B-53: The Cognitive Burden of Comorbidity: Executive Dysfunction in Youth With ASD and MDD During Acute Psychiatric Crisis

Abstract

Objective: This review aims to identify how specific components of executive dysfunction (EF), including cognitive flexibility, working memory, and inhibition, moderate the severity of acute crisis-level distress (e.g., suicidal ideation and aggression) in children and adolescents with comorbid Autism Spectrum Disorder (ASD) and Major Depressive Disorder (MDD). It further evaluates the efficacy and adaptation of interventions for this population. Method/Data Selection: Data were gathered from a systematic review of literature (2015–2025) and cross-sectional studies. Data Sources included searches focused on ASD, MDD, and EF. Study Selection identified research involving youth (ages 5–16) and a large-scale medical record review (N=1,101) of psychiatric admissions. Data Extraction followed guidelines to analyze parent-rated executive functioning (BRIEF), intelligence (RPM), and clinical symptoms (CARS). Results/Data Synthesis: Results indicate that youth with ASD exhibit significant impairments across all EF subscales, specifically in working memory and inhibition, which correlate with social and sensory impairments. Data reveals that ASD/ID youth are three times more likely to be hospitalized for aggression than non-ASD youth. Furthermore, MDD often manifests atypically as worsening ASD symptoms, such as increased rigidity and self-injury, rather than traditional dysphoria. Conclusions: Executive dysfunction fundamental to ASD significantly contributes to acute crisis-level distress. Higher rates of aggression and reliance on psychotropic medications highlight a need for improved treatment approaches, such as the Autism Spectrum Disorder Care Pathway (ASD-CP). Future studies should focus on standardized tools to recognize atypical depression in this population.