Research Summary

INSAR 2023 Research Summary: Executive Functioning in Early Childhood Development (< 48 months old)

Dr. Fakhri Shafai
The International Society for Autism Research (INSAR) is the largest autism research conference in the world. This year's meeting was held in Stockholm, Sweden on March 3-6, 2023. One focus this year was on Executive Functioning issues in early development.

In this research summary, researchers from the UK were interested in exploring the relationship between Executive Functioning and traits associated with autism in young children. This study sought to see if a relationship between Executive Functioning and autistic traits could be found in infants or toddlers, prior to a formal diagnosis.

Conference Summary: The International Society for Autism Research (INSAR) is the largest autism research conference in the world. This year’s conference took place May 03 – 06 and was held in Stockholm, Sweden. There has been a push in recent years to elevate autistic voices and the “nothing about us without us” movement has led to additional events to provide a platform for autistic individuals to share their perspectives. This year also had multiple sessions devoted to exploring aging in autism and how to better support Autistic people as they enter their senior years. Topics for research panel sessions are chosen based on proposals around the world that are in line with the stated goals of the INSAR community.


INSAR 2023 Session: Executive Functions in Early Development

Presentation: Toddlers (but not infants) with Elevated Autistic Traits Show Lower Executive Function Scores

Presenting Author: M. Nosyk, University College London

Additional Authors: A. Hendry, University of Oxford

Background: Executive Functioning is a term that describes multiple cognitive processes, behaviours, and skills that develop as we age. While there is some disagreement between different groups about what skills exactly should be included under the umbrella of ‘Executive Functioning’, some common ones include:

  • Attentional Control: The ability to ‘concentrate’ or focus your attention on what you want and ignore what you don’t want to focus on
  • Inhibitory/Impulse Control: The ability to stop before saying something or acting in a way that could be considered ‘inappropriate’
  • Working Memory: The ability to keep a small amount of information in mind temporarily to be used in cognitive tasks (sometimes called short-term memory, but not all researchers agree that they are the same thing)
  • Cognitive Flexibility: The ability to adapt to new, changing, or unplanned information, rules, or events, sometimes called ‘cognitive shifting’
  • Problem Solving: The ability to overcome obstacles to achieve a goal, requires understanding the context of a situation, thinking of possible solutions, and finally deciding on a solution with the end goal in mind
  • Planning: The process of thinking of the steps necessary to achieve a goal, requires the ability to think ahead and use logic and/or imagination
  • Self-regulation: The ability to manage behaviour and emotions when upset or excited

Executive Functioning begins to develop in the first year of life, develops rapidly during the toddler and preschool period, and continues to develop into adulthood1. There are strong links between Executive Functioning skills and social and academic success later in life.

Research has previously demonstrated that some Executive Functioning skills may be impaired in Autistic people, those with ADHD, or people with addiction issues2-3. Executive Functioning challenges may also be the result of brain injuries, blood clots, infections, or related to aging (e.g., dementia)4.


INSAR presentation: How are Executive Functioning skills related to autism in toddlers?
The presenting researchers were interested in exploring the relationship between Executive Functioning and traits associated with autism for young children. Previous research has indicated that Executive Functioning challenges are common amongst autistic children and adults5 This study sought to see if a relationship between Executive Functioning and autistic traits could be found in infants or toddlers, prior to a formal diagnosis.

The researchers used a recently developed questionnaire designed for use with children between 9- to 36-month-olds (described below). They also had families fill out a questionnaire designed for measuring autistic traits in infants or toddlers. Participating families had a history of autism or ADHD (e.g., the parent or a sibling have previously been diagnosed). The authors confirmed that there is a relationship between Executive Functioning and autistic traits in children as young as 2 years old but was not measurable in children younger than two. Future directions for the research include seeing if it is possible to identify Executive Functioning challenges in infants.

How are Executive Functioning challenges spotted in toddlers?
There are a variety of tools and questionnaires that clinicians may use to measure traits related to Executive Functioning in young children. Some of these tools are only available to clinicians at a cost. One more recent tool is the Early Executive Functions Questionnaire (EEFQ)6, which was developed by Dr. Hendry’s and has been shared on the Open Science Framework (see This means that the questionnaire is available to researchers around the world for free in order to enable better collaboration.

This questionnaire was developed with a relatively limited sample of families in the UK and is currently being assessed for how well it can generalize to other populations. One big advantage of this tool is that it combines parent report of everyday behaviour with instructions for parents to try different ‘games’ at home that capture other aspects of Executive Functioning that might be harder for parents to spot during day-to-day activities. For instance, one ‘game’ asks parents to give their child a food they like but ask them to wait before they eat it. Parents then time how long it takes for their child to eat it. If the child can wait 30 seconds the parent then tells them they can have it. This ‘game’ measures the ‘impulse control’ aspect of Executive Functioning.

This questionnaire is not able to diagnose Executive Functioning challenges specifically (e.g., there is not a specific score that lets you know that a child definitely has Executive Functioning difficulties). However, using this questionnaire and bringing it to your child’s pediatrician can help you start a conversation about some of the challenges you have observed with executive functioning. This can help your child’s doctor to better understand the areas that your child struggles with and perhaps narrow down the best possible types of support to offer.

To access this questionnaire and scoring guide, please go to the following links:

Only available in English Version EEFQ:

What can I do with this information?
As previously mentioned, this questionnaire can be helpful for starting a conversation with your child’s pediatrician. Previous research has shown that engaging your child in regular activities at home can help with developing Executive Functioning skills7. If you believe your child may struggle with Executive Functioning, you can do age-appropriate activities and games to help improve those skills. For instance, if your child has challenges with working memory, hiding games can help to build that skill.

You can find a range of free, downloadable activity ideas from the Playful Packs project

The Center on the Developing Child at Harvard University has some age-appropriate activity guides for specific age ranges:

Activities for 6- to 18-month-olds

Activities for 18- to 36-month-olds

Activities for 3- to 5-year-olds


  1. Hendry, A., Jones, E. J. et Charman, T. (2016). Executive function in the first three years of life : Precursors, predictors and patterns. Developmental Review42, 1-33.
  2. Vaidya, C. J., You, X., Mostofsky, S., Pereira, F., Berl, M. M. et Kenworthy, L. (2020). Data-driven identification of subtypes of executive function across typical development, attention deficit hyperactivity disorder, and autism spectrum disorders. Journal of Child Psychology and Psychiatry61(1), 51-61.
  3. Verdejo-Garcia, A., Garcia-Fernandez, G. et Dom, G. (2022). Cognition et addiction. Dialogues en neurosciences cliniques.
  4. Cristofori, I., Cohen-Zimerman, S. et Grafman, J. (2019). Executive functions. Manuel de neurologie clinique163, 197-219.
  5. Demetriou, E. A., Lampit, A., Quintana, D. S., Naismith, S. L., Song, Y. J., Pye, J. E., ... & Guastella, A. J. (2018). Troubles du spectre autistique : une méta-analyse des fonctions exécutives. Molecular psychiatry23(5), 1198-1204.
  6. Hendry, A. et Holmboe, K. (2021). Développement et validation du Early Executive Functions Questionnaire : A carer-administered measure of Executive Functions suitable for 9-to 30-month-olds. Infancy26(6), 932-961.
  7. Hendry, A., Gibson, S. P., Davies, C., McGillion, M. et Gonzalez-Gomez, N. (2023). Toward a dimensional model of risk and protective factors influencing children's early cognitive, social, and emotional development during the COVID-19 pandemic. Infancy28(1), 158-186.

Photo Credit: Markus Spiske on Unsplash

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