SynthesisAutism research : official journal of the International Society for Autism Research2022
Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis.
Synthesis in Autism research : official journal of the International Society for Autism Research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 3 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Comparative effects of different exercise modalities on executive function in children with attention-deficit/hyperactivity disorder: a systematic review and network meta-analysis.Frontiers in psychology · 2026Pooled it
- Understanding Mechanisms that Maintain Social Anxiety Disorder in Autistic Individuals Through the Clark and Wells (1995) Model and Beyond: A Systematic Review.Clinical child and family psychology review · 2024Pooled it
- Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis.Autism research : official journal of the International Society for Autism Research · 2022Pooled it
- Executive Functioning Is Linked to Internalizing Symptoms in Autistic Adults With Higher Support Needs.Autism : the international journal of research and practice · 2026Article
- The Unique Roles of Executive Function in Co-Occurring Psychopathologies in Autism.Autism research : official journal of the International Society for Autism Research · 2026Article
- A Multimodal Investigation of Flexibility and Socialization in Autistic Children With and Without ADHD.Journal of autism and developmental disorders · 2026Article
- Psychometric Properties of the Japanese Translation of the Detail and Flexibility Questionnaire (DFlex).Behavioral sciences (Basel, Switzerland) · 2026Article
- Childhood trauma as a mediator between autistic traits and depression: Evidence from the ALSPAC birth cohort.Psychological medicine · 2026Article
- Age-varying associations between parent-reported executive function and internalizing/externalizing problems in children with neurofibromatosis type 1: an integrative analysis of data from nine institutions.Journal of the International Neuropsychological Society : JINS · 2026Article
- Thinking flexibly: A cognitive remediation therapy-informed intervention for autistic youth.Autism : the international journal of research and practice · 2026Article
- The impact of autism on the relations between social anxiety, camouflaging, and depression in Taiwanese adolescents.Child and adolescent psychiatry and mental health · 2026Article
- Misophonia symptom severity is linked to impaired flexibility and heightened rumination.British journal of psychology (London, England : 1953) · 2026Article
- Transdiagnostic determinants of access to mental health care for youth with disabilities: a systems-oriented structured narrative review.Frontiers in public health · 2026Review
- Processes Associated with the Development of Depression in Autistic Individuals: A Narrative Review.Healthcare (Basel, Switzerland) · 2025Review
- Bridging the gap: unveiling key links between autism and anxiety symptoms in autistic children and youth using a network analysis in pooled data from four countries.Child and adolescent mental health · 2025Article
- Cognitive Flexibility Mediates the Associations Between Perceived Stress, Social Camouflaging and Mental Health Challenges in Autistic Adults.Autism research : official journal of the International Society for Autism Research · 2025Article
- Social aloofness is associated with non-social explore-exploit decisions.Communications psychology · 2025Article
- Cross-Cultural Comparison of Adaptive Behaviour Between British and Brazilian Clinical Samples With Neurodevelopmental Disorders.Child: care, health and development · 2025Article
- Insistence on sameness, repetitive negative thinking and mental health in autistic and non-autistic adults.Autism : the international journal of research and practice · 2025Article
- Conceptualizing Pathways to Depression and Anxiety in Autistic Youth Using the Cognitive and Behavioral Model of Low Self-Esteem.Cognitive and behavioral practice · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Compared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n = 1608) of CI and INT, and 15 studies (n = 1115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n = 833; r = 0.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n = 295; r = 0.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.