J Autism Dev Disord (2011) 41:352–356

DOI 10.1007/s10803-010-1039-2

BRIEF REPORT

Brief Report: Executive Functioning in Autism Spectrum

Disorders: A Gender Comparison of Response Inhibition
Janine M. Lemon • Belinda Gargaro •
Peter G. Enticott • Nicole J. Rinehart

Published online: 27 May 2010

Ó Springer Science+Business Media, LLC 2010

Abstract Although autism spectrum disorders (ASD) Introduction

affect more males than females, it is not clear whether
neurobehavioural correlates of ASD are equivalent across Autism spectrum disorders (ASD) predominantly affect
genders. This study examined gender differences in neu- males, with diagnostic ratios suggesting at minimum a 4:1
robehavioural functioning in boys and girls with ASD. ratio (Bryson et al. 1988; Gray and Tonge 2005; Volkmar
Participants were males with ASD (n = 10), females with et al. 2005). It has been suggested that this could, at least in
ASD (n = 13), typically developing males (n = 8), and part, result from gender differences in the expression of
typically developing females (n = 14). Each completed the ASD, which may lead to misdiagnosis or under diagnosis
stop task, a common measure of response inhibition. among girls (Attwood 2007; Nyden et al. 2000). Girls with
Females with ASD demonstrated a significant increase in ASD may be able to ‘camouflage’ their symptoms; when
stopping time (indicating poorer inhibition). By contrast, compared with boys with ASD they seem to exhibit fewer
no response inhibition impairments were evident among challenging behaviours, have greater social and commu-
males with ASD. Females with ASD may have a different nicative abilities, and have fewer and more ‘typical’ special
neurobehavioural profile, and therefore different clinical interests (Attwood 2007; Faherty 2006; Gillberg and
needs, when compared with males with ASD. Coleman 2000; McLennan et al. 1993). Thus, it is possible
that there are neurobehavioural gender differences in ASD
Keywords Response inhibition
Stop task
that can account for the differences in clinical manifesta-
Executive function
Gender tion of the core features.
To date there has been little attention paid to possible
gender differences in ASD, except for the purpose of
examining prevalence (Thompson et al. 2003). Indeed,
there is a paucity of research examining females with ASD
(or possible gender differences), and most of our current
understanding of autism is actually about males. Investi-
gations into other neurodevelopmental disorders with
J. M. Lemon
B. Gargaro
P. G. Enticott
N. J. Rinehart (&) underlying neurocognitive deficits that also show prepon-
Centre for Developmental Psychiatry and Psychology, School of
derance for males (such as ADHD), however, provide
Psychology and Psychiatry, Monash University, 270 Ferntree
Gully Rd, Nottinghill, VIC 3168, Australia evidence that females and males exhibit different profiles
e-mail: [email protected] (Denckla 1996; Gaub and Carlson 1997; Gershon 2002).
P. G. Enticott Indeed, in ADHD, there is evidence to suggest that females
e-mail: [email protected] exhibit greater cognitive impairment than their male
counterparts (Gaub and Carlson 1997; Gershon 2002).
P. G. Enticott
Among ASD, there is initial evidence to suggest gender
Monash Alfred Psychiatry Research Centre, School of
Psychology and Psychiatry, Monash University and the Alfred, effects on neuropsychological profile (Carter et al. 2007;
Commercial Rd, Melbourne, VIC 3004, Australia Koyama et al. 2009; Koyama et al. 2007), and that females

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may actually exhibit greater cognitive impairment (despite diagnosed by a multidisciplinary team with either high-
an apparently ‘milder’ clinical presentation in relation to functioning autism or Asperger’s disorder according to
core features; Lord et al. 1982). Other studies, however, DSM-IV criteria (American Psychiatric Association 2000).
have found no such differences (Pilowsky et al. 1998; Tsai Participants were only included if Wechsler scales testing
and Beisler 1983; Volkmar et al. 1993). indicated that their full scale IQ score was equal to or
The current study examined gender differences in ASD above 70. ANOVA revealed no differences in age or full-
in response inhibition, a fundamental aspect of executive scale IQ. Parents of each participant completed the
function that may be impaired in ASD (Christ et al. 2007) Developmental Behaviour Checklist—Primary Carer Ver-
(although some authors have found no evidence of defi- sion (DBC-P; Einfeld and Tonge 2002), which is a 96-item
cient inhibition in ASD; Ozonoff and Strayer 1997). This scale that provides an index of emotional and behavioural
involved a version of the stop task (Logan 1994), which is a problems. The DBC-P has good psychometric properties,
commonly used measure of the ability to inhibit a prepotent includes five subscales (disruptive/antisocial, self-absor-
response. Based on previous ADHD and ASD research that bed, communication disturbance, anxiety, social relating),
suggest greater cognitive impairments among females and also provides an autism screening algorithm (in which
(which could conceivably extend to a fundamental cogni- autism-related items are weighted and collated to reveal an
tive ability such as response inhibition), it was hypothe- overall risk index). Higher scores are indicative of greater
sised that, compared with gender matched controls, only problems in that particular domain. These data are also
females with ASD would display reduced inhibitory con- presented in Table 1; the clinical groups scored signifi-
trol, and that inhibitory control among females with ASD cantly higher than their gender matched controls on all
would be poorer than for males with ASD. While previ- DBC-P measures. Ethical approval was obtained from
ous findings have been mixed, our hypothesis arose from Monash University and Southern Health, and parents pro-
those studies reporting greater male ASD performance on vided signed informed consent.
domains presumably reliant on inhibitory control (e.g.,
motor performance, social competence; Carter et al. 2007). Materials

Response inhibition was assessed using a version of the

Method stop task that has been described elsewhere (Enticott et al.
2009; Enticott et al. 2006, 2008). Briefly, this involved a
Participants foam board that contains four 6.5 cm 9 6.5 cm wooden
boxes (see Fig. 1). Two boxes contained both a tri-colour
Participants were 45 children aged between 6 and 16 years. (green, red, yellow) light emitting diode (LED) and a small
There were four groups: females with ASD; males with plastic push-button response key, one box contained only a
ASD; typically developing females, and; typically devel- plastic push-button, while the fourth box contained only an
oping males (see Table 1). Clinical participants were LED. Three boxes were placed in a row equidistant from

Table 1 Demographic data for the four participant groups

ASD (female) ASD (male) Control (female) Control (male)
a b
n 13 10 14 8
Mean age in months (SD) 132 (36) 133 (43) 128 (28) 145 (50)
Mean full-scale IQ (SD) 97.30 (16.74) 91.68 (18.40) 107.00 (10.72) 108.00 (11.00)
DBC-P mean (SD)
Disruptive/antisocial* 19.50 (11.07) 17.60 (8.50) 2.36 (3.20) 2.50 (3.63)
Self-absorbed* 12.00 (9.89) 14.20 (7.73) 0.64 (1.15) 0.50 (0.76)
Communication disturbance* 7.58 (4.54) 8.40 (4.67) 0.14 (0.36) 0.38 (0.74)
Anxiety* 6.58 (3.75) 7.20 (2.20) 0.71 (1.07) 0.62 (0.74)
Social relating* 6.42 (3.20) 6.80 (3.55) 0.29 (0.47) 0.25 (0.46)
Total behaviour problem score* 53.25 (27.09) 57.00 (21.50) 4.57 (4.64) 4.12 (5.67)
Autism screening algorithm* 18.75 (11.24) 23.10 (9.97) 1.14 (1.70) 1.00 (1.69)
a b
* p \ .05: ASD Female/ASD Male [ Control Female/Control Male; 6 high-functioning autism, 7 Asperger’s disorder; 10 high-functioning
autism

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Response inhibition on the stop task is determined by

varying the stop signal delay (SSD), which is the length of
time between the onset of the go signal (green LED) and
onset of the stop signal (red LED). As described within
Logan’s (1994) ‘‘race model,’’ in which inhibition is
determined by a ‘‘race’’ between go and stop processes, an
increased SSD is typically associated with a reduced like-
lihood of successful stopping. Four SSD intervals were
used: 20, 40, 60, and 80% of mean response time (MRT;
Carter et al. 2003). MRT was determined immediately
prior to the stop task by administering 20 go signal trials
(10 on each side, presented at random). Participants com-
pleted 4 blocks of 72 trials (i.e., 288 trials). Each of the
four SSD values was presented four times per block.
Fig. 1 Schematic diagram of the stop task apparatus
Data Analysis
one another (approximately 2 cm apart), and one directly
Standard measures of response inhibition were extracted
in the middle of the board, approximately 2 cm above the
(see Logan 1994, and Carter et al. 2003 for a detailed
central box.
explanation). This included stop signal reaction time
(SSRT) (ms), which provides an estimate of the speed of
Procedure
stopping, z-scores of the relative finishing times gradient
(ZRFT-gradient), which provides a measure of the ability
Each trial on this task involved the presentation a green
to trigger stopping processes, and area of inhibition (AoI),
LED above the left or right response key. On one-third of
which provides an estimate of the amount a participant is
all trials (presented at random), the green LED would
able to inhibit. Data were analysed using SPSS v15.0.
switch to red. Using only the index finger of their preferred
ANOVA was used to assess group difference in response
hand, participants were instructed to press the corre-
inhibition, and t-tests were used for follow-up comparisons.
sponding response key as fast as possible upon presentation
While group differences in IQ were non-significant, this
of a green LED (go signal), but to attempt to stop their
may reflect a lack of statistical power due to the small
response if the green LED switched to red (stop signal).
sample size. Accordingly, we also conducted Pearson
Each trial started with the onset of the centrally-located
correlation analyses between IQ and stop task performance
(yellow) LED, which prompted the participant to begin the
to determine the likely effect of intellectual functioning.
trial by depressing the start (central) key. The start key was
held down until the yellow LED extinguished (a variable
500–1,000 ms after depressing the central key), and a
green LED appeared above the left or right response key. Results
Lateral (green/red) LEDs remained illuminated until a
response was recorded or for 1,500 ms (at which time an Summary data are presented in Table 2. Levene’s statistic
error of omission was recorded). Trials in which the par- was significant for SSRT, indicating failed homogeneity of
ticipant did not continue to depress the start key until the variances, and the Welch F-ratio is reported. There was a
fixation light extinguished were stopped and repeated; thus, significant effect of group on SSRT, F(3,19) = 3.87,
for a trial to be considered valid, it was not possible for an p = .026. Females with ASD displayed slower SSRT than
individual to remove their finger from the start button prior typically developing females (p = .002, Cohen’s d = 1.30)
to the presentation of a green LED. and males with ASD (p = .025, Cohen’s d = 0.86). There

Table 2 Stop task performance

ASD (female) ASD (male) Control (female) Control (male)

SSRT [ms] (SD)* 350 (72) 270 (86) 266 (56) 265 (119)
ZRFT-gradient [m] (SD) 0.28 (0.25) 0.34 (0.13) 0.42 (0.20) 0.35 (0.22)
Area of Inhibition (SD) 0.80 (0.50) 1.16 (0.48) 1.39 (0.99) 1.09 (0.77)
* p \ .05: ASD female [ ASD male/control female/control male

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was no difference in SSRT among the male groups associated with different clinical presentations and
(p = .919, Cohen’s d = 0.05). There was no effect of group outcomes.
for ZRFT-gradient, F(3,41) = 1.07, p = .372, or AoI, The main limitation to this study is a small sample size,
F(3,41) = 1.45, p = .243. which limits statistical power and ensures that these find-
There were no significant correlations between SSRT ings must be considered preliminary. In relation to statis-
and full scale IQ (r = -.056, p = .742), verbal compre- tical power, for example, inspection of mean values reveals
hension index (r = -.019, p = .911), perceptual reasoning a non-significant reduction in ZRFT-gradient among
index (r = -.028, p = .861), working memory index females with ASD (which would indicate reduced trig-
(r = .027, p = .877), or processing speed index (r = gering of stopping processes). Replication of this study
-.039, p = .819), indicating that IQ differences do not among larger groups will therefore be important, as will the
appear to underpin the group differences in SSRT. use of a broader range of neurobehavioural measures.
There are also possible confounds that require further
investigation, including gender effects of motor speed and
Discussion the influence of IQ (i.e., non-significant differences in the
current study likely reflect insufficient statistical power,
This study provides evidence that one aspect of inhibitory although IQ was not associated with task performance in
control may be impaired in females with ASD. Specifi- the current study). This study, however, indicates that the
cally, females with ASD, when compared with healthy neuropsychological profile of girls with ASD may be dif-
females and males with ASD, displayed evidence of ferent from that of boys with ASD. A more refined
reduced speed of stopping processes (as indicated by understanding of the developmental trajectory of females
increased SSRT). It should be noted, however, that other with ASD raises the possibility of tailored management and
aspects of inhibition, including the ability to trigger stop- treatment approaches specifically for females with these
ping processes (as determined by the ZRFT-gradient), were conditions.
unaffected, suggesting that any impairments lie within a
very specific component of inhibitory control (i.e., speed of
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