Project ID NS-MH2026_17

ThemeNS-MH

Co Supervisor 1A Dr Matthew Hollocks Institute of Psychiatry, Psychology & Neuroscience, School of Academic Psychiatry, Department of Child & Adolescent PsychiatryEmail

Co Supervisor 1B Prof Emily Jones Institute of Psychiatry, Psychology & Neuroscience, School of Academic Psychiatry, Department of Child & Adolescent PsychiatryEmail

Developing a Multi-Dimensional Assessment of Cognitive Inflexibility as a Translational Tool for use with Autistic Youth

Cognitive Inflexibility, a prominent difficulty experienced by autistic people, is strongly associated with a range of negative outcomes. This includes common co-occurring psychiatric conditions such as anxiety and depression. The identification of Cognitive Inflexibility as a key mechanism associated with poor mental health outcomes has led is to start developing targeted intervention approaches which aim to improve flexible thinking. Despite these innovations there remain issues around the measurement of cognitive inflexibility which is overly reliant on parent or self-reported questionnaire measures. The development of objective and robust measurement across different modalities (brain, cognition and behaviour) has high translational value and is vital to provide a) unbiased measurement of treatment response; b) a way to test mechanisms of treatment effectiveness and c) to stratify those in most need of treatment.

One promising approach is to use functional Near Infra-Red Spectroscopy (fNIRS), which offers a low-cost, high-accessibility tool which can map CI in a granular manner. By combining fNIRS with computerised tasks designed to measure CI, we can develop an objective, real-time measure of the mechanism, reducing reliance on self and parent-report measures. Functional connectivity at rest using fNIRS has been used to map changes in EF in young children, with differences in pre-frontal cortex connectivity being associated with task-based EF performance and behavioural measurement (Eng et al., 2023). One study has demonstrated differences in pre-frontal cortex (PFC) functional connectivity in autistic youth (ages 14-23) are associated with inflexibility during a Wisconsin Card Sort Task (Chan et al., 2022). Suggesting that functional connectivity during tasks designed to measure CI is a viable biomarker that requires further study, including whether there is convergent validity with our behavioural measurement.

Aims:
– To systematically review the literature on the assessment of CI in autism and other clinical populations
– To develop and test battery of fNIRS tasks that measure CI in autistic youth and use these to replicate findings demonstrating differences in pre-frontal cortex (PFC) functional connectivity.
– To demonstrate construct validity by investigating the association between fNIRS PFC connectivity differences in autistic youth and cognitive/questionnaire measures.
– To gather proof-of-principle data on the use of fNIRS PFC connectivity to detect the modulating effects of interventions on brain functioning.

Key skills/development opportunities:
– Systematic reviews / meta-analysis
– Advanced fNIRS analysis
– Neuropsychological task design / programming skills
– Advanced statistical analysis techniques
– Experience working with neurodiverse children and adolescents.
– Translational research skills
– Conference presentation skills

Representative Publications

Hollocks MJ, McQuaid GA, Lee NR, Wallace GL. Cognitive Flexibility Mediates the Associations Between Perceived Stress, Social Camouflaging and Mental Health Challenges in Autistic Adults. Autism Res. 2025 Jun 3. doi: 10.1002/aur.70061. Epub ahead of print. PMID: 40462453. Lei J, Charman T, Leigh E, Russell A, Mohamed Z, Hollocks MJ. Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis. Autism Res. 2022 Dec;15(12):2265-2295. doi: 10.1002/aur.2826. Epub 2022 Oct 5. PMID: 36196666; PMCID: PMC10092776. Hollocks MJ, Leno VC, Chandler S, White P, Yorke I, Charman T, Pickles A, Baird G, Simonoff E. Psychiatric conditions in autistic adolescents: longitudinal stability from childhood and associated risk factors. Eur Child Adolesc Psychiatry. 2023 Nov;32(11):2197-2208. doi: 10.1007/s00787-022-02065-9. Epub 2022 Aug 17. PMID: 35976471; PMCID: PMC10576662.

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