The relationship between cognitive flexibility and restricted, repetitive behaviors in children with autism: Parents’ reports vs. cognitive task performance

Cognitive flexibility (CF), a key aspect of executive functioning (EF), is often impaired in children with autism and closely linked to restricted and repetitive behaviors and interests (RRBIs). While higher-order RRBIs are associated with behavioral rigidity, few studies have examined CF using both performance-based and parent-report methods in early childhood. This study explored the relationship between CF, RRBIs, and EF in 43 children with autism aged 3 to 7 years through multiple methods of assessment. Children completed a computerized CF task measuring switch costs via reaction time and accuracy, while caregivers provided standardized ratings of EF, RRBIs, and behavioral flexibility. Significant correlations emerged across CF indices, suggesting convergence between lab-based and caregiver-reported assessments. Accuracy-based switch cost was the strongest predictor of cognitive inflexibility, with higher-order RRBIs and working memory deficits explaining over 80% of the variance. Reaction time measures were less predictive, and parent-reported CF was associated with higher-order RRBIs, communication challenges, and EF impairments. Lower-order sensorimotor RRBIs showed no significant link to CF. These findings highlight the importance of accuracy-based CF measures and multi-method assessment, pointing to modifiable targets for early intervention during critical EF development in autism. Moreover, the results offer insight into distinct underlying mechanisms differentiating higher-order and lower-order restricted and repetitive behaviors and interests.