Abilities to Explicitly and Implicitly Infer Intentions from Actions in Adults with Autism Spectrum Disorder

Correlation Between Gaze Behaviors and Social Communication Skills of Young Autistic Children: A Meta-Analysis of Eye-Tracking Studies

This meta-analysis examined correlations between eye-tracking measures of gaze behaviors manifested during dynamic salient social stimuli and behavioral assessment measures of social communication skills of young autistic children. We employed a multilevel model with random effects to perform three separate meta-analyses for correlation between social communication skills and (a) all gaze behaviors, (b) gaze duration, and (c) gaze transition. Subsequently, we performed meta-regression to assess the role of four moderators, including age, continuum of naturalness of stimuli, gaze metric, and area of interest, on correlation effect sizes that were heterogeneous at the population level. A total of 111 correlation coefficients from 17 studies for 1132 young autistic children or children with high-likelihood for autism (Mage range = 6-95 months) were included in this meta-analysis. The correlation effect sizes for all three meta-analyses were significant, supporting the relation between improved gaze behaviors and better social communication skills. In addition, age, gaze metric, and area of interest were significant moderators. This suggests the importance of identifying meaningful gaze behaviors related to social communication skills and the increasingly influential role of gaze behaviors in shaping social communication skills as young autistic children progress through the early childhood stage. The continuum of naturalness of stimuli, however, was revealed to trend towards having a significant moderating effect. Lastly, it is important to note the evidence of potential publication bias. Our findings are discussed in the context of early identification and intervention and unraveling the complex nature of autism.

Examining whether adults with autism spectrum disorder encounter multiple problems in theory of mind: a study based on meta-analysis

Theory of mind (ToM) represents a complex ability, while persons with autism spectrum disorder (ASD) encounter difficulties in the processing of ToM. The present ToM-focused studies on adults with ASD report inconsistent results, possibly owing to the differences between tasks. For instance, different ToM-related tasks involve different cognitive abilities, but the development of these cognitive abilities is different among adults with ASD, thereby leading to different behaviors by the same individual with ASD in different tasks. Therefore, it is of vital significance to explore the potential reasons for inconsistencies in the existing studies based on the task classification perspective. Hence, this study primarily reviews the existing ToM tasks used in studies on adults with ASD; afterward, based on the forms and characteristics of the task, the current ToM tasks are classified into four categories-reading comprehension, perceptual scene comprehension, comprehensive scene comprehension , and self-other processing. Subsequently, a meta-analysis is undertaken to determine the difference in each ToM task category between the ASD group and the typically developing (TD) group. As a result, 110 research papers (including 3,205 adults with ASD and 3,675 TD adults) that fulfilled the stated criteria are examined in this study. The study findings suggest that adults with ASD demonstrate worse performance in terms of all four ToM task categories as compared to TD adults. Furthermore, compared with tasks of self-other processing and perceptual scene comprehension, adults with ASD perform worse in reading comprehension and comprehensive scene comprehension. This shows that the differences between tasks may exert a potential influence on the study results. Future studies should focus on different abilities involved in ToM processing and the choice of ToM tasks, in order to elucidate the critical problems of ToM in adults with ASD.

Autism and intention attribution test: a non-verbal evaluation with comic strips

BACKGROUND

Despite autism spectrum disorder (ASD) and mentalization being two words often associated in the literature, the assessment of this ability in individuals with ASD in the clinical setting is still limited. Indeed, there are no standardized Theory of Mind (ToM) tests that are adaptable to different cognitive profiles, such as individuals with language poverty, and intellectual or memory impairments. This study proposes a non-verbal test (Intentions Attribution-Comic Strip Test; IA-CST) to evaluate the ability to infer the intentions of others, a basic component of ToM, in the clinical setting.

METHOD

In Study 1, the test was administered to 261 healthy individuals and we performed structural validation using Exploratory Graph Analysis. In Study 2, the final version of the test was administered to 32 individuals with ASD to assess the known group validity of the measure by comparing their scores with a sample of IQ-matched controls. Moreover, we performed logistic regression and ROC curve to preliminarily assess the diagnostic performance of the IA-CST.

RESULTS

The IA-CST resulted in a 3-dimension measure with good structural stability. Group comparison indicated that the ASD group shows significantly lower performance in intention attribution but not in inferring causal consequences. The test demonstrated known group validity and that, preliminarily, it is suitable for implementation within the clinical practice.

CONCLUSIONS

The results support the IA-CST as a valid non-verbal task for evaluating intentions attribution in the clinical setting. Difficulties in ToM are early and relevant in ASD, so assessing these aspects is valuable for structuring individualized and evidence-based interventions.

Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction

BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.

A narrative sequencing and mentalizing training for adults with autism: A pilot study

Adults diagnosed with autism experience difficulties with understanding the mental states of others, or themselves (mentalizing) and with adequately sequencing personal stories (narrative coherence). Given that the posterior cerebellum is implicated in both skills, as well as in the etiology of autism, we developed a narrative sequencing and mentalizing training for autistic adults. Participants with an official autism diagnosis were randomly assigned to a Training group (n = 17) or a waiting-list Control group (n = 15). The Training group took part in six weekly sessions in groups of three participants lasting each about 60 min. During training, participants had to (re)tell stories from the perspective of the original storyteller and answer questions that required mentalizing. We found significant improvements in mentalizing about others’ beliefs and in narrative coherence for the Training group compared to the Control group immediately after the training compared to before the training. Almost all participants from the Training group expressed beneficial effects of the training on their mood and half of the participants reported positive effects on their self-confidence in social situations. All participants recommended the current training to others. Results are discussed in light of cerebellar theories on sequencing of social actions during mentalizing. Further improvements to the program are suggested. Our results highlight the potential clinical utility of adopting a neuroscience-informed approach to developing novel therapeutic interventions for autistic populations.

Motor performance, praxis, and social skills in autism spectrum disorder and developmental coordination disorder

Previous research has shown that individuals with autism spectrum disorder (ASD) and developmental coordination disorder (DCD) may have overlapping social and motor skill impairments. This study compares ASD, DCD, and typically developing (TD) youth on a range of social, praxis and motor skills, and investigates the relationship between these skills in each group. Data were collected on participants aged 8–17 (n = 33 ASD, n = 28 DCD, n = 35 TD). Overall, the clinical groups showed some similar patterns of social and motor impairments but diverged in praxis impairments, cognitive empathy, and Theory of Mind ability. When controlling for both social and motor performance impairments, the ASD group showed significantly lower accuracy on imitation of meaningful gestures and gesture to command, indicating a prominent deficit in these praxis skills in ASD.

Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis

Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low‐level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta‐analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics.

Attribution of intentions in autism spectrum disorder: A study of event-related potentials

Autism spectrum disorder (ASD) is characterized by social cognition deficits, including difficulties inferring the intentions of others. Although deficits in attribution of intentions (AI) have been consistently replicated in ASD, their exact nature remains unexplored. Here we registered the electrophysiological correlates of a nonverbal social cognition task to investigate AI in autistic adults. Twenty-one male autistic adults and 30 male neurotypical volunteers performed a comic strips task depicting either intentional action (AI) or physical causality with or without human characters, while their electroencephalographic signal was recorded. Compared to neurotypical volunteers, autistic participants were significantly less accurate in correctly identifying congruence in the AI condition, but not in the physical causality conditions. In the AI condition a bilateral posterior positive event-related potential (ERP) occurred 200-400 ms post-stimulus (the ERP intention effect) in both groups. This waveform comprised a P200 and a P300 component, with the P200 component being larger for the AI condition in neurotypical volunteers but not in autistic individuals, who also showed a longer latency for this waveform. Group differences in amplitude of the ERP intention effect only became evident when we compared autistic participants to a subgroup of similarly performing neurotypical participants, suggesting that the atypical ERP waveform in ASD is an effect of group, rather than a marker of low-task performance. Together, these results suggest that the lower accuracy of the ASD group in the AI task may result from impaired early attentional processing and contextual integration of socially relevant cues. LAY SUMMARY: To understand why autistic people have difficulties in inferring others' intentions, we asked participants to judge the congruence of the endings of comic strips depicting either intentional actions (e.g., fetching a chair to reach for something) or situations solely following physical rules (e.g., an apple falling on someone's head), while their electrical brain activity was recorded. Autistic individuals had more difficulties in inferring intentions than neurotypical controls, which may reflect impaired attention and contextual integration of social cues.

A New Real-Life Test for Reciprocity in Autistic Adults: The Interactive Drawing Test

Impaired social-emotional reciprocity is a defining feature of Autism Spectrum Disorder (ASD). Deficits in reciprocity can be difficult to assess, particularly in adults with average or above average intelligence. The recently developed Interactive Drawing Test (IDT) measures reciprocity in children and adolescents with and without ASD based on spontaneous non-verbal interactions during the joint creation of a drawing. In this study, we examined if the IDT is able to differentiate between 19 normally intelligent adults with ASD and 18 without ASD. The IDT total reciprocity score, including the number of meaningful contributions to objects initially drawn by the examiner, was lower in the autistic adults compared to those without ASD. By assessing both the quantity and quality of spontaneous reciprocal behavior, the IDT was able to identify subtle differences in reciprocal behavior of adults with and without ASD with average intelligence. Even though a larger sample is required to determine its psychometric properties, the IDT appears a promising tool to enrich the diagnostic process of ASD in adults. Impaired social-emotional reciprocity is a defining feature of Autism Spectrum Disorder (ASD). The clinical field lacks sensitive tests for assessing impaired reciprocity. The recently developed Interactive Drawing Test (IDT) for reciprocity was tested in autistic and non-autistic adults. During the IDT, an examiner and participant make a joint drawing, taking turns, without specifying what they will draw. We aimed to investigated whether autistic adults showed less reciprocal behavior on the IDT compared to non-autistic participants. Autistic participants were less likely to jointly draw with the examiner, in particular when the examiner initiated a topic. The IDT revealed subtle but characteristic differences in reciprocal behavior related to ASD, suggesting it may be a promising diagnostic tool.

Multisession Anodal tDCS on the Right Temporo-Parietal Junction Improves Mentalizing Processes in Adults with Autistic Traits

Persons with autism spectrum disorder (ASD) have impaired mentalizing skills. In this study, a group of persons with ASD traits (high-AQ scores) initially received sham tDCS before completing a pre-test in two mentalizing tasks: false belief and self-other judgments. Over the next week, on four consecutive days, they received sessions of anodal electrical stimulation (a-tDCS) over the right temporo-parietal junction (rTPJ), a region frequently associated with the theory of mind. On the last day, after the stimulation session, they completed a new set of mentalizing tasks. A control group (with low-AQ scores) matched in age, education and intelligence received just sham stimulation and completed the same pre-test and post-test. The results showed that the high-AQ group improved their performance (faster responses), after a-tDCS, in the false belief and in the self-other judgments of mental features, whereas they did not change performance in the false photographs or the self-other judgments of physical features. These selective improvements cannot be attributed to increased familiarity with the tasks, because the performance of the low-AQ control group remained stable about one week later. Therefore, our study provides initial proof that tDCS could be used to improve mentalizing skills in persons with ASD traits.

Social cognition in 22q11.2 deletion syndrome and idiopathic developmental neuropsychiatric disorders

BACKGROUND

22q11.2 deletion syndrome (22q11DS) is a common recurrent neurogenetic condition associated with elevated risk for developmental neuropsychiatric disorders and intellectual disability. Children and adults with 22q11DS often exhibit marked social impairment as well as neurocognitive deficits, and have elevated rates of both autism spectrum disorder (ASD) and psychosis. However, the relationship between the basic processes of social cognition and cognitive ability has not been well studied in 22q11DS. Here, we examined differences in social cognition in 22q11DS, relative to multiple groups of idiopathic neuropsychiatric disorders, and typically developing healthy controls (HC). Additionally, we examined differences in intellectual functioning and its relationship to social cognitive abilities. Finally, we examined the relationship between social cognitive abilities and real-world social behavior.

METHODS

We examined social cognition and intellectual functioning in 273 participants (mean age = 17.74 ± 5.18% female = 44.3%): 50 with 22q11DS, 49 youth with first episode psychosis (FEP), 48 at clinical high-risk (CHR) for psychosis, 24 participants with ASD, and 102 HC. Social cognition was assessed using The Awareness of Social Inference Test (TASIT), while reciprocal social behavior was assessed via parent/caregiver ratings on the Social Responsiveness Scale (SRS). Participants were also administered the Wechsler Abbreviated Scale of Intelligence, 2nd edition (WASI-II) to assess intellectual functioning.

RESULTS

The 22q11DS group exhibited significantly lower social cognitive abilities compared to CHR, FEP, and HC groups after controlling for intellectual functioning, but not in comparison to the ASD group. Significant positive correlations were found between social cognition, as measured by the TASIT and IQ across groups. In contrast, no significant relationships were found between TASIT and real-world social behavior (SRS) for any group.

CONCLUSIONS

Our findings indicate social cognitive deficits are more prominent in 22q11DS than idiopathic neuropsychiatric conditions across the age range, even after adjusting for global intellectual function. These results contribute to our understanding of the intellectual and social vulnerabilities of 22q11DS in comparison to idiopathic neuropsychiatric disorders. Our findings of robust associations between intellectual ability and social cognition emphasizes the importance of accounting for neurocognitive deficits in social skills interventions and tailoring these existing treatment models for 22q11DS and other populations with intellectual impairment.

Empirical Failures of the Claim That Autistic People Lack a Theory of Mind

The claim that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. This article (a) reviews empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks; (b) highlights original findings that have failed to replicate; (c) documents multiple instances in which the various theory-of-mind tasks fail to relate to each other and fail to account for autistic traits, social interaction, and empathy; (c) summarizes a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric; and (d) concludes that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

The assertion that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. In this article, we critically examine the empirical basis of this assertion. We review empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks. We highlight seminal theory-of-mind findings that have failed to replicate. We document multiple instances in which the various theory-of-mind tasks fail to converge and fail to predict autistic traits, social interaction, and empathy. We summarize a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric. We conclude that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

Investigating Mirror System (MS) Activity in Adults with ASD When Inferring Others' Intentions Using Both TMS and EEG

ASD is associated with mentalizing deficits that may correspond with atypical mirror system (MS) activation. We investigated MS activity in adults with and without ASD when inferring others' intentions using TMS-induced motor evoked potentials (MEPs) and mu suppression measured by EEG. Autistic traits were measured for all participants. Our EEG data show, high levels of autistic traits predicted reduced right mu (8-10 Hz) suppression when mentalizing. Higher left mu (8-10 Hz) suppression was associated with superior mentalizing performances. Eye-tracking and TMS data showed no differences associated with autistic traits. Our data suggest ASD is associated with reduced right MS activity when mentalizing, TMS-induced MEPs and mu suppression measure different aspects of MS functioning and the MS is directly involved in inferring intentions.