Characterizing Inhibitory Control Challenges Among Autistic Adults: An Examination of Demographic and Psychiatric Moderators and Associations with Anxiety Symptomatology

Autism spectrum disorder is associated with elevated rates of mental health difficulties and executive function challenges. Emerging evidence links executive function to mental health in autistic individuals. However, less is known about (a) everyday inhibitory control difficulties among autistic adults; (b) the influence of sex assigned at birth and co-occurring attention deficit/hyperactivity disorder (ADHD) features on inhibition challenges; and (c) relations between inhibition challenges and anxiety symptoms. Drawing upon data from 732 autistic adults aged 18-83, this online study examined self-reported inhibitory control in autistic adults and the influence of assigned sex and ADHD screening status (based on a positive screening score on a self-report tool) on the degree of inhibitory control challenges experienced. In addition, this research examined relations between inhibitory control challenges and anxiety symptoms, and the moderating role of assigned sex and ADHD screening status in this relationship. Autistic adults endorsed significantly more inhibitory control challenges relative to published norms. Participants assigned female reported more difficulties in inhibitory control relative to sex-adjusted normative expectations than participants assigned male. Participants who screened positive for ADHD reported more inhibitory control challenges than those who screened negative. Greater endorsement of inhibitory control challenges was associated with greater anxiety symptomatology; this relationship was moderated by ADHD screening status, but not by assigned sex. Inhibitory control is an area of difficulty in autistic adults and is associated with anxiety symptomatology, suggesting that inhibitory control may be a valuable intervention target to improve emotional well-being in autistic adults.