Cogntive Theories Of Autism (MindBlind) Flashcards
Autism spectrum disorder
•Autism Spectrum Disorder is the official term in DSM-V, but some use the term ‘condition’ - less stigmatising
•Aspergers Syndrome (AS) / High functioning Autism refers to autism without language delay or learning disability
–AS introduced in 1992, recently removed from DSM-V(!), but still in use in ICD-10 in Europe …
–High functioning in terms of what? Be specific
Kenny et al 2016
Recent research has showed that
‘autistic people/person’ is preferred by people on the spectrum, and ‘person with autism’ is preferred by professionals
History of diagnosis Hans Asperger (1944) Leo Kanner (1943
- Innate inability to form the usual biologically provided affective contact with people
- Poverty of facial expression
- Many stereotypical movements that do not convey meaning
- Impulsive and stimulus driven
- Can have excellent logical and abstract thought
Kanner’s cardinal features:
Autistic aloneness
–Obsessive insistence on sameness
Wing and Gould 1979
Triad of Impairments
Socialisation
Communication
Imagination (Repetitive behaviour interests)
Delay or atypical functioning in at least one, with onset prior to age 3 years
Impairment of social interaction / development includes
Social attachment
Understanding others minds/thoughts/feelings
Emotion regulation / coping with change
Impairment of social interaction/development
Social attachment:
- indifference to other people; difficulty making friends
- may seem independent as a toddler, resists or does not seek affection
- can be affectionate and show attachment on a simple level, but…….
Impairment of social interaction/development (triad)
•Understanding other’s minds/thoughts/feelings
- difficulty interpreting other person’s need for affection
- difficult to understand other people’s thoughts and emotions
- irregular eye contact -> do not follow gaze -> seem to be ‘in a world of their own’
Impairment of social interaction/development (triad)
•Emotion regulation/coping with change
- difficulty managing emotions, -> expressed as outbursts of anger or aggression
- difficulties coping with new situations
- difficult to accept simple social rules, causing problems at school
•2. Impairment of social communication (triad)
Non verbal
–difficulty to read body language and facial expressions
–lack of appreciation of the social uses and pleasure of communication
–Don’t develop usual non-verbal (e.g., pointing) skills or imitation skills
Impairment of social communication (triad)
Verbal
–don’t develop the usual verbal skills like typical children
–trouble with understanding meaning in spoken or written language
–not babble or point by the age of one, not respond to their name, not learn two words by the age of two
–repeat learned words over and over again (echolalia)
–unusual use of language (e.g., reversal of pronouns I vs you), and difficulty starting conversations
–severe autism may never speak at all (but can be helped with signing or using picture symbols)
–unable to understand jokes or sarcasm
Impairment of imagination (narrowing interests and behaviour) (triad)
- inability to play imaginatively with objects or toys (pretend play) or others
- is an outward manifestation of this impairment
- may be overly interested in repetitive activities, resistance to novel topics
- may take up a special interest at a young age, such as collecting, or music and art
- older children/adolescents may develop obsessions (excessive interest in timetables or lists, storing up trivial facts/encyclopaedic knowledge)
Other symptoms
- sit up or walk later than most children
- be oversensitive to noise or touch
- have odd mannerisms such as rocking back and forth, hand flapping, walking on tip- toes or head banging
- be clumsy and struggle with physical activity
- like sticking to the same routines, and may get very upset if these are disturbed
- be over or undersensitive to sight, sound, smell, touch and taste
Features of ASD
Wing and Gould 1979
Triad of impairment (socialisation, communication, imagination)
Non-social features of ASD
- restricted area of interest/preoccupation with parts of objects
- desire for sameness and routine
- excellent rote memory
- savant abilities
- islets of ability
ASD as a spectrum
–Some require special educational provision
–Others have less severe difficulties (e.g. Asperger’s Syndrome)
Gillberg & Billstedt, 2000
High co occurrence with other difficulties
•Attention or motor difficulties (ADHD, DCD, DAMP)
•Unspecific – (e.g. Cognitive impairment - 80%)
•Specific - (e.g. Associated medical disorder or chromosomal disorder – 10-25%)
Lever and Geurts, 2016)
79% meet criteria for at least 1 psychiatric condition
Prevalence
–ASD- affects up to 1% of children
–Boys outnumber girls 10:1 (but this is changing …)
How is autism diagnosed?
•Experienced clinicians use a range of assessments to establish whether the behaviour of an individual meets specific criteria.
•(e.g. Diagnostic and statistical manual for mental Disorders -DSM-V).
•Standard assessments of ASD:
–Autism Diagnostic Interview (ADI)
–Autism Diagnostic Observation Schedule
(ADOS)
Early research on cognitive abilities argued
autism arises from a primary cognitive deficit.
What makes a good theory
–Specificity
–Uniqueness
–Universality
3 main theories
1.Theory of Mind
failure to acknowledge others have their own thoughts and beliefs
2.Executive Dysfunction
deficits in inhibition, planning and executive memory
3.Weak Central Coherence
preference for local details over the global whole or context.
-Perceptual & conceptual
Theory of mind
failure to acknowledge others have their own thoughts and beliefs
Executive dysfunction
deficits in inhibition, planning and executive memory
Weak central coherence
preference for local details over the global whole or context.
-Perceptual & conceptual
Theory of mind
Agent without mind =
Machine •how do you treat a machine? –socialisation? –communication? –Imagination?
without understanding other minds
Baron Cohen et al 1985
Socialisation difficulties
[autism and false belief]
social and emotional problems secondary to cognitive problem
Klin 2000
Inferring mental states of geometric figures
What happened was that the larger square - which was like a bigger kid or bully - had isolated himself from everything else until two new kids come along and the little one was a bit more shy, scared, and the smaller square more like stood up for himself and protected the little one…
De Gelder 1987
Autism and false belief
- Why should people with autism attribute mental states to dolls?
- Why test understanding with a game that involves make-believe when children with autism are known to be weak at that?
Autism is the result of a
Complex interplay between multiple factors and cannot be explained by a single cognitive deficit
Likely that several functional
Neural pathway are implanted and that all impinge on neurocognitive /social functions that are crucially impaired in autism
Autism is very
Heterogeneous
Alternative theories of ASD
Mirror neurones theory Extreme male brain Social motivation theory Enhanced perceptual functioning Enlarged temporal binding window Sensorimotor theory of autism
Mirror neuron theory
Williams et al 2001
Brain level explanation
Not well supported
Extreme male brain
More descriptive than explanatory
Social motivation theory
Chevalier et al 2012
Not cognitive but motivational / reward deficit
Enhanced perceptual functioning
Accounts for inconsistencies in WCC literature
Enlarged temporal binding window
Explains ASD symptoms at a sensory level
Sensorimotor theory of autism
Could be a more parsimonious explanation of autism
Current disganosis of Autism
DSM-5
•Changes to categories •The terms ‘autistic disorder’, ‘Asperger disorder’, ‘childhood disintegrative disorder’ and ‘PDD-NOS’ have been replaced by the collective term 'autism spectrum disorder'. •No more Asperger’s Syndrome •New emphasis is on an individual needs: •Three levels of severity –Level 1 - requiring support Level 2 - requiring substantial support Level 3 - requiring very substantial support
Three levels of severity
–Level 1 - requiring support
Level 2 - requiring substantial support
Level 3 - requiring very substantial support
There is a new emphasis on
Individual needs
Changes in criteria
DSM 4 > DSM 5
Triad > Dyad
1) social communication and interaction.
2) restricted, repetitive patterns of behaviour, interests or activities. (Includes sensory abnormalities!)
Socialisation, communication and imagination is now social communication and restricted repetitive behaviour / interests
Is Autism a unitary disorder
Happe et al 2006
Happe and Ronald 2008
The triad of impairments do not correlate highly in normal population
Each component may have a different cause
• Autism may be a mixture of conditions
Happe and Ronald 2008
Autism cannot be explained by a single cognitive deficit
Fractionation of the triad
The 3 main cognitive theories explain some symptoms of ASD, but not all of them.
•Specificity?
may be domain-general or specific (multiple deficits?)
•Uniqueness? none to ASD
•Universality? none to ASD
Challenges of WCC
Differentiating itself from other theories which attempt to explain non-social features of Autism
–Enhanced Perceptual functioning (Mottron & Burack, 2001; Mottron et al., 2006)
–Reduced top-down processing (Loth, Gómez, & Happé, 2010; Mitchell, Mottron, Soulières, & Ropar, 2010; Ropar and Mitchell, 2002)
Is WCC a primary cause of ASD
Good specificity, however…..
Not universal (Not all individuals show WCC)
Unique?
- Children with pragmatic language impairment (PLI) also have problems with processing context (Norbury et al. 2002)
Norbury et al 2002
Is WCC a primary cause of ASD
Unique?
- Children with pragmatic language impairment (PLI) also have problems with processing context
Inconsistent evidence for WCC
Happe 1996
reduced susceptibility to visual illusions, but see…
-Ropar & Mitchell (2001)
Inconsistent evidence for WCC
Mottron et al 1993
Reduced global precedence in Navon task but see….
Plaisted
WCC and perception
Islets of ability
Embedded figures test
Shah & Frith 1983) Block design Shah & Frith 1993)
ASD significantly faster than matched controls
WCC and perception (islets of ability)
Pring et al 1995
Individuals with autism were as fast at solving a jigsaw upside-down as right-way-up
WCC and social difficulties in ASD
Language processing - Snowling and Frith 1986
–Those with autism fail to use context when processing ambiguous homographs. (e.g. The actor took a bow.)
•Literal
•Difficulties with sarcasm & irony
what is WCC
Frith 2003
Weak central coherence
Weak central coherence
Frith 2003
Attempts to explain social and non social
–Do not automatically process contextual meaning or use prior knowledge
– A bias towards piecemeal or local (over global) processing.
Leslie and frith 1988
Perner et al 1989
Converging evidence problems with acknowledging own believes
Widely replicated in different tasks
Autism linked to deficits in theory of mind
Communication impairment
Mitchell and Isaac 1994
Mitchell et al 1997
Message desire task
normally we interpret this request as non-literal as based on false belief
•participant asked to judge
–(1) which item the mum really wants (interpret) and
–(2) which item the mum put in the drawer (memory)
• ASD more errors in interpreting desire (i.e. Mum wants bag in cupboard) than in judging that bag of wool mum put in drawer is now in cupboard (memory)
•Those with ASD incorrectly interpreted utterances literally
suggesting difficulty making non-literal interpretations
Leslie 1987
Link between cognitive impairment and
Lack of pretend play
Pretend play is a
basic expression of understanding other minds.
Engaging in imaginative play with another person requires
acknowledging another person’s non-literal thoughts/beliefs.
Theory of mind Hypothesis if autism
Good specificity for triad
•powerful & convincing
•difficulties in relating, communicating, etc.
•all related to understanding of the mind
Theory of mind Hypothesis of autism
Not universal
Happe 1994
•Happe (1994): what about those who pass? –solve differently (and how counts) –not autistic? –ToM hypothesis wrong? –not primary element of ASD?
Sparrevohn and Howie 1995
Theory of mind Hypothesis
ASD with higher verbal mental age more likely to succeed
Theory of mind d Hypothesis of autism
Happe 1995
•Happe (1995) – meta analysis on ASD & ToM:
–Relationship between child’s verbal mental age and passing FB tasks
–Verbal mental age of 12 able to pass compared to 4yrs in typically developing children
I think that he thinks that she thinks
aka 2nd order false belief
- Mary and John saw the ice cream van in the park
- Mary went home for some money and meanwhile John saw the ice-cream van move to the church
- Mary unexpectedly sees the ice-cream van at the church
- John sets out to find Mary, whom he is told has gone for ice-cream.
- not where John thinks the ice-cream van is, but where John thinks Mary thinks the ice-cream van is
I think that he thinks that she thinks
aka 2nd order false belief
Baron Cohen 1989
– ASD pass 1st order, fail 2nd order
–Proposed that ToM problem was a delay rather than a deficit
•BUT: Aspergers pass 2nd order (Bowler, 1992)
•-> Deficit of ToM not universal!
•perhaps not primary
–Even if not deficit, but delay
–Impaired ToM is not the same as ASD!
Children with visual impairment showed difficulty with…
Minter, Hobson & Bishop, 1998
(Uniqueness)
False belief
Children with hearing impairment have development delay In…
Woolfe, Want & Siegal, 2002
(Uniqueness)
Acknowledging false belief
Communication disadvantage during early years
leads to delay in understanding minds
Language and communication is important for
Understanding other minds
Deficit of theory of mind not unique to
ASD
Does Theory of Mind have good specificity?
•Accounts for triad •But: –insistence on sameness –routines –narrow interests –Repetitive behaviour
Executive control is proposed to account for
Social and non social symptoms (repetitive behaviour)
Ozonoff et al 1991
•“The ability to maintain an appropriate problem-solving set for the attainment of a future goal; it includes behaviours such as: –planning –impulse control –inhibition of prepotent but irrelevant responses –set maintenance –organized search –and flexibility of search and action.”
Tower of Hanoi
Planning
Wisconsin card sort
Set shifting
Ozonoff et al 1991
Tower of Hanoi, Wisconsin card sort and theory of mind tests
•Tower of Hanoi:
Acted impulsively, could not plan several moves ahead, shifted all loops directly, etc
•Wisconsin Card Sort:
Unable to shift attentional focus, persevered to sort by established system
•Theory of Mind tests:
Many passed 1st order
Some passed 2nd order
More accurate basis for discriminating between who was and was not autistic compared with tests of false belief
Not common denominator
Can EC explain social/communication problems?
Russell et al 1991
Windows task
- Perhaps FB task failure due to insufficient flexibility in imagination to give correct judgment?
- Children <4 yrs and autistic children unable to inhibit pre-potent response (Russell et al 991)
- It’s about resisting to point to attentional focus/salient part
- Perhaps FB task not about lack of insight but more about failure to inhibit?
- also Hughes & Russell, 1993; Hala & Hughes, 2003
•also Hughes & Russell, 1993; Hala & Hughes, 2003
Can EC explain social/communication problems?
Executive control and autism-
is EC it a primary cause of ASD? Specificity?
•Unexpected transfer task: Rigidity and repetitve behaviour
–Point impulsively to where the chocolate is
•Deceptive box: pattern of behaviour in theory of mind tests
–Say impulsively what we know to be in the box
•Windows task:
–Point to where the chocolate is
•EF leads to acting impulsively on environment
Is executive dysfunction (ED) the primary cause of ASD
Sodian and Frith 1992
Study: ASD no problem in sabotage, but cannot withhold information (fail deception) ➢Impairment is not an EF deficit ➢Not specific •adults onset ED not cause ASD •Children with PKU show ED, but are not ASD (Welsh et al, 1990) - also in Tourette’s –Not unique •no evidence for Executive Dysfunction in autistic pre-school children (Griffith, et al. 1999; Dawson, et al. 2002) –Not universal
Welsh et al 1990
Children with PKU…
show ED
but are not ASD - also in Tourette’s
–Not unique
(Griffith, et al. 1999; Dawson, et al. 2002)
No evidence for…
Executive Dysfunction
in autistic pre-school children
Can executive dysfunction be a primary cause of ASD?
Specificity?
can explain many of the deficits, but doesn’t always hold up
Can executive dysfunction be a primary cause of ASD?
Universality?
Not all individuals with ASD show EF problems
Can executive dysfunction be a primary cause of ASD?
Uniqueness?
Not unique to ASD
Stephen Wiltshire
Drawn a very detailed picture of London Bridge from memory
However need to explain
- non-social features of autism
- savant abilities
- anecdotal reports of heightened perceptual abilities
- uneven intellectual profile
