پیش بین های شناختیِ انعطاف ناپذیری رفتاری در خردسالان با علائم اختلال طیف اُتیسم Journal Article

چکیده مقدمه: یکی از علائم افراد با اختلال طیف اُتیسم، انعطاف‌ناپذیری رفتاری است که سبب ضعف در انطباق با تقاضاهای محیط و مشکلات رفتاری می‌شود. در مطالعه حاضر به بررسی نقش کارکردهای اجرایی در پیش‌بینی انعطاف‌پذیری رفتاری خردسالان پرداخته شد. روش کار: مطالعه حاضر از نوع مقطعی بود. 45 خردسال بین 16 الی 36 ماه با روش نمونه‌گیری در دسترس انتخاب شدند. داده‌‌ها با استفاده از پرسشنامه سنجش کارکردهای اجرایی- نسخه پیش‌دبستان (BRIEF) و نسخه تجدیدنظرشده مقیاس انعطاف پذیری رفتاری (BFRS-R) جمع‌آوری شدند. برای تحلیل داده‌ها از ضریب همبستگی پیرسون و رگرسیون همزمان استفاده شد. یافته‌ها: نتایج ضریب همبستگی پیرسون و تحلیل رگرسیون همزمان نشان داد که میزان انعطاف‌ رفتاری خردسالان با بازداری (p، r=037)، انتقال (p، r=0/45)، مهار هیجانی (p، r=0/49)، برنامه‌ریزی/سازمان‌دهی (p، r=0/34)، خودکنترلی مهاری (p، r=0/44)، انعطاف‌پذیری شناختی (p، r=0/55)، فراشناخت (p، r=0/30) و نمره‌کل کارکردهای اجرایی (p، r=0/46) همبسته است. حافظه کاری رابطه معنی‌داری با انعطاف‌پذیری شناختی خردسالان نداشت (p>05، r=0/23). نمره‌کل کارکردهای اجرایی خردسالان به ترتیب 18، 15 و 21 درصد از واریانس میزان انعطاف‌پذیری رفتاری خردسالان نسبت به اشیاء، نسبت به محیط و نمره‌کل انعطاف‌پذیری رفتاری را پیش‌بینی می‌کند. کارکردهای اجرایی توانایی پیش‌بینی معنی‌دار انعطاف‌پذیری رفتاری نسبت به افراد را نداشت. نتیجه‌گیری: مطالعه حاضر نشان داد که نقص در کارکردهای اجرایی با انعطاف ناپذیری رفتاری در خردسالان با علائم اختلال طیف اُتیسم همراه است. پیشنهاد می‌شود که در مطالعات آتی، طراحی مداخلات زودهنگام ارتقاء کارکردهای اجرایی با هدف افزایش انغطاف‌پذیری کودکان با اختلال طیف اُتیسم مورد بررسی قرار گیرد.

Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and social communication and a range of restricted, repetitive, and stereotyped behavior patterns, interests, and activities (1). The onset of ASD symptoms usually occurs in symptoms of autism in infancy and toddlers before the age of 2 years. Although new theories have been developed to explain different features of ASD core impairments in recent years, no neuro-psychological theory has been proposed to explain all ASD aspects satisfactorily. EFs, theory of mind (ToM), and weak central coherence cognitive theories have dominated neuropsychological research into ASD (10, 11). It is assumed that the theory of mind and weak central coherence could explain many of the deficits in social interaction and social communication associated with ASD (12). However, the EFs theory may provide the best explanation for the non-social aspects of ASD, such as repetitive behaviors and restricted interests (13). EFs are a set of cognitive skills defined as an “umbrella” term that includes goal-directed and self-regulatory cognitive abilities such as inhibition, shifting, working memory, flexibility, and planning (20). Additionally, EF is the only theory that acknowledges both the motor and cognitive characteristics of ASD (e.g., perseveration, insistence on sameness, repetitive hand flapping, and rocking) (10). Deficits in behavioral flexibility have been repeatedly documented in ASD. Behavioral inflexibility in ASD is characterized by circumscribed interests, restricted and repetitive behaviors (RRBs), pervasive impairments in social interactions and communication. Behavioral inflexibility refers to rigid behavioral patterns that contrast with the need to adapt to the changing needs of the environment. Behavioral Inflexibility is a potential dimensional ability that can explain the RRBs domains. RRBs are a hallmark of ASD (1). The RRBS manifests across echolalia, stereotyped behaviors, self-injurious behaviors, ritualistic behaviors, sameness behaviors, restricted behaviors, compulsive behaviors, and hyper- or hypo-reactivity to sensory stimuli. Despite the findings of previous studies showing a deficit in the behavioral flexibility of people with ASD, determining the degree of predictability of each of the executive functions in the behavioral flexibility of children with ASD has not yet been studied. By identifying the cognitive underpinnings of behavioral inflexibility at an early age in people with autism spectrum disorder, early and specific interventions can be designed to improve the underlying cognitive function and thus increase behavioral flexibility. Indeed, clarifying the cognitive basis of behavioral flexibility in people with autism spectrum disorder can provide clues to its pathophysiology, improve clinical evaluation, and guide the development of new interventions to address behavioral flexibility as one of the hallmarks of autism spectrum disorder. The present study seeks to answer the question of what is the relationship between the components of executive functions and behavioral flexibility and can executive functions predict behavioral flexibility as one of the hallmarks of autism. Methods Participants included forty-five toddlers (34 males, 11 females; mean age=26.33 months; range 16–36 months) who were referred to the autism center. Each subject was diagnosed using comprehensive evaluation that included standardized testing, behavioral observation, and extensive parent reports gathered through interviews and questionnaires. Diagnoses were based on DSM 5 guidelines (1). All subjects were evaluated by an ASD specialist with a PhD in clinical psychology and at least one assistant (with at least a master's degree in clinical psychology). The diagnosis was made based on informed clinical judgment following interaction with the child, formal testing, and review parent reports and records review. Cross-sectional data were collected from mothers of toddlers. The behavior rating inventory of executive functioning-preschool version (BRIEF-P) and the behavior flexibility rating scale-revised (BFRS-R) was administered to mothers. To participate in the current study, parents completed an informed consent form for the child’s participation, executive functions and repetitive behavior measures (described below), and a demographic information checklist. Inclusion criteria included no known comorbid psychological and medical disorders or hearing and visual deficits. Results The results of the Pearson correlation test revealed that the degree of behavioral flexibility in young children was correlated with inhibition, shifting, emotional control, planning/organization, inhibitory self-control, cognitive flexibility, metacognition, and the overall score of executive functions. Only working memory had no significant relationship with children's behavioral flexibility among executive functions. Regression analysis was used to evaluate the predictive role of executive functions of defects in the behavioral flexibility of young children. Executive functions predict 18%, 15%, and 21% of the variance of children's behavioral flexibility towards objects, environment, and total behavioral flexibility score, respectively. Conclusion This study's findings showed that all executive functions studied, except working memory, have a significant relationship with behavioral flexibility in young children. The regression analysis results also showed that executive functions had the ability to significantly predict part of the variance of flexibility in children with symptoms of autism spectrum disorder to the environment and objects. At the same time, this predictive was not significant in behavioral flexibility towards individuals. According to this study’s findings, it can be concluded that the ability to shift attention between different situations and tasks and inhibit thoughts and movements are essential cognitive predictions in the amount of behavioral flexibility in young children. Also, executive function theory has the ability to predict the behavioral flexibility related to non-social stimuli. Other cognitive theories such as ToM and weak central coherence should be considered to explain social and behavioral flexibility. Ethical Considerations Compliance with ethical guidelines The present study observed ethical principles, including obtaining written consent in order to participate in the research, respecting the principle of confidentiality of the participants in such a way that the names of the participants were removed for confidentiality; adequate information on how the research was conducted was provided to all participating parents and they were free to leave the research process. Authors’ contributions Both authors of the present study collaborated in the design and conceptualization of the study and its final approval. The article's first author was responsible for preparing and revising the manuscript. Funding No financial support has been received from any organization for this research. Acknowledgments The authors would like to thank all the families who helped us in this research. Conflict of interest The authors declared no conflict of interest.