Executive functions: planning, starting, switching

What is meant

The meta-analysis summarised studies that measured executive functions with tasks and compared people on the spectrum with comparison groups. ^[1] In everyday life this can show as difficulty starting, planning, prioritising or switching between tasks (description by the editorial team, not a statement of the study). Whether something is “not feeling like it” or “not being able to” cannot be reliably told from outside. On motivation itself, we have read no studies.

What research found

The meta-analysis (up to June 2016, 235 studies, 6,816 participants with autism, 7,265 controls) found: ^[1]

• a moderate overall effect for reduced executive functions (Hedges’ g = 0.48);
• similar effects in the different sub-areas and relatively stable across development; most comparisons by influencing factors showed no significant difference, one exception being an age difference in working memory;
• the effect became smaller in newer studies; the authors consider it possible that this is related to the widening of diagnostic criteria;
• only few measures achieved diagnostic sensitivity; a division into individual sub-areas was not supported;
• questionnaires (self- or other-report) gave clearly larger effects than tests and tasks; the main analyses largely excluded them. Self-reports and test findings are therefore not the same thing.

Training of flexibility and self-organisation

The 2021 therapy guideline reported a study (Kenworthy et al. 2014) on a programme for executive functions: it improved flexibility and self-organisation, but not social interaction. ^{[2, Ch. C.4.2.2, C.4.3.2]} The guideline made no recommendation on this; the study has not been checked by the editorial team.

What can help in everyday life

For everyday life, the guideline named structure, predictability and visual means as helpful in dealing with people with autism. ^{[2, Rec. 3]} This does not refer explicitly to executive functions. As suggestions from the editorial team (not backed): split tasks into small steps, fixed starting rituals, visible plans, timers and announcing transitions. More: Routines, structure and predictability in everyday life and Preparing well for changes and transitions.

What else you should know

• Burnout and exhaustion can make planning and starting even harder; see Autistic burnout.
• Getting help: For strong everyday problems, advice and assessment make sense; orientation: Finding advice.
• Not covered: coaching, apps and medication for self-organisation.

Sources and literature

1. Demetriou EA, Lampit A, Quintana DS, Naismith SL, Song YJC, Pye JE, Hickie I, Guastella AJ. Autism spectrum disorders: a meta-analysis of executive function. Molecular Psychiatry 2018;23(5):1198–1204. https://doi.org/10.1038/mp.2017.75 – Meta-analysis
2. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Empf. 3; Kap. C.4.2.2, C.4.3.2). – Guideline (in German); expired on 23 March 2026 (see no. 3)
3. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)