Question 4.

Summarize articles that discuss executive function and decision-making skills as they may contribute to repetitive behaviors.

As we have discussed in previous weeks, executive function disorders are a common feature shown by people with an ASD. One may assume that weak central coherence and deficits in executive function may contribute to repetitive behaviors. One study found that repetitive actions are a result of executive function as opposed to weak central coherence. (South, Ozonoff, & Mcmahon, 2007)

Executive functions control our ability to initiate and to stop actions, as well as to plan future actions. Executive function helps us to monitor what we are doing, to form abstract ideas, and to bring information together in novel ways. People with EF issues may experience poor impulse control, which may lead to verbalizing in bizarre or inappropriate ways to other people. Executive function encourages flexible thought and the ability to change topics or activities. Routine or repetitive tasks may make fewer demands upon executive functioning. (Kuhaneck & Watling, 2010)

When compared to children with ADHD, also a disorder that features problems with executive function, children with ASD exhibit more issues with planning and flexibility, while children with ADHD have more difficulty with impulse control. It has been noted that as many as half of children with an ASD seem to have ADHD symptoms as well. Is it possible, then, that the rigidity of ASD in combination with the lack of impulse control of comorbid ADHD can contribute to repetitive behavior?

(Sinzig, Morsch, Bruning, Schmidt, & Lehmkuhl, 2008)

 

Research suggests that without the ability to regulate behaviors or to inhibit repetitive behaviors, the child with ASD may become “locked in” to certain behaviors. (Turner, 1999) With a diminished system in place to enable one’s ability to self-regulate behaviors, assimilate new routines, and to remain flexible in new environments, it is easy to understand that children with an ASD engage in repetitive behaviors, especially when faced with new and stressful situations.

An EMT friend of mine relayed a story about a patient with high-functioning ASD she transported recently. He was very ill and needed surgery immediately, but he had tickets to an art exhibit the next day. He was so locked into the idea of going to the exhibit he repeatedly demanded that the doctor release him right away. She noticed that he also had a fascination with addresses, so she distracted him with the addresses of all the hospitals in the area, which kept him calm enough for transport. Fortunately, the gentleman was conserved and could not refuse the surgery that saved his life. This patient's inability to take in the information that he was critically ill and his unwillingness to cancel his trip to an art show are perfect examples of how problems with executive function and the lack of flexibility associated with ASD can impact decision making.

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References:

Kuhaneck, H. M., & Watling, R. (Eds.). (2010). Autism, A Comprehensive Occupational Therapy Approach (3rd ed.). Bethesda, MD: AOTA Press.

Sinzig, J., Morsch, D., Bruning, N., Schmidt, M. H., & Lehmkuhl, G. (2008). Inhibition, flexibility, working memory, and planning in autism spectrum disorders with and without comorbid ADHD symptoms. Child and Adolescent Psychiatry and Mental Health.

South, M., Ozonoff, S., & Mcmahon, W. M. (2007). The relationship between executive functioning, central coherence, and repetitive behaviors on the high functioning autism spectrum. Autism, 437-451.

Turner, M. (1999). Annotation: Repetitive Behaviour in Autism: A Review. Journal of Child Psychology and Psychiatry, 839-849.