mean age,
mean IQ, male-to-female ratio between the ASD and
the controls groups were included in the regression
analysis. Each variable was entered one at a time since
the number of studies used in the regression of differ-
ent variables varied.
Results
Characteristics of Included Studies
Ninety-eight different samples of ASD participants
and 99 different samples of controls from 98 articles
were included in this meta-analysis (Appendix B). The
flow chart of the study is presented in Figure 1.
Details of the individual studies are presented in
Table 1. The total number of participants was 5,991,
in which 2,986 were individuals with ASD and 3,005
were typically developing individuals. There were
2,470 male participants (86.88%) in the ASD group
among the 92 studies that reported the gender ratios,
whereas there were 2,145 male participants (76.23%)
in the typically developing group among the 90 stud-
ies that reported gender ratios. All studies reported
the mean age of the ASD group and the typically
developing group. The mean age was 10.65 and
10.81, respectively. A total of 270 effect sizes were
included in the meta-analysis.
Weighted Mean Effect Sizes
Results are summarised in Table 2. Only the tasks uti-
lised by more than three studies are listed. A summary
forest plot of all the studies is presented in Figure 2.
Inhibition. Forty-two studies explored inhibition in
individuals with ASD with seven different types of tests.
Individuals with ASD were impaired on the inhibition
composite score (k 5 42, g 5 0.41, P < 0.001, where k
denotes the number of included studies). The largest
effect size was found in the Opposite World subtest of
the TEA-Ch (k 5 3, g 5 0.59, P 5 0.015). The most com-
monly used test was the Stroop task (k 5 22, g 5 0.39,
P < 0.001).
4 Lai et al./Meta-analysis of executive functioning in ASD
Verbal working memory. Ten tests from 30 studies
were included. Individuals with ASD were impaired on
the verbal working memory composite (k 5 30, g 5 0.67,
P < 0.001). The most commonly used task was the digit
span task (k 5 19, g 5 0.46, P < 0.001). The Sentence
Repetition task detected the most impairment in indi-
viduals with ASD relative to controls (k 5 5, g 5 1.09,
P 5 0.006).
Spatial working memory. Twenty-eight studies
using 15 different tests capturing spatial working mem-
ory were included. Overall participants with ASD were
impaired in this construct (k 5 28, g 5 0.58, P < 0.001).
The most commonly used task was the Spatial Working
Memory task of Cambridge Neuropsychological Test
Automated Battery (CANTAB) (k 5 8, g 5 0.67,
P < 0.001). The most impairment was detected by the
Rey Complex Figure Test (k 5 3, g 5 1.13, P 5 0.007).
Flexibility. Thirty-seven studies using three main
types of tasks assessing flexibility were included (k 5 37,
g 5 0.59, P < 0.001). The most commonly used task was
the WCST (k 5 21, g 5 0.62, P < 0.001). Other types of
card sorting tasks were pooled together (k 5 6, g 5 0.79
P < 0.001). The most deficits were observed in the Trail
Making Test (k 5 5, g 5 1.03, P < 0.001). Both groups
made comparable number of errors in the extra-
dimensional stage of the IED task of the CANTAB
(k 5 8, g 5 0.090, P 5 0.51).
Planning. Twenty-one studies with four different
tasks were included in the construct. Individuals with
ASD were impaired on the planning composite (k 5 21,
g 5 0.62, P < 0.001). Since the tower task of the NEPSY,
the tower task of the D-KEFS and the Tower of London
task were similar, they were pooled together (k 5 14,
g 5 0.67, P < 0.001). Five studies utilising the Stocking
of Cambridge task of the CANTAB were analysed sepa-
rately (k 5 5, g 5 0.43, P 5 0.086).
Generativity. Twenty-three studies using three differ-
ent kinds of tasks were included. Children and adoles-
cents with ASD were impaired on the generativity
composite (k 5 23, g 5 0.60, P < 0.001). They showed the
most impairment in ideational fluency, as illustrated by
the Use of Common Objects task (k 5 3, g 5 1.03,
P < 0.001). The least impairment was observed in the
Design Fluency Task (k 5 4, g 5 0.35, P 5 0.021).
Subgroup Analysis
The results are presented in Tables 3 and 4. By exclud-
ing comorbid ADHD in the ASD sample, the effect sizes
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Figure 1. Flow diagram of the meta-analysis.
were of smaller magnitude in the inhibition and plan-
ning constructs. The effect sizes were still of medium to
large magnitude in the verbal working memory, spatial
working memory, flexibility, and generativity con-
structs. Conversely, through focusing exclusively on
studies matching the ASD and control subjects on IQ,
the effect sizes were of similar magnitude across all
constructs.
Meta-Regression
The results of meta-regression are presented in Table 5.
Deficits in flexibility appeared to decrease with age
(B 5 20.062, P 5 0.031). Regression using other variables
and in other constructs did not yield any statistically
significant results.
INSAR Lai et al./Meta-analysis of executive functioning in ASD
Heterogeneity of Effect Sizes
The results of assessment of heterogeneity are also pre-
sented in Tables 2–4. Overall the effect sizes were het-
erogeneous across all constructs. Studying a subgroup
of ASD samples without comorbid ADHD led to statisti-
cally insignificant Q values, which indicates that the
results were relatively more homogenous. Conversely,
the results were still heterogeneous in all components
except inhibition in the IQ-matched subgroup.
Publication Bias
The funnel plots are displayed in Figures 3–8. The
results of the trim-and-fill analysis and the fail-safe N
test are presented in Table 2. With trim-and-fill analy-
sis, asymmetry was detected in the spatial working
memory and generativity constructs, with a reduced
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Table 1. Summary of Details of the Included Studies
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Alderson-Day, 2014 ASD 28/2 ADOS/ ASD 13.84 ASD 105.07 WASI A, G, IQ 1 NR NA CFT Number of correct responses 1.09
TD 10/5 ADI-R (2.44) (14.06) LFT Number of correct responses 0.64
TD 14.05 TD 110.40
(2.72) (10.54)
Altgassen, 2009 ASD 9/2 3DI/ADOS ASD 9.6 (2.6) NR WISC A, IQ NR NR NA DS Score 0.37
TD 6/5 TD 10.6 (2.9)
Ambrosino, 2014 ASD 19/0 ADI-R ASD 11.5 (1.2) ASD 112.2 WISC A, G, IQ NR 7 SS GNG % of correct responses on no-go 0.43
TD 19/0 TD 11.1 (1.6) (15.3) trial
TD 120.2
(15.8)
Andersen, 2013 ASD 31/7 K-SADS-PL ASD 12.0 (2.3) ASD 98.2 WASI A, IQ 8 4 SS HVLT Acquisition score 0.88
TD 32/18 TD 11.6 (2.0) (17.8) LNS Number of correct responses 1.20
TD 103.8
(13.0)
Andersen, 2015 ASD 28/6 K-SADS-PL ASD 11.6 (2.0) ASD 99.9 WASI A, G, IQ 8 4 SS LNS Score 1.33
TD 29/16 TD 11.4 (1.5) (17.4) Stroop Reaction time in condition 4 0.94
TD 104.5 (D-KEFS)
(13.1)
Barron- ASD 28/2 ADI-R ASD 9.1 (1.3) ASD 107.2 WISC A, G, IQ NR 3 NR DFT Score 0.012
Linnankoski, 2015 TD 56/4 TD 9.1 (1.4) (17.3) Stroop Switching score (NEPSY) 20.14
TD NR VFT Number of correct responses 0.59
Bishop, 2005a, ASD 14/0 SCQ/ADOS ASD 8.3 (0.99) ASD 107.21 Raven A, G, IQ NR NR NA OW Time difference 1.35
2005b TD 15/3 TD 8.56 (1.00) (15.62) UCO Number of correct responses 1.00
TD 110.83 WDW Number of correct responses 1.15
(10.38)
Brenner, 2015 ASD 23/4 ADI-R/ ASD 12.68 ASD 101.31 WISC A, G, IQ NR NR NA LNS Score 0.44
TD 22/3 ADOS (2.85) (11.24)
TD 13.41 TD 106.96
(2.32) (11.46)

Lai et al./Meta-analysis of executive functioning in ASD

Chan, 2011a ASD 20/0 Clinical ASD 7.98 ASD 89.5 WISC A, G, IQ NR NR NA CFT Number of correct responses 0.89
TD 20/0 (1.90) (18.23) Stroop Number of errors 0.35
TD 8.30 (1.98) TD 101.0 WCST Number of perseverative errors 0.71
(20.65)
Chan, 2011b ASD 19/1 ADOS ASD 10.75 ASD 101.4 TONI A, G, IQ 0 0 NA CPT Commission errors 0.005
TD 19/1 (2.07) (16.83) FD Score 1.13
TD 9.8 (1.88) TD 110.7 GNG Commission errors 0.59
(17.84)
Chan, 2011c ASD 19/2 Clinical ASD 10.27 ASD 101.86 TONI A, G, IQ 0 0 NA FD Score 0.72
TD 14/7 (2.26) (16.09) RCFT Recall score 0.50
TD 9.85 (2.15) TD 106.0
(14.59)

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 Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF

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(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Chantiluke, 2015 ASD 17/0 ADI-R/ ASD 15.2 (1.8) ASD 114 (14) WASI-R A, G, IQ 0 0 NA NBT Percentage of correct responses 0.21
TD 17/0 ADOS TD 14.0 (2.6) TD 111 (14)
Chien, 2014 ASD 316/38 ADI-R ASD 10.5 (3.1) ASD 96.75 WISC A 251 NR NA CPT Commission errors 0.43
TD 180/46 TD 11.8 (2.2) (21.88)
TD 111.95
(10.23)
Corbett, 2009 ASD 17/1 ADOS ASD 9.44 ASD 94.17 WASI A NR 6 SS CCTT Interference score 1.29
TD 12/6 (1.96) (17.79) CFT Number of correct responses 1.33
TD 9.56 (1.81) TD 112.22 IED Extra-dimensional stage errors 20.15
(14.84) LFT Number of correct responses 1.37
SOC Number of perfect solutions 0.89
SSP Score 1.17
Stroop Reaction time in condition 4 1.46
SWM (D-KEFS) 1.31
Between-search errors
Cui, 2010 ASD 11/1 Clinical ASD 7.46 ASD 100.03 WISC A, G, IQ NR NR NA BD Score 0.028
TD 24/6 (0.84) (17.13) BT Spatial span 0.91
TD 7.37 (0.48) TD 108.31 FD Score 21.15
(14.08) NBT Percentage of correct responses 20.063
(digit) 20.37
Percentage of correct responses
(figure)
Czermainski, 2014 ASD 9/2 Clinical ASD 11.73 ASD 31.36 Raven A, G, IQ 0 4 NR BD Score 0.16
TD 17/2 (1.9) (4.75)c BT Spatial span 0.96
TD 11.42 (1.8) TD 30.18 CFT Number of correct responses 0.84
(3.81) LFT Number of correct responses 0.88
NWR Score 0.64
RCFT Recall score 1.91
Stroop SCW score (SCWT) 0.69
TMT Time taken in part b 1.11

Lai et al./Meta-analysis of executive functioning in ASD

de Vries, 2014 ASD 67/10 ADI-R/SRS ASD 10.7 (1.4) ASD 109.5 WISC A, IQ NR 27 NS NBT Number of errors 20.16
TD 27/18 TD 10.3 (1.3) (20.5)
TD 105.9
(18.7)
Dichter, 2009 ASD 38/1 ADI-R ASD 9.72 ASD 101.69 Leiter-R A, IQ NR 13 NS CFT Number of correct responses 0.83
TD 38/1 (2.66) (17.5) UCO Number of correct responses 1.46
TD 10.57 TD 111.67
(3.35) (16.11)
Dunn, 1996 ASD 10 Clinical ASD 6.79 ASD 102.4 SB-4 IQ NR NR NA CFT Number of correct responses 0.38
TD 10 (1.90) (10.06)
TD 4.93 (1.51) TD 106.4
(12.10)
Faja, 2014 ASD 18/5 ADI-R/ ASD 6.88 ASD 102.3 DAS A, G, IQ NR NR NA BD Score 0.32
TD 15/5 ADOS (0.61) (12.4)
TD 6.74 (0.63) TD 108.0 (5.3)

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Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Gabig, 2008 ASD 13/2 ADOS/ ASD 6.5 (0.7) ASD 95 (10.6) PPVT/DAS A NR NR NA DS Score 2.16
TD 10 ADI-R TD 6.67 (0.9) TD 106 (9.5) NWR Score 1.34
Geurts, 2004 ASD 41/0 ADI-R ASD 9.4 (1.8) ASD 98.3 WISC A, G 11 NR NA BVRT Number of correct responses 0.60
TD 41/0 TD 9.1 (1.7) (18.4) BT Spatial span 0.70
TD 111.5 CFT Number of correct responses 0.92
(18.0) LFT Number of correct responses 1.01
OW Time difference 0.37
SOPT Number of errors 0.57
TOL Scores based on the number of trials 0.43
WCST required to solve a problem 0.86
Number of perseverative responses
Geurts, 2009 ASD 16/2 CCC/CSBQ/ ASD 10.3 (1.6) ASD 108.0 NR A, G, IQ NR 1 SS GNG Commission errors 0.42
TD 19/3 clinical TD 10.3 (1.4) (19.0)
TD 103.2
(24.1)
Geurts, 2014 ASD 20/4 SRS/CSBQ/ ASD 10.5 (1.1) ASD 108.5 SON-R A, G, IQ NR 9 NS DS Score 0.41
TD 17/7 clinical TD 10.6 (0.7) (17.4)
TD 103.6
(13.9)
Goddard, 2014 ASD 51/12 SCQ ASD 12.55 ASD 103.6 WASI A, G, IQ NR NR NA CFT Number of correct responses 20.008
TD 51/12 (2.81) (13.08) CMS Score – visual 0.57
TD 12.10 TD 104.76 JHT Score – verbal 20.03
(2.26) (11.79) Stroop Total score of section B 0.41
TOL Number of correct responses 0.49
WCST Move score 0.58
Number of perseverative errors 0.49
Goldberg, 2005 ASD 13/4 ADI-R/ ASD 10.3 (1.8) ASD 96.5 NR A, G NR 2 SS IED Extra-dimensional stage errors 0.12
TD 21/11 ADOS TD 10.4 (1.5) (15.9) SOC Number of perfect solutions 0.55
TD 112.6 Stroop SCW score (SCWT) 0.11
(12.1) SWM Between-search errors 0.97

Lai et al./Meta-analysis of executive functioning in ASD

Henry, 2014 ASD 24/6 Clinical ASD 10.1 ASD 112.93 WASI A, G, IQ 0 NR NA CFT Number of correct responses 0.44
TD 19/11 (1.47) (16.71) Stroop Reaction time in condition 4 (D- 0.10
TD 10.0 (1.46) TD 115.30 TMT KEFS) 0.89
(14.69) Score in condition 4 (D-KEFS)
Hooper, 2006 ASD 19/4 Clinical ASD 9.59 ASD 97.39 NR A, G NR NR NA Tower Score (NEPSY) 1.17
TD 19/4 (2.29) (15.48)
TD 9.70 (2.28) TD 104.65
(10.44)
Kado, 2012 ASD 39/13 Clinical ASD 9.88 (2.4) ASD 97.7 WISC A, G 0 0 NA WCST Number of perseverative errors 0.75
TD 41/11 TD 9.98 (2.8) (10.1)
TD NR
Kaufmann, 2013 ASD 8/2 ADI-R/ ASD 14.7 (5.0) ASD 102.3 WISC/ A, G, IQ 0 NR NA DMS Number of errors 0.69
TD 8/2 ADOS TD 13.8 (5.3) (15.9) WAIS IED Extra-dimensional stage errors 20.36
TD 109.5 (6.4) SOC Number of unsolved problems 20.034
SWM Total errors 0.37

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 Table 1. Continued

INSAR
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Kawakubo, 2009 ASD 12/2 CARS/clinical ASD 12.7 (3.4) ASD 95.2 (8.4) WISC A, G, IQ NR 10 NR LFT Number of correct responses 20.20
TD 12/2 TD 10.6 (2.8) TD 102.1 (6.5)
Kilincaslan, 2010 ASD 18/3 Clinical ASD 12.44 ASD 105.52 WISC A, G, IQ 9 6 SS CFT Number of correct responses 0.47
TD 15/3 (2.87) (14.74) CPT Commission errors 0.61
TD 11.96 TD 107.27 LFT Number of correct responses 0.76
(2.36) (13.39) Stroop Interference score (correct 0.11
WCST responses) 0.87
Number of perseverative errors
Kimhi, 2014 ASD 25/4 ADI-R/ ASD 4.95 ASD 103.52 WISC/ A, G, IQ NR NR NA TOL Scores based on the number of trials 0.53
TD 26/4 ADOS (0.92) (17.21) WPPSI/ required to solve a problem
TD 4.61 (0.91) TD 107.60 Mullen
(14.13)
Kretschmer, 2014 ASD 18/3 ADI-R/ ASD 10.22 ASD 10.86 WISC A, G, IQ NR NR NA DS Score 0.35
TD 14/7 ADOS (1.55) (2.99)c GNG % of correct responses on no-go 0.48
TD 9.83 (2.36) TD 10.71 trial
(3.75)
Landa, 2005 ASD 19 ADI-R/ ASD 11.01 ASD 109.7 WISC A, G, IQ NR NR NA IED Extra-dimensional stage errors 20.96
TD 19 ADOS (2.89) (15.8) SOC Number of perfect solutions 0.99
TD 11.00 TD 113.4 SWM Between-search errors 0.99
(2.85) (14.34)
Lee, 2009 ASD 9/3 ADI-R/ ASD 10.17 ASD 113.33 NR A, G, IQ NR NR NA GNG Commission errors 0.26
TD 8/4 ADOS (1.57) (17.33)
TD 11.91 TD 114.92
(1.78) (10.28)
Li, 2014 ASD 30/8 CARS/ABC/clinical ASD 9.59 ASD 109.76 Raven A, G, IQ NR NR NA WCST Number of perseverative errors 0.58
TD 31 (2.29) (18.85)
TD 10.20 TD 113.00
(1.53) (15.12)
Loucas, 2010 ASD 16/0 ADI-R/ ASD 14.69 NR NR A NR NR NA NWR Number of correct responses 1.17

Lai et al./Meta-analysis of executive functioning in ASD

TD 17/7 ADOS (0.48)
TD 14.39
(0.35)
Loukusa, 2014 ASD 13/1 ADI-R/ ASD 7.17 NR NR A NR NR NA SR Score 1.35
TD 20/5 ADOS (1.25)
TD 6.58 (1.08)
Mahone, 2006 ASD 23/1 ADOS/ ASD 10.0 (1.6) ASD 99.1 WISC A NR 12 SS LHG Number of correct responses in the 20.051
TD 34/26 ADI-R TD 9.8 (1.4) (16.3) conflict condition
TD 118.2
(10.5)
Maister, 2011 ASD 15/0 ADI-R ASD 11.8 (1.5) ASD 39.7 Raven A, IQ 0 0 NA DMS Number of correct responses 0.37
TD 11/4 TD 11.2 (1.2) (6.1)c NWR Number of correct responses 0.59
TD 40.0 (5.9)

9
 Table 1. Continued

10
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Maister, 2013a ASD 14/0 ADI-R/ ASD 12.2 (0.6) ASD 43.9 Raven A, G, IQ 0 0 NA IED Extra-dimensional stage errors 0.28
TD 13/1 ADOS TD 12.1 (0.2) (6.4)c SSP Score 0.064
TD 46.4 (7.4) Stroop Interference score (correct 20.18
VFT responses) 0.45
Number of correct responses
Maister, 2013b ASD 13/1 ADI-R/ ASD 11.8 (1.4) ASD 41.6 Raven A, G, IQ 0 0 NA IED Extra-dimensional stage errors 0.48
TD 11/3 ADOS TD 11.8 (1.1) (8.3)c SSP Score 0.53
TD 44.3 (6.3)
Mashal, 2012 ASD 32/5 Clinical ASD 13.02 NR NR A, G 0 NR NA CFT Number of correct responses 2.86
TD 16/5 TD 12.09 LFT Number of correct responses 20.087
Matsuura, 2014 ASD 11/0 ADOS/ ASD 12.0 (2.2) ASD 105.6 WISC A, IQ 0 2 SS DMS Number of errors 20.32
TD 12/7 ADI-R TD 11.4 (1.6) (14.3) DS Score 20.22
TD 111.8 LNS Score 20.057
(13.4) SSP Score 0.39
SWM Between-search errors 0.72
May, 2015 ASD 20/20 SRS/clinical ASD 9.62 ASD 100.5 WISC A, G, IQ NR 7 NS FD Score 0.10
TD 20/20 (1.57) (15.1) (PIQ) SR Score 20.055
TD 9.62 (1.34) ASD 100.7
(13.4) (VIQ)
TD 104.8
(14.4) (PIQ)
TD 107.2
(10.5) (VIQ)
Narzisi, 2013 ASD 22/0 Clinical ASD 9.77 ASD 99.09 WISC A, G NR NR NA CFT Number of correct responses 0.43
TD 44/0 (3.65) (14.23) CST Score (D-KEFS) 1.44
TD NR TD NR DFT Score 0.59
LFT Number of correct responses 0.51
NWR Score 0.78
SR Score 1.35
Stroop Switching score (NEPSY) 1.23

Lai et al./Meta-analysis of executive functioning in ASD

WLI Score 1.63
Norbury, 2002 ASD 10 ADOS ASD 8.95 ASD 107.70 Raven A, IQ NR NR NA FD Number of correct responses 1.42
TD 18 (1.31) (15.30) SR Score 2.76
TD 8.56 (0.99) TD 110.83
(10.38)
Nyden, 1999 ASD 10/0 Clinical ASD 10.1 (0.9) ASD 100.7 WISC A, G 0 NR NA WCST Number of categories <.001
TD 10/0 TD 10.0 (0.9) (16.3)
TD NR
Ozonoff, 1994 ASD 13/1 Clinical ASD 12.43 ASD101.9 WISC A, G, IQ NR NR NA GNG Commission errors 0.045
TD 11/3 (2.47) (17.17)
TD 12.15 TD 100.4
(1.73) (13.39)
Ozonoff, 1995a ASD 9/1 CARS/ ASD 11.9 (2.7) ASD 98.1 WISC A, G, IQ NR NR NA WCST Number of perseverative responses 20.071
TD 8/3 clinical TD 11.9 (1.3) (18.2)
TD 99.1 (15.0)

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 Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF

INSAR
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Ozonoff, 1995b ASD 23/1 CARS/ ASD 12.0 (3.1) ASD 97.4 WISC A, G, IQ NR NR NA WCST Number of perseverative responses 0.89
TD 19/5 clinical TD 12.4 (1.5) (17.0)
TD 101.9
(14.8)
Ozonoff, 1999 ASD 40 ADI-R/ ASD 12.6 (3.4) ASD 95.2 WISC A NR NR NA Stroop NR 0.40
TD 29 ADOS TD 12.1 (3.0) (18.8) TOH NR 0.69
TD 107.8 WCST Number of perseverative responses 0.79
(10.8)
Pankert, 2014 ASD 16/1 SCQ/SRS/ ASD 11.6 (1.5) ASD 109.3 WISC A, G, IQ 8 2 SS GNG Commission errors 0.72
TD 12/5 ADOS TD 11.7 (1.2) (17.5)
TD 109.2 (9.9)
Pellicano, 2006 ASD 35/5 ADI-R ASD 5.60 ASD 113.58 Leiter-R A, G, IQ 0 NR NA LHG Number of correct responses in the 0.67
TD 31/9 (0.91) (14.11) Maze conflict condition 0.26
TD 5.48 (0.96) TD 112.52 TOL Score 0.98
(14.47) TBCS Number of problems solved in mini- 0.76
mal number of moves
Number of trials taken
Pellicano, 2010 ASD 40/5 ADI-R ASD 5.66 ASD 113.27 Leiter-R A, G, IQ 2 NR NA TBCS Number of perseverative errors 1.12
TD 37/8 (0.87) (13.93) TOL Number of problems solved in mini- 0.98
TD 5.43 (1.05) TD 115.61 mal number of moves
(16.42)
Perez, 2009 ASD 14/1 Clinical ASD 10.8 (3.4) ASD 111.2 WASI A, IQ NR NR NA CST Number of perseverative errors 0.60
TD 9/7 TD 11.1 (2.6) (15) Stroop Number of errors 0.94
TD 123 (8)
Planche, 2012 ASD 27/3 ADI-R ASD 8.4 ASD 101.8 WISC A, G, IQ NR NR NA Tower Score (NEPSY) 20.041
TD 12/3 TD 9.0 (21.96)
TD 106.02
(8.31)
Prior, 1990 ASD 9/3 Clinical ASD 13.75 ASD 88 Leiter-R A, G NR NR NA Maze Time taken 1.26
TD 9/3 TD 13.75 TD 100 RCFT Recall score 1.12

Lai et al./Meta-analysis of executive functioning in ASD

WCST Number of perseverative errors 0.84
Reinvall, 2013 ASD 20/10 ADI-R ASD 13.5 (1.2) ASD 103.2 WISC A, G NR NR NA DFT Score 0.68
TD 20/10 TD 13.7 (1.0) (10.7)
TD NR
Riches, 2010 ASD 16/0 ADOS/ ASD 14.67 NR WISC A, IQ NR NR NA BD Score 0.82
TD 10/7 ADI-R (5.77) FD Score 0.87
TD 14.33 NWR Number of correct responses 1.14
(4.20)
Robinson, 2009 ASD 42/12 SCQ/clinical ASD 12.54 ASD 103.53 WASI A, G, IQ NR NR NA CFT Number of correct responses 0.11
TD 42/12 (2.80) (10.54) JHT Total score of section B 0.43
TD 12.08 TD 104.80 Stroop Interference score (correct 0.30
(2.36) (9.07) TOL responses) 0.52
WCST Move score 0.38
Number of perseverative errors

11
 12
Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Russell-smith, 2014 ASD 14/3 ADI-R ASD 11.93 PIQ WISC A, G, IQ NR NR NA CST Number of perseverative errors 0.11
TD 16/2 (1.9) ASD 101.6
TD 10.69 (2.3) (14.6)
TD 102.9
(11.7)
VIQ
ASD 101.4
(14.8)
TD 109.6
(14.7)
Salmanian, 2012 ASD 15 Clinical ASD 12.8 ASD 99 Raven A NR NR NA DMS Number of correct responses 1.21
TD 15 (3.23) (11.92) PAL First trial memory score 0.74
TD 10.53 TD 113.47 PRM Number of correct responses 0.76
(3.04) (8.29) SRM Number of correct responses 1.09
Samyn, 2015 ASD 31/0 SRS/clinical ASD 12.83 ASD 101.16 NR A 0 0 NA GNG Commission errors 0.46
TD 95/53 (1.41) (12.48) Stroop Interference score (correct 0.073
TD 12.73 TD 107.21 responses)
(1.48) (11.68)
Sawa, 2013 ASD 17/2 Clinical ASD 13.24 ASD 95.95 NR A, G, IQ 0 NR NA WCST Number of perseverative errors 0.91
TD 17/2 (1.79) (12.83)
TD 13.12 TD 97.32
(1.98) (9.48)
Schneider, 1987 ASD 14/1 K-SADS ASD 10.71 ASD 85.73 WISC A, G NR 1 NS WCST Number of perseverative responses 0.27
TD 22/6 (2.14) (14.56)
TD 11.00 TD NR
(1.72)
Schuh, 2012 ASD 16/2 ADOS/ ASD 12 (3) ASD 105 (10) SB-5 A, G, IQ 0 0 NA FW Score 0.98

Lai et al./Meta-analysis of executive functioning in ASD

TD 14/4 ADI-R TD 13 (2) TD 104 (10) LNS Score 0.39
NWR Score 1.24
Schurink, 2012 ASD 19/9 CSBQ/clinical ASD 10.5 ASD 81.4 NR A, G 0 NR NA TOL Scores based on the number of trials 0.59
TD 19/9 (1.42) (8.44) required to solve a problem
TD 10.42 TD NR
(1.25)
Semrud-Clikeman, 2010 ASD 8/7 Clinical ASD 10.6 (2.6) ASD 100.8 WASI A, G, IQ NR NR NA Stroop Reaction time in condition 4 (D- 0.47
TD 23/9 TD 9.8 (2.1) (13.0) Tower KEFS) 0.80
TD 109.4 Rule violation score (D-KEFS)
(10.0)
Semrud-Clikeman, 2014 ASD 30/6 ADI-R ASD 12.8 (2.6) ASD 102.9 WASI A, G NR NR NA CST Score (D-KEFS) 0.58
TD 24/14 TD 13.1 (2.6) (16.0) TMT Score in condition 4 (D-KEFS) 1.02
TD 113.0
(10.9)

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INSAR
Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Sinzig, 2008 ASD 35/5 ADI-R/ ASD 12.6 (3.5) ASD 108 CFIT A, G 20 7 SA GNG Commission errors 0.15
TD 14/6 ADOS TD 13.1 (3.0) (16.0) IED Extra-dimensional stage errors 0.11
TD 113 (11.9) SOC Number of perfect solutions 20.22
SWM Between-search errors 0.57
Sinzig, 2014 ASD 26/0 ADI-R/ ASD 6.7 ASD 90.5 KAB-C A 17 9 NR GNG Commission errors 0.78
TD 11/19 ADOS 0(1.18) (13.5)
TD 5.19 (1.10) TD 107.4 (8.1)
Stieglitz, 2011 ASD 17/2 ADOS/SCQ ASD 12.1 (2.4) ASD 106.0 WASI A, G, IQ 0 NR NA DS Score 0.39
TD 21/2 TD 12.0 (2.1) (21.0)
TD 111.4
(16.5)
Terrett, 2013 ASD 23/7 SCQ/clinical ASD 9.50 ASD 115.63 NR A, G, IQ NR NR NA Stroop Switching score (NEPSY) 20.12
TD 21/9 (1.31) (16.8)
TD 9.73 (1.02) TD 116.57
(17.26)
Tye, 2014 ASD 48/0 ADI-R/ ASD 10.99 ASD 112.08 WASI A, IQ 29 6 SS CPT Commission errors 0.32
TD 26/0 ADOS (1.77) (14.51)
TD 10.56 TD 120.04
(1.79) (13.42)
Unterrainer, 2016 ASD 41/0 ADI-R/ ASD 10.16 ASD 98.07 Raven A, G, IQ 23 14 SS TOL Number of problems solved in mini- 20.085
TD 42/0 ADOS (2.20) (14.19) mal number of moves
TD 9.76 (2.36) TD 97.59
(13.86)
Urbain, 2015 ASD 16/4 ADOS ASD 11.25 ASD 108.25 WASI A, G, IQ NR NR NA NBT Percentage of correct responses 0.46
TD 13/7 (1.58) (14.31)
TD 11.26 TD 115.95
(1.64) (10.97)

Lai et al./Meta-analysis of executive functioning in ASD

van Eylen, 2011 ASD 36/4 3DI/clinical ASD 11.33 ASD 105.45 WISC A, G, IQ 0 0 NA WCST Number of perseverative errors 0.52
TD 36/4 (2.18) (12.34)
TD 11.13 TD 106.76
(2.22) (9.04)
van Eylen, 2015 ASD 30/20 3DI/clinical ASD 12.21 ASD 104.32 WISC A, G, IQ 7 6 NS BT Spatial span 0.31
TD 30/20 (2.58) (10.83) DFT Number of correct responses 0.24
TD 12.48 TD 107.72 GNG Commission errors 0.50
(2.72) (9.30) SWM Total errors 0.35
Tower Move accuracy ratio (D-KEFS) 0.22
WCST Number of perseverative errors 0.63
UCO Number of correct responses 0.66
Vanegas, 2015 ASD 21/3 ASQ/SRS ASD 9.70 ASD 100.29 Raven G 5 NR NA WCST Number of perseverative errors 0.49
TD 18/7 (1.35) (15.09)
TD 8.86 (1.09) TD 110.12
(14.59)

13
 14
Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Vara, 2014 ASD 12/3 ADI-R/ ASD 15.5 (1.2) ASD 103.8 WASI A, G NR 0 NA GNG Commission errors 0.62
TD 12/3 ADOS TD 15.6 (1.3) (13.6)
TD 112.4
(10.3)
Verte, 2006 ASD 99/13 ADI-R ASD 8.6 (1.9) ASD 100.5 WISC A, G, IQ 32 NR NA BT Spatial span 0.69
TD 40/7 TD 9.4 (1.6) (16.6) BVRT Number of correct responses 0.86
TD 112.1 (9.7) CFT Number of correct responses 0.93
LFT Number of correct responses 0.69
OW Time difference 0.35
SOPT Number of errors 0.65
TOL Scores based on the number of trials 1.34
WCST required to solve a problem 0.81
Number of perseverative responses
Voelbel, 2006 ASD 38/0 ADI-R ASD 10.16 ASD 99.37 WISC A, G 18 20 NS CFT Number of correct responses 0.50
TD 13/0 (1.92) (16.08) LFT Number of correct responses 0.068
TD 10.77 TD 115.15 Stroop SCW score (SCWT) 0.85
(1.48) (9.41) TMT Time taken in part b 0.96
WCST Number of perseverative errors 0.44
Vogan, 2014 ASD 16/3 ADOS ASD 11.05 ASD 109.42 WASI A, G, IQ NR 6 NS BD Score 0.74
TD 13/4 (1.43) (15.72) BT Spatial span 0.49
TD 11.12 TD 115.35 FD Score 0.46
(2.00) (9.27)
Weissman, 2010 ASD 52/3 ADI-R ASD 9.89 ASD 49.90 WISC A 19 43 NS CPT Commission errors 20.42
TD 19/8 (2.03) (9.73)c Stroop SCW score (SCWT) 0.41
TD 10.48 TD 58.36 (7.6)
(1.76)
Williams, 2005 ASD 22/2 ADOS/ ASD 11.75 ASD 109.67 WISC A, G, IQ NR NR NA FW Score 0.57

Lai et al./Meta-analysis of executive functioning in ASD

TD 33/11 ADI-R (2.36) (16.07) LNS Score 0.11
TD 12.39 TD 109.95 NBT Reaction time to hits 0.32
(2.16) (10.66)
Williams, 2006a ASD 46/10 ADOS/ ASD 11.36 ASD 104.13 WISC A, G, IQ NR NR NA DM Score 0.71
TD 39/17 ADI-R (2.18) (15.09) DS Score 0.23
TD 11.82 TD 107.50 FW Score 0.77
(2.20) (8.21) LFT Number of correct responses 0.17
PM Score 0.50
Williams, 2006b ASD 38 ADI-R/ ASD 11.68 ASD 103.82 WISC A, G, IQ NR 25 NS DM Score 0.62
TD 38 ADOS (2.46) (14.29) DS Score 0.20
TD 12.16 TD 107.18 FW Score 0.71
(2.19) (9.37) LNS Score 0.22
PM Score 0.46
SR Score 0.49

INSAR
 Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF

INSAR
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Williams, 2013 ASD 21 3DI/SRS/clinical ASD 10.60 VIQ WASI A, IQ 0 NR NA WCST Number of perseverative errors 0.83
TD 21 (2.01) ASD 103.57
TD 10.59 (17.88)
(1.31) TD 106.48
(14.01)
PIQ
ASD 110.19
(16.35)
TD 107.48
(13.23)
Winsler, 2007 ASD 32/1 Clinical ASD 11.0 (2.3) ASD 107.07 NR A NR 19 SS WCST Number of perseverative errors 0.63
TD 19/9 TD 10.3 (3.2) (14.82)
TD NR
Xiao, 2012 ASD 19/0 ADI-R ASD 10.11 ASD 99.26 WISC A, G, IQ 0 NR NA GNG Commission errors 0.87
TD 16/0 (2.08) (9.03) Stroop Number of errors 0.34
TD 9.69 (1.74) TD 105.63
(13.12)
Yasumura, 2014 ASD 7/4 ADOS/ ASD 10.51 ASD 30.70 Raven A, G, IQ NR NR NA Stroop Interference score (correct 0.23
TD 6/9 ADI-R (2.30) (2.41)c Reversed stroop responses) 20.090
TD 9.56 (1.51) TD 29.47 Interference score (correct
(4.05) responses)
Yerys, 2009a ASD 38/11 ADI-R/ADOS ASD 9.68 ASD 114.75 WISC A, G, IQ 21 7 SS BD Score 0.58
TD 13/8 (1.90) (16.80) SWM Between-search errors 0.57
TD 10.30 TD 116.24 WDW Score 0.45
(1.76) (11.53)
Yerys, 2009b ASD 33/9 ADOS/ ASD 10.19 ASD 111.95 WASI/WISC A, G, IQ NR 2 SS IED Extra-dimensional stage errors 0.41
TD 65/19 ADI-R (2.00) (18.04)
TD 10.26 TD 113.18
(2.08) (11.94)
Yerys, 2011 ASD 21/7 ADOS/ ASD 10.89 ASD 113.86 WISC A, G, IQ NR 5 SS CTT Score 2.52

Lai et al./Meta-analysis of executive functioning in ASD

TD 13/5 ADI-R (1.50) (15.49)
TD 11.07 TD 118.89
(1.32) (12.94)
Yoran-Hegesh, 2009 ASD 23/0 Clinical ASD 15.1 (3.6) NR NR A, G NR 0 NA Stroop Number of correct responses 0.22
TD 43/0 TD 15.5 (0.6)
Zandt, 2009 ASD 16/3 Clinical ASD 10.97 VIQ WISC A, IQ NR 5 NS VFT Number of correct responses 0.96
TD 6/12 (2.42) ASD 96.45 WDW Score 0.40
TD 11.94 (14.71)
(2.74) TD 94.89
(9.28)
PIQ
ASD 95.38
(19.96)
TD 102.72
(12.15)

15
 16
Table 1. Continued
Study Sample size Diagnostic Mean age Mean IQ EF
(1st author, year) (Male/Female) method M (SD) M (SD) IQ Ax Matching ADHDa Medb MS assessment Variable ES

Zinke, 2010 ASD 13/2 ADOS/ ASD 9.0 (1.5) ASD 96.4 WISC A, G NR 7 NS BT Spatial span 1.14
TD 14/3 ADI-R TD 9.8 (1.7) (14.5) FD Longest sequence 0.64
TD NR TOL Number of problems solved in mini- 0.95
mal number of moves

a
Number of subjects with comorbid ADHD in the ASD sample.
b
Number of medicated subjects in the ASD sample, irrespective of what the medications were and whether the medications were discontinued at the time of testing.
c
The reported IQ scores were on different scales.
General abbreviations: A 5 Age; G 5 Gender; NR 5 Not recorded; M 5 Mean; SD 5 Standard Deviation; IQ Ax 5 Method of IQ assessment; MS 5 Medication status (NS 5 Not stopped; SS 5 Stopped
stimulant; SA 5 Stopped all medications; NA 5 Not applicable); EF 5 Executive functioning; ADHD 5 Attention-deficit/hyperactivity Disorder; ASD 5 Autism Spectrum Disorder.
Abbreviations for diagnostic methods: 3DI 5 The Developmental, Dimensional and Diagnostic Interview; ABC 5 Aberrant Behavior Checklist; ADI-R 5 Autism Diagnostic Interview-Revised;
ADOS 5 Autism Diagnostic Observation Schedule; AQ 5 Autism Spectrum Quotient; CARS 5 Childhood Autism Rating Scale; CCC 5 Children’s Communication Checklist; CSBQ 5 Children’s Social Behavior
Questionnaire; KSADS-PL 5 Kiddie-Sads-Present and Lifetime Version; SCQ 5 Social Communication Questionnaire; SRS 5 Social Responsiveness Scale.
Abbreviations for inhibition assessments: CPT 5 Continuous Performance Test; GNG 5 Go-No-Go; JHT 5 Junior Hayling Test; LHG 5 Luria’s Hand Game; OW 5 Opposite World; Stroop 5 Stroop
Color Word Test; TEA-Ch 5 Test of Everyday Attention for Children; WDW 5 Walk-Don’t-Walk.
Abbreviations for verbal working memory assessments: BD 5 Backward Digit Span; CTT 5 Consonant Trigrams Test; DS 5 Digit Span; FD 5 Forward Digit Span; HVLT 5 Hopkin’s Verbal Learning
Test; LNS 5 Letter Number Sequencing; SR 5 Sentence repetition; WLI 5 Word list interference; WMTB 5 Working Memory Test Battery for Children.
Abbreviations for spatial working memory assessments: BT 5 Block Tapping; BVRT 5 Benton Visual Retention Test; DM 5 Designs Memory; DMS 5 Delayed Matching to Sample; FW 5 Fingers
Window; NBT 5 N-Back Task; PAL 5 Paired Associates Learning (CANTAB); PM 5 Picture Memory; PRM 5 Pattern Recognition Memory (CANTAB); RCFT 5 Rey Complex Figure Test; SRM 5 Spatial Recogni-
tion Memory (CANTAB); SSP 5 Spatial Span Test (CANTAB); SWM 5 Spatial Working Memory (CANTAB); SOPT 5 Self-ordered Pointing Test.
Abbreviations for flexibility assessments: CCTT 5 Children’s Color Trails Test; CST 5 Card Sorting Test; IED 5 Intra/Extra-Dimensional Shift; TBCS 5 Teddy Bear Card Sorting Test; TMT 5 Trails
Making Test; WCST 5 Wisconsin Card Sorting Test.
Abbreviations for planning assessments: SOC 5 Stockings of Cambridge; TOH 5 Tower of Hanoi; TOL 5 Tower of London.
Abbreviations for generativity assessments: DFT 5 Design Fluency Test; LFT 5 Letter Fluency Test; UCO 5 Use of Common Objects; VFT 5 Verbal Fluency Test.
Abbreviations for batteries: CMS 5 Children’s Memory Scale; CANTAB 5 Cambridge Neuropsychological Test Automated Battery; DKEFS 5 Delis-Kaplan Executive Function System; NEPSY 5 A Devel-
opmental Neuropsychological Assessment; WRAML 5 Wide Range Assessment of Memory and Learning.
Abbreviations for IQ assessments: CFIT 5 Culture Fair Intelligence Test; DAS 5 Differential Ability Scales; KAB-C 5 Kaufman Assessment Battery for Children; Mullen 5 Mullen Scales of Early

Lai et al./Meta-analysis of executive functioning in ASD

Learning; LIP-R 5 Leiter International Performance Scale – Revised; PPVT 5 Peabody Picture Vocabulary Test; Raven 5 Raven’s Progressive Matrices; SB-4/5 5 Stanford-Binet Intelligence Scales-Fourth
or Fifth Edition; SON-R 5 Snijders-Oomen Nonverbal Intelligence Scale–Revised; TONI 5 Test of Nonverbal Intelligence; WAIS 5 Wechsler Adult Intelligence Scale; WASI 5 Wechsler Abbreviated Scale
of Intelligence; WISC 5 Wechsler Intelligence Scale for Children; WPPSI 5 Wechsler Preschool and Primary Scale of Intelligence.

INSAR
Table 2. Summary of Results
95% CI Heterogeneity test Publication bias
Measure N (ASD/TD) k g LL UL SE Z P Q I2 T&F gadj NFs

INHIBITION
Continuous Performance Test 488/316 5 0.20 20.16 0.55 0.18 1.10 0.28 13.07* 69.40 Nil NA 6
Go-No-Go 302/403 13 0.49 0.33 0.64 0.080 6.07 <.001 6.52 0.00 Nil NA 106
Opposite World 167/106 3 0.59 0.11 1.06 0.24 2.42 0.015 5.83# 65.71 Nil NA 11
Stroop 590/781 22 0.39 0.22 0.57 0.088 4.50 <.001 46.38** 54.72 Nil NA 234
Walk-Don’t-Walk 74/57 3 0.58 0.18 0.98 0.20 2.87 0.004 2.29 12.84 Nil NA 6
Inhibition Composite 1,534/1,517 42 0.41 0.31 0.51 0.050 8.22 <.001 61.34* 33.16 Nil NA 1,110
VERBAL WORKING MEMORY
Non-Word Repetition 113/147 7 0.96 0.70 1.21 0.13 7.25 <.001 4.17 0.00 R1 0.92 90
Digit Span 429/440 19 0.46 0.25 0.68 0.11 4.28 <.001 41.19** 56.30 Nil NA 187
Letter-Number Sequencing 188/239 7 0.54 0.13 0.96 0.21 2.56 0.011 25.71** 76.66 Nil NA 48
Sentence repetition 124/165 5 1.09 0.31 1.87 0.40 2.75 0.006 36.01*** 88.89 Nil NA 59
Verbal WM Composite 728/811 30 0.67 0.45 0.88 0.11 6.14 <.001 114.33*** 74.74 Nil NA 1,018
SPATIAL WORKING MEMORY
Block Tapping 321/267 7 0.65 0.46 0.84 0.097 6.70 <.001 6.06 1.05 R2 0.60 79
Delayed Match to Sample 51/59 4 0.48 20.16 1.12 0.33 1.46 0.14 8.46* 64.52 Nil NA 3
Rey Complex Figure Test 44/52 3 1.13 0.31 1.95 0.42 2.69 0.007 6.97* 71.30 Nil NA 17
SSP (CANTAB) 57/65 4 0.55 0.08 1.01 0.24 2.31 0.021 5.00 40.05 L1 0.71 6
SWM (CANTAB) 214/189 8 0.67 0.45 0.90 0.12 5.82 <.001 8.29 15.51 Nil NA 80
Finger Windows 126/144 4 0.73 0.49 0.98 0.13 5.82 <.001 0.93 0.00 R1 0.69 32
N-Back Task 146/152 5 0.099 20.17 0.36 0.14 0.73 0.46 4.82 17.03 Nil NA 0
Spatial WM Composite 816/738 28 0.58 0.45 0.71 0.070 8.56 <.001 41.04* 34.21 R6 0.48 809
FLEXIBILITY
Card Sorting Task 168/189 6 0.79 0.44 1.13 0.18 4.47 <.001 12.16* 58.87 L1 0.90 71
IED (CANTAB) 164/201 8 0.090 20.18 0.36 0.14 0.65 0.51 10.46 33.07 Nil NA 0
Trail Making Test 134/120 5 1.03 0.76 1.29 0.14 7.58 <.001 0.87 0.00 Nil NA 70
Wisconsin Card Sorting 739/641 21 0.62 0.51 0.73 0.056 11.16 <.001 16.49 0.00 R1 0.61 600
Flexibility Composite 1,112/1,080 37 0.59 0.48 0.71 0.058 10.17 <.001 58.77* 38.74 Nil NA 1,531
PLANNING
Stocking of Cambridge 104/99 5 0.43 20.061 0.93 0.25 1.72 0.086 11.64* 65.63 Nil NA 6
Tower of London and variants 577/518 14 0.67 0.42 0.92 0.02 5.17 <.001 52.42*** 75.20 Nil NA 373
Planning Composite 733/658 21 0.62 0.42 0.83 0.11 5.93 <.001 66.36*** 69.86 Nil NA 609
GENERATIVITY
Verbal Fluency 663/593 20 0.59 0.40 0.78 0.095 6.16 <.001 45.74** 58.46 R4 0.46 445
Design Fluency 132/184 4 0.35 0.054 0.65 0.15 2.31 0.021 5.04 40.50 R1 0.25 6
Use of Common Objects 103/107 3 1.03 0.50 1.56 0.27 3.79 <.001 6.17* 67.56 Nil NA 33
Generativity Composite 757/691 23 0.60 0.43 0.78 0.089 6.75 <.001 53.44*** 58.83 R4 0.49 624

Note. Only tasks utilised by more than three studies are listed in this table. SSP 5 Spatial span task of CANTAB; SWM 5 Spatial Working Memory
task of CANTAB; IED 5 Intra-extra Dimesntional Set-shifting task; CANTAB 5 Cambridge Neuropsychological Test Automated Battery; N 5 Number of
subjects; k 5 Number of studies; g 5 Hedges’s g; LL 5 Lower limit; UL 5 Upper limit; CI 5 Confident interval; SE 5 Standard error; Z 5 Z value; P 5 P-
value; Q 5 Q statistics; T&F 5 Trim and fill test; gadj 5 Adjusted Hedges’s g; NFs 5 Number of studies needed to nullify results in fail-safe N test;
Nil 5 No articles were trimmed by T&F; L 5 Studies were trimmed to the left of the mean with the number of articles trimmed denoted by the follow-
ing digit; R 5 Studies were trimmed to the right of the mean with the number of articles trimmed denoted by the following digit; NA 5 Not applica-
ble. Other abbreviations are listed under Table 1.
# P < .10; *P < .05; **P < .01; ***P < .001.

weighted mean effect sizes 0.48 and 0.49, respectively,
on subsequent incorporation of hypothetical missing
studies. The Fail-safe N test showed that 609 to 1,531
negative articles had to be identified to render the effect
sizes non-significant.
Discussion
This is the first meta-analysis conducted to examine the
profile of executive function in children and
adolescents with high-functioning ASD across six major
components of executive function. It is also the first
meta-analysis to examine the impact of comorbid
ADHD on the expression of executive function deficits
in ASD. Positive weighted mean effect sizes were found
across all components of executive function. In particu-
lar, the impairment of verbal working memory, spatial
working memory, flexibility, and generativity were evi-
dent irrespective of whether comorbid ADHD was
excluded or whether an IQ-matched control group was
used.

INSAR Lai et al./Meta-analysis of executive functioning in ASD 17

Figure 2. Forest plot of included tests and composites. Items in boldface are composite scores. g 5 Hedges’s g; CI 5 Confidence
interval. CPT 5 Continuous Performance Test; GNG 5 Go-No-Go Test; WDW 5 Walk-Don’t-Walk Test; NWR 5 Non-word Repetition;
DS 5 Digit Span; LNS 5 Letter Number Sequencing; SR 5 Sentence Repetition; BT 5 Block Tapping; DMS 5 Delayed Match to Sample;
RCFT 5 Rey’s Complex Figure Test; SSP 5 Spatial Span task of CANTAB; SWM 5 Spatial Working Memory task of CANTAB; FW 5 Finger
Windows; NBT 5 N-Back Task; CST 5 Card-sorting Test; IED 5 Intra-extra Dimensional Set-shifting; TMT 5 Trail Making Test;
WCST 5 Wisconsin Card Sorting Test; SOC 5 Stockings of Cambridge; TOL 5 Tower of London; VFT 5 Verbal Fluency Test; DFT 5 Design
Fluency Test; UCO 5 Use of Common Objects.

Working Memory, Flexibility, and Generativity as Core
Deficits
The pooled effect size of verbal working memory (g 5.
67) was comparable to that of spatial working memory
(g 5 0.58) as a whole. The results were similar when
considering the subgroups excluding co-morbid ADHD
(g 5 0.53 for verbal; g 5 0.51 for spatial) or participants
with matched IQ (g 5 0.56 for verbal; g 5 0.50 for spa-
tial). This suggests the absence of differential impair-
ment of these constructs, in contrast to the postulation
by some of the researchers [Cui, Gao, Chen, Zou, &
Wang, 2010; Williams, Goldstein, Carpenter, & Min-
shew, 2005]. Moreover, the fact that the impairments
of both components in either condition in the sub-
group analyses were of at least medium magnitude sug-
gests that these impairments were not solely explained
by the effect of comorbid ADHD and IQ. When consid-
ering the results of individual tests, there was consider-
able variability in the effect sizes. In the verbal working
memory component, more impairment was elicited by
the Sentence Repetition task and the Non-Word Repeti-
tion task. Compared with other verbal working memory
tasks (such as the digit span task and the letter-number
sequencing task), these two tasks place high demand on
language ability [Conti-Ramsden, Botting, & Faragher,
2001]. Given that individuals with ASD often have
communication difficulties, encompassing syntax, pho-
nological skills, and communications skills [Bartak, Rut-
ter, & Cox, 1975], it is difficult to distinguish whether
poor performance on these tasks actually reflects execu-
tive dysfunction or poor language skills [Joseph,
McGrath, & Tager-Flusberg, 2005]. Conversely, in the

18 Lai et al./Meta-analysis of executive functioning in ASD INSAR

spatial working memory construct, more impairment complex the task is and the more information is being
was elicited by the Rey Complex Figure Test than other processed, the higher the demand is placed on the
tests (such as the self-ordered pointing test or the memory system such that the deficits will emerge. The
delayed matching to sample test) that simply assess rec- N-Back task yielded the smallest pooled effect size
ognition of previously seen images. The Rey Complex (g 5 0.099), which was not statistically significant. Of
Figure Test tests recall rather than recognition, and the five studies that adopted the N-Back task, four
recall is considered to place higher demand on working reported difficulties in task completion in both individ-
memory than recognition [Craik & McDowd, 1987]. uals with ASD and control participants, resulting in
This is consistent with theoretical models of working either exclusion of such participants [Cui et al., 2010;
memory, such as the information processing model de Vries & Geurts, 2014; Urbain, Pang, & Taylor, 2015]
[Just & Carpenter, 1992] and the central executive mod- or removal as outliers on analysis [Williams et al.,
el [Baddeley, 1986], both of which posit that the more 2005]. This might have introduced biases into the
assessment.
Consistent with Leung and Zakzanis [2014]’s meta-
Table 3. Subgroup Analysis of Exclusion of Comorbid ADHD
analysis, our findings in the component of flexibility
ADHD excluded showed considerable variability of effect sizes when a
k ASD TD g Q I2 sample of children and adolescents with high-
functioning ASD was considered. The least impairment
Inhibition 11 242 371 0.32** 7.34 0.00
Verbal Working Memory 8 142 156 0.53** 8.36 16.22 was captured by the IED task of the CANTAB
Spatial Working Memory 11 179 193 0.50*** 10.06 0.59 (g 5 0.090). Geurts et al. [2009] pointed out several diffi-
Flexibility 13 293 307 0.61*** 15.14 20.73 culties associated with this task, and suggested that fail-
Planning 5 116 140 0.24 7.41 46.04 ure to complete the stages in the IED task actually
Generativity 5 104 102 0.68** 7.32 45.39
reflects difficulties in sustaining attention rather than
Note. Qbet 5 Q between; P 5 P-value; k 5 Number of studies; deficits in flexibility, because the part capturing flexibil-
g 5 Hedges’s g. ity only occurs in the last part of the test and not
*P < .05; **P < .01; ***P < .001. throughout the test, contrary to the WCST. Moreover,
Landa and Goldberg [2005] utilised the IED task but did
not code the errors in the conventional manner by
Table 4. Subgroup Analysis of Matching Strategies entering 25 errors for each stage failed and excluded
Matched IQ participants who failed in the analysis. The variable
k ASD TD g Q I2 scoring system in the IED might have contributed to
the negative effect size (g 5 20.96) found by Landa and
Inhibition 28 795 772 0.40*** 30.64 11.88
Goldberg [2005], and might have introduced biases in
Verbal Working Memory 25 646 691 0.56*** 92.00*** 73.91
Spatial Working Memory 21 658 583 0.49*** 28.60# 30.06 the pooled results in our findings.
Flexibility 23 713 688 0.57*** 37.41* 41.18 In the generativity construct, the effect size was actu-
Planning 12 499 438 0.59*** 49.24*** 77.66 ally larger when comorbid ADHD was excluded. Overall
Generativity 17 571 524 0.52*** 36.30** 55.92 autistic participants produced fewer correct responses
on the Verbal Fluency tasks, named fewer de novo uses
Note. Qbet 5 Q between; P 5 P-value; k 5 Number of studies;
g 5 Hedges’s g. in the Use of Common Object task and created fewer
#P < .10; *P < .05; **P < .01; ***P < .001. designs in the Design Fluency task. Impairment was
more marked when the dependent outcome was verbal,

Table 5. Summary Table of the Results of Meta-Regression

Mean age Mean IQ % Male % Med
k B SE P k B SE P k B SE P k B SE P

Inhibition 42 20.027 0.026 0.30 17 20.011 0.011 0.31 32 0.35 0.48 0.47 21 0.006 0.005 0.24
Verbal Working Memory 30 20.018 0.057 0.75 13 0.038 0.036 0.30 21 0.94 1.18 0.42 15 20.009 0.008 0.22
Spatial Working Memory 28 20.028 0.042 0.51 14 20.018 0.019 0.33 21 20.062 0.58 0.92 16 0.004 0.006 0.53
Flexibility 36 20.062 0.029 0.031 14 20.0064 0.017 0.71 30 0.60 0.65 0.35 13 0.003 0.004 0.40
Planning 21 20.059 0.040 0.13 9 2<0.001 0.064 0.99 18 20.39 1.02 0.70 5 0.023 0.014 0.098
Generativity 22 20.073 0.050 0.14 11 20.0083 0.020 0.67 19 0.88 0.76 0.25 9 20.004 0.008 0.59

Note. k 5 Number of studies; B 5 Regression coefficient; SE 5 Standard error of the slope; P 5 P-value; % Male 5 Percentage of male in the ASD
sample; % Med 5 Percentage of medicated subjects in the ASD sample.

INSAR Lai et al./Meta-analysis of executive functioning in ASD 19

Figure 3. Funnel plot of inhibition.
Figure 4. Funnel plot of verbal working memory.
Figure 5. Funnel plot of spatial working memory.
as in the Verbal Fluency and Use of Common Object
tasks, but still existed when it was non-verbal, as in the
Design Fluency task. This may suggest that the genera-
tivity impairment is further exacerbated when demand
is placed on the participants’ communicative abilities as
suggested by Bishop and Norbury [2005a].
Inhibition and planning were both shown to be
impaired in ADHD [Willcutt et al., 2005]. This meta-
analysis demonstrated that the effect sizes of inhibition
and planning were of small to medium magnitude
when the subgroup of participants without co-morbid
20 Lai et al./Meta-analysis of executive functioning in ASD
Figure 6. Funnel plot of flexibility.
Figure 7. Funnel plot of planning.
Figure 8. Funnel plot of generativity.
ADHD was considered. Apparently, our finding suggests
that inhibition and planning are not the most promi-
nent deficits in ASD. Friedman and Miyake [2004]
argued that inhibition is not a unitary construct but a
constellation of three different functions, including pre-
potent response inhibition, resistance to distractor
interference and resistance to proactive interference.
However, our meta-analysis did not separately analyse
these different types of inhibition, and also excluded
several experimental paradigms which specifically mea-
sure interference controls (such as the Flanker Task and
INSAR
the Simon Task) or prepotent response inhibition (such
as the Stop Signal Task). Notably, different types of
inhibition could be impaired variably among ASD indi-
viduals. Geurts et al. [2014] concluded a weighted
mean effect size of 0.55 for deficits in prepotent
response inhibition deficit, but a weighted mean effect
size of 0.31 for deficits in interference control in ASD
individuals. Therefore, our findings regarding compo-
nent of inhibition must be interpreted in the context of
these factors carefully.
Unexplained Heterogeneity
Heterogeneity was in general small, except for the plan-
ning and generativity component, when the subgroup
of ADHD-excluded samples was analysed. This finding
lends support to our hypothesis that comorbid ADHD
serves as a significant confounder to the profile of exec-
utive dysfunction in ASD. However, there was still con-
siderable heterogeneity when a subgroup of studies
with IQ-matched samples was used. Apart from the
effect of comorbid ADHD, the heterogeneity may also
have resulted from the variability in matching strategies
within this group, since studies with performance-IQ-
matched, verbal-IQ-matched or full-scale-IQ-matched
samples were all considered as IQ-matched in this
study. Moreover, it should be borne in mind that com-
ponents of executive function are unlikely to be homo-
geneous. For instance, ASD individuals could be
impaired variably in different types of inhibition
[Geurts et al., 2014]. In our meta-analysis, conflating
different types of inhibition and treating them as a uni-
tary construct might have contributed to heterogeneity
between studies which examined the component of
inhibition.
Implications
Our meta-analysis provided strong evidence for substan-
tial executive dysfunctions across different components
in children and adolescents with high-functioning
autism spectrum disorder (HFASD). These impairments
in working memory, flexibility and generativity exist
even in ASD individuals without comorbid ADHD. Our
findings enable us to better understand the behavioural
characteristics observed in these individuals, and call
for more research on devising cognitive remediation
strategies for these individuals. Executive function has
been shown to be closely linked to academic success
[Blair & Razza, 2007], adult outcomes [Eakin et al.,
2004; Prince et al., 2007] and adaptive functioning
[Pugliese et al., 2015]. There is evidence in the literature
that suggests that computerised training and strategies-
based interventions could either improve executive
function or alleviate deficits in typically developing
individuals and other clinical populations, and support
INSAR Lai et al./Meta-analysis of executive functioning in ASD
the notion that working memory and flexibility are
malleable [Karbach & Unger, 2014]. Moreover, it has
been postulated that clinical populations who are more
impaired in executive functions could benefit most
from EF training [Titz & Karbach, 2014]. There is a
growing body of evidence for training of executive
function in individuals with HFASD [Fisher & Happe,
2005; Kenworthy et al., 2013; Kouijzer, de Moor, Ger-
rits, Congedo, & van Schie, 2009]. In view of our meta-
analytic findings, more studies on how these specific
deficits can be remediated in the future are indicated.
Limitations and Future Research Direction
Twenty studies were excluded from this meta-analysis
because the authors of the studies could not be con-
tacted for additional information that was necessary
either for assessment of eligibility of inclusion or for
computation of effect sizes. Importantly, these excluded
studies likely contributed to non-random bias, and
reduced the number of studies available for meta-
analysis.
Moreover, the exclusion of experimental paradigms
and the arbitrariness of our choice of variables listed in
Table 1 are also limitations of this study. This variabili-
ty of measurements has plagued much of the literature
and might have contributed to conflicting results.
Geurts et al. [2004] had attempted to identify which
variable that a single executive function paradigm gen-
erates would be the most representative, by using both
theory-driven and statistical methods. However, it was
not feasible for us to do so, because we did not have
the raw data of each individual studies. We also fol-
lowed a pre-defined inclusion list of executive function
tasks according to Lezak [2012]’s and Strauss et al.
[2006]’s authoritative text, to reduce authors’ biases in
task selection.
Moreover, the meta-analytic method only captures
the quantitative aspects of previous research findings,
and do not necessarily reflect the quality or significance
of the individual studies, which might vary consider-
ably, because of differences in experimental paradigms
and study design [Walker, Hernandez, & Kattan, 2008].
One significant limitation of our meta-analysis is that
it is difficult to ascertain whether working memory,
flexibility, and generativity are core deficits in individu-
als with ASD who often have impaired language ability
and poor understanding of verbal instructions. In fact,
individuals with specific language impairment (SLI) but
not ASD have also been found to have executive dys-
functions [Bishop & Norbury, 2005a; Marton, 2008;
Marton & Schwartz, 2003; Montgomery, 2000; Spauld-
ing, 2010]. This confound should be addressed using
more sophisticated methods, such as direct comparison
of individuals with ASD with individuals with SLI
21
[Bishop & Norbury, 2005a,b; Liss et al., 2001], and co-
variating language ability in the analysis [Joseph et al.,
2005].
While DSM-IV-TR specifically defined ASD and ADHD
as mutually exclusive diagnostic entities [American Psy-
chiatric Association, 2000], DSM-5 no longer made this
distinction. Therefore, comorbidity as such could be
conceptualised as the ASD-ADHD continuum/spectrum,
with pure form of ASD and pure form of ADHD situat-
ing on the two opposite ends. Our findings provide a
robust profiling of executive deficits in ASD individuals
without comorbid ADHD. However, the profile of defi-
cits in individuals with ASD and comorbid ADHD could
not be ascertained by this meta-analysis due to the
insufficient number of studies focusing exclusively on
ASD participants with comorbid ADHD. With the
implementation of DSM-V, it is expected that more
studies examining this subgroup of autistic individuals
may be conducted, so that future meta-analysis could
address this issue. At the other end of the spectrum,
whether the demonstrated executive dysfunction in
ADHD could be partially explained by co-occurring ASD
remains unclear. Therefore, future meta-analysis of defi-
cits in executive function in ADHD should also take
ASD symptoms into consideration.
It was shown in the meta-regression that there would
be a reduction of effect size by 0.062 in the flexibility
component for each year of increase in mean age, but
not in other components. This finding suggests that
older individuals with ASD may exhibit less severe defi-
cits in flexibility than younger individuals with ASD in
their childhood and adolescence. The lack of reduction
of deficits in other components appears to suggest that
other executive components in ASD individuals are rel-
atively static in childhood and adolescence, as postulat-
ed by some researchers [Christ, Holt, White, & Green,
2007; Luna, Doll, Hegedus, Minshew, & Sweeney,
2006]. However, meta-regression analyses group-rather
than individual-level variables, and thus is not sensitive
in assessing individual differences in developmental tra-
jectory of executive functions. Given this limitation of
our findings, future studies should adopt a longitudinal
approach to delineate the differential development of
executive function in ASD.
Conclusions
This meta-analysis demonstrates deficits in all compo-
nents of executive function in children and adolescents
with high-functioning ASD. In particular, impairment
in working memory, flexibility, and generativity appear
to be the core deficits in these individuals with ASD.
Comorbid ADHD may contribute to deficits in inhibi-
tion and planning. These deficits are not solely
accounted for by general cognitive abilities. Our results
22 Lai et al./Meta-analysis of executive functioning in ASD
support the executive dysfunction hypothesis and con-
tribute to the clinical understanding and possible devel-
opment of interventions to alleviate these deficits in
individuals with ASD.
Contributors
Eric C. L. Lai, Simon S. Y. Lui, S. M. Lam, Eric F. C.
Cheung conceived and designed this study. Eric C. L.
Lai and Zoe Lau reviewed all the articles. Eric CL Lai
wrote the first draft of the manuscript. Eugenia Lok,
Quinney Chan, Venus Tam, K. M. Cheng contributed
in revising the manuscript. All authors have approved
the final text.
Acknowledgment
We would like to thank Dr. Raymond C. K. Chan and
Dr. Ya Wang for providing their expert opinions on the
selection of tests and variables of executive functions.
Appendix A: List of Reviews Included in Backward
Search
Allen, G., & Courchesne, E. (2001). Attention function
and dysfunction in autism. Frontiers in Bioscience, 6,
D105–D119.
Bailey, A., Phillips, W., & Rutter, M. (1996). Autism:
Towards an integration of clinical, genetic, neuropsy-
chological, and neurobiological perspectives. Journal of
Child Psychology and Psychiatry, 37(1), 89–126.
Barendse, E.M., Hendriks, M.P., Jansen, J.F., Backes,
W.H., Hofman, P.A., Thoonen, G., . . . Aldenkamp, A.P.
(2013). Working memory deficits in high-functioning
adolescents with autism spectrum disorders: Neuropsy-
chological and neuroimaging correlates. Journal of Neu-
rodevelopmental Disorders, 5(1), 14.
Baron-Cohen, S. (2004). The cognitive neuroscience
of autism. Journal of Neurology, Neurosurgery, and Psy-
chiatry, 75(7), 945–948.
Boucher, J., & Mayes, A. (2012). Memory in ASD:
Have we been barking up the wrong tree? Autism,
16(6), 603–611.
Boucher, J., Mayes, A., & Bigham, S. (2012). Memory
in autistic spectrum disorder. Psychological Bulletin,
138(3), 458–496.
Dawson, G. (1996). Brief report: Neuropsychology of
autism: A report on the state of the science. Journal of
Autism and Developmental Disorders, 26(2), 179–184.
Geurts, H.M., Corbett, B., & Solomon, M. (2009). The
paradox of cognitive flexibility in autism. Trends in
Cognitive Sciences, 13(2), 74–82.
Geurts, H.M., van den Bergh, S.F., & Ruzzano, L.
(2014). Prepotent response inhibition and interference
INSAR
control in autism spectrum disorders: Two meta-analy-
ses. Autism Research, 7(4), 407–420.
Hill, E.L. (2004a). Evaluating the theory of executive
dysfunction in autism. Developmental Review, 24(2),
189–233.
Hill, E.L. (2004b). Executive dysfunction in autism.
Trends in Cognitive Sciences, 8(1), 26–32.
Kenworthy, L., Yerys, B.E., Anthony, L.G., & Wallace,
G.L. (2008). Understanding executive control in autism
spectrum disorders in the lab and in the real world.
Neuropsychology Review, 18(4), 320–338.
Kirkovski, M., Enticott, P.G., & Fitzgerald, P.B. (2013).
A review of the role of female gender in autism spec-
trum disorders. Journal of Autism and Developmental
Disorders, 43(11), 2584–2603.
Leung, R.C., & Zakzanis, K.K. (2014). Brief report:
Cognitive flexibility in autism spectrum disorders: A
quantitative review. Journal of Autism and Develop-
mental Disorders, 44(10), 2628–2645.
O’Hearn, K., Asato, M., Ordaz, S., & Luna, B. (2008).
Neurodevelopment and executive function in autism.
Development and Psychopathology, 20(4), 1103–1132.
Pellicano, E. (2012). The development of executive
function in autism. Autism Research and Treatment,
2012, 146132.
Pennington, B.F., & Ozonoff, S. (1996). Executive
functions and developmental psychopathology. Journal
of Child Psychology and Psychiatry, 37(1), 51–87.
Pisula, E. (2010). The autistic mind in the light of
neuropsychological studies. Acta Neurobiologiae Experi-
mentalis, 70(2), 119–130.
Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo,
P.D., & Burack, J.A. (2007). Deconstructing executive defi-
cits among persons with autism: Implications for cogni-
tive neuroscience. Brain and Cognition, 65(1), 77–86.
Sanders, J., Johnson, K.A., Garavan, H., Gill, M., &
Gallagher, L. (2008). A review of neuropsychological
and neuroimaging research in autistic spectrum disor-
ders: Attention, inhibition and cognitive flexibility.
Research in Autism Spectrum Disorders, 2(1), 1–16.
Tonn, R., & Obrzut, J. (2005). The Neuropsychologi-
cal Perspective on Autism. Journal of Developmental
and Physical Disabilities, 17(4), 409–441.
Appendix B: List of Studies Included in This Meta-
Analysis
Alderson-Day, B. (2014). Verbal problem-solving diffi-
culties in autism spectrum disorders and atypical lan-
guage development. Autism Research, 7(6), 720–730.
Altgassen, M., Williams, T.I., Bolte, S., & Kliegel, M.
(2009). Time-based prospective memory in children
with autism spectrum disorder. Brain Impairment,
10(1), 52–58.
INSAR Lai et al./Meta-analysis of executive functioning in ASD
Ambrosino, S., Bos, D.J., van Raalten, T.R., Kobussen,
N.A., van Belle, J., Oranje, B., & Durston, S. (2014).
Functional connectivity during cognitive control in
children with autism spectrum disorder: An indepen-
dent component analysis. Journal of Neural Transmis-
sion, 121(9), 1145–1155.
Andersen, P.N., Hovik, K.T., Skogli, E.W., Egeland, J.,
& Oie, M. (2013). Symptoms of ADHD in children with
high-functioning autism are related to impaired verbal
working memory and verbal delayed recall. PLoS One,
8(5), e64842.
Andersen, P.N., Skogli, E.W., Hovik, K.T., Egeland, J.,
& Oie, M. (2015). Associations among symptoms of
autism, symptoms of depression and executive func-
tions in children with high-functioning autism: A 2
year follow-up study. Journal of Autism and Develop-
mental Disorders, 45(8), 2497–2507.
Barron-Linnankoski, S., Reinvall, O., Lahervuori, A.,
Voutilainen, A., Lahti-Nuuttila, P., & Korkman, M.
(2015). Neurocognitive performance of children with
higher functioning Autism Spectrum disorders on the
NEPSY-II. Child Neuropsychology, 21(1), 55–77.
Bishop, D.V.M., & Norbury, C.F. (2005a). Executive
functions in children with communication impair-
ments, in relation to autistic symptomatology - I: Gen-
erativity. Autism, 9(1), 7–27.
Bishop, D.V.M., & Norbury, C.F. (2005b). Executive
functions in children with communication impair-
ments, in relation to autistic symptomatology - 2:
Response inhibition. Autism, 9(1), 29–43.
Brenner, L.A., Shih, V.H., Colich, N.L., Sugar, C.A.,
Bearden, C.E., & Dapretto, M. (2015). Time reproduc-
tion performance is associated with age and working
memory in high-functioning youth with autism spec-
trum disorder. Autism Research, 8(1), 29–37.
Chan, R.C.K., Hu, Z.Y., Cui, J.F., Wang, Y., & McAlo-
nand, G.M. (2011a). Social attribution in children with
high functioning autism and Asperger syndrome: An
exploratory study in the Chinese setting. Research in
Autism Spectrum Disorders, 5(4), 1538–1548.
Chan, A.S., Han, Y.M.Y., Leung, W.W.M., Leung, C.,
Wong, V.C.N., & Cheung, M.C. (2011b). Abnormalities
in the anterior cingulate cortex associated with atten-
tional and inhibitory control deficits: A neurophysio-
logical study on children with autism spectrum
disorders. Research in Autism Spectrum Disorders, 5(1),
254–266.
Chan, A.S., Han, Y.M.Y., Sze, S.L., Cheung, M.C.,
Leung, W.W.M., Chan, R.C.K., & To, C.Y. (2011c). Dis-
ordered connectivity associated with memory deficits in
children with autism spectrum disorders. Research in
Autism Spectrum Disorders, 5(1), 237–245.
Chantiluke, K., Barrett, N., Giampietro, V., Brammer,
M., Simmons, A., & Rubia, K. (2015). Disorder-dissociat-
ed effects of fluoxetine on brain function of working
23
memory in attention deficit hyperactivity disorder and
autism spectrum disorder. Psychological Medicine, 45,
1195–1205.
Chien, Y.L., Gau, S.S.F., Chiu, Y.N., Tsai, W.C.,
Shang, C.Y., & Wu, Y.Y. (2014). Impaired sustained
attention, focused attention, and vigilance in youths
with autistic disorder and Asperger’s disorder. Research
in Autism Spectrum Disorders, 8(7), 881–889.
Cohen, J. (1988). Statistical power analysis for the
behavioral sciences. Hillsdale, NJ: L. Erlbaum Associates.
Corbett, B.A., Constantine, L.J., Hendren, R., Rocke,
D., & Ozonoff, S. (2009). Examining executive function-
ing in children with autism spectrum disorder, atten-
tion deficit hyperactivity disorder and typical
development. Psychiatry Research, 166(2–3), 210–222.
Cui, J.F., Gao, D.G., Chen, Y.H., Zou, X.B., & Wang,
Y. (2010). Working memory in early-school-age chil-
dren with Asperger’s syndrome. Journal of Autism and
Developmental Disorders, 40(8), 958–967.
Czermainski, F.R., Riesgo, R.D.S., Guimara ~es, L.S.P.,
Salles, J.F.D., & Bosa, C.A. (2014). Executive functions
in children and adolescents with autism spectrum disor-
der. Paideia (Ribeir~ao Preto), 24, 85–94.
de Vries, M., & Geurts, H.M. (2014). Beyond individu-
al differences: Are working memory and inhibition
informative specifiers within ASD?. Journal of Neural
Transmission, 121(9), 1183–1198.
Dichter, G.S., Lam, K.S.L., Turner-Brown, L.M., Holtz-
claw, T.N., & Bodfish, J.W. (2009). Generativity abilities
predict communication deficits but not repetitive
behaviors in autism spectrum disorders. Journal of
Autism and Developmental Disorders, 39(9), 1298–
1304.
Dunn, M., Gomes, H., & Sebastian, M.J. (1996). Proto-
typicality of responses of autistic, language disordered,
and normal children in a word fluency task. Child Neu-
ropsychology, 2(2), 99–108.
Faja, S., & Dawson, G. (2014). Performance on the
dimensional change card sort and backward digit span
by young children with autism without intellectual dis-
ability. Child Neuropsychology, 20(6), 692–699.
Gabig, C.S. (2008). Verbal working memory and story
retelling in school-age children with autism. Language
Speech and Hearing Services in Schools, 39(4), 498–511.
Geurts, H.M., Begeer, S., & Stockmann, L. (2009).
Inhibitory control of socially relevant stimuli in chil-
dren with high functioning autism. Journal of Autism
and Developmental Disorders, 39(11), 1603–1607.
Geurts, H.M., & de Wit, S. (2014). Goal- directed
action control in children with autism spectrum disor-
ders. Autism, 18(4), 409–418.
Geurts, H.M., Vertie, S., Oosterlaan, J., Roeyers, H., &
Sergeant, J.A. (2004). How specific are executive func-
tioning deficits in attention deficit hyperactivity
24 Lai et al./Meta-analysis of executive functioning in ASD
disorder and autism? Journal of Child Psychology and
Psychiatry, 45(4), 836–854.
Goddard, L., Dritschel, B., Robinson, S., & Howlin, P.
(2014). Development of autobiographical memory in
children with autism spectrum disorders: Deficits, gains,
and predictors of performance. Development and Psy-
chopathology, 26(1), 215–228.
Goldberg, M.C., Mostofsky, S.H., Cutting, L.E.,
Mahone, E.M., Astor, B.C., Denckla, M.B., & Landa, R.J.
(2005). Subtle executive impairment in children with
autism and children with ADHD. Journal of Autism and
Developmental Disorders, 35(3), 279–293.
Henry, J.D., Terrett, G., Altgassen, M., Raponi-Saun-
ders, S., Ballhausen, N., Schnitzspahn, K.M., & Rendell,
P.G. (2014). A virtual week study of prospective memo-
ry function in autism spectrum disorders. Journal of
Experimental Child Psychology, 127, 110–125.
Hooper, S.R., Poon, K.K., Marcus, L., & Fine, C.
(2006). Neuropsychological characteristics of school-age
children with high-functioning autism: Performance on
the NEPSY. Child Neuropsychology, 12(4–5), 299–305.
Kado, Y., Sanada, S., Yanagihara, M., Ogino, T.,
Ohno, S., Watanabe, K., . . . Ohtsuka, Y. (2012). Execu-
tive function in children with pervasive developmental
disorder and attention-deficit/hyperactivity disorder
assessed by the Keio version of the Wisconsin card sort-
ing test. Brain & Development, 34(5), 354–359.
Kaufmann, L., Zotter, S., Pixner, S., Starke, M., Haber-
landt, E., Steinmayr-Gensluckner, M., . . . Marksteiner, J.
(2013). Brief report: CANTAB performance and brain
structure in pediatric patients with Asperger syndrome.
Journal of Autism and Developmental Disorders, 43(6),
1483–1490.
Kawakubo, Y., Kuwabara, H., Watanabe, K., Minowa,
M., Someya, T., Minowa, I., . . . Kasai, K. (2009).
Impaired prefrontal hemodynamic maturation in
autism and unaffected siblings. PLoS One, 4(9), e6881.
Kilincaslan, A., Motavalli Mukaddes, N., Sozen Kucu-
kyazici, G., & Gurvit, H. (2010). Assessment of execu-
tive/attentional performance in Asperger’s disorder.
Turkish Journal of Psychiatry, 21(4), 289–299.
Kimhi, Y., Shoam-Kugelmas, D., Ben-Artzi, G.A., Ben-
Moshe, I., & Bauminger-Zviely, N. (2014). Theory of
mind and executive function in preschoolers with typi-
cal development versus intellectually able preschoolers
with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 44(9), 2341–2354.
Kretschmer, A., Lampmann, S.A., & Altgassen, M.
(2014). Relations between moral reasoning, theory of
mind and executive functions in children with autism
spectrum disorders. International Journal of Develop-
mental Disabilities, 60(3), 174–183.
Landa, R.J., & Goldberg, M.C. (2005). Language,
social, and executive functions in high functioning
INSAR
autism: A continuum of performance. Journal of Autism
and Developmental Disorders, 35(5), 557–573.
Lee, P.S., Yerys, B.E., Della Rosa, A., Foss-Feig, J.,
Barnes, K.A., James, J.D., . . . Kenworthy, L.E. (2009).
Functional connectivity of the inferior frontal cortex
changes with age in children with autism spectrum dis-
orders: A fcMRI study of response inhibition. Cerebral
Cortex, 19(8), 1787–1794.
Li, J., Zhu, L.Q., Liu, J., & Li, X. (2014). Social and
non-social deficits in children with high-functioning
autism and their cooperative behaviors. Research in
Autism Spectrum Disorders, 8(12), 1657–1671.
Loucas, T., Riches, N.G., Charman, T., Pickles, A.,
Simonoff, E., Chandler, S., & Baird, G. (2010). Speech
perception and phonological short-term memory capac-
ity in language impairment: Preliminary evidence from
adolescents with specific language impairment (SLI)
and autism spectrum disorders (ASD). International
Journal of Language & Communication Disorders,
45(3), 275–286.
Loukusa, S., Makinen, L., Kuusikko-Gauffin, S., Ebel-
ing, H., & Moilanen, I. (2014). Theory of mind and
emotion recognition skills in children with specific lan-
guage impairment, autism spectrum disorder and typi-
cal development: Group differences and connection to
knowledge of grammatical morphology, word-finding
abilities and verbal working memory. International
Journal of Language & Communication Disorders,
49(4), 498–507.
Mahone, E.M., Powell, S.K., Loftis, C.W., Goldberg,
M.C., Denckla, M.B., & Mostofsky, S.H. (2006). Motor
persistence and inhibition in autism and ADHD. Jour-
nal of the International Neuropsychological Society,
12(5), 622–631.
Maister, L., & Plaisted-Grant, K.C. (2011). Time per-
ception and its relationship to memory in autism spec-
trum conditions. Developmental Science, 14(6), 1311–
1322.
Maister, L., Simons, J.S., & Plaisted-Grant, K. (2013).
Executive functions are employed to process episodic
and relational memories in children with autism spec-
trum disorders. Neuropsychology, 27(6), 615–627.
Mashal, N., & Kasirer, A. (2012). Principal component
analysis study of visual and verbal metaphoric compre-
hension in children with autism and learning disabil-
ities. Research in Developmental Disabilities, 33(1),
274–282.
Matsuura, N., Ishitobi, M., Arai, S., Kawamura, K.,
Asano, M., Inohara, K., . . . Kosaka, H. (2014). Distin-
guishing between autism spectrum disorder and atten-
tion deficit hyperactivity disorder by using behavioral
checklists, cognitive assessments, and neuropsychologi-
cal test battery. Asian Journal of Psychiatry, 12, 50–57.
May, T., Rinehart, N.J., Wilding, J., & Cornish, K.
(2015). Attention and basic literacy and numeracy in
INSAR Lai et al./Meta-analysis of executive functioning in ASD
children with autism spectrum disorder: A one-year fol-
low-up study. Research in Autism Spectrum Disorders,
9, 193–201.
Narzisi, A., Muratori, F., Calderoni, S., Fabbro, F., &
Urgesi, C. (2013). Neuropsychological profile in high
functioning autism spectrum disorders. Journal of
Autism and Developmental Disorders, 43(8), 1895–
1909.
Norbury, C.F., & Bishop, D.V. (2002). Inferential
processing and story recall in children with communi-
cation problems: A comparison of specific language
impairment, pragmatic language impairment and high-
functioning autism. International Journal of Language
& Communication Disorders, 37(3), 227–251.
Nyden, A., Gillberg, C., Hjelmquist, E., & Heiman, M.
(1999). Executive function/attention deficits in boys
with Asperger syndrome, attention disorder and read-
ing/writing disorder. Autism, 3(3), 213–228.
Ozonoff, S. (1995). Reliability and validity of the Wis-
consin card sorting testing test in studies of autism.
Neuropsychology, 9(4), 491–500.
Ozonoff, S., & Jensen, J. (1999). Brief report: Specific
executive function profiles in three neurodevelopmen-
tal disorders. Journal of Autism and Developmental Dis-
orders, 29(2), 171–177.
Ozonoff, S., Strayer, D.L., McMahon, W.M., & Filloux,
F. (1994). Executive function abilities in autism and
Tourette syndrome – An informating processing
approach. Journal of Child Psychology and Psychiatry
and Allied Disciplines, 35(6), 1015–1032.
Pankert, A., Pankert, K., Herpertz-Dahlmann, B., Kon-
rad, K., & Kohls, G. (2014). Responsivity to familiar ver-
sus unfamiliar social reward in children with autism.
Journal of Neural Transmission, 121(9), 1199–1210.
Pellicano, E. (2010). The development of core cogni-
tive skills in autism: A 3-year prospective study. Child
Development, 81(5), 1400–1416.
Pellicano, E., Maybery, M., Durkin, K., & Maley, A.
(2006). Multiple cognitive capabilities/deficits in chil-
dren with an autism spectrum disorder: “Weak” central
coherence and its relationship to theory of mind and
executive control. Development and Psychopathology,
18(1), 77–98.
Perez Velazquez, J.L., Barcelo, F., Hung, Y., Lesh-
chenko, Y., Nenadovic, V., Belkas, J., . . . Garcia Domi-
nguez, L. (2009). Decreased brain coordinated activity
in autism spectrum disorders during executive tasks:
Reduced long-range synchronization in the fronto-
parietal networks. International Journal of Psychophysi-
ology, 73(3), 341–349.
Planche, P., & Lemonnier, E. (2012). Children with
high-functioning autism and Asperger’s syndrome: Can
we differentiate their cognitive profiles? Research in
Autism Spectrum Disorders, 6(2), 939–948.
25
 Prior, M., & Hoffmann, W. (1990). Brief report: Neu-
ropsychological testing of autistic children through an
exploration with frontal lobe tests. Journal of Autism
and Developmental Disorders, 20(4), 581–590.
Reinvall, O., Voutilainen, A., Kujala, T., & Korkman,
M. (2013). Neurocognitive functioning in adolescents
with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 43(6), 1367–1379.
Riches, N.G., Loucas, T., Baird, G., Charman, T., &
Simonoff, E. (2010). Sentence repetition in adolescents
with specific language impairments and autism: An
investigation of complex syntax. International Journal
of Language & Communication Disorders, 45(1), 47–60.
Robinson, S., Goddard, L., Dritschel, B., Wisley, M., &
Howlin, P. (2009). Executive functions in children with
autism spectrum disorders. Brain and Cognition, 71(3),
362–368.
Russell-Smith, S.N., Comerford, B.J.E., Maybery, M.T.,
& Whitehouse, A.J.O. (2014). Brief report: Further evi-
dence for a link between inner speech limitations and
executive function in high-functioning children with
autism spectrum disorders. Journal of Autism and
Developmental Disorders, 44(5), 1236–1243.
Salmanian, M., Tehrani-Doost, M., Ghanbari-Mot-
lagh, M., & Shahrivar, Z. (2012). Visual memory of
meaningless shapes in children and adolescents with
autism spectrum disorders. Iran J Psychiatry, 7(3), 104–
108.
Samyn, V., Roeyers, H., Bijttebier, P., Rosseel, Y., &
Wiersema, J.R. (2015). Assessing effortful control in typ-
ical and atypical development: Are questionnaires and
neuropsychological measures interchangeable? A latent-
variable analysis. Research in Developmental Disabil-
ities, 36, 587–599.
Sawa, T., Kodaira, M., Oiji, A., Sasayama, D., Iwadare,
Y., Ushijima, H., . . . Saito, K. (2013). Dysfunction of
orbitofrontal and dorsolateral prefrontal cortices in chil-
dren and adolescents with high-functioning pervasive
developmental disorders. Annals of General Psychiatry,
12(1), 31.
Schneider, S.G., & Asarnow, R.F. (1987). A compari-
son of cognitive/neuropsychological impairments of
nonretarded autistic and schizophrenic children. Jour-
nal of Abnormal Child Psychology, 15(1), 29–45.
Schuh, J.M., & Eigsti, I.M. (2012). Working memory,
language skills, and autism symptomatology. Behavioral
Sciences (Basel), 2(4), 207–218.
Schurink, J., Hartman, E., Scherder, E.J.A., Houwen,
S., & Visscher, C. (2012). Relationship between motor
and executive functioning in school-age children with
pervasive developmental disorder not otherwise speci-
fied. Research in Autism Spectrum Disorders, 6(2), 726–
732.
Semrud-Clikeman, M., Fine, J.G., & Bledsoe, J. (2014).
Comparison among children with children with autism
26 Lai et al./Meta-analysis of executive functioning in ASD
spectrum disorder, nonverbal learning disorder and typ-
ically developing children on measures of executive
functioning. Journal of Autism and Developmental Dis-
orders, 44(2), 331–342.
Semrud-Clikeman, M., Walkowiak, J., Wilkinson, A.,
& Butcher, B. (2010). Executive functioning in children
with Asperger syndrome, ADHD-combined type, ADHD-
predominately inattentive type, and controls. Journal of
Autism and Developmental Disorders, 40(8), 1017–
1027.
Sinzig, J., Morsch, D., Bruning, N., Schmidt, M.H., &
Lehmkuhl, G. (2008). Inhibition, flexibility, working
memory and planning in autism spectrum disorders
with and without comorbid ADHD-symptoms. Child
and Adolescent Psychiatry and Mental Health, 2, 4–4.
Sinzig, J., Vinzelberg, I., Evers, D., & Lehmkuhl, G.
(2014). Executive function and attention profiles in pre-
school and elementary school children with autism
spectrum disorder and attention deficit hyperactivity
disorder. Journal of Applied Research in Intellectual Dis-
abilities, 27(4), 298–298.
Stieglitz Ham, H., Bartolo, A., Corley, M., Rajendran,
G., Szabo, A., & Swanson, S. (2011). Exploring the rela-
tionship between gestural recognition and imitation:
Evidence of dyspraxia in autism spectrum disorders.
Journal of Autism and Developmental Disorders, 41(1),
1–12.
Terrett, G., Rendell, P.G., Raponi-Saunders, S., Henry,
J.D., Bailey, P.E., & Altgassen, M. (2013). Episodic future
thinking in children with autism spectrum disorder.
Journal of Autism and Developmental Disorders,
43(11), 2558–2568.
Tye, C., Asherson, P., Ashwood, K.L., Azadi, B., Bol-
ton, P., & McLoughlin, G. (2014). Attention and inhibi-
tion in children with ASD, ADHD and co-morbid ASD
plus ADHD: An event-related potential study. Psycho-
logical Medicine, 44(5), 1101–1116.
Unterrainer, J.M., Rauh, R., Rahm, B., Hardt, J., Kal-
ler, C.P., Klein, C., Paschke-Mu € ller, M., & Biscaldi, M.
(2016). Development of planning in children with
high-functioning autism spectrum disorders and/or
attention deficit/hyperactivity disorder. Autism
Research, 9(7), 739–751. doi:10.1002/aur.1574
Urbain, C.M., Pang, E.W., & Taylor, M.J. (2015).
Atypical spatiotemporal signatures of working memory
brain processes in autism. Translational Psychiatry, 5,
e617.
Vanegas, S.B., & Davidson, D. (2015). Investigating
distinct and related contributions of Weak Central
Coherence, Executive Dysfunction, and Systemizing
theories to the cognitive profiles of children with
Autism Spectrum Disorders and typically developing
children. Research in Autism Spectrum Disorders, 11,
77–92.
INSAR
 Van Eylen, L., Boets, B., Steyaert, J., Evers, K., Wage-
mans, J., & Noens, I. (2011). Cognitive flexibility in
autism spectrum disorder: Explaining the inconsisten-
cies? Research in Autism Spectrum Disorders, 5(4),
1390–1401.
Van Eylen, L., Boets, B., Steyaert, J., Wagemans, J., &
Noens, I. (2015). Executive functioning in autism spec-
trum disorders: Influence of task and sample character-
istics and relation to symptom severity. European Child
and Adolescent Psychiatry, 24(11), 1399–1417.
Vara, A.S., Pang, E.W., Doyle-Thomas, K.A.R., Vidal,
J., Taylor, M.J., & Anagnostou, E. (2014). Is inhibitory
control a ‘no-go’ in adolescents with autism spectrum
disorder? Molecular Autism, 5(1), 6.
Verte, S., Geurts, H.M., Roeyers, H., Oosterlaan, J., &
Sergeant, J.A. (2006). Executive functioning in children
with an autism spectrum disorder: Can we differentiate
within the spectrum? Journal of Autism and Develop-
mental Disorders, 36(3), 351–372.
Voelbel, G.T., Bates, M.E., Buckman, J.F., Pandina, G.,
& Hendren, R.L. (2006). Caudate nucleus volume and
cognitive performance: Are they related in childhood
psychopathology? Biological Psychiatry, 60(9), 942–950.
Vogan, V.M., Morgan, B.R., Lee, W., Powell, T.L.,
Smith, M.L., & Taylor, M.J. (2014). The neural correlates
of visuo-spatial working memory in children with
autism spectrum disorder: Effects of cognitive load.
Journal of Neurodevelopmental Disorders, 6(19).
Weissman, A.S., & Bates, M.E. (2010). Increased clini-
cal and neurocognitive impairment in children with
autism spectrum disorders and comorbid bipolar disor-
der. Research in Autism Spectrum Disorders, 4(4), 670–
680.
Williams, D., Boucher, J., Lind, S., & Jarrold, C.
(2013). Time-based and event-based prospective memo-
ry in autism spectrum disorder: The roles of executive
function and theory of mind, and time-estimation.
Journal of Autism and Developmental Disorders, 43(7),
1555–1567.
Williams, D.L., Goldstein, G., Carpenter, P.A., & Min-
shew, N.J. (2005). Verbal and spatial working memory
in autism. Journal of Autism and Developmental Disor-
ders, 35(6), 747–756.
Williams, D.L., Goldstein, G., & Minshew, N.J.
(2006a). Neuropsychologic functioning in children with
autism: Further evidence for disordered complex infor-
mation-processing. Child Neuropsychology, 12(4–5),
279–298.
Williams, D.L., Goldstein, G., & Minshew, N.J.
(2006b). The profile of memory function in children
with autism. Neuropsychology, 20(1), 21–29.
Winsler, A., Abar, B., Feder, M.A., Schunn, C.D., &
Rubio, D.A. (2007). Private speech and executive func-
tioning among high-functioning children with autistic
INSAR Lai et al./Meta-analysis of executive functioning in ASD
spectrum disorders. Journal of Autism and Developmen-
tal Disorders, 37(9), 1617–1635.
Xiao, T., Xiao, Z., Ke, X.Y., Hong, S.S., Yang, H.Y., Su,
Y.L., . . . Liu, Y.J. (2012). Response inhibition impair-
ment in high functioning autism and attention deficit
hyperactivity disorder: Evidence from near-infrared
spectroscopy data. PLoS One, 7(10), e46569.
Yasumura, A., Kokubo, N., Yamamoto, H., Yasumura,
Y., Nakagawa, E., Kaga, M., . . . Inagaki, M. (2014). Neu-
robehavioral and hemodynamic evaluation of Stroop
and reverse Stroop interference in children with atten-
tion-deficit/hyperactivity disorder. Brain & Develop-
ment, 36(2), 97–106.
Yerys, B.E., Wallace, G.L., Sokoloff, J.L., Shook, D.A.,
James, J.D., & Kenworthy, L. (2009a). Attention deficit/
hyperactivity disorder symptoms moderate cognition
and behavior in children with autism spectrum disor-
ders. Autism Research, 2(6), 322–333.
Yerys, B.E., Wallace, G.L., Harrison, B., Celano, M.J.,
Giedd, J.N., & Kenworthy, L.E. (2009b). Set-shifting in
children with autism spectrum disorders reversal shift-
ing deficits on the intradimensional/extradimensional
shift test correlate with repetitive behaviors. Autism,
13(5), 523–538.
Yerys, B.E., Wallace, G.L., Jankowski, K.F., Bollich, A.,
& Kenworthy, L. (2011). Impaired consonant trigrams
test (CTT) performance relates to everyday working
memory difficulties in children with autism spectrum
disorders. Child Neuropsychology, 17(4), 391–399.
Yoran-Hegesh, R., Kertzman, S., Vishne, T., Weizman,
A., & Kotler, M. (2009). Neuropsychological mecha-
nisms of digit symbol substitution test impairment in
Asperger disorder. Psychiatry Research, 166(1), 35–45.
Zandt, F., Prior, M., & Kyrios, M. (2009). Similarities
and differences between children and adolescents with
autism spectrum disorder and those with obsessive
compulsive disorder Executive functioning and repeti-
tive behaviour. Autism, 13(1), 43–57.
Zinke, K., Fries, E., Altgassen, M., Kirschbaum, C.,
Dettenborn, L., & Kliegel, M. (2010). Visuospatial short-
term memory explains deficits in tower task planning
in high-functioning children with autism spectrum dis-
order. Child Neuropsychology, 16(3), 229–241.
References
American Psychiatric Association. (2000). Diagnostic and statis-
tical manual of mental disorders (4th ed., text rev.). Wash-
ington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statis-
tical manual of mental disorders (5th ed.). Washington,
DC: Author.
Baddeley, A. (1986). Working memory. New York: Oxford Uni-
versity Press.
Baddeley, A. (1992). Working memory. Science, 255, 556–559.
27
Baron-Cohen, S., Leslie, A.M., & Frith, U. (1985). Does the
autistic child have a “theory of mind”?. Cognition, 21, 37–
46.
Bartak, L., Rutter, M., & Cox, A. (1975). A comparative study
of infantile autism and specific development receptive lan-
guage disorder. I. The children. British Journal of Psychia-
try, 126, 127–145.
Bishop, D.V.M., & Norbury, C.F. (2005a). Executive functions
in children with communication impairments, in relation
to autistic symptomatology - 2: Response inhibition.
Autism, 9, 29–43.
Bishop, D.V.M., & Norbury, C.F. (2005b). Executive functions
in children with communication impairments, in relation
to autistic symptomatology - I: Generativity. Autism, 9, 7–
27.
Blair, C., & Razza, R.P. (2007). Relating effortful control, execu-
tive function, and false belief understanding to emerging
math and literacy ability in kindergarten. Child Develop-
ment, 78, 647–663.
Borenstein, M., Hedges, L.V., Higgins, J.P.T., & Rothstein, H.R.
(2009). Introduction to meta-analysis. Chichester, UK:
Wiley.
Christ, S.E., Holt, D.D., White, D.A., & Green, L. (2007). Inhib-
itory control in children with autism spectrum disorder.
Journal of Autism and Developmental Disorders, 37, 1155–
1165.
Cohen, J. (1988). Statistical power analysis for the behavioral
sciences. Hillsdale, NJ: L. Erlbaum Associates.
Conti-Ramsden, G., Botting, N., & Faragher, B. (2001). Psycho-
linguistic markers for specific language impairment (SLI).
Journal of Child Psychology and Psychiatry, 42, 741–748.
Craik, F.I.M., & McDowd, J.M. (1987). Age differences in recall
and recognition. Journal of Experimental Psychology:
Learning, Memory, and Cognition, 13, 474–479.
Cui, J.F., Gao, D.G., Chen, Y.H., Zou, X.B., & Wang, Y. (2010).
Working memory in early-school-age children with Asperg-
er’s syndrome. Journal of Autism and Developmental Disor-
ders, 40, 958–967.
de Vries, M., & Geurts, H.M. (2014). Beyond individual differ-
ences: Are working memory and inhibition informative
specifiers within ASD?. Journal of Neural Transmission, 121,
1183–1198.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-
plot-based method of testing and adjusting for publication
bias in meta-analysis. Biometrics, 56, 455–463.
Eakin, L., Minde, K., Hechtman, L., Ochs, E., Krane, E.,
Bouffard, R., & Looper, K. (2004). The marital and family
functioning of adults with ADHD and their spouses. Journal
of Attention Disorders, 8, 1–10.
Engels, E.A., Schmid, C.H., Terrin, N., Olkin, I., & Lau, J.
(2000). Heterogeneity and statistical significance in meta-
analysis: An empirical study of 125 meta-analyses. Statistics
in Medicine, 13, 1707–1728.
Frith, U. (1989). Autism: Explaining the enigma. Oxford, UK:
Cambridge.
Fisher, N., & Happe, F. (2005). A training study of theory of
mind and executive function in children with autistic spec-
trum disorders. Journal of Autism and Developmental Dis-
orders, 35, 757–771.
28 Lai et al./Meta-analysis of executive functioning in ASD
Friedman, N.P., & Miyake, A. (2004). The relations among
inhibition and interference control functions: A latent-
variable analysis. Journal of Experimental Psychology Gen-
eral, 1, 101–135.
Geurts, H.M., Corbett, B., & Solomon, M. (2009). The paradox
of cognitive flexibility in autism. Trends in Cognitive Scien-
ces, 13, 74–82.
Geurts, H.M., van den Bergh, S.F., & Ruzzano, L. (2014). Prepo-
tent response inhibition and interference control in autism
spectrum disorders: Two meta-analyses. Autism Research, 7,
407–420.
Geurts, H.M., Vertie, S., Oosterlaan, J., Roeyers, H., & Sergeant,
J.A. (2004). How specific are executive functioning deficits
in attention deficit hyperactivity disorder and autism?.
Journal of Child Psychology and Psychiatry, 45, 836–854.
Hedges, L.V., & Olkin, I. (1985). Statistical methods for meta-
analysis. Orlando: Academic Press.
Higgins, J.P.T., Green, S., & Cochrane, C. (2008). Cochrane
handbook for systematic reviews of interventions. Chiches-
ter, England: Wiley-Blackwell.
Hill, E.L. (2004). Evaluating the theory of executive dysfunc-
tion in autism. Developmental Review, 24, 189–233.
Joseph, R.M., McGrath, L.M., & Tager-Flusberg, H. (2005).
Executive dysfunction and its relation to language ability in
verbal school-age children with autism. Developmental
Neuropsychology, 3, 361–378.
Just, M.A., & Carpenter, P.A. (1992). A capacity theory of com-
prehension: Individual differences in working memory. Psy-
chological Review, 99, 122–149.
Karbach, J., & Unger, K. (2014). Executive control training
from middle childhood to adolescence. Frontiers in Psy-
chology, 5, 390.
Kenworthy, L., Anthony, L.G., Naiman, D.Q., Cannon, L.,
Wills, M.C., Luong-Tran, C., . . . Wallace, G.L. (2013). Ran-
domized controlled effectiveness trial of executive function
intervention for children on the autism spectrum. Journal
of Child Psychology and Psychiatry, and Allied Disciplines,
4, 374–383.
Kouijzer, M.E., de Moor, J.M., Gerrits, B.J., Buitelaar, J.K., &
van Schie, H.T. (2009). Long-term effects of neurofeedback
treatment in autism. Research in Autism Spectrum Disor-
ders, 3, 496–501.
Landa, R.J., & Goldberg, M.C. (2005). Language, social, and
executive functions in high functioning autism: A continu-
um of performance. Journal of Autism and Developmental
Disorders, 35, 557–573.
Landry, O., & Al-Taie, S. (2016). A Meta-analysis of the Wis-
consin Card Sort Task in Autism. Journal of Autism and
Developmental Disorders, 4, 1220–1235.
Lee, D., & Ousley, O. (2006). Attention-deficit hyperactivity
disorder symptoms in a clinic sample of children and ado-
lescents with pervasive developmental disorders. Journal of
Child and Adolescent Psychopharmacology, 16, 737–746.
Leung, R.C., & Zakzanis, K.K. (2014). Brief report: Cognitive
flexibility in autism spectrum disorders: A quantitative
review. Journal of Autism and Developmental Disorders, 44,
2628–2645.
Lezak, M.D. (2012). Neuropsychological assessment. Oxford:
Oxford University Press.
INSAR
Liss, M., Fein, D., Allen, D., Dunn, M., Feinstein, C., Morris,
R., Waterhouse, L., & Rapin, I. (2001). Executive function-
ing in high-functioning children with autism. Journal of
Child Psychology and Psychiatry, and Allied Disciplines, 2,
261–270.
Luna, B., Doll, S.K., Hegedus, S.J., Minshew, N.J., & Sweeney,
J.A. (2006). Maturation of executive function in autism.
Biological Psychiatry, 4, 474–481.
Marton, K. (2008). Visuo-spatial processing and executive func-
tions in children with specific language impairment. Inter-
national Journal of Language & Communication Disorders,
2, 181–200.
Marton, K., & Schwartz, R.G. (2003). Working memory capaci-
ty and language processes in children with specific lan-
guage impairment. Journal of Speech, Language, and
Hearing Research: JSLHR, 5, 1138–1153.
Miyake, A., & Friedman, N.P. (2012). The nature and organiza-
tion of individual differences in executive functions: Four
general conclusions. Current Directions in Psychological
Science, 21, 8–14.
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H.,
Howerter, A., & Wager, T.D. (2000). The unity and diversity
of executive functions and their contributions to complex
“Frontal Lobe” tasks: A latent variable analysis. Cognitive
Psychology, 41, 49–100.
Montgomery, J.W. (2000). Verbal working memory and sen-
tence comprehension in children with specific language
impairment. Journal of Speech, Language, and Hearing
Research: JSLHR, 2, 293–308.
Mosconi, M., Kay, M., D’Cruz, A., Seidenfeld, A., Guter, S.,
Stanford, L., & Sweeney, J. (2009). Impaired inhibitory con-
trol is associated with higher-order repetitive behaviors in
autism spectrum disorders. Psychological Medicine, 39(9),
1559–1566.
Mullen, B., Muellerleile, P., & Bryant, B. (2001). Cumulative
meta-analysis: A consideration of indicators of sufficiency
and stability. Personality and Social Psychology Bulletin,
27, 1450–1462.
Ozonoff, S., Pennington, B.F., & Rogers, S.J. (1991). Executive
function deficits in high-functioning autistic individuals:
Relationship to theory of mind. Journal of Child Psycholo-
gy and Psychiatry, 32, 1081–1105.
Pellicano, E. (2011). Psychological models of autism: An over-
view. In I. Roth & P. Rezaie (Eds.), Researching the autism
spectrum contemporary perspectives (pp. 219–265). Cam-
bridge: Cambridge University Press.
Pennington, B.F., & Ozonoff, S. (1996). Executive functions
and developmental psychopathology. Journal of Child Psy-
chology and Psychiatry, 37, 51–87.
INSAR Lai et al./Meta-analysis of executive functioning in ASD
Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips,
M.R., & Rahman, A. (2007). No health without mental
health. Lancet, 9590, 859–877.
Pugliese, C.E., Anthony, L., Strang, J.F., Dudley, K., Wallace,
G.L., & Kenworthy, L. (2015). Increasing adaptive behavior
skill deficits from childhood to adolescence in autism spec-
trum disorder: Role of executive function. Journal of
Autism and Developmental Disorders, 6, 1579–1587.
Romine, C.B., & Reynolds, C.R. (2005). A model of the devel-
opment of frontal lobe functioning: Findings from a meta-
analysis. Applied Neuropsychology, 12, 190–201.
Rosenthal, R. (1979). The file drawer problem and tolerance for
null results. Psychological Bulletin, 86, 638–641.
Spaulding, T.J. (2010). Investigating mechanisms of suppres-
sion in preschool children with specific language impair-
ment. Journal of Speech, Language, and Hearing Research:
JSLHR, 3, 725–738.
Strauss, E., Sherman, E.M.S., & Spreen, O. (2006). A compendi-
um of neuropsychological tests: Administration, norms,
and commentary. Oxford: Oxford University Press.
Titz, C., & Karbach, J. (2014). Working memory and executive
functions: Effects of training on academic achievement.
Psychological Research, 852–868.
Urbain, C.M., Pang, E.W., & Taylor, M.J. (2015). Atypical spa-
tiotemporal signatures of working memory brain processes
in autism. Translational Psychiatry, 5, e617.
Walker, E., Hernandez, A.V., & Kattan, M.W. (2008). Meta-
analysis: Its strengths and limitations. Cleveland Clinic
Journal of Medicine, 6, 431–439.
Weissman, A.S., & Bates, M.E. (2010). Increased clinical and
neurocognitive impairment in children with autism spec-
trum disorders and comorbid bipolar disorder. Research in
Autism Spectrum Disorders, 4, 670–680.
Willcutt, E.G., Doyle, A.E., Nigg, J.T., Faraone, S.V., &
Pennington, B.F. (2005). Validity of the executive function
theory of attention-deficit/hyperactivity disorder: A meta-
analytic review. Biological Psychiatry, 57, 1336–1346.
Williams, D.L., Goldstein, G., Carpenter, P.A., & Minshew, N.J.
(2005). Verbal and spatial working memory in autism. Jour-
nal of Autism and Developmental Disorders, 35, 747–756.
World Health Organisation. (1978). The international classifica-
tion of diseases (9th ed., clinical modification). Ann Arbor,
MI: Commission on Professional and Hospital Activities.
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