blind to other minds...... the puzzle of autism spectrum disorder

dr fenja zieglerc82 sad • lecture 4

busy...busy... busy...

reading mindsinteracting with othersmaking social connections................

history of diagnosisHans 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

history of diagnosis

Wing & Gould (1979)Triad of Impairments

Socialisation

Communication

Imagination

what are you looking for in a theory?

• Specificity: Does autism arise from a domain-specific factor or are multiple factors involved?

• Uniqueness: Is the factor unique to the disorder or is it also involved in other developmental disorders?

• Universality: Is the factor (or factors) found in every individual with autism or just in the majority?

all in the mind?

Socialisation

Communication

Imagination

• agent without mind = machine

• how do you treat machine?

• communication?

• socialisation?

• imagination without understanding other minds

• no understanding without imagination

autism and false belief

• social and emotional problems secondary to cognitive problem

autism and false belief

• social and emotional problems secondary to cognitive problem

•de Gelder (1987) 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?

understanding minds without make-believeLeslie & Frith,

1988Perner et al.,

1989

communication impairment?

I need one of the bags of wool. it’s

the one in the drawer.

Which is the bag mum put in

the drawer?

pretend play

• Link between social impairment and lack of pretend play (Leslie, 1987)

• Pretend play as a basic expression of understanding other minds

• Other minds cannot be perceived directly:

• Recognising other minds through imagination

• Children with autism devoid of imaginative abilities

• Therefore no pretend play and no understanding of other minds

tom hypothesis of autism

• powerful & convincing

• difficulties in relating, communicating, etc.

• all related to understanding of the mind

• BUT…. Happe (1994): what about those who pass?

• solve differently (and how counts)

• not autistic?

• ToM hypothesis wrong?

• not primary element of ASD? - explain some but not all the deficits?

Socialisation

Communication

Imagination

fail FB autistic

I think that he thinks that she thinksaka 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.

I think that he thinks that she thinksaka 2nd order false belief

• Where will Jon look for Mary?

• not where Jon thinks the ice-cream van is, but where John thinks Mary thinks the ice-cream van is

• Baron-Cohen (1989) ASD pass 1st order, fail 2nd order

• Bowler, 1992: Aspergers pass 2nd order

specific to autism?

• Children with visual impairment showed difficulty with false belief (Minter, Hobson & Bishop, 1998)

• Children with hearing impairment have development delay in acknowledging false belief (Woolfe, Want & Siegal 2002)

• Particularly those who are not natural signers

• Communication disadvantage during early years leads to delay in understanding minds

• perhaps not primary

• not deficit, but delay

• Impaired ToM is not the same as ASD

mind in the eyes?

• advanced ToM test (Baron-Cohen et al. 1997)

• developed for those who pass 2nd order test

• perform at ceiling for whole face, but impaired on the eyes task

• not problem with understanding emotion but problem with reading mentalistic information from the eyes

mind in the eyes?• Baron-Cohen et al. (1999):

• passing 1st and 2nd order tests of FB are early accomplishment in acquiring a ToM and not an end point.

• with these tests ToM deficits remain undetected in higher- functioning autistic individuals

• But: FB as litmus tests of ToM to have or not to have

• Baron-Cohen: advanced ToM task requires more of an amount of ToM

• a quantifiable entity?

• no causal relation of mental state and eyes (c.f. seeing and knowing)

Klin, 2000

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...

The big square went into the box. There were a small square and a circle. The square went out. The shapes bounce of each other. The small circle went inside the box. The big square was in the box with the circle. The small square and the circle went around each other a few times...

Viewing Social Scenes • The Enactive Mind

Klin et al 2002

The Eye Direction Detector as a brain module that effectively is the seat of our understanding of the mind

explaining the triad, the whole triad and nothing but the triad...

• domain-specific cognitive factor? (ToM)

• But:

• insistence on sameness

• routines

• narrow interests

• arrange items repetitvely, etc

Socialisation

Communication

Imagination

Executive control • domain-generalSally 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

Results

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 orderSome

passed 2nd order

not common denominator

specificity?universality?

Windows task

• can failure on FB be explained through EF?

• point to empty location

• win: point to empty box

• first chance (windows closed)

• then windows opened

• also Hughes & Russell, 1993; Hala & Hughes, 2003

5 y.o.3 y.o.asd

cognitive control and autism

• Unexpected transfer task:

• Point impulsively to where the chocolate is

• Deceptive box:

• 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

• rigidity of behaviour

• repetitive behaviour

• pattern of behaviour in ToM tests

• Does EDF = ASD?

edf = asd?

• adults onset edf not cause asd

• sensitive period?

• Welsh et al (1990) children with PKU who showed impairments on tests of EF, but not ASD

• Griffith, et al (1999) & Dawson, et al (2002) – no evidence for Executive Dysfunction in autistic pre-school children

• match EF demand - contrast FB demand

• Sodian and Frith (1992) It’s locked

• Zaitchik (1990) “false photo”

• take picture of doll on mat

• as picture develops:

• move doll to box

• in the picture where is the doll?

• picture is outdated representation, but not belief

this photo may be “false”Leslie and Thaiss, 1992

is it all ef?

• can explain many of the deficits

• not all individuals with ASD show EF problems (universality)

• not unique to ASD (e.g. Tourette’s etc.)

• may be related to theory of mind (chicken or egg?)

savant skillsStephen Wiltshire

drawn from memory

need to explain...Frith, 2003

• non-social features of autism

• savant abilities

• an apparent lack of common sense

• anecdotal reports of heightened perceptual abilities

• an uneven intellectual profile

need to explain...Frith, 2003

• typical developing extract overall meaning or gist

• drive for global coherence

• ASD: weak central coherence

• process in detail-focused or piecemeal way

Shah and Frith, 1983Embedded Figure

Test

block design test

• Shah and Frith, 1993

• Individuals with autism were significantly faster than matched controls

• Pre-segmentation helped controls but not individuals with autism

• Pring et al (1995): Individuals with autism were as fast at solving a jigsaw upside-down as right-way-up

Superiority in Visual Search • O’Riordan et al (2001)

• Mottron et al. (1993) The Navon Task

• Mann & Walker (2003): Narrowing of attentional spread

• Intraub (1990) Boundary extension

• Chapman et al. (2005): clear boundary extension & virtually identical between those with and without autism

• Happe (1996) reduced susceptibility to illusions (c.f. Ropar & Mitchell, 2001)

weak central coherence?

cognitive theories of autism

• each of the 3 main cognitive theories explains some deficits

• none explains all deficits

• may be domain-general or specific (multiple deficits?

• none unique to ASD

• none universal to ASD

• different theories of autism?

• Broken mirrors? see Southgate & Hamilton (2008) Unbroken Mirrors: Challenging a Theory of Autism Trends in Cognitive Sciences

• Male brain....? .....

selected key references

• Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Cognition, 21(1), 37–46.

• Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001) Journal of Child Psychology and Psychiatry and Allied Disciplines, 42(2), 241–251.

• Frith, U. (2003). Autism: Explaining the enigma (2nd ed.). Oxford: Blackwell.

• Happé, F. (1999). Trends in Cognitive Sciences, 3(6), 216–222.

• Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Journal of Child Psychology and Psychiatry and Allied Disciplines, 32(7), 1081–1105.

• Rajendran, G. & Mitchell, P. (2007). Cognitive theories of autism Developmental Review, 27, 224-260

some additional information

• the following slides are handout only to provide some additional information

Diagnosis• ICD 10 (International classification of disorders)• DSM IV (Diagnostic and statistical manual)• DISCO (Diagnostic Interview for Social and Communication Disorders)• 1 Impairment of social interaction – The most severe form is aloofness and indifference to other people although most enjoy certain

forms of active physical contact and show attachment on a simple level to parents or carers. • 2 Impairment of social communication – A lack of appreciation of the social uses and the pleasure of communication is always present in

one form or another• 3 Impairment of imagination – In children, inability to play imaginatively with objects or toys or with other children or adults is

an outward manifestation of this impairment.

• Delay or abnormal functioning in at least one, with onset prior to age 3 years (c.f. schizophrenia)

Stereotyped activities• Simple stereotyped activities include: – flicking fingers, objects, pieces of string watching things that spin

• tapping and scratching on surfaces

• inspecting, walking along and tracing lines and angles

• feeling special textures

• rocking, especially standing up and jumping from back foot to front foot

• tapping, scratching or otherwise manipulating parts of the body

• repetitive head banging or self injury

• teeth grinding

• repetitive grunting, screaming or other noises

Other stereotyped activities• Complex stereotyped activities involving objects include: – intense attachment to particular objects for no apparent purpose– a fascination with regular repeated patterns of objects, sounds– arranging objects in lines or patterns– the collection, for no apparent purpose, of large numbers of particular objects, such as

plastic bottles, pebbles, or the tops from tubes of Smarties

• Complex stereotyped activities involving routines include: – insistence on a lengthy bedtime ritual– repetition of a sequence of odd bodily movements

• Complex verbal or abstract repetitive activities include: – fascination with certain topics, such as electricity, astronomy, birds, train timetables,

even specific persons, asking the same series of questions and demanding standard answers

Other features that may be present

• Problems affecting formal language (in addition to the essential communication impairments mentioned above) including difficulties in comprehension and use of speech as in developmental language disorders

• Odd responses to sensory stimuli, such as hypersensitivity to sound, fascination with visual stimuli, dislike of gentle touch but enjoyment of firm pressure etc

• Poor motor co-ordination including clumsiness, odd gait and posture • Over or under activity • Abnormalities of mood, such as excitement, misery • Abnormalities of eating, drinking, sleeping • Physical disabilities, such as epilepsy, sensory impairments, Down’s syndrome or any other • Additional developmental disorders affecting language, reading, writing, number work etc • Psychiatric conditions, such as depressions, anxiety, catatonia, ‘psychotic states’ • Disturbance of behaviour such as aggression, self injury, running away, screaming etc • Special skills. About 10% of children with autistic spectrum disorders have some special skill at a much

higher level than the rest of their abilities - for example, music, art, numerical calculations or jigsaw puzzles

Incidence• Lotter et al (1966) calculated the incidence as

approximately 5 per 10,000, following an epidemiological study that screened all (78,000) 8-10 yr olds in Middlesex• The NAS web site currently says that the incidence is just

under 1:100• Sex ratio–Girls:Boys – 1:4

• About ¾ have associated learning disabilities• There is no association with social class

IncidenceBaird et al (2006)

Within a total population cohort of 56 946 children aged 9–10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515).

The prevalence of childhood autism was 38·9 per 10 000 (95% CI 29·9–47·8) and that of other ASDs was 77·2 per 10 000 (52·1–102·3), making the total prevalence of all ASDs 116·1 per 10 000 (90·4–141·8).

Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear.

Bailey, et al. (1996)

•Autism is a neurodevelopmental disorder, in which specific cognitive deficits play a key role, and for which genetic factors predominate in aetiology.