Peer-reviewed article
A Multimodal Investigation of Flexibility and Socialization in Autistic Children With and Without ADHD.
Fiona Journal, Michel Godel, Nada Kojovic, Kenza Latrèche, Maude Schneider et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined flexibility and social skills in 124 children aged 6-12 years from Geneva, comparing typically developing children with autistic children, and autistic children with and without ADHD. Children with autism showed higher levels of repetitive behaviors than typically developing children, while those with both autism and ADHD showed additional difficulties with daily and cognitive flexibility. Flexibility problems, especially caregiver-reported flexibility, were strongly linked to poor socialization skills in autistic children.
Key points
- Both autism and autism with ADHD groups showed higher restricted and repetitive behaviors compared to typically developing children, with no difference between the two autism groups
- Children with autism plus ADHD showed more pronounced difficulties with daily and cognitive flexibility, particularly on tasks with time pressure or implicit learning demands
- Caregiver-reported behavioral flexibility (BRIEF scores) correlated strongly with both repetitive behaviors and socialization difficulties in autistic children
- The relationship between repetitive behaviors and socialization was significant only in autism alone, suggesting ADHD co-occurrence may change how repetitive behaviors affect social functioning
- Flexibility difficulties were strongly associated with lower socialization scores across both autism groups
Limitations
This is a cross-sectional study examining associations rather than causation, so it cannot determine whether flexibility difficulties cause socialization problems or vice versa. The study is limited to one geographic location (Geneva) and does not investigate which specific supports or interventions might improve both flexibility and social outcomes.
Abstract
PURPOSE: This study investigated the multiple components of flexibility in autistic children with and without co-occurring ADHD, and their associations with social functioning. We aimed to determine ADHD co-occurence influence on flexibility profiles and the links between flexibility and social outcomes. METHOD: 124 children aged 6-12 years were drawn from the Geneva Autism Cohort. Flexibility was assessed across three domains: restricted and repetitive behaviors (RRBs; EC2R), daily behavioral flexibility (BRIEF-2), and cognitive flexibility (MTT and IED: CANTAB, and CST: Early Years Toolbox). Socialization skills were measured using the Vineland-II. Group comparisons and correlation analyses were conducted across three groups: typically developing (TD), autism (ASD), and autism with co-occurring ADHD (ASD + ADHD). RESULTS: Both ASD and ASD + ADHD groups showed higher levels of RRBs compared to TD, with no difference between ASD and ASD + ADHD. Daily and cognitive flexibility difficulties were more pronounced in ASD + ADHD, particularly on tasks involving time pressure or implicit learning. BRIEF scores correlated strongly with RRBs in both ASD groups, while links with task-based flexibility were weak. Socialization difficulties were observed in both ASD groups and were strongly associated with caregiver-reported flexibility. Notably, the inverse correlation between RRBs and socialization was significant only in ASD, suggesting co-occuring ADHD may alter the regulatory function of RRBs. CONCLUSION: ADHD co-occurrence contributes to a distinct flexibility profile in autistic children, especially under implicit instructions or timed conditions. Flexibility difficulties were strongly related lower socialization scores, underscoring the need for tailored supports that address both executive and social domains across neurodevelopmental profiles.