Executive functions in neurodevelopmental disorders: evidence of a cognitive continuum between autism and schizophrenia

Abstract

Background

Recent evidence supports the hypothesis that schizophrenia is part of a continuum of neurodevelopmental disorders (NDDs), characterized by early alterations in fronto-striatal, parietal, and cerebellar circuits (Owen, 2017). In this perspective, Autism Spectrum Disorder Level 1 (ASD-L1) and schizophrenia share genetic and neurocognitive vulnerabilities, particularly in the domains of executive functions (EF), such as sustained attention, working memory, and perseveration.

Comparative studies have highlighted a wide overlap in the cognitive profiles of adults with ASD-L1 and patients with schizophrenia (Morais et al., 2024; Yon-Hernández et al., 2023). Furthermore, these deficits are also observable in subjects at high clinical risk for psychosis (Fusar-Poli et al., 2012), supporting the hypothesis that some executive deficits represent shared cognitive vulnerability markers among various neurodevelopmental disorders.

The use of virtual reality (VR) tools for EF assessment offers an ecologically valid approach, which is sensitive to the dynamic components of cognitive functioning and particularly suitable for the assessment of subjects with complex cognitive profiles, such as those observed in neurodevelopmental disorders.

Aims & Objectives

To explore the profile of executive functions in a sample of adults with ASD-L1 using virtual reality tools, and to evaluate its convergence with the cognitive patterns described in schizophrenia and clinical high-risk states for psychosis.

Method

24 adults diagnosed with ASD-L1 (DSM-5; 17 males, 7 females; mean age: 26 years) and 21 healthy controls matched for age and sex were evaluated.

Executive Functions were investigated using the NESPLORA virtual reality software, across the following domains: sustained attention, working memory, flexibility, perseveration, inhibition, vigilance, and planning. Performance was classified into ordinal categories (normal, low, very low).

Descriptive analyses and association tests (chi-square test; Fisher’s exact test) were conducted using R Studio (version 4.2).

Results

The most compromised domains in the sample of adults with ASD-L1 were: attention (60% with low/very low performance), working memory (54%), and perseveration (52%).

Significant associations emerged between attention and working memory (p = 0.0007), and between working memory and perseveration (p = 0.032).

Using Fisher’s exact test, a statistically significant difference was observed between the two groups (patients and controls) in the proportion of subjects showing deficits in attention (p-value = 0.01795) and perseveration (p-value = 0.0001648).

Discussion & Conclusions

The observed pattern of impairment is consistent with that described in chronic schizophrenia and clinical high-risk states for psychosis (Engel & Karch, 2023), confirming that these domains are frequently altered along the continuum of Neurodevelopmental Syndromes (NDS).

Comparative studies indicate that adults with ASD-L1 and SCZ patients show overlapping performance in executive functions, confirming a sharing of cognitive vulnerabilities (Eack et al., 2013; Yon-Hernández et al., 2023). Ongoing analyses of effect magnitude will contribute to a more precise understanding of their clinical relevance.

The use of virtual reality proved to be a highly sensitive tool suitable for the assessment of these profiles, providing dynamic and contextualized measures of executive functioning.

These results open interesting perspectives for the development of early and personalized interventions in NDDs, with potential implications for transdiagnostic and prevention fields.