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Original Investigation
January 2, 2019

Patterns of Nonsocial and Social Cognitive Functioning in Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2The Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
  • 3Department of Psychology, City University of London, London, United Kingdom
JAMA Psychiatry. Published online January 2, 2019. doi:10.1001/jamapsychiatry.2018.3645
Key Points

Question  What are the patterns of nonsocial and social cognitive functioning in adults with autism spectrum disorder?

Findings  In this systematic review and meta-analysis of 75 studies comprising 3361 individuals with autism spectrum disorder and 5344 neurotypical adults, those with autism spectrum disorder showed the greatest impairments in theory of mind and emotion perception and processing, followed by processing speed and verbal learning and memory.

Meaning  The severity of impairments across domains of nonsocial and social cognition in adults with autism spectrum disorder identified highlight key intervention targets and suggest significant implications for clinical practice.


Importance  Many studies have investigated impairments in cognitive domains in adults with autism spectrum disorder (ASD). Yet, to date, a comprehensive overview on the patterns of cognitive functioning is lacking.

Objective  To provide an overview of nonsocial and social cognitive functioning in various domains in adults with ASD, allowing for comparison of the severity of deficits between different domains.

Data Sources  A literature search performed in an academic medical setting was conducted using PubMed, PsycINFO, Embase, and Medline databases with the combination of the following free-text and Medical Subject Headings where applicable: [cogniti* OR neurocogniti* OR neuropsycholog* OR executive function* OR IQ OR intelligence quotient OR social cognition OR emotion perception OR affect perception OR emotion recognition OR attribution OR ToM OR mentalising OR mentalizing OR prosody OR social knowledge OR mind reading OR social cue OR social judgment] AND [autis* OR ASD OR Asperger OR Asperger’s OR PDD OR pervasive developmental disorder]. The search was further limited to studies published between 1980 (first inclusion of autism diagnosis in the DSM-III) and July 2018.

Study Selection  Studies included were published as a primary peer-reviewed research article in English, included individuals with ASD 16 years or older, and assessed at least 1 domain of neurocognitive functioning or social cognition using standard measures.

Data Extraction and Synthesis  Of 9892 articles identified and screened, 75 met the inclusion criteria for the systematic review and meta-analysis.

Main Outcomes and Measures  Hedges g effect sizes were computed, and random-effects models were used for all analyses. Moderators of between-study variability in effect sizes were assessed using meta-regressions.

Results  The systematic review and meta-analysis included 75 studies, with a combined sample of 3361 individuals with ASD (mean [SD] age, 32.0 [9.3] years; 75.9% male) and 5344 neurotypical adults (mean [SD] age, 32.3 [9.1] years; 70.1% male). Adults with ASD showed large impairments in theory of mind (g = −1.09; 95% CI, −1.25 to −0.92; number of studies = 39) and emotion perception and processing (g = −0.80; 95% CI, −1.04 to −0.55; n = 18), followed by medium impairments in processing speed (g = −0.61; 95% CI, −0.83 to −0.38; n = 21) and verbal learning and memory (g = −0.55; 95% CI, −0.86 to −0.25; n = 12). The least altered cognitive domains were attention and vigilance (g = −0.30; 95% CI, −0.81 to 0.21; n = 5) and working memory (g = −0.23; 95% CI, −0.47 to 0.01; n = 19). Meta-regressions confirmed robustness of the results.

Conclusions and Relevance  Results of this systematic review and meta-analysis suggest that adults with ASD show impairments in social cognitive domains and in specific nonsocial cognitive domains. These findings contribute to the understanding of the patterns of cognitive functioning in adults with ASD and may assist in the identification of targets for cognitive interventions.