Executive function scores are lower for 20-month-olds with an elevated likelihood of autism and/or ADHD

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Background: Executive function (EF) difficulties are a transdiagnostic feature of autism and ADHD, but the emergence of these difficulties is not well understood, nor are the influences of socio-economic circumstances and autistic traits. Prior research involving toddlers < 2 years is scarce and has yielded null findings, possibly due to measurement limitations. We address these challenges with a battery of EF measures combining parent report with performance measures. Methods: 110 20-month-olds at elevated likelihood of autism/ADHD due to a first-degree relative with autism/ADHD and/or showing elevated autistic traits (n = 62), or at low likelihood (n = 48), completed six EF performance tasks. Parent report of EF was collected with the Early Executive Functions Questionnaire (EEFQ). An EF composite score was derived from the intercorrelated EF measures. Emotion regulation was analysed separately. Autistic traits were assessed using the ADOS-2 and the Q-CHAT. A socio-economic circumstance (SEC) score was derived from parental education level, parental occupational status, neighbourhood deprivation, and family income. Preregistered hypotheses, specified separately in the preregistration, were tested in one regression model for parsimony. Results: Toddlers at elevated likelihood of autism/ADHD showed lower EF scores (likelihood β = −0.4, p = 0.04, R² = 0.04), but this difference was fully attenuated after accounting for autistic traits (ADOS-2 β = −0.46, p < 0.001; likelihood β = 0.05, p = 0 .79, R² = 0.21), with little additional contribution from SEC (β = 0.17, p = 0.10, R² = 0.23). Emotion regulation was also lower in the elevated-likelihood group (likelihood β = −0.69, p < 0 .001, R² = 0.12), was unrelated to autistic traits (p = 0.89), and was partly attenuated after accounting for SEC (SEC β = 0.35, p < 0.01; likelihood β = −0.51, p = 0.02, R² = 0.2). Conclusions: We have detected relative EF difficulties in toddlers with an elevated likelihood of autism/ADHD earlier than previously reported, likely due to our more comprehensive measurement approach. Our findings indicate that EF scores may be a useful transdiagnostic indicator of autism and/or ADHD as young as 20 months and highlight the potential value of early intervention.

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