Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) present increased risk of educational and vocational failure, psychiatric comorbidity, and physical illness. Executive functioning (EF) problems (including inflexibility and poor goal setting and planning) are common in children with ASD and ADHD and are related to negative outcomes. Behavioral classroom management (eg, giving rewards and enforcing consequences to improve behavior) and parent training are the current nonmedication standards of care for ADHD and ASD, but evidence for the long-term efficacy of behavior management is mixed. Reviewers have called for the expansion of cognitive behavioral therapy for ADHD and ASD—specifically, treatments that directly target neuropsychological processes such as EF—but there are very few studies of these treatments in school settings. Poverty impairs EF in all children. Evidence-based EF interventions such as Tools of the Mind have been developed for at-risk preschoolers and adopted by school districts with large numbers of students living in poverty, but no equivalent treatments exist for older children who have already developed significant EF-related developmental disorders, such as ADHD and ASD.
