Funcionamiento ejecutivo en habilidades para la vida diaria de adultos con Trastorno del Espectro Autista

Abstract

Autism spectrum disorder (ASD) is a lifelong condition characterized by significant deficits in social-emotional communication and by repetitive and restricted behaviors or specific interests. It is also characterized by impaired functioning in different areas of daily life, which are more limiting in adulthood. We do not know precisely what factors are behind this limited functioning. However, this lack of knowledge has important implications for the conceptualization of ASD, especially for understanding its heterogeneity, analyzing the efficacy of therapeutic interventions, and developing diagnostic tools. To reduce this research gap in the field of adult life in ASD, in this doctoral thesis we adopt a dimensional approach to analyze and understand the heterogeneity observed in these individuals. We consider that behind the different clinical presentations of this disorder and its limited functioning lies a series of dimensions, which in one way or another, contribute positively or negatively to the characteristics of ASD. For example, the level of language, the age group in which the individual is, his or her intelligence and finally we believe that executive functions (EF) play a very important role in relation to the skills and adaptive functioning. We believe that it is important to deepen the knowledge available that EFs have in the ability to perform everyday tasks that allow the person with ASD to adapt to the environment and cope in different settings. To evaluate this hypothesis, we argue that other co-occurring conditions further increase the heterogeneity of ASD, which we believe could affect the functional outcomes of adults with ASD. For this reason, we incorporated into this research work not only a control group of typically developing individuals, but also included a group of individuals who have a clinical presentation similar to that seen in adults with ASD, thus including individuals with schizophrenia spectrum disorders (SSD). Analyzing in detail the aforementioned dimensions between both co-occurring conditions will lead us to unveil and identify which of these dimensions may be associated with symptomatic features of ASD and alterations at the functional level. All this, in its totality, opens a way for health care professionals to better characterize at the time of diagnosis, as well as to design better diagnostic and intervention strategies to achieve goals characteristic of adulthood (such as, for example, getting a job and living autonomously) and to make them competent individuals. The results of this thesis suggest that EFs play a predominant role due to their involvement with adaptive skills, which are vital to achieve appropriate functioning. In the different studies conducted, we observed a significant relationship between these two variables and even identified the predictive value of EFs on low adaptive functioning. This pattern was only observed in the ASD group. Likewise, by tracing the neuropsychological profile of EFs in both groups, we have established differences and similarities between both groups, we also identified EF skills that are preserved. Specifically, we have identified that the ASD group presents significant deficits in relation to flexibility, difficulties in performing tasks that require initiating, planning, or organizing tasks or activities, as well as needing more time to perform tasks that require eliminating distractors and inhibiting certain unwanted responses to mention a few. These findings not only allow us to delineate differences in the diagnostic process, but also to design better therapeutic intervention strategies or intervention programs.