Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-020-04461-z

ORIGINAL PAPER

Executive Function in High‑Functioning Autism Spectrum Disorder:

A Meta‑analysis of fMRI Studies
Zheng Zhang1 · Peng Peng1 · Delong Zhang2

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Abnormalities in executive function (EF) are clinical markers for autism spectrum disorder (ASD). However, the neural
mechanisms underlying abnormal EF in ASD remain unclear. This meta-analysis investigated the construct, abnormali-
ties, and age-related changes of EF in ASD. Thirty-three fMRI studies of inhibition, updating, and switching in individuals
with high-functioning ASD were included (n = 1114; age range 7–57 years). The results revealed that the EF construct in
ASD could be unitary (i.e., common EF) in children/adolescents, but unitary and diverse (i.e., common EF and inhibition)
in adults. Abnormalities in this EF construct were found across development in individuals with ASD in comparison with
typically developing individuals. Implications and recommendations are discussed for EF theory and for practice in ASD.

Keywords  Autism spectrum disorder · Executive function · Unity and diversity · Development · Fronto-parietal areas ·
Meta-analysis

Introduction Until recently, neurocognitive studies have linked ASD

Autism spectrum disorder (ASD) consists of a wide range
of neurodevelopmental conditions characterized by clinical
symptoms that include difficulties in social communication
and interaction; restricted and repetitive patterns of interests
or activities; and atypical sensitivity to sensory information
(American Psychiatric Association 2013). Approximately
70% of individuals with ASD are reported to have normal
intelligence (an IQ of 70 or above; California Department
of Developmental Services 2019). Such individuals are typi-
cally said to have high-functioning ASD (Jarrold and Brock
2004; Scheeren et al. 2013).
Electronic supplementary material  The online version of this
article (https​://doi.org/10.1007/s1080​3-020-04461​-z) contains
supplementary material, which is available to authorized users.
* Zheng Zhang
zhengzhang796@gmail.com
1
Department of Special Education, College of Education, The
University of Texas at Austin, 1912 Speedway, Stop D5000,
Austin, TX 78712, USA
2
Key Laboratory of Mental Health and Cognitive Science
of Guangdong Province, School of Psychology, Center
for the Study of Applied Psychology, South China Normal
University, Guangzhou, China
with impairments in widely distributed brain systems.
Accordingly, functions that depend on those systems, such
as sensorimotor processing, theory of mind, attention, and
executive function (EF), are compromised in those who have
ASD (Loukusa et al. 2014; Mosconi et al. 2011; O’Hearn
et al. 2008). Among these functions, EF has been of great
interest in ASD research (De Vries and Geurts 2015; Mos-
tert-Kerckhoffs et al. 2015). EF is itself an umbrella term
that refers to a set of cognitive processes that guide individu-
als toward goal-oriented behaviors (Diamond 2013). It has
been postulated that EF abnormalities are clinical markers
for ASD (Rødgaard et al. 2019), representing poor func-
tional integration of prefrontal areas and posterior cortical
and subcortical areas (e.g., parietal cortex and striatum; Lan-
gen et al. 2012; Maximo et al. 2014). Furthermore, evidence
has supported that EF abnormalities may vary with age but
in general appear to be present both in childhood and adult-
hood (Dawson 2008; Luna et al. 2007; Takarae et al. 2004).
Despite much research, however, the findings for abnormal
EF are quite mixed (e.g., Craig et al. 2016; Lawson et al.
2015; Luna et al. 2002). The neural correlates underpinning
abnormal EF in those with ASD remain to be clarified.

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The Construct of EF in ASD
One explanation for the previous inconsistent findings is
a clear lack of agreement about the EF construct in those
with ASD (e.g., Baggetta and Alexander 2016; Barkley
2012). The integrative EF model (unity and diversity)
decomposes the EF construct into what is common across
all EF processes (i.e., common EF) and what is unique to
each specific EF process (Friedman and Miyake 2017).
The specific EF processes are correlated, yet separa-
ble. They include inhibition (the restriction of prepotent
actions); updating (constant monitoring and addition or
deletion of the contents of working memory); and switch-
ing (task or mindset shifting).
Previous neuroimaging studies of ASD have not fully
considered this EF construct. For example, Hill (2004)
included planning, mental flexibility, and inhibition in
order to represent EF. Diamond (2013), however, pos-
ited that planning is a higher-level EF process that the
three fundamental EF processes in the integrative model
work together to build up. Indeed, among the studies that
have emphasized the fundamental EF processes, most
have focused on only one or two specific processes; few
have evaluated EF across all three. For example, O’Hearn
et  al. (2008) included only inhibition and updating in
their investigation of EF, whereas Schmitz et al. (2006)
explored only inhibition and switching in their attempt to
understand the specific EF processes in ASD.
In addition, among the ASD studies that have focused
on a specific EF process, findings are conflicting. For inhi-
bition, some studies have found significantly increased
brain activation in the inferior frontal gyrus in partici-
pants with ASD in comparison with typically develop-
ing (TD) controls on go/no-go tasks (Kana et al. 2007;
Schmitz et al. 2006). But Shafritz et al. (2015) recently
found that the inferior frontal gyrus was deactivated in
those with ASD performing two versions of a go/no-go
task (emotional and nonemotional). For updating, Luna
et al. (2002) reported deactivation in the prefrontal gyrus
and the posterior cingulate gyrus in participants with ASD
in comparison with TD controls. Yet Herrington et al.
(2015) found increased activation in prefrontal areas in
participants with ASD in comparison with TD controls.
As for switching, Schmitz et al. (2006) identified increased
activation in the parietal lobe in those with ASD during
task shifting. But Shafritz et al. (2008) provided evidence
to support the opposite view—that reduced activation in
the parietal lobe was responsible for the underlying abnor-
malities in switching in those with ASD.
Meta-analysis is an effective way to address these
inconsistencies across individual studies (Rothman et al.
2008). Based on our review, only one neuroimaging
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Journal of Autism and Developmental Disorders
meta-analysis, conducted by Philip et  al. (2012), has
explored EF abnormalities in those with ASD. Philip et al.
included 13 EF studies of ASD. Data for between-group
effects (ASD vs. TD) on brain activity were selected. The
results showed greater activation in the left middle fron-
tal gyrus in the ASD group, and greater activation in the
right middle frontal gyrus, the left inferior parietal lobe,
the left insula, the right posterior cingulate gyrus, and the
left lentiform nucleus in the TD group. However, Philip
et al.’s meta-analysis integrated all EF processes as unitary
EF and did not seek to ascertain brain activity specific to
each of the three fundamental EF processes.
Age‑Related Changes of EF in ASD
Age-related changes are also worthy of consideration when
investigating EF in those with ASD. Until recently, the inte-
grative model of EF has been generally confirmed by behav-
ioral evidence across different age groups (e.g., Duan et al.
2010; Ito et al. 2015; Vaughan and Giovanello 2010). How-
ever, these studies suggest that the pattern of unity and diver-
sity in EF may be quite nuanced and that it can vary with
development. At younger ages, different EF processes have
been reported as indistinguishable, so that EF in this stage
has often been interpreted as a unitary construct (Brydges
et al. 2014; Wiebe et al. 2011). In later development, how-
ever, different EF processes, although they share an overlap-
ping variance (i.e., common EF), become more separable
(Huizinga et al. 2006; Lehto et al. 2003; Senn et al. 2004;
St Clair-Thompson and Gathercole 2006). Such age-related
changes in the EF construct have also been reported in a
neuroimaging meta-analysis (McKenna et al. 2017). This
evidence from TD samples indicates that the integrative
model of EF seems to bear a developmental feature.
Based on neuroscientific evidence from the TD popula-
tion, cognitive maturation in EF is believed to be subserved
by changes in brain activation that continue through child-
hood and begin to reach adult levels in mid-adolescence
(Christou et al. 2002; Gogtay et al. 2004). One EF study
found that children relied more on the prefrontal areas than
did adults, who relied more on the parietal lobe, indicating a
transition from the prefrontal areas to the parietal lobe with
increasing age (Houdé et al. 2010). In TD samples, children
do not seem to share the completely common neural cor-
relates of EF with adults.
In ASD, age-related changes have been reported in the
cerebral cortex, limbic structures, and cerebellum (Amaral
et al. 2008). From childhood to adolescence, Amaral et al.
(2008) found an apparent increase in brain size in those
with ASD in comparison with TD participants, especially
in the frontal lobe. Nonetheless, the brain of those with ASD
would result in a normal size by adulthood (Redcay and
Journal of Autism and Developmental Disorders
Courchesne 2005). Such age-related differences in the brain
structure of those with ASD reflect distinct brain circuits
recruited by children and adults (Russo et al. 2007). fMRI
studies of ASD have revealed a more direct link between
abnormalities in the frontal lobe and EF (Hill 2004). The
failure of the frontal lobe to follow a normal maturational
pattern is likely to have long-term consequences for EF
abnormalities in those with ASD (Luna et al. 2002; Ohnishi
et al. 2000).
Given the evidence for possible effects of age on the
neural mechanisms of EF in those with ASD, many stud-
ies have tended to combine participants across different age
groups into a single sample, which cannot reflect age-related
changes in EF abnormalities (Mosconi et al. 2009; Philip
et al. 2012; Wallace et al. 2016). Although a few neuroim-
aging studies have focused mainly on a specific age range,
findings are mixed. Specifically, EF abnormalities in those
with ASD (including abnormalities in inhibition, updating,
and switching) have been found in both childhood and adult-
hood (Chantiluke et al. 2015; Daly et al. 2014; Gooskens
et al. 2019; Takarae et al. 2007; Vogan et al. 2014; Yerys
et al. 2015). In contrast, some studies have argued that some
EF processes such as those assessed in delayed match-to-
sample tasks and tasks with simple rules are intact in early
development (Dawson et al. 2002; Liss et al. 2001). Other
studies have also found intact aspects of updating in adult-
hood (Edgin and Pennington 2005). Such discrepancies
across studies may be due to the late maturation of brain
areas including the frontal gyrus that support EF during
development (Gogtay et al. 2004). Given this context, these
mixed findings of age-related EF abnormalities in those with
ASD are difficult to interpret.
Research Aims
Since the construct of EF in those with ASD has not been
established and age-related changes have not been clarified,
EF abnormalities associated with age should be further
investigated in those with ASD. The purpose of the present
meta-analysis is to identify the neural construct of EF and
explore the neural mechanisms underlying abnormal EF,
including specific EF processes, in individuals with ASD
across different age groups.
For this meta-analysis of data from neuroimaging stud-
ies, we used coordinate-based activation likelihood estima-
tion (ALE). fMRI studies that assessed brain activity in
high-functioning ASD during EF task performance were
included. Specific EF processes of interest included inhibi-
tion, updating, and switching (Friedman and Miyake 2017).
Data from the contrasts focusing on the within-group effects
in the ASD sample and the TD sample and the between-
group effects (ASD vs. TD) were selected. Data analyses
were implemented as follows. First, data from different EF
tasks were separated into a young group (< 18 years of age),
an adult group (> 18 years), and a whole group (including
the young and the adult groups). Convergence of brain activ-
ity across all EF tasks was extracted to identify the brain pat-
tern for common EF in each of the three groups. The brain
pattern of each EF process was identified by calculating
convergence of activation pertaining to inhibition, switch-
ing, or updating, separately, in each of the three groups.
These analyses should reveal the neural construct of EF in
those with ASD. Neural abnormalities in EF were revealed
by comparing common EF and each of the three EF pro-
cesses between the ASD sample and the TD sample in each
of the three groups, separately. By comparing common EF
and each of the three EF processes between the young and
the adult groups, age effects on the EF construct and the EF
abnormalities in those with ASD were further investigated.
We decided to use a cut-off point of 18 years for groups
because both the behavioral and the neuroimaging literature
suggest that EF processes including inhibition, updating, and
switching across the development of ASD would be mature
in mid-adolescence (Chantiluke et al. 2015; Happé and Frith
2006; van den Bergh et al. 2014; Yerys et al. 2015) or in
early adulthood (Lever et al. 2015; Rosenthal et al. 2013;
Solomon et al. 2014).
Methods
Studies Search and Selection Criteria
Studies for this meta-analysis were identified as follows.
First, a computer search of ERIC, MEDLINE, PsycARTI-
CLES, and PsycINFO databases for studies was conducted
from the earliest possible start date through February 2019.
Then, unpublished studies were searched through the Dis-
sertation and Masters Abstract indexes in ProQuest Disserta-
tions and Theses. The search terms for full-text search com-
bined with AND operators were (a) “working memory” OR
flexib* OR inhibit* OR execut* OR shift* OR switch* OR
updat* OR refresh* OR atten*; (b) autis* OR Asperger OR
“pervasive developmental” OR PDD OR ASD; (c) fMRI OR
“functional magnetic resonance.” Next, we hand-searched
citations in prior relevant reviews. Finally, we completed
forward and backward searches by reviewing the reference
lists of the included studies and searching all the studies that
cited the included studies in order to identify any that might
have been missed in the former search phases.
The initial search revealed 18,633 studies. Titles and
abstracts were then reviewed for removing irrelevant stud-
ies. After 547 duplicate studies and 17,470 irrelevant stud-
ies were excluded, 616 studies remained; these were further
reviewed according to the following criteria:
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Criterion 1
Studies that employed an fMRI technique to explore human
brain activity related to the review topic were included.
Studies that employed other techniques (e.g., EEG, PET,
DTI, sMRI) were excluded.
Criterion 2
Studies recruiting both participants with ASD and TD con-
trols were included. Data from participants with ASD were
included even if data from the TD controls were not acces-
sible. Similarly, data from TD participants were included
even if data from participants with ASD were not accessible.
Studies that recruited participants with ASD and participants
with other disorders (e.g., ADHD, Down syndrome, learning
disorders) were included if data from participants with ASD
were accessible. Studies that recruited a single participant
were excluded. Additionally, data related to after-training,
(post)-intervention, sleep deprivation, or pharmacological
manipulation were excluded, whereas data from participants
with ASD and TD participants without experimental manip-
ulations were included if separately available.
Criterion 3
Studies reporting activation and deactivation data from
subtractions between target conditions and lower cognitive
control, sensorimotor control, or resting-baseline conditions
were included, and comparisons between participants with
ASD and TD controls were included. Data from correla-
tions between brain areas and other predictors (e.g., ASD
diagnostic scores, IQ scores, task reaction times) and from
functional connectivity analyses, independent component
analysis, or principal component analysis, were excluded.
Data from conjunction analysis or common analysis were
excluded. Data from studies that investigated only within-
or between-group effects due to sex, handedness, and age
were excluded, because those data did not purely reflect the
critical processes of EF.
Criterion 4
Studies that reported results in whole-brain analyses as coor-
dinates in standard reference space (Talairach or Montreal
Neurological Institute) were included. Studies that reported
significant effects only in region of interest (ROI), hid-
den ROI, or small volume correction (SVC) analysis were
excluded. The inclusion of heterogeneous ROI or SVC
analyses would lead to inflated significance for brain areas
overrepresented in ROI/SVC analyses. However, it is worth
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Journal of Autism and Developmental Disorders
noting that SVC analyses should potentially be included if
peaks in the areas were statistically thresholded as in the rest
of the brain (Müller et al. 2018).
A total of 33 studies met all criteria and were identified
as eligible for inclusion in this meta-analysis; 30 of the stud-
ies were peer-reviewed articles, and three were dissertations
(see Tables S1–S4). Figure 1 shows the PRISMA flow chart
for the search process. Overall, the 33 studies recruited both
participants with high-functioning ASD and TD controls.
The ASD group and the TD group in each of the 33 stud-
ies were matched for age, mean IQ values, sex, or handed-
ness. The 33 studies measured “cool” EF, which operates in
more affectively neutral contexts (i.e., a task that “does not
involve obvious rewards or punishers”), unlike “hot” EF,
which operates in “motivationally and emotionally signifi-
cant high-stakes situations” (Zelazo and Carlson 2012, p.
355). In addition, 32 of the studies employed a threshold of
p < 0.05 to correct multiple comparisons; one study used a
threshold of p < 0.001 (Shafritz et al. 2015).
Inclusion Coding
A consensus coding schema was created for extracting
information from the 33 studies, including several charac-
teristics: authors, publication dates, demographics, sample
sizes, ASD diagnostic instruments, IQ tests and mean scores,
match types for the ASD and the TD groups, EF types,
experimental tasks, experimental contrasts, main findings,
and coordinate space (see Tables S1–S4). All studies were
coded by the first author and a trained graduate student. The
interrater reliability of the averages across characteristics
was 0.97. Any nuanced coding was discussed by referring
to the original studies in order to reach consensus. If char-
acteristics of interest were not reported, researchers were
contacted by e-mail.
Analytic Strategy
Four types of contrasts from the 33 studies were selected.
Activation and deactivation data were extracted separately.
Contrast 1 examined brain activity in participants with ASD
when they performed EF tasks compared with control con-
ditions, such as resting-state, fixation cross, motor response
tasks, and lower cognitive tasks. Contrast 2 examined brain
activity in TD participants when they performed the same
EF tasks compared with the same control conditions. Con-
trast 3 investigated greater activity in participants with ASD
than in TD participants during the same EF tasks. Contrast
4 focused on greater activity in TD participants than in par-
ticipants with ASD during the same EF tasks.
It is possible that a single study might have multi-
ple contrasts of the same type. Because ALE analyses
treat contrasts of the same type within a study as distinct
Journal of Autism and Developmental Disorders
Fig. 1  PRISMA flow chart of the studies search process
experiments, this might bias findings of convergence
across studies, leading to within-experiment effects (Tur-
keltaub et al. 2002). To minimize such effects, we imple-
mented the ALE analyses by combining multiple contrasts
of the same type within a study into a single experiment
(Müller et al. 2018). Nonetheless, these contrasts could be
treated as distinct experiments if they were independent
of each other (i.e., if they resulted from nonoverlapping
samples).
The data from each type of contrast were then grouped
into different ALE analyses, in which activation and deac-
tivation data were grouped separately: (1) common EF
analyses (convergence of brain activity across tasks tap-
ping inhibition, updating, and switching), and (2) analy-
ses of each EF process (convergence of brain activity in
tasks tapping only inhibition, updating, or switching).
Next, these different ALE analyses were further sepa-
rated into three groups: young (< 18  years old), adult
(> 18 years old), and whole (including both young and
adult groups). The numbers of experiments, foci, and
participants included in each group are summarized in
Table 1.
ALE Meta‑analyses
We performed ALE meta-analyses using BrainMap Gin-
gerALE script (version 3.0) based on the MATLAB plat-
form. Activation and deactivation data were analyzed
separately. Coordinates of brain areas reported in Talairach
stereotactic space were transformed into the Montreal Neu-
rological Institute reference system using the Lancaster
transform (Lancaster et al. 2007). For each experimental
contrast, the ALE meta-analysis used the foci and the num-
ber of participants in each study as input.
ALE is an important algorithm for coordinate-based
meta-analyses. It is used for a quantitative evaluation of
the reliability of spatial patterns of activation foci across
independently conducted neuroimaging studies. Spatial
uncertainty can influence the distribution, including
between-subject and between-laboratory variances (Eick-
hoff et al. 2009). The number of participants in each study
can adjust the spatial uncertainty of each focus. The study
with more participants endows a larger likelihood of true
activation to the reported foci. During the ALE meta-
analysis, the included foci are modeled as the centers
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 Journal of Autism and Developmental Disorders

Table 1  Number of studies, foci, and subjects in the present meta-analysis

Whole group (Young & Adult) Age group
Young Adult
EF process Experiments Foci Participants Experiments Foci Participants Experiments Foci Participants

ASD group (Contrast 1)

 Inhibition 10 141 141 3 63 47 7 78 94
 Updating 5 63 93 2 21 46 3 42 47
 Switching 4 25 54 1 7 20 3 18 34
TD group (Contrast 2)
 Inhibition 11 180 202 4 76 103 7 104 99
 Updating 4 61 72 2 22 47 2 39 25
 Switching 3 30 37 1 14 19 2 16 18
ASD > TD (Contrast 3)
 Inhibition 11 37 333 2 3 56 9 34 277
 Updating 2 18 53 1 15 31 1 3 22
 Switching 3 10 89 2 8 67 1 2 22
TD > ASD (Contrast 4)
 Inhibition 11 89 383 3 47 136 8 42 247
 Updating 5 45 189 3 19 143 2 26 46
 Switching 1 9 12 0 0 0 1 9 12

of a 3D Gaussian probability distribution in stereotactic Second‑Level Analyses

space. The probability of activation occurring at a given
voxel is calculated. Then the probability estimate for the
entire voxel volume is calculated using a permutation-
testing framework to assess the extent to which the spa-
tial locations of activation foci are correlated across each
conducted study. A final ALE map would be generated
with a p value for each voxel that indicates that the brain
voxel is more active than would be expected by chance
alone. To assess the statistical significance of the ALE
scores, the p values were cut off at a threshold of p < 0.05
with a cluster-level family-wise error (cFWE) correction
(cluster-forming threshold at voxel level: p < 0.001), a
permutation testing with 10,000 iterations, and a cluster
extent threshold of 50 m­ m3 and transformed into Z scores
for display (Eickhoff et al. 2016).
First‑Level Analyses
After obtaining the ALE maps for the ASD sample (Contrast
1) and the TD sample (Contrast 2), we performed second-
level analyses—contrast analyses to examine group differ-
ences in convergence. Second-level analyses compare two
first-level analyses, examining significant differences in
convergence between two ALE maps, by subtracting one
ALE map from the other. The second-level analyses were
computed only for Contrasts 1 and 2.
Specifically, for common EF, the contrast analyses
between the ASD sample and the TD sample were con-
ducted. Then, the contrast analyses between the young group
and the adult group were conducted for the ASD sample
and the TD sample separately. Next, the contrast analyses
between the ASD sample and the TD sample were conducted
for the young group and the adult group separately. These
second-level analyses were also conducted for each of the
three EF processes separately.

First-level analyses were conducted on common EF and

each EF process in each of the three groups (the whole
group, the young group, and the adult group) separately.
First-level analyses describe clusters that pass the applied
threshold for significant convergence of activation across
these groups of studies. The first-level analyses were
computed for the four types of contrasts separately.
Results
The 33 studies included in this meta-analysis comprised
data from 1114 participants (age range 7–57 years) and
reported 708 activation foci observed in 70 experimental
contrasts (see Table 1) and 21 deactivation foci observed in

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Journal of Autism and Developmental Disorders

five experimental contrasts. Among the deactivation data,

there were three experiments and 10 foci for inhibition (one
experiment and three foci in Contrast 1; two experiments
and seven foci in Contrast 2), and two experiments and 11
foci for updating (one experiment and six foci in Contrast
1, one experiment and five foci in Contrast 2). There were
no experiments with switching. The ALE results revealed
no convergence of deactivation in the first-level analyses or
differences in convergence in the second-level analyses using
deactivation data. For the activation data, we summarize the
ALE results in Tables S5–S8 and Figs. 2, 3, 4 and 5 describe
the details below.

Common EF

First‑Level Analyses

For Contrast 1 (the ASD sample), the first-level analyses

for common EF included 19 experiments with 229 foci
(see Table 1). In the whole group (19 experiments, 229
foci), analysis demonstrated convergence of activation in
the fronto-parietal areas, with the largest cluster in the
left inferior frontal gyrus, extending to the right inferior

Fig. 3  Brain patterns showing differences in convergence for com-

mon EF by comparing the ASD sample and the TD sample. a The
whole group. b The young group. c The adult group. IFG inferior
frontal gyrus, IPG inferior parietal gyrus, SMA supplementary motor
area, ACG​anterior cingulate gyrus, MFG middle frontal gyrus

frontal gyrus, the left precentral gyrus, the right superior

Fig. 2  Brain patterns showing convergence of activation for common
EF within the ASD sample and the TD sample, respectively. a The
whole group. b The young group. c The adult group. IFG inferior
frontal gyrus, IPG inferior parietal gyrus, SFGmed superior medial
frontal gyrus, SMA supplementary motor area, ACG​ anterior cingu-
late gyrus, PreCG precentral gyrus, MFG middle frontal gyrus
medial frontal gyrus, and the left inferior parietal gyrus.
In the young group (six experiments, 91 foci), analysis
revealed convergence of activation in the left inferior fron-
tal gyrus. In the adult group (13 experiments, 138 foci),
analysis revealed convergence of activation in the left
inferior frontal gyrus and the left inferior parietal gyrus
(Table S5; Fig. 2).
For Contrast 2 (the TD sample), the first-level analyses
for common EF included 18 experiments with 271 foci (see
Table 1). In the whole group (18 experiments, 271 foci),
convergence of activation was found only in the right cere-
brum, with the largest cluster in the anterior cingulate gyrus,
as well as the inferior frontal gyrus and the middle frontal
gyrus. In the young group (7 experiments, 112 foci), con-
vergence of activation was found in the right inferior frontal
gyri and the right anterior cingulate gyrus. In the adult group
(11 experiments, 159 foci), convergence of activation was
found in the right inferior frontal gyrus and the left supple-
mentary motor area (Table S6; Fig. 2).
For Contrast 3 (16 experiments, 65 foci) and 4 (17 experi-
ments, 143 foci; see Table 1), no convergence of activation
was revealed for common EF.

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Fig. 4  Brain patterns showing convergence of activation for inhibi-
tion within the ASD sample and the TD sample, respectively. a The
whole group. b The young group. c The adult group. IFG inferior
frontal gyrus, ACG​ anterior cingulate gyrus, SFG superior frontal
gyrus, MFG middle frontal gyrus
Second‑Level Analyses
Comparing common EF between the ASD sample (Contrast
1) and the TD sample (Contrast 2) in the whole group, a dif-
ference in convergence was found in the left inferior parietal
gyrus for the ASD sample compared with the TD sample.
In the young group, no difference in convergence was found
for the ASD sample. In the adult group, a difference in con-
vergence was found in the left inferior parietal gyrus for the
ASD sample (Table S7; Fig. 3).
In contrast, comparing common EF between the ASD
sample (Contrast 1) and the TD sample (Contrast 2) in the
whole group, differences in convergence were found in
the right inferior frontal gyrus, the right anterior cingulate
gyrus, the left supplementary motor area, and the right mid-
dle frontal gyrus for the TD sample compared with the ASD
sample. In the young group, differences in convergence were
found in the right inferior frontal gyrus and the right anterior
cingulate gyrus for the TD sample compared with the ASD
sample. In the adult group, differences in convergence were
found in the right inferior frontal gyrus, the right anterior
cingulate gyrus, and the left supplementary motor area for
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Journal of Autism and Developmental Disorders
Fig. 5  Brain patterns showing differences in convergence for inhibi-
tion by comparing the ASD sample and the TD sample. a The whole
group. b The young group. c The adult group. IFG inferior frontal
gyrus, SMA supplementary motor area, ACG​anterior cingulate gyrus,
MFG middle frontal gyrus, PreCG precentral gyrus
the TD sample compared with the ASD sample (Table S8;
Fig. 3).
Within the ASD sample (Contrast 1), comparing common
EF between the young and the adult groups, there was no
difference in convergence for the young or the adult group
compared with each other. Within the TD sample (Contrast
2), comparing common EF between the two age groups,
there was no difference in convergence for the young group,
whereas there were differences in convergence in the right
sub-lobar matter, the right inferior frontal gyrus, and the
right medial frontal gyrus for the adult group.
The Three EF Processes
First‑Level Analyses for Contrast 1 (the ASD Sample)
The first-level analyses included 10 experiments with inhibi-
tion (141 foci), four experiments with switching (25 foci),
and five experiments with updating (63 foci; see Table 1).
Journal of Autism and Developmental Disorders
Inhibition
In the whole group, the ALE results demonstrated con-
vergence of activation in the bilateral inferior frontal gyri
and the right anterior cingulate gyrus. No convergence of
activation was found in the young group, but convergence
of activation was found in the bilateral inferior frontal gyri
in the adult group (Table S5; Fig. 4).
Updating
The ALE results revealed convergence of activation in the
left middle occipital gyrus in the young group, but there
was no convergence of activation in the whole group or
the adult group (Table S5).
Switching
No convergence of activation was revealed in any of the
three groups (Table S5).
First‑Level Analyses for Contrast 2 (the TD Sample)
The first-level analyses for each EF process included 11
experiments with inhibition (180 foci), three experiments
with switching (30 foci), and seven experiments with
updating (61 foci; see Table 1).
Inhibition
In the whole group, the ALE results revealed convergence
of activation only in the right cerebrum, including the infe-
rior frontal gyrus, the anterior cingulate gyrus, and the
middle frontal gyrus. No convergence of activation was
found in the young group, whereas the results revealed
convergence of activation in the right cerebrum in the
adult group, including the inferior frontal gyri, the anterior
cingulate gyrus, and the superior frontal gyrus (Table S6;
Fig. 4).
Updating and Switching
No convergence of activation was found for updating or
switching in any of the three groups (Table S6).
First‑Level Analyses for Contrasts 3 and 4
For Contrast 3 (16 experiments, 65 foci) and Contrast 4
(17 experiments, 143 foci; see Table 1), no convergence of
activation was revealed for any of the three EF processes.
Second‑Level Analyses
The detailed ALE results of second-level analyses are
summarized in Tables S7–S8 and Fig. 5.
Inhibition
Comparing inhibition between the ASD sample (Contrast
1) and the TD sample (Contrast 2) in the whole group,
the ALE results revealed a difference in convergence in
the left inferior frontal gyrus for the ASD sample com-
pared with the TD sample. In the young group, no dif-
ference in convergence was revealed for the ASD sample
compared with the TD sample. In the adult group, a dif-
ference in convergence in the left inferior frontal gyrus
was revealed for the ASD sample compared with the TD
sample (Table S7; Fig. 5).
In contrast, comparing inhibition between the ASD sam-
ple (Contrast 1) and the TD sample (Contrast 2) in the whole
group, the ALE results revealed differences in convergence
in the right anterior cingulate gyrus, the right precentral
gyrus, and the left supplementary motor area for the TD
sample compared with the ASD sample. In the young group,
no difference in convergence was revealed for the TD sample
compared with the ASD sample. In the adult group, a differ-
ence in convergence in the right middle frontal gyrus was
revealed for the TD sample compared with the ASD sample
(Table S8).
Within the ASD sample (Contrast 1), comparing inhibi-
tion between the young group and the adult group, the ALE
results revealed a difference in convergence in the left infe-
rior frontal gyrus for the adult group, whereas no difference
in convergence was found for the young group. Within the
TD sample (Contrast 2), there was no difference in conver-
gence for the young or the adult group in comparison with
each other.
Updating and Switching
The ALE results did not reveal any difference in convergence
for the ASD sample or the TD sample compared with each
other in the whole, young, or adult groups (Tables S7–S8).
Additionally, the second-level analyses did not reveal any
difference in convergence when the young group and the
13

adult group were compared within the ASD sample (Con-
trast 1) or the TD sample (Contrast 2), separately.
Contributions of the Included Studies to Specific
Brain Regional Effects
Post-hoc analyses were conducted to provide more detailed
information about the revealed brain areas of convergence.
In the Supplemental Material, we present a list of the stud-
ies that contributed to the specific regional effects, and most
of the results were stable and not likely to be have been
driven by only a small portion of studies. Specifically, for
the first-level analyses within the ASD or the TD sample,
half of the studies or more included in a specific analysis
contributed to the effect in each brain area. For example, 10
studies of inhibition were included in the first-level analysis
for revealing convergence of activation in inhibition. The
results showed that five of the 10 studies contributed to the
effect in the right inferior frontal gyrus and six of the 10
studies contributed to the effect in the left inferior frontal
gyrus. Less convergence was found in the second-level con-
trast analyses, where less than half of the included studies
in a specific analysis contributed to the effect in each brain
area, especially for the brain areas in the ASD sample when
compared with the TD sample (only one or two studies).
Discussion
The present meta-analysis is the first to comprehensively
explore the construct of EF and the first to investigate EF
abnormalities in individuals with high-functioning ASD
across ages. This study provides updated information about
the construct EF and abnormalities of EF associated with
age in those with ASD on a neural level.
The EF Construct and Age‑Related Changes in ASD
Common EF
Within the ASD sample, we identified a brain pattern of
activation for common EF in the whole group, mainly in
the bilateral inferior frontal gyri, the left precentral gyrus,
the right superior medial frontal gyrus, and the left inferior
parietal gyrus, consistent with previous ASD studies (Lynch
et al. 2017; Schmitz et al. 2006). These fronto-parietal areas
were found to be commonly activated across EF tasks in the
TD samples (Church et al. 2017; Nee et al. 2012; Niendam
et al. 2012; Yaple and Arsalidou 2018). Given the present
findings, the fronto-parietal areas may be the core areas that
subserve performance during the common EF processing in
both TD and ASD samples.
13
Journal of Autism and Developmental Disorders
Within the ASD sample, we also identified brain patterns
of activation for both the young group (in the left inferior
frontal gyrus) and the adult group (in the left inferior frontal
gyrus and the left inferior parietal gyrus). In many EF stud-
ies, the prefrontal areas are well known to be primary brain
areas that support general EF processing (inhibition, updat-
ing, switching) in both young individuals and adults in TD
samples (Brázdil et al. 2007; Wang et al. 2010). The present
findings may indicate that the prefrontal areas also play an
important role in individuals with ASD across ages. How-
ever, we did not find differences in convergence between the
two age groups for the common EF within the ASD sample.
Therefore, we suggest that the neural correlates for common
EF in those with ASD may be relatively stable from child-
hood to adulthood.
Inhibition
Within the ASD sample, we identified a brain pattern of
activation for inhibition in the whole group, mainly in the
bilateral inferior frontal gyri and the right anterior cingulate
gyrus. In TD samples, the right inferior frontal gyrus has
been found critical for inhibitory control across go/no-go
(Chiu and Egner 2015), stop-signal (Aron 2011), Stroop
(Kim et al. 2011), and antisaccade (Fitzgerald et al. 2008)
tasks. The right anterior cingulate gyrus has been found
to play a central role in several functions associated with
response inhibition, conflict monitoring, and error detection
(Botvinick et al. 2004). Findings are similar in ASD studies
(Chan et al. 2011; Kana et al. 2007; Vara et al. 2014). Given
this evidence, the right inferior frontal gyrus and the right
anterior cingulate gyrus could be the key areas for the inhibi-
tory function in individuals with and without ASD.
Further, within the ASD sample, we did not find any con-
vergence of activation in the young group, but we identi-
fied a brain pattern (in the bilateral inferior frontal gyri) in
adults. In TD samples, previous studies have often failed
to find an inhibition factor in young individuals (Karr et al.
2018; McKenna et al. 2017; van der Sluis et al. 2007). With
increasing age, the process of inhibition emerges (Brydges
et al. 2014; Lerner and Lonigan 2014). Combined with this
evidence, our findings may indicate that the inhibition-spe-
cific process may not be observable in individuals with ASD
until adulthood, in line with TD individuals.
Updating and Switching
Within the ASD sample, for updating, we found the conver-
gence of activation only in the left middle occipital gyrus
in the young group. The occipital areas are known to be
selective for visual-based functions, such as mirror actions
(Rizzolatti and Craighero 2004), visual imagery processes
(Jung and Haier 2007), and face processing (Dalton et al.
Journal of Autism and Developmental Disorders
2005). ASD studies have proposed that activation in the
occipital areas may reflect a tendency to rely primarily on
visual features and visual attention during cognitive tasks
(Koshino et al. 2007; Mottron et al. 2006; Vogan et al. 2014).
Given this evidence, our findings may imply that young indi-
viduals with ASD may utilize visuoperceptual strategies to
perform updating tasks. Hence, the activation in the left mid-
dle occipital gyrus could not be considered specialized for
updating as a brain pattern in young individuals with ASD.
In addition, we did not find any convergence of activation
for updating or switching across the three groups. That is, we
failed to identify significant brain patterns for updating or
switching. However, this result should be treated with sub-
stantial caution due to underpowered analyses of restricted
data in our meta-analysis (five experiments and 63 foci for
updating, four experiments and 25 foci for switching). Alter-
natively, these null results could reflect the heterogeneity in
findings across the included studies of ASD, despite con-
sistent task paradigms used for examining updating (n-back
tasks) and switching (set-switching or rule-switching tasks)
in those studies. Future research, possibly with larger
samples, should continue to explore whether the specific
processes of updating and switching exist in ASD across
development, as well as whether the updating or switching
measures for the TD population apply to ASD in different
age groups.
In sum, our findings demonstrate that for the ASD sam-
ple, there was a brain pattern of activation for common
EF (in the left inferior frontal gyrus) among children and
adolescents, and there were brain patterns for common EF
(in part of the fronto-parietal areas) and inhibition (in the
bilateral inferior frontal gyri) in adults. These findings are,
to some extent, in line with the body of behavioral literature
on EF development suggesting age-related changes in the EF
construct in TD samples (Best and Miller 2010; Karr et al.
2018; Lee et al. 2013; Rottschy et al. 2012). We therefore
suggest a unitary model of EF (common EF) in children and
adolescents and a unitary yet diverse model of EF in adults
(common EF and inhibition) for ASD individuals.
The EF Abnormalities and Age‑Related Changes
in ASD
Common EF
Based on the whole group, the ASD sample showed a dif-
ference in convergence in the left inferior parietal gyrus
for common EF in comparison with the TD sample. The
parietal lobe has been found important for spatial atten-
tion and spatial coordinate transformations in TD samples
(Merriam et al. 2003). Abnormal parietal activation could
occur with the effort to maintain attention during EF tasks
in those with ASD (Fatemi et al. 2002; McAlonan et al.
2009), indicating the use of different cognitive strategies to
successfully solve EF tasks. These findings, together with
ours, indicate that abnormalities in common EF may be
associated with abnormal attention control in those with
ASD.
In contrast, compared with the ASD sample, the TD sam-
ple showed differences in convergence for common EF in the
right inferior frontal gyrus, the right middle frontal gyrus,
the right anterior cingulate gyrus, and the left supplemen-
tary motor area. Activation in these brain areas is essential
for performance during EF tasks (Bonini et al. 2009; Wang
et al. 2010), as well as in supporting sensorimotor function
(Mosconi and Sweeney 2015). It has been reported that sen-
sorimotor deficits are the primary features of ASD (Mosconi
and Sweeney 2015). Abnormalities in these areas under-
lying sensorimotor deficits have been associated with EF
abnormalities (Bock and Girgenrath 2006; Perry et al. 2007;
Sheridan and Hausdorff 2007) and have even accounted for
them in part (Hyder et al. 1997). Since our findings indicate
that the ASD sample could be less likely to recruit these sen-
sorimotor areas than would the TD sample during EF tasks,
we hypothesize that sensorimotor deficits in those with ASD
may affect these brain areas and thus lead to abnormalities
in EF (Rødgaard et al. 2019).
In our Introduction, we noted a neuroimaging meta-analy-
sis (Philip et al. 2012) that also recruited data from between-
group effects (ASD vs. TD) to explore EF abnormalities in
those with ASD. However, those results show some limita-
tions, such as the inclusion of inaccurate data in the analyses
and the adopting of an inadequate correction (false discovery
rate) to threshold the ALE values. By addressing these limi-
tations, we have confirmed some of Philips et al.’s (2012)
findings and have extended them by revealing a difference in
convergence in the left supplementary motor area for the TD
sample in comparison with the ASD sample. This brain area
is often revealed in EF processes in TD individuals (Hazel-
tine et al. 2000; Scherf et al. 2006; Smolker et al. 2015),
especially in the inhibition of motor behavior (Dinomais
et al. 2009). ASD studies have found abnormal activation
in the left supplementary motor area during EF tasks (Ishii-
Takahashi et al. 2014; Smith et al. 2004). Combining these
findings, we propose that the left supplementary motor area
plays an important role in EF abnormalities in ASD.
Regarding age effects, within the ASD sample, we did not
find differences in convergence between the young and the
adult groups for common EF. However, across samples, we
found a difference in convergence for common EF in the TD
sample as opposed to the ASD sample in the right inferior
frontal gyrus across the young and the adult groups. This
may suggest that the abnormal mechanisms underlying com-
mon EF in those with ASD are relatively stable across young
and adult groups. These findings are supported by behavioral
evidence that, overall, EF abnormalities are present from
13

childhood through adulthood (Dawson 2008; Oznoff et al.
2004; Zelazo and Müller 2002).
Inhibition
Based on the whole group, we found a difference in conver-
gence in the left inferior frontal gyrus in those with ASD
in comparison with the TD sample. This is consistent with
previous findings demonstrating that abnormalities in the
prefrontal areas undermined inhibitory ability in those with
ASD (Dumontheil et al. 2008; Kana et al. 2007; Schmitz
et al. 2006). The abnormal activation could be due to inef-
ficient effort or neuronal network recruitment in ASD (Rubia
et al. 2006). Of note, in the present study, this difference in
convergence in the inferior frontal gyrus resided only in the
left hemisphere. On the contrary, in TD samples, the inhibi-
tion process was found to be mediated by the predominantly
right prefrontal areas (Rubia et al. 2006). Thus, this finding
may point toward abnormally left lateralization in individu-
als with ASD during inhibition (Paus et al. 1999).
It is also likely that this difference in convergence in the
left inferior frontal gyrus may reflect language deficits (e.g.,
phonological deficits, semantics deficits, and communication
disorders) in those with ASD (De Fossé et al. 2004; Tager-
Flusberg and Joseph 2003). Language deficits are salient
symptoms for explaining restrictive and repetitive behaviors
in individuals with ASD (Solomon et al. 2014). Previous
ASD studies have linked language deficits to abnormalities
in the left inferior frontal gyrus (Hodge et al. 2010; Knaus
et al. 2008; Sharda et al. 2016). Within this context, our
finding may suggest a unitary site in the left inferior frontal
gyrus that underlies both language and inhibition deficits in
those with ASD.
Regarding age effects, within the ASD sample, we found
a difference in convergence in the left inferior frontal gyrus
in the adult group compared with the young group, which
could indicate that adults with ASD were more likely to
recruit this brain area to solve inhibition tasks. On the other
hand, comparing ASD and TD samples, we found a differ-
ence in convergence in the right inferior frontal gyrus in
TD adults but not in young individuals. These results, taken
together, reveal a lack of significant difference in inhibition
between children/adolescents with and without ASD, but in
adults, this difference was becoming pronounced. Thus, we
suggest that for those with ASD, abnormalities in inhibitory
function may not be manifest until adulthood.
Updating and Switching
The ALE results showed no age-related differences for
updating and switching within the ASD sample or between
the two samples (ASD vs. TD). As we have discussed
above, these results could owe to limited data in the present
13
Journal of Autism and Developmental Disorders
meta-analysis or the reliability of the updating and switching
measures for ASD.
In sum, for common EF, our results show that compared
with TD controls, individuals with ASD recruited the left
inferior parietal gyrus but were less likely to recruit the sen-
sorimotor areas to perform EF tasks. For inhibition, the left
inferior frontal gyrus could be the core abnormality under-
mining inhibition abilities in individuals with ASD. In addi-
tion, there were no differences in convergence between the
ASD sample and the TD sample for updating or switching.
Thus, EF abnormalities in those with ASD may manifest
early in common EF, but with increasing age, they may
manifest in common EF as well as inhibition.
Limitations
Some limitations to our meta-analysis should be considered.
To investigate the construct of EF in those with ASD, we
conducted an extensive ALE meta-analysis that was robust
(McKenna et al. 2017). In the first-level analyses, conver-
gence of activation for common EF and each of the three
specific processes was found in the young group, the adult
group, and the whole group separately. Then, in the second-
level analyses, brain areas commonly activated for each spe-
cific process compared with common EF was examined for
the three groups separately. Since ALE analyses pool data
across studies, they are very likely to include the same study
in common EF and specific process maps, which would lead
to a bias in significant convergence. We therefore prevented
any individual study included in two first-level maps from
being compared in the second-level analyses. For exam-
ple, to reveal inhibition-specific activation, the ALE map
for inhibition was compared with that for “common EF”
(updating and switching), which was defined as including
all EF processes except inhibition. Corresponding analyses
were also administered for updating and switching. How-
ever, due to the small number of qualified studies, some of
these analyses could not be conducted, because at least two
studies must be included in each ALE analysis (Eickhoff
et al. 2016). Further, the second-level analyses did not yield
any process-specific activation. Thus, our findings on the
construct of EF in those with ASD across ages may have
been underpowered. Future research should consider recruit-
ing sufficient data to clarify the construct of EF in those with
ASD using this approach.
Second, it is important to acknowledge issues with the sta-
tistical approach used in this study. ALE, as well as many other
coordinate-based neuroimaging meta-analytic approaches,
examines spatial convergence of brain effects across individual
neuroimaging studies in the null space of random spatial con-
vergence (Rottschy et al. 2012). This implies that significant
ALE effects should be interpreted as reflecting brain areas
commonly associated with a cognitive process across studies
Journal of Autism and Developmental Disorders
but not as increases or decreases in activation. Similarly, the
contrasts between coordinate-based meta-analyses reveal dif-
ferences in convergence of brain activation between groups but
not convergence of activation in differences between groups.
Since image-based meta-analyses and effect-size signed dif-
ferential mapping do not own these limitations (Radua et al.
2012; Salimi-Khorshidi et al. 2009), they provide possibilities
for researchers to further discuss EF abnormalities (patterns of
increases vs. decreases) in ASD.
Third, we originally aimed to study a wide range of ASD,
including high-functioning and other types of ASD. However,
the 33 EF studies included in this meta-analysis focused only
on high-functioning ASD. Thus, whether our findings would
generalize across the whole spectrum of individuals with ASD
(e.g., individuals with “typical” autism—those with learn-
ing disabilities and developmental language delay) remains
unresolved.
Fourth, we planned to divide the age groups into several
age groups, including children (< 12 years old), adolescents
(> 12 & < 18 years old), young adults (> 18 & < 45 years old),
middle-aged adults (> 45 & < 65 years old), and older adults
(< 65 years old). However, owing to the small number of neu-
roscience EF studies conducted in children or adolescents,
we combined children and adolescents into a young group. In
addition, no study was conducted in older adults. The exist-
ing brain imaging studies are not well suited to address the
important question of whether there are differential brain
effects across children, adolescents, young adults, middle-aged
adults, and older adults. More neuroscience studies associated
with age would allow a closer look at the neural correlates of
EF processes in ASD across development.
Finally, behavioral research suggests that the measurement
of EF may make it difficult to explain age-related features of
the EF construct. That is, it is widely acknowledged that EF
measures suffer from validity issues such that any tasks tap-
ping a specific EF process often measure other EF processes
as well. Such validity problems in EF measurement are par-
ticularly salient among young children, possibly because these
EF tasks are often cognitively demanding (e.g., to perform
a switching task, besides using switching resources, children
often actively use more working memory/updating and inhibi-
tion resources to remember/use switching rules than do adults;
Jacob and Parkinson 2015). Our findings of unclear age effects
on some EF processes in those with ASD should also be inter-
preted with caution with respect to the validity of EF measures
in young children.
Conclusions and Implications for Future ASD
Studies
With all these limitations in mind, the present meta-anal-
ysis of neuroimaging data does suggest that the EF con-
struct for ASD is unitary in the early stage but unitary and
partially diverse in later development. Even when com-
pared with TD controls, those with ASD show relatively
stable EF abnormalities across development. However, the
fractionation of EF abnormalities into specific EF pro-
cesses is partially supported (mainly in inhibition).
These findings may have implications for theory and
practice. Theoretically, our findings provide some evi-
dence that the integrative EF model (Friedman and Miyake
2017) is partially applicable to those with ASD. Specifi-
cally, the EF construct and EF abnormalities have a uni-
tary and diverse nature in those with ASD, showing more
unitary early but becoming more separable with age.
Practically, our findings show that in addition to using
behavioral measures, evaluations of neural changes in EF-
related brain areas may provide evidence for the effective-
ness of EF interventions for individuals with ASD. Our
findings could not allow any conclusions about increased
or decreased activation in brain areas. Thus, future
research could test what activation patterns (increases vs.
decreases) represent training-induced changes in ASD.
Brain activity changes in these areas could be indices to
assess improvements in EF abilities and even the magni-
tude of transfer-related effects on clinical symptoms in
those with ASD after EF intervention.
Moreover, the establishment of the role of EF in those
with ASD in our meta-analysis sheds light for interven-
tions in this population. We suggest that any interven-
tion directly targeting the improvement of EF abilities
by using EF tasks for training may need to consider the
developmental construct of EF in those with ASD. That
is, early EF interventions may need to consider improv-
ing general EF abilities (common EF), and types of EF
training tasks may not necessarily moderate intervention
outcomes. In contrast, for EF interventions in adults with
ASD, researchers might consider programs that not only
consist of training different EF processes but also a spe-
cific EF process (e.g., inhibition) associated with the tar-
geted individual’s EF behavior.
With respect to methodology, all 33 studies included
in this meta-analysis reported results of whole-brain
analyses. Our search for studies excluded 13 studies that
reported significant effects only in ROI analyses. Of these
13 studies, most defined the inferior frontal gyrus and
anterior cingulate gyrus as ROIs. The left supplementary
motor area and the left inferior parietal gyrus revealed in
our present study were discussed less in the studies using
13

the ROI analyses. Additional research on brain activity
and functional connectivity should enable more extensive
examination of the functional roles of these brain areas in
the neural basis of EF abnormalities in those with ASD.
Author Contributions  ZZ conceived of the study, participated in the
coordination of the study, performed literature search, data extraction,
coding, and statistical analysis, participated in the interpretation of the
data, and drafted the manuscript; PP participated in the coordination of
the study, contributed to the interpretation of the data, and helped draft
the manuscript; DZ helped draft the manuscript. All authors have read
and approved the final manuscript.
Funding  No funding was received for this study.
Compliance with Ethical Standards  (2002). The development of mental processing: Efficiency, work-
Conflict of interest  The authors declare no conflicts of interest.
Ethical Approval  All procedures in this meta-analysis were in accord-
ance with the ethical standards of the institutional and/or national
research committee and with the 1964 Helsinki declaration and its
later amendments or comparable ethical standards.
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