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Updated: Jan 20, 2026
Behavioral Tests to Assess Executive Functions in Children with ASD
Published on: April 30, 2023
Relations between caregiver-report of sleep and executive function problems in children with autism spectrum disorder
Amanda Cremone-Caira1, Julia Buirkle2, Rachel Gilbert3
1Division of Developmental Medicine, Boston Children's Hospital, 02215, United States; Harvard Medical School, 02215, United States.
Insights
Children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms are at higher risk if they have sleep and executive functioning (EF) difficulties. Working memory deficits specifically increase ADHD symptom risk in ASD.
Area of Science:
- Neurodevelopmental disorders
- Child psychology
Background:
- Autism spectrum disorder (ASD) frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD).
- Children with ASD and ADHD often exhibit sleep disturbances and executive functioning (EF) deficits.
- Sleep issues are known to worsen ADHD symptoms and impair EF in typical development.
Purpose of the Study:
- To investigate if caregiver-reported sleep and EF difficulties predict ADHD symptoms in children with ASD.
- To understand the relationship between sleep, EF, and ADHD symptom severity in this population.
Main Methods:
- Collected caregiver-report data on sleep, EF, and ADHD symptoms for 101 children with ASD (ages 7-11).
- Employed hierarchical linear regressions to analyze the predictive power of sleep and EF on ADHD symptoms.
Main Results:
- Children with ASD experiencing both sleep and EF difficulties were more prone to ADHD symptoms.
- Difficulties in working memory were a significant risk factor for clinically relevant ADHD symptoms.
- Sleep did not mediate or moderate the link between working memory and ADHD symptoms, suggesting independent pathways.
Conclusions:
- Sleep and EF deficits can help identify a subgroup of children with ASD at higher risk for comorbid ADHD.
- These findings have clinical implications for targeted interventions and early identification of comorbidity in ASD.
Background:
Many children with autism spectrum disorder (ASD) experience comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD). Additionally, children with ASD and ADHD often have sleep disturbances and deficits in executive functioning (EF). In typical development, sleep disturbances are causally linked to EF deficits and exacerbate ADHD-like symptoms.
Aim:
The aim of this study was to determine whether caregiver-report sleep and EF difficulties predict ADHD symptoms in children with ASD.
Methods:
Caregiver-report of child sleep, EF, and ADHD symptom severity was collected for 101 children with ASD, 7-11 years of age. Hierarchical linear regressions tested the independent and interactive effects of sleep and EF in predicting ADHD symptoms.
Results:
Children with ASD were more likely to have symptoms of ADHD if they experienced both sleep and EF difficulties. Children with difficulties in working memory were particularly at risk for clinically significant symptoms of ADHD. Notably, however, sleep did not mediate or moderate the relation between working memory and ADHD symptoms in this sample, suggesting that these variables act through independent mechanisms to increase vulnerability for comorbidity.
Conclusions:
These results have clinical significance as sleep and EF deficits may identify an ASD subgroup that is at increased risk for a comorbid ADHD diagnosis.
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