(PS3-B40) Characterizing the Role of Cognitive Inflexibility in Predicting Social Communication and Interaction and Restricted Repetitive Behaviors in Youth

Autism spectrum condition is characterized by difficulties in social communication and interaction (SCI) and the presence of repetitive and restrictive behaviors (RRBs; American Psychiatric Association, 2013). Both SCI and RRB challenges can be impacted by a myriad of contributing factors that are associated with autism. One such factor is cognitive inflexibility (CI), which is an inability to adjust thoughts and behaviors according to a changing environment (Uddin, 2021). Despite clear links between CI and autism characteristics (e.g., Dajani & Uddin, 2015), CI is a complex construct involving multiple aspects and limited research has examined how specific aspects of CI impact the expression of autistic traits. This study examined specific CI presentations (i.e., flexibility around changes in routines, behavioral flexibility, flexibility in interests, generating ideas, and transitions) relate to increased difficulty with SCI and RRB amongst autistic and non-autistic youth. Examining specific flexibility across various facets of behavior and cognition will better help understand contributions of CI on autism characteristics across the broader autism phenotype.

Thirty youth (Mage=11.22, SDage=3.15, 56.7% male, 36.7% Non-White, 43.3% autistic) and their parents participated in this study, of which 13 youth met the criteria for autism spectrum on the Autism Diagnostic Observation Schedule-2 (ADOS-2; Lord et al., 2012). Parents completed measures of CI (Flexibility Scale; Strang et al, 2017), and autism traits including SCI and RRBs (Social Responsiveness Scale-2; Constantino & Gruber, 2012).

Pearson correlations revealed overall CI related to both SCI (r=.80, p< .001) and RRBs (r=.824, p< .001). In terms of specific aspects of CI, multiple linear regressions indicated that flexibility related to generating ideas predicted difficulties with SCI above and beyond other aspects of CI (𝛃=.30, p=. 04). In terms of RRBs, difficulty in flexibly transitioning (𝛃=.40, p=.03) and reduced flexibility in interests (𝛃=.34, p=. 03) were unique predictors of RRBs, but not behavioral flexibility, flexibility around changes in routines, or flexibility with generating ideas (ps>.13). 

Results suggest that CI, which is commonly experienced by autistic youth, is strongly related to both SCI and RRBs in youth overall, and specific aspects of CI may differentially predict social communication challenges and RRBs. These findings provide important information about specific influence of CI on specific autism characteristics, which may be translated to better refine targeted interventions to support autistic youth with heterogeneous presentations. Cognitive-behavioral therapy may be especially well-suited to address CI (Lackner et al., 2022; Nazarzadeh et al., 2015), which can help further improve challenges associated with core autism characteristics based on their presentations. For instance, in those with more SCI challenges, targeting flexibility with generativity in CBT may be especially beneficial, whereas targeting flexibility with transitioning and interests can help reduce RRBs.