Executive Functioning Is Linked to Mental Health Challenges Among Autistic Adults with Higher Support Needs

Executive function (EF) refers to a set of cognitive skills essential for self-regulation, problemsolving, and goal-directed behavior. Although EF’s relationship with co-occurringpsychopathology is well established in autistic individuals without intellectual disability, its rolein autistic individuals with higher support needs, including those with intellectual disability,remains underexplored, particularly beyond childhood. The present study addresses this gap byexamining associations between three EF components (flexibility, emotion regulation, andinhibitory control) and symptoms of anxiety and depression in 486 autistic adults with highersupport needs (ages 18–68; M = 31.07), recruited through the Simons Powering AutismResearch (SPARK) Research Match service. Caregivers completed the Flexibility Scale, theBarkley Deficits in Executive Functioning Scale (inhibitory control and emotion regulationsubscales), and the Anxiety, Depression, and Mood Scale (ADAMS; anxiety and depressionsubscales). Hierarchical linear regressions, controlling for age, sex assigned at birth, and co-occurring intellectual disability, revealed that greater difficulties with flexibility and emotionregulation were significantly associated with elevated anxiety and depression symptoms,whereas inhibitory control difficulties were not. These findings identify flexibility and emotionregulation as key correlates of internalizing symptoms in autistic adults with higher supportneeds, highlighting their potential as targets for interventions aimed at improving mental healthoutcomes in this group.