Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems

Mental health conditions such as anxiety, depression, aggression, and inattention are common in autistic youth and are challenging to treat by community providers. We aim to parse the heterogeneity of autism based on dimensions of executive function and determine whether specific executive function profiles are differentially related to psychiatric symptoms. Parents of 397 well-characterized 8-14-year-old autistic children without an intellectual disability reported on their child's executive function skills and psychiatric symptoms. We applied a data-driven, graph theory-based, community-detection approach to a common executive function measure, revealing three distinct executive function profile subgroups. Despite having similar social challenges, the executive function subgroups differed on anxiety, aggression, affect, and inattention symptoms. Results support the need for more intensive subtyping with autistic youth to develop appropriate, individualized mental health treatments and supports. Characterizing youth through neurocognitive strengths and challenges can guide the development of precision medicine, allowing for more meaningful, specialized treatment.Lay Abstract Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.