Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis.

This research looked at how rigid thinking patterns (difficulty switching between tasks or ideas) relate to mental health problems in autistic children and teens. By combining results from multiple studies, researchers found that autistic young people with more rigid thinking tend to have more anxiety, depression, and behavioral problems. The connection was particularly strong for behavioral issues. This suggests that helping autistic children become more flexible in their thinking might improve their mental health and help them benefit more from therapy.

This systematic review and meta-analysis examined the relationship between cognitive inflexibility and mental health symptoms in autistic children and adolescents. Analyzing 21 studies (n=1608) for internalizing symptoms and 15 studies (n=1115) for externalizing symptoms, researchers found significant associations between greater cognitive inflexibility and both types of symptoms. The pooled analysis revealed moderate associations with internalizing symptoms (r=0.39) and large associations with externalizing symptoms (r=0.48). Results remained consistent when using parental reports and excluding participants with co-occurring ADHD.

The findings suggest cognitive inflexibility may be a transdiagnostic vulnerability factor that increases rigid thinking patterns and reduces ability to access psychological interventions, highlighting the importance of addressing cognitive flexibility in therapeutic approaches.

Cognitive inflexibility may serve as a transdiagnostic vulnerability factor for mental health difficulties in autistic youth. Targeting cognitive flexibility in therapeutic interventions could improve treatment engagement and outcomes. Clinicians should assess and address rigid thinking patterns when treating internalizing and externalizing symptoms in autistic children and adolescents.

The abstract does not specify methodological limitations of included studies or potential sources of heterogeneity. Sample sizes varied considerably between analyses for internalizing (n=833) versus externalizing (n=295) symptoms. Information about age ranges, measurement tools, and study quality assessments is not provided in the abstract.

Compared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n = 1608) of CI and INT, and 15 studies (n = 1115) of CI and EXT.

A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n = 833; r = 0.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n = 295; r = 0.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD.

Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties.