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Executive Functioning Is Linked to Internalizing Symptoms in Autistic Adults With Higher Support Needs
Journal article   Peer reviewed

Executive Functioning Is Linked to Internalizing Symptoms in Autistic Adults With Higher Support Needs

Ethan Greenstein, Nancy Raitano Lee, Goldie A McQuaid and Gregory L Wallace
Autism : the international journal of research and practice, Forthcoming
28 Jul 2026
DOI: https://doi.org/10.1177/13623613261466302
PMID: 42522015

Abstract

anxiety emotion regulation higher support needs depression adulthood intellectual disability executive function Autism
Executive function (EF) refers to a set of cognitive skills essential for self-regulation, problem-solving, and goal-directed behavior. Although EF's relationship with co-occurring depression and anxiety symptoms is well documented in autistic individuals, particularly children without intellectual disability (ID), far less is known about this relationship in autistic adults with higher support needs, including those with ID. The present study addresses this gap by examining associations between three EF components (flexibility, emotion regulation, and inhibitory control) and symptoms of anxiety and depression in 486 autistic adults with higher support needs (ages 18-68;    31.07 years), recruited through the Simons Powering Autism Research for Knowledge (SPARK) Research Match service. Caregivers completed the Flexibility Scale, the Barkley Deficits in Executive Functioning Scale (inhibitory control and emotion regulation subscales), and the Anxiety, Depression, and Mood Scale (anxiety and depression subscales). Hierarchical linear regressions, controlling for age, sex assigned at birth, likely cognitive impairment, and caregiver educational attainment, revealed that greater difficulties with flexibility and emotion regulation were significantly associated with elevated anxiety and depression symptoms, whereas inhibitory control difficulties were not. These findings identify flexibility and emotion regulation as key correlates of internalizing symptoms in autistic adults with higher support needs, highlighting these domains as potential targets for future mechanistic and intervention research aimed at reducing anxiety and depression symptoms in this group.Lay AbstractSome everyday thinking skills help people manage feelings, handle change, and pause before acting. These are called executive functions. Most studies on these skills in autism have focused on children or on adults who do not have an intellectual disability, so autistic adults who need higher levels of support are often left out of research. In this study, caregivers answered questions about these thinking skills and about anxiety and depression for a large group of autistic adults with higher support needs, including people with intellectual disability. The results showed that greater challenges with flexibility and emotion regulation were linked with more anxiety and depression symptoms, suggesting that flexibility and emotion regulation could be an important focus for intervention development and support provision efforts aimed at reducing anxiety and depression symptoms in this group.

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