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This systematic review and meta\u2010analysis explored the association between CI and INT\/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a01608) of CI and INT, and 15 studies (<jats:italic>n<\/jats:italic>\u00a0=\u00a01115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT\/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta\u2010regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co\u2010occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; <jats:italic>n<\/jats:italic>\u00a0=\u00a0833; <jats:italic>r<\/jats:italic>\u00a0=\u00a00.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; <jats:italic>n<\/jats:italic>\u00a0=\u00a0295; <jats:italic>r<\/jats:italic>\u00a0=\u00a00.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co\u2010occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co\u2010occurring mental health difficulties.<\/jats:p>","DOI":"10.1002\/aur.2826","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T08:44:49Z","timestamp":1664959489000},"page":"2265-2295","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9005-5512","authenticated-orcid":false,"given":"Jiedi","family":"Lei","sequence":"first","affiliation":[{"name":"Institute of Psychiatry, Psychology &amp; Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1993-6549","authenticated-orcid":false,"given":"Tony","family":"Charman","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology &amp; Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-3770","authenticated-orcid":false,"given":"Eleanor","family":"Leigh","sequence":"additional","affiliation":[{"name":"Department of Experimental Psychology University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8443-9381","authenticated-orcid":false,"given":"Ailsa","family":"Russell","sequence":"additional","affiliation":[{"name":"Centre for Applied Autism Research, Department of Psychology University of Bath  Bath UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zameer","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology &amp; Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-6917","authenticated-orcid":false,"given":"Matthew J.","family":"Hollocks","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Psychology &amp; Neuroscience, King's College London  London UK"},{"name":"South London and Maudsley NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-015-2415-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1353\/mpq.2010.0004"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ridd.2018.10.001"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10803-019-04220-9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-021-03519-1"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/nn.3177"},{"key":"e_1_2_9_9_1","first-page":"5","volume-title":"Worrying: Perspectives on theory, assessment, and treatment","author":"Borkovec T. 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