Advanced theory of mind in high-functioning adults with autism

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.

Response to McKenzie et al. 2021: Keep It Simple; Young Adults With Autism Spectrum Disorder Without Intellectual Disability Can Process Basic Emotions

We recently read the interesting and informative paper entitled "Empathic accuracy and cognitive and affective empathy in young adults with and without autism spectrum disorder" (McKenzie et al. in Journal of Autism and Developmental Disorders 52: 1-15, 2021). This paper expands recent findings from our lab (Ben-David in Journal of Autism and Developmental Disorders 50: 741-756, 2020a; International Journal of Audiology 60: 319-321, 2020b) and a recent theoretical framework (Icht et al. in Autism Research 14: 1948-1964, 2021) that may suggest a new purview for McKenzie et al.'s results. Namely, these papers suggest that young adults with autism spectrum disorder without intellectual disability can successfully recruit their cognitive abilities to distinguish between different simple spoken emotions, but may still face difficulties processing complex, subtle emotions. McKenzie et al. (Journal of Autism and Developmental Disorders 52: 1-15, 2021) extended these findings to the processing of emotions in video clips, with both visual and auditory information.

Relationship between different types of complement syntax and false belief in Mandarin-speaking children with autism spectrum disorder and typically developing children

Previous studies have shown that complement syntax is closely associated with false belief (FB) in children with autism spectrum disorder (ASD). However, the relationship between different types of complement syntax and FB remains unclear. This study examined the relationship between different types of complement syntax and FB in both ASD and typically developing (TD) children. Thirty Mandarin-speaking ASD and TD children, each matched for language ability, were included. Children completed different types of complement syntax tasks, verbal and nonverbal FB. For the ASD children, results demonstrated that sentential complement syntax independently predicted verbal and nonverbal FB, while phrasal complement syntax only predicted nonverbal FB. For the TD children group, sentential complement syntax only predicted verbal FB. This indicates that as the language demands of the FB task decrease, ASD children can use both types of complement syntax for its prediction. Moreover, the characteristics of ASD children differ from TD children in terms of the relationship between different types of complement syntax and FB. The results of this study support de Villiers’ point of view from the Mandarin perspective and provide evidence for the social-cognitive component of the theory of mind.

The Multidimensional Battery of Prosody Perception (MBOPP)

Prosody can be defined as the rhythm and intonation patterns spanning words, phrases and sentences. Accurate perception of prosody is an important component of many aspects of language processing, such as parsing grammatical structures, recognizing words, and determining where emphasis may be placed. Prosody perception is important for language acquisition and can be impaired in language-related developmental disorders. However, existing assessments of prosodic perception suffer from some shortcomings.  These include being unsuitable for use with typically developing adults due to ceiling effects and failing to allow the investigator to distinguish the unique contributions of individual acoustic features such as pitch and temporal cues. Here we present the Multi-Dimensional Battery of Prosody Perception (MBOPP), a novel tool for the assessment of prosody perception. It consists of two subtests: Linguistic Focus, which measures the ability to hear emphasis or sentential stress, and Phrase Boundaries, which measures the ability to hear where in a compound sentence one phrase ends, and another begins. Perception of individual acoustic dimensions (Pitch and Duration) can be examined separately, and test difficulty can be precisely calibrated by the experimenter because stimuli were created using a continuous voice morph space. We present validation analyses from a sample of 59 individuals and discuss how the battery might be deployed to examine perception of prosody in various populations.

The Multidimensional Battery of Prosody Perception (MBOPP)

Prosody can be defined as the rhythm and intonation patterns spanning words, phrases and sentences. Accurate perception of prosody is an important component of many aspects of language processing, such as parsing grammatical structures, recognizing words, and determining where emphasis may be placed. Prosody perception is important for language acquisition and can be impaired in language-related developmental disorders. However, existing assessments of prosodic perception suffer from some shortcomings.  These include being unsuitable for use with typically developing adults due to ceiling effects and failing to allow the investigator to distinguish the unique contributions of individual acoustic features such as pitch and temporal cues. Here we present the Multi-Dimensional Battery of Prosody Perception (MBOPP), a novel tool for the assessment of prosody perception. It consists of two subtests: Linguistic Focus, which measures the ability to hear emphasis or sentential stress, and Phrase Boundaries, which measures the ability to hear where in a compound sentence one phrase ends, and another begins. Perception of individual acoustic dimensions (Pitch and Duration) can be examined separately, and test difficulty can be precisely calibrated by the experimenter because stimuli were created using a continuous voice morph space. We present validation analyses from a sample of 59 individuals and discuss how the battery might be deployed to examine perception of prosody in various populations.

Keep it simple: Identification of basic versus complex emotions in spoken language in individuals with autism spectrum disorder without intellectual disability: A meta-analysis study

Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) experience difficulties in identification of spoken emotions. We conducted a meta-analysis (literature search following the PRISMA guidelines), with 26 data sets (taken from 23 peer-reviewed journal articles) comparing individuals with ASD-without-ID (N = 614) and typically-developed (TD) controls (N = 640), from nine countries and in seven languages (published until February 2020). In our analyses there was no sufficient evidence to suggest that individuals with HF-ASD differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, individuals with ASD-without-ID were found to perform significantly worse than controls in identification of complex prosodic emotions (e.g., envy and boredom). The level of the semantic content of the stimuli presented (e.g., sentences vs. strings of digits) was not found to have an impact on the results. In conclusion, the difference in findings between simple and complex emotions calls for a new-look on emotion processing in ASD-without-ID. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions and target improved performance with complex emotions. LAY SUMMARY: Individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) do not differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, they were found to perform significantly worse than controls in the identification of complex prosodic emotions (e.g., envy, boredom). This was found in a meta-analysis of 26 data sets with 1254 participants from nine countries and in seven languages. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions.

Developmental effects in physiological stress in early adolescents with and without autism spectrum disorder

INTRODUCTION

Humans place high value on how they are socially evaluated by others. The Trier Social Stress Test (TSST) is a well-established measure of social evaluative threat that promotes activation of the hypothalamic pituitary adrenal (HPA) axis and release of cortisol. Higher cortisol responses in typically developing (TD) adolescents are influenced by age and pubertal development especially in later stages. Children with ASD have been shown to exhibit blunted cortisol in response to the TSST although adults with ASD show a more prototypical response. The current study examined physiological stress in early adolescents with ASD and TD. It was hypothesized that TD youth would show elevated cortisol in response to the TSST influenced by age and pubertal stage. In contrast, youth with ASD would show a more diminished stress response yet still show effects for age and pubertal development METHODS: The sample included 241 youth, 138 with ASD (median age=11.25) and 103 TD (median age=11.67). Standardized diagnostic and pubertal development (genital/breast (GB), and pubic hair (PH) stage) physical exams were performed. Salivary cortisol was collected before and after the TSST. Linear mixed effects models examined the effects of baseline cortisol, time, age, sex, pubertal stage, and diagnosis.

RESULTS

We did not find an effect of early pubertal development stage (GB or PH) on cortisol response. There was an interaction between age and TSST timepoint, showing stronger effects for older children across the timeline especially during the stressor. Finally, there was a significant diagnosis by TSST timepoint interaction characterized by a blunted cortisol stress response in youth with ASD compared to TD participants who showed higher cortisol.

DISCUSSION

We found evidence that age contributes to an increase in cortisol in response to social evaluative threat during early adolescence. TD youth exhibit an adaptive elevated stress response to psychosocial threat whereas youth with ASD do not. There may exist a developmental lag in the perception of and stress responsivity to social evaluation which may emerge in older adolescents with ASD.

Camouflaging in Autism: Examining Sex-Based and Compensatory Models in Social Cognition and Communication

Camouflaging refers to behavioral adaptations that individuals with autism spectrum disorder (ASD), especially females, use to mask symptoms during social situations. Compensation is a component of camouflaging in which an individual's observed behavior is considerably better than actual ability. The study explored diagnostic, sex-based, and compensatory differences using the Contextual Assessment of Social Skills (CASS). The sample included 161 youth 10:0-to-16:11 years (115 males, 46 females). T-tests were performed based on sex (female, male) or High (good ADOS + poor Theory of Mind (TOM)) compared to Low (poor ADOS + poor TOM) Compensation groups. Comparisons were examined for Social Affect (SA), Restricted Repetitive Behavior, (RRB), IQ, social behavior (Positive Affect, Overall Involvement) and communication (Vocal Expression, Gestures). Females exhibited fewer RRB t(158) = 3.05, P = 0.003, d = 0.54. For the CASS, females evidenced more Vocal Expressiveness t(157) = -2.03, P = 0.05, d = 0.35, which corroborates sex-based differences in the literature. Compensation group differences indicated the High compared to Low group showed stronger Social and Communication behaviors on the CASS for Vocal Expression t(72) = 2.56, P = 0.01, d = 0.62, and overall rapport t(72) = 2.36, P = 0.02, d = 0.56. Several differences were observed when the groups were stratified based on level of compensation, with the High compensation participants showing stronger social engagement and communication behaviors. Findings may inform efforts to understand camouflaging, compensation, and clinical practices for male and female adolescents with ASD. A more nuanced consideration of camouflaging alongside compensation models reveals subtle differences in cognition, behavior, and affect that may reflect underlying profiles of challenge and strength in youth with ASD. LAY SUMMARY: Camouflaging refers to ways individuals with autism spectrum disorder (ASD), especially females, mask symptoms. Compensation occurs when a person's observed behavior appears more typical than what would be expected based on underlying ability and symptoms. The study explored camouflaging and compensation differences in 161 youth with ASD. Findings suggest sex-based differences with females showing better vocal expression. However, several compensation differences were observed with the High compensators showing stronger social communication and rapport. A more nuanced consideration of camouflaging using compensation models reveal subtle differences in underlying challenge and strength.

Social Cognition in Autism Spectrum Disorder Across the Adult Lifespan: Influence of Age and Sex on Reading the Mind in the Eyes Task in a Cross-sectional Sample

Background: Approximately 50,000 U.S. teens with autism spectrum disorder (ASD) become adults every year, however little is known regarding how age influences social cognition and if men and women with ASD are differentially impacted across the adult lifespan. Social cognition declines non-linearly with age in neurotypical (NT) adults. Moreover, sex differences have been observed on RME tasks in NT adults but not adults with ASD, although aging effects have been largely ignored.

Objective: This cross-sectional study examined the influence of age and sex on social cognition in adults with ASD compared to NT adults.

Methods: The Reading the Mind in the Eyes (RME) task was administered to evaluate the theory of mind abilities in 95 adults with ASD and 82 NT adults ages 18–71 years. The main effects of diagnosis, age, and sex, as well as two-way and three-way interaction were modeled using linear and quadratic aging terms in a multiple regression analysis.

Results: A main effect of diagnosis was observed, indicating poorer performance in adults with ASD relative to NT adults. Age and sex interactions were nonsignificant.

Discussion: We replicated previous findings of reduced theory of mind (ToM) abilities in adults with ASD, compared to NT adults. While interactions were nonsignificant, visual inspection of quadratic age curves indicated the possibility of unique ToM trajectories in men and women with and without ASD that should be investigated in larger longitudinal studies.

The social responsiveness scale is an efficient screening tool for autism spectrum disorder traits in adults with anorexia nervosa

OBJECTIVE

A significant proportion of individuals with anorexia nervosa (AN) show high levels of autism spectrum disorder (ASD) traits, a factor associated with poorer treatment outcomes. An important question for both researchers and clinicians relates to how ASD traits should be assessed in individuals with AN. This study aimed to examine scores on the Social Responsiveness Scale adult self-report version (SRS-2) in individuals in the acute (AN) and recovered stages (REC) of illness compared to healthy controls (HCs). We also aimed to examine associations between the SRS-2 and an observational diagnostic measure, the Autism Diagnostic Observation Schedule - second edition (ADOS-2).

METHOD

The SRS-2 and ADOS-2 were administered to 142 adults with AN, REC, and HCs. Eating disorder (ED) psychopathology and functional impairment were also assessed.

RESULTS

AN and REC scored significantly higher than HCs on the SRS-2. SRS-2 scores significantly predicted ADOS-2 classification and were positively associated with ED psychopathology and functional impairment. SRS-2 scores were not associated with BMI or illness duration.

CONCLUSIONS

The SRS-2 may be a useful tool in screening for ASD traits in individuals with AN. Although cross-sectional, the results also suggest ASD symptoms are independent of BMI and persist in individuals recovered from AN.

Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa

BACKGROUND

Social and emotional difficulties have been identified as key factors in the development and maintenance of anorexia nervosa (AN). However, few studies have investigated the influence of comorbid psychopathology on social cognition. The aim of the current study was to examine perception of nonverbal communication and empathy in AN using ecologically valid, performance-based measures, and to explore associations with comorbid psychopathology (anxiety, depression, autism spectrum disorder (ASD) traits, alexithymia, and social anxiety).

METHODS

In this cross-sectional study, the Multifaceted Empathy Test (MET) and the Mini Profile of Nonverbal Sensitivity (MiniPONS) were administered to 51 adults with AN, 51 recovered AN (REC), and 51 healthy controls (HCs). Comorbid psychopathological traits were assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2).

RESULTS

Individuals with AN showed reduced affective empathy to positive stimuli compared to HCs, and a trend towards lower vocal prosody recognition scores relative to REC. Around a quarter of AN and REC scored above the clinical cut-off for ASD on the ADOS-2, and high ASD symptoms predicted lower cognitive and affective empathy scores.

LIMITATIONS

The study is cross-sectional, future research would benefit from examining social-cognition performance and comorbid psychopathology longitudinally.

CONCLUSIONS

The findings highlight the importance of ASD symptoms in empathy dysfunction in those with a lifetime history of AN. Future research should explore whether treatment adaptations to accommodate for differences in social-cognitive abilities may be helpful in the treatment of AN.

Distinct neural mechanisms of social orienting and mentalizing revealed by independent measures of neural and eye movement typicality

Extensive study of typically developing individuals and those on the autism spectrum has identified a large number of brain regions associated with our ability to navigate the social world. Although it is widely appreciated that this so-called "social brain" is composed of distinct, interacting systems, these component parts have yet to be clearly elucidated. Here we used measures of eye movement and neural typicality-based on the degree to which subjects deviated from the norm-while typically developing (N = 62) and individuals with autism (N = 36) watched a large battery of movies depicting social interactions. Our findings provide clear evidence for distinct, but overlapping, neural systems underpinning two major components of the "social brain," social orienting, and inferring the mental state of others.

Cognitive processes predicting advanced theory of mind in the broader autism phenotype

Little is known about executive functions (EFs) associated with advanced theory of mind (ToM) abilities. We aimed to determine if advanced ToM abilities were reduced in individuals with subclinical traits of autism spectrum disorder (ASD), known as the "Broader Autism Phenotype" (BAP), and identify the EFs that predicted unimpaired performance on an advanced ToM task, the faux pas test. We assessed 29 participants (13 males) with the BAP who were relatives of children with ASD. Thirteen participants showed reduced ability to understand a faux pas. A discriminant function analysis correctly classified 79% of cases as impaired or unimpaired, with high sensitivity (80%) and specificity (77%), which was best predicted by language-mediated EFs, including verbal generativity, working memory, cognitive inhibition, and flexibility. Autism Res 2020, 13: 921-934. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Little is known about the complex cognitive processes that enable accurate interpretation of another person's thoughts and emotions, known as "theory of mind." In relatives of individuals with autism, who had mild traits of autism themselves, approximately half had difficulty interpreting situations involving a social faux pas. Cognitive inhibition and flexibility, working memory, and verbal generativity were related to, and appeared to be protective for, unimpaired understanding of a faux pas.

Autism and Faux Pas. Influences of Presentation Modality and Working Memory

People diagnosed with an autism spectrum disorder (ASD) often have difficulties on Theory of Mind (ToM) tasks involving social situations, such as 'faux pas'. The objective of this study was to find the modality of presentation (visual, verbal, or mixed) that yields the best understanding of a 'faux pas', and the possible influence of other variables, including intelligence (IQ), age, and working memory. Thirty autistic children and 30 neurotypical children, all aged 7 to 12 years old and comparable in age and IQ, participated in this study. They were asked to resolve nine 'faux pas' stories (three per modality). Significant between-groups differences were found in the visual (t = 2.99, p = .004) and verbal modalities (t = 2.64, p = .011), such that the neurotypical (NT) group had higher scores than the ASD group. The ASD group's comprehension was better via the mixed modality than the verbal modality (t = 2.48, p = .019). In addition, working memory had a bigger impact on Faux Pas understanding in cases of autism than in typical development (R2 explained between .19 and .28 of variance in Faux Pas test outcomes), and could therefore explain some of the difficulties previously reported in this area. Future research should include a measure of working memory and a control among the stimuli presented to test for group differences in faux pas understanding.

Ungrammatical utterances and disfluent speech as causes of comprehension problems in interactions of preadolescents with high functioning autism

This study describes the role of ungrammatical utterances and disfluent speech in the creation of comprehension problems between the participants in group therapy sessions of preadolescents with autism. The speech of the autistic preadolescents included frequent disfluencies and morpho-syntactic problems, such as wrong case endings, ambiguous pronominal references, grammatically incoherent syntactic structures and inaccurate tenses, which caused problems of comprehension. Three different interactional trajectories occurred when solving the potential problems of comprehension following the morpho-syntactically disfluent turns. First, the disfluent turn sometimes led to a clarification request by a co-participant, either a therapist or another participant with ASD. The preadolescents with ASD showed interactional skilfulness in requesting clarification when faced with comprehension problems. Second, in contrast, other occurrences included one or several self-repairs by the speaker with ASD. In these cases, the other group participants either did not react or they encouraged the speaker to continue using discourse particles. If the self-repairing disfluencies led to a persisting problem of comprehension, the therapists sometimes intervened and resolved the problem. However, direct interventions by the therapists were infrequent because the participants with ASD were mostly able to resolve the comprehension problems by themselves. Third, some disfluent and/or grammatically incorrect turns were not treated as problematic by the co-participants nor by the speaker himself. Abbreviations: ADE: Adessive; ALL: Allative; CLI: clitic; GEN: Genitive; INE: Inessive; NOM: Nominative; PER: person; PL: plural; PRT: particle; SG: singular.

Belief-attribution in adults with and without autistic spectrum disorders

An important aspect of daily life is the ability to infer information about the contents of other people's minds, such as what they can see and what they know, in order to engage in successful interactions. This is referred to as possession of a "Theory of Mind" (ToM). Past research has shown that adults with Autistic Spectrum Disorders (ASD) often show deficits in social communication abilities, although can successfully pass tests of explicit ToM. The current study utilized a computerized false-belief task to explore subtle differences (i.e., measuring response times and accuracy rates) in how efficiently ToM capacities-specifically, belief-attribution-are utilized in adults with and without ASD. In the task, participants were asked to attribute a belief-state to either themselves or another person, following establishment of a true or false-belief scenario. Results revealed comparable patterns of ToM engagement across individuals with and without ASD, with faster and more accurate responses to "Self" versus "Other" oriented questions, and slower response times when shifting between the "Self" and "Other" perspective compared to when maintaining a perspective. However, autistic individuals showed a particular deficit in correctly identifying a belief-state in false-belief trials, in which two contrasting belief-states had to be held in mind, suggesting more difficulty disengaging from current, reality based belief-states than neuro-typical individuals. Autism Res 2018, 11: 1542-1553. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: To successfully communicate, we have to think about what other people do/do not know; this is called having a "Theory of Mind." This study looked at how well people use their Theory of Mind when thinking about the contents of people's minds. Results showed that people with autism had difficulties considering more than one mental state at a time, suggesting they may have more trouble in stopping themselves thinking about what is happening in reality than people without autism.

False belief and relative clauses in Autism Spectrum Disorders

Previous studies have suggested sentential complementation is the crucial ingredient of language that relates to false-belief (FB) reasoning, while the role of relative clauses (RCs) is less clear. Nevertheless, under the hypothesis that clausal embedding has a meta-representational effect, arguably implied in FB, one expects a link between FB and not only complementation but also relativization. Seventeen children with ASD (6 to 16 years, mean age 9;2) were assessed for RCs and FB. Comprehension of RCs significantly predicted FB performance, while none of the controlled factors played a predictive role (comprehension of simple sentences, vocabulary, morpho-syntax and working memory). Findings suggest that clausal embedding, common to both sentential complements and RCs, serves as a bootstrap for FB reasoning.

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

Previous research suggests that Autism Spectrum Disorder (ASD) might be associated with impairments on implicit but not explicit mentalizing tasks. However, such comparisons are made difficult by the heterogeneity of stimuli and the techniques used to measure mentalizing capabilities. We tested the abilities of 34 individuals (17 with ASD) to derive intentions from others' actions during both explicit and implicit tasks and tracked their eye-movements. Adults with ASD displayed explicit but not implicit mentalizing deficits. Adults with ASD displayed typical fixation patterns during both implicit and explicit tasks. These results illustrate an explicit mentalizing deficit in adults with ASD, which cannot be attributed to differences in fixation patterns.

Brief Report: Adults with Autism are Less Accurate at Predicting How Their Personality Traits are Evaluated by Unfamiliar Observers

Social cognitive impairments in autism spectrum disorder (ASD) are well-documented, yet little research has examined whether ASD is also characterized by difficulties in meta-perception, or the ability to gauge how one is perceived. In this study, ASD and TD adults (N = 22) largely did not differ on the self-perception of their personality traits or on how they expected to be perceived by unfamiliar observers. However adults with ASD were rated less favorably by TD observers (N = 412) on 19 out of 20 personality items, and adults with ASD were less accurate at predicting how they would be perceived. These findings suggest impaired meta-perception in ASD that may serve as a potential mechanism through which reduced social cognitive ability contributes to social impairment.

Social and Non-social Hazard Response in Drivers with Autism Spectrum Disorder

Driving is a complex task that relies on manual, cognitive, visual and social skill. The social demands of driving may be challenging for individuals with Autism Spectrum Disorder (ASD) due to known social impairments. This study investigated how drivers with ASD respond to social (e.g., pedestrians) and non-social (e.g., vehicles) hazards in a driving simulator compared to typically developing drivers. Overall, participants responded faster to social hazards than non-social hazards. It was also found that drivers with typical development reacted faster to social hazards, while drivers with ASD showed no difference in reaction time to social versus non-social hazards. Future work should further investigate how social impairments in ASD may affect driving safety.

The influence of presentation modality on the social comprehension of naturalistic scenes in adults with autism spectrum disorder

The comprehension of dynamically unfolding social situations is made possible by the seamless integration of multimodal information merged with rich intuitions about the thoughts and behaviors of others. We examined how high-functioning adults with autism spectrum disorder and neurotypical controls made a complex social judgment (i.e. rating the social awkwardness of scenes from a television sitcom) across three conditions that manipulated presentation modality-visual alone, transcribed text alone, or visual and auditory together. The autism spectrum disorder and control groups collectively assigned similar mean awkwardness ratings to individual scenes. However, individual participants with autism spectrum disorder tended to respond more idiosyncratically than controls, assigning ratings that were less correlated with the ratings of the other participants in the sample. We found no evidence that this group difference was isolated to any specific presentation modality. In a comparison condition, we found no group differences when participants instead rated the happiness of characters (a more basic social judgment) in full audiovisual format. Thus, although we observed differences in the manner with which high-functioning adults with autism spectrum disorder make social judgments compared to controls, these group differences may be dependent on the social dimension being judged, rather than the specific modality of presentation.

Performance of Children with Autism Spectrum Disorder on Advanced Theory of Mind Tasks

Although a number of advanced theory of mind tasks have been developed, there is sparse information on whether performance on different tasks is associated. The study examined the performance of 20 high-functioning 6- to 12-year-old children with autism spectrum disorder and 20 controls on three high-level theory of mind tasks: Strange Stories, Cartoons and the children’s version of the Eyes task. The pattern of findings suggests that the three tasks may share differing, non-specific, information-processing requirements in addition to tapping any putative mentalizing ability. They may also indicate a degree of dissociation between social-cognitive and social-perceptual or affective components of the mentalizing system.

Is Autism Partly a Consolidation Disorder?

Computational modeling has been useful for understanding processes of encoding and consolidation in cortical structures. In particular, this work suggests a role of neuromodulators in setting dynamics for consolidation processes during different stages of waking and sleep. Because autistic individuals show symptoms of a cognitive nature coupled with a high prevalence of comorbid conditions such as epileptiform discharge during sleep and sleep disorders, it is possible that autism could involve a breakdown in consolidation processes, which are essential to build effective cognitive representations of the environment on the basis of individual experiences. In this article, theories of consolidation during different stages of waking and sleep and the role of different neuromodulators in these consolidation processes are reviewed in conjunction with different features of autism, which may be understood in the context of these theories.

Relations Among Detection of Syllable Stress, Speech Abnormalities, and Communicative Ability in Adults With Autism Spectrum Disorders

PURPOSE

To date, the literature on perception of affective, pragmatic, and grammatical prosody abilities in autism spectrum disorders (ASD) has been sparse and contradictory. It is interesting to note that the primary perception of syllable stress within the word structure, which is crucial for all prosody functions, remains relatively unexplored in ASD. Thus, in the current study, we explored syllable stress perception sensitivity and its relationship to speech production abnormalities and communicative ability in adults with ASD.

METHOD

A same-different syllable stress perception task using pairs of identical 4-syllable words was delivered to 42 adults with/without high-functioning ASD, matched for age, to investigate primary speech perception ability in ASD. Speech production and communicative ability in ASD was measured using the Autism Diagnostic Observation Schedule (Lord et al., 2000).

RESULTS

As predicted, the results showed that adults with ASD were less sensitive in making judgments about syllable stress relative to controls. Also, partial correlations revealed a key association of speech production abnormalities with stress perception sensitivity, rather than communicative ability.

CONCLUSIONS

Our findings provide empirical evidence for deficits on primary syllable stress perception in ASD and its role on sociocommunicative difficulties. This information could facilitate the development of effective interventions for speech and language therapy and social communication.

Discriminating autism spectrum disorders from schizophrenia by investigation of mental state attribution on an on-line mentalizing task: A review and meta-analysis

In recent years, theories of how humans form a "theory of mind" of others ("mentalizing") have increasingly been called upon to explain impairments in social interaction in mental disorders, such as autism spectrum disorders (ASD) and schizophrenia. However, it remains unclear whether tasks that assess impairments in mentalizing can also contribute to determining differential deficits across disorders, which may be important for early identification and treatment. Paradigms that challenge mentalizing abilities in an on-line, real-life fashion have been considered helpful in detecting disease-specific deficits. In this review, we are therefore summarizing results of studies that assess the attribution of mental states using an animated triangles task. Behavioral as well as brain imaging studies in ASD and schizophrenia have been taken into account. While for neuroimaging methods, data are sparse and investigation methods inconsistent, we performed a meta-analysis of behavioral data to directly investigate performance deficits across disorders. Here, more impaired abilities in the appropriate description of interactions were found in ASD patients than in patients with schizophrenia. Moreover, an analysis of first-episode (FES) versus longer lasting (LLS) schizophrenia showed that usage of mental state terms was reduced in the LLS group. In our review and meta-analysis, we identified performance differences between ASD and schizophrenia that seem helpful in targeting differential deficits, taking into account different stages of schizophrenia. However, to tackle the deficits in more detail, studies are needed that directly compare patients with ASD and schizophrenia using behavioral or neuroimaging methods with more standardized task versions.

Emotion recognition in animated compared to human stimuli in adolescents with autism spectrum disorder

There is equivocal evidence as to whether there is a deficit in recognising emotional expressions in Autism spectrum disorder (ASD). This study compared emotion recognition in ASD in three types of emotion expression media (still image, dynamic image, auditory) across human stimuli (e.g. photo of a human face) and animated stimuli (e.g. cartoon face). Participants were 37 adolescents (age 11-16) with a diagnosis of ASD (33 male, 4 female). 42 males and 39 females served as typically developing, age-matched controls. Overall there was significant advantage for control groups over the ASD group for emotion recognition in human stimuli but not animated stimuli, across modalities. For static animated images specifically, those with ASD significantly outperformed controls. The findings are consistent with the ASD group using atypical explicit strategies.

Behavioral, perceptual, and neural alterations in sensory and multisensory function in autism spectrum disorder

Although sensory processing challenges have been noted since the first clinical descriptions of autism, it has taken until the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 for sensory problems to be included as part of the core symptoms of autism spectrum disorder (ASD) in the diagnostic profile. Because sensory information forms the building blocks for higher-order social and cognitive functions, we argue that sensory processing is not only an additional piece of the puzzle, but rather a critical cornerstone for characterizing and understanding ASD. In this review we discuss what is currently known about sensory processing in ASD, how sensory function fits within contemporary models of ASD, and what is understood about the differences in the underlying neural processing of sensory and social communication observed between individuals with and without ASD. In addition to highlighting the sensory features associated with ASD, we also emphasize the importance of multisensory processing in building perceptual and cognitive representations, and how deficits in multisensory integration may also be a core characteristic of ASD.

Evidence for shared deficits in identifying emotions from faces and from voices in autism spectrum disorders and specific language impairment

BACKGROUND

While autism spectrum disorder (ASD) and specific language impairment (SLI) have traditionally been conceptualized as distinct disorders, recent findings indicate that the boundaries between these two conditions are not clear-cut. While considerable research has investigated overlap in the linguistic characteristics of ASD and SLI, relatively less research has explored possible overlap in the socio-cognitive domain, particularly in terms of the emotion recognition abilities of these two groups of children.

AIMS

To investigate facial and vocal emotion recognition in children with ASD, children with SLI and typically developing (TD) children. To do so, the ASD group was subdivided into those with 'normal' (ALN) and those with 'impaired' (ALI) language to explore the extent to which language ability influenced performance on the emotion recognition task.

METHODS & PROCEDURES

Twenty-nine children with ASD (17 ALN and 12 ALI), 18 children with SLI and 66 TD children completed visual and auditory versions of an emotion recognition task. For the visual version of the task, the participants saw photographs of people expressing one of six emotions (happy, sad, scared, angry, surprised, disgusted) on the whole face. For the auditory modality, the participants heard a neutral sentence that conveyed one of the six emotional expressions in the tone of the voice. In both conditions, the children were required to indicate how the person they could see/hear was feeling by selecting a cartoon face that was presented on the computer screen.

OUTCOMES & RESULTS

The results showed that all clinical groups were less accurate than the TD children when identifying emotions on the face and in the voice. While the ALN children were less accurate than the TD children only when identifying expressions that require inferring another's mental state (surprise, disgust) emotional expressions, the ALI and the SLI children were less accurate than the TD children when identifying the basic (happy, sad, scared, angry) as well as the inferred emotions.

CONCLUSIONS & IMPLICATIONS

The results indicate that children with ALI and children with SLI share emotion recognition deficits, which are likely to be driven by the poor language abilities of these two groups.

In two minds: Theory of Mind, intersubjectivity, and autism

Mind is an inner property of individual being but, paradoxically, to live in the social world requires being able to know what is in other people’s minds. This article explores two approaches to making sense of this paradox; the concept of “theory of mind” and the phenomenological concept of “intersubjectivity.” Theory of mind is discussed in terms of its development as a concept in cognitive psychology to understand autism and intersubjectivity is discussed in relation to five processes—co-presence, apperception, empathy, the look, and communicative interaction—that are described in the work of phenomenologists including Husserl, Merleau-Ponty, Sartre, and Schutz. The paper argues that while “theory of mind” has stimulated research and discussion on autism, the phenomenological understanding of “intersubjectivity” is more appropriate to trying to understand the difficulties faced by people with autism.

The use of prosody during syntactic processing in children and adolescents with autism spectrum disorders

In this study, we employed an eye-gaze paradigm to explore whether children (ages 8–12) and adolescents (ages 12–18) with autism spectrum disorders (ASDs) are able to use prosodic cues to determine the syntactic structure of an utterance. Persons with ASD were compared to typically developing (TD) peers matched on age, IQ, gender, and receptive language abilities. The stimuli were syntactically ambiguous but had a prosodic break that indicated the appropriate interpretation (feel the frog … with the feathervs.feel … the frog with the feather). We found that all groups were equally sensitive to the initial prosodic cues that were presented. Children and teens with ASD used prosody to interpret the ambiguous phrase as rapidly and efficiently as their TD peers. However, when a different cue was presented in subsequent trials, the younger ASD group was more likely to respond in a manner consistent with the initial prosodic cue rather than the new one. Eye-tracking data indicated that both younger groups (ASD and TD) had trouble shifting their interpretation as the prosodic cue changed, but the younger TD group was able to overcome this interference and produce an action consistent with the prosodic cue.

A meta-analysis of mentalizing impairments in adults with schizophrenia and autism spectrum disorder

Mentalizing has been examined both in autism spectrum disorder (ASD) and schizophrenia (SCZ) primarily by either cognitive-linguistic (referred to as verbal) or emotion recognition from eyes (referred to as visual) mentalizing tasks. Each type of task is thought to measure different aspects of mentalizing. Differences in clinical features and developmental courses of each disorder may predict distinct patterns of mentalizing performance across dis orders on each type of task. To test this, a meta-analysis was conducted using 37 studies that assessed mentalizing either verbally or visually in adults with SCZ or ASD. We found that the estimated effect sizes of impairments in verbal and visual mentalizing tasks for both clinical groups were statistically large and at a similar level (overall Hedges' g = 0.73-1.05). For each disorder, adults with SCZ showed a trend towards larger impairments on verbal (overall Hedges' g = 0.99) than on visual mentalizing task (overall Hedges' g = 0.73; Qbet = 3.45, p =.06, df =1). Adults with ASD did not show different levels of impairment on the verbal versus visual tasks (Qbet = 0.08, p =.78, df =1). These results suggest that both clinical groups share, at least in part, some common cognitive processing deficits associated with mentalizing impairments.

Evidence for impaired verbal identification but intact nonverbal recognition of fearful body postures in Asperger's syndrome

While most studies of emotion recognition in Asperger's Syndrome (AS) have focused solely on the verbal decoding of affective states, the current research employed the novel technique of using both nonverbal matching and verbal labeling tasks to examine the decoding of emotional body postures and facial expressions. AS participants performed as accurately as controls at matching fear body postures, but were significantly less accurate than controls verbally identifying these same stimuli. This profile arguably indicates that that while the AS participants were aware that the fear body posture stimuli represented a distinct emotion, they were unsure as to which specific emotion. In addition, the AS participants took significantly longer than the controls to respond to anger body posture stimuli on a matching task. However, in contrast to previous studies, AS and control participants did not differ significantly in their responses to facial expression stimuli, in terms of either accuracy or response times.

The uses of cognitive training technologies in the treatment of autism spectrum disorders

In this review, we focus on research that has used technology to provide cognitive training - i.e. to improve performance on some measurable aspect of behaviour - in individuals with autism spectrum disorders. We review technology-enhanced interventions that target three different cognitive domains: (a) emotion and face recognition, (b) language and literacy, and (c) social skills. The interventions reviewed allow for interaction through different modes, including point-and-click and eye-gaze contingent software, and are delivered through diverse implementations, including virtual reality and robotics. In each case, we examine the evidence of the degree of post-training improvement observed following the intervention, including evidence of transfer to altered behaviour in ecologically valid contexts. We conclude that a number of technological interventions have found that observed improvements within the computerised training paradigm fail to generalise to altered behaviour in more naturalistic settings, which may result from problems that people with autism spectrum disorders experience in generalising and extrapolating knowledge. However, we also point to several promising findings in this area. We discuss possible directions for future work.

Rethinking theory of mind in high-functioning autism spectrum disorder

BACKGROUND

 The sociocommunicative problems in autism spectrum disorder (ASD) are traditionally linked to impairments in theory of mind (ToM), the ability to ascribe mental states to others. Although ToM impairments are consistently reported in young children with ASD, findings on more advanced ToM understanding in older individuals with high-functioning ASD (HFASD) are less straightforward. Therefore, we assessed the advanced ToM abilities of a large sample of school-aged children and adolescents with HFASD (n = 194; 6-20 years) and compared them to a typically developing (TD) comparison group (n = 60).

METHODS

Participants' advanced ToM was assessed with five social stories containing second-order false beliefs, display rules, double bluff, faux pas, and sarcasm.

RESULTS

Participants with HFASD performed equally well on each of the ToM stories as their TD peers. Consistent age effects were noticed with adolescents outperforming the children. Furthermore, advanced ToM was positively associated with participants' age, verbal abilities, and general reasoning abilities.

CONCLUSIONS

Counter to what the ToM theory of ASD would predict, school-aged children and adolescents with HFASD seem to be able to master the theoretical principles of advanced mental state reasoning. However, they may still fail to apply these theoretical principles during everyday social interactions.

A new interactive computer simulation system for violence risk assessment of mentally disordered violent offenders

BACKGROUND

Assessment of risk of future violence has developed from reliance on static indicators towards a more dynamic approach. In the latter context, however, the offender is seldom confronted with real life situations.

AIMS

The aim of this study is to evaluate a computer-based system--Reactions on Display, which presents human interactions based on real-life situations--for its effectiveness in distinguishing between potentially violent offenders with mental disorder and a healthy comparison group.

METHODS

Male offenders with autism spectrum disorders or psychosis were recruited from specialist forensic psychiatric units in Sweden and healthy participants from the local communities. Each consenting participant was presented with film clips of a man in neutral and violent situations, which at critical moments stopped the story to ask him to predict the thoughts, feelings and actions of the actor.

RESULTS

Offender patients, irrespective of diagnosis, detected fewer emotional reactions in the actor in the non-violent sequence compared with controls. When asked to choose one of four violent actions, the offender patients chose more violent actions than did the controls. They also reported fewer physical reactions in the actors when actors were being violent. There were also some examples of incongruent or deviant responses by some individual patients.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The use of interactive computer simulation techniques is not only generally acceptable to offender patients, but it also helps to differentiate their current response style to particular circumstances from that of healthy controls in a way that does not rely on their verbal abilities and may tap more effectively into their emotional reactions than standard verbal questions and answer approaches. This may pave the way for Reactions on Display providing a useful complement to traditional risk assessment, and a training route with respect to learning more empathic responding, thus having a role in aiding risk management.

Neurofunctional underpinnings of audiovisual emotion processing in teens with autism spectrum disorders

Despite successful performance on some audiovisual emotion tasks, hypoactivity has been observed in frontal and temporal integration cortices in individuals with autism spectrum disorders (ASD). Little is understood about the neurofunctional network underlying this ability in individuals with ASD. Research suggests that there may be processing biases in individuals with ASD, based on their ability to obtain meaningful information from the face and/or the voice. This functional magnetic resonance imaging study examined brain activity in teens with ASD (n = 18) and typically developing controls (n = 16) during audiovisual and unimodal emotion processing. Teens with ASD had a significantly lower accuracy when matching an emotional face to an emotion label. However, no differences in accuracy were observed between groups when matching an emotional voice or face-voice pair to an emotion label. In both groups brain activity during audiovisual emotion matching differed significantly from activity during unimodal emotion matching. Between-group analyses of audiovisual processing revealed significantly greater activation in teens with ASD in a parietofrontal network believed to be implicated in attention, goal-directed behaviors, and semantic processing. In contrast, controls showed greater activity in frontal and temporal association cortices during this task. These results suggest that in the absence of engaging integrative emotional networks during audiovisual emotion matching, teens with ASD may have recruited the parietofrontal network as an alternate compensatory system.

Emotional recognition in autism spectrum conditions from voices and faces

The present study reports on a new vocal emotion recognition task and assesses whether people with autism spectrum conditions (ASC) perform differently from typically developed individuals on tests of emotional identification from both the face and the voice. The new test of vocal emotion contained trials in which the vocal emotion of the sentence were congruent, incongruent, or neutral with respect to the semantic content. We also included a condition in which there was no semantic content (an 'mmm' was uttered using an emotional tone). Performance was compared between 11 adults with ASC and 14 typically developed adults. Identification of emotion from sentences in which the vocal emotion and the meaning of sentence were congruent was similar in people with ASC and a typically developed comparison group. However, the comparison group was more accurate at identifying the emotion in the voice from incongruent and neutral trials, and also from trials with no semantic content. The results of the vocal emotion task were correlated with performance on a face emotion recognition task. In decoding emotion from spoken utterances, individuals with ASC relied more on verbal semantics than did typically developed individuals, presumably as a strategy to compensate for their difficulties in using prosodic cues to recognize emotions.

Living the categorical imperative: autistic perspectives on lying and truth telling-between Kant and care ethics

Lying is a common phenomenon amongst human beings. It seems to play a role in making social interactions run more smoothly. Too much honesty can be regarded as impolite or downright rude. Remarkably, lying is not a common phenomenon amongst normally intelligent human beings who are on the autism spectrum. They appear to be 'attractively morally innocent' and seem to have an above average moral conscientious objection against deception. In this paper, the behavior of persons with autism with regard to deception and truthfulness will be discussed in the light of two different ethical theories, illustrated by fragments from autobiographies of persons with autism. A systemizing 'Kantian' and an empathizing 'ethics of care' perspective reveal insights on high-functioning autism, truthfulness and moral behavior. Both perspectives are problematic from the point of view of a moral agent with autism. High-functioning persons with autism are, generally speaking, strong systemizes and weak empathizers. Particularly, they lack 'cognitive empathy' which would allow them to understand the position of the other person. Instead, some tend to invent a set of rules that makes their behavior compatible with the expectations of others. From a Kantian point of view, the autistic tendency to always tell the truth appears praiseworthy and should not be changed, though it creates problems in the social life of persons with autism. From a care ethics perspective, on the other hand, a way should be found to allow the high-functioning persons with autism to respect the feelings and needs of other persons as sometimes overruling the duty of truthfulness. We suggest this may even entail 'morally educating' children and adolescents with autism to become socially skilled empathic 'liars'.

Cognitive Behaviour Therapy for Children and Adults with Asperger's Syndrome

Asperger's syndrome is a relatively newly diagnosed developmental disorder within the autistic spectrum. Children and adults with Asperger's syndrome have an intellectual ability within the normal range but due to their unusual profile of cognitive, social and emotional abilities are vulnerable to the development of a secondary mood disorder. This paper provides an explanation of the abilities associated with Asperger's syndrome, and modifications to cognitive behaviour therapy (CBT) for this very unusual client group. In particular, the paper emphasises the importance of affective education for this clinical population and describes a new strategy used in cognitive restructuring, namely, the emotional toolbox. The paper concludes with a brief description of a current evaluation study of the effectiveness of CBT to treat anxiety and anger in children who have Asperger's syndrome. However, the strategies described in this paper can also be used with adults with Asperger's syndrome and applied to other clinical populations.

Acoustic Differences In The Imitation Of Prosodic Patterns In Children With Autism Spectrum Disorders

In research, it has been difficult to characterize the prosodic production differences that have been observed clinically in Autism Spectrum Disorders (ASD). Moreover, the nature of these differences has been particularly hard to identify. This study examined one possible contributor to these perceived differences: motor planning. We examined the ability of children and adolescents with ASD to imitate prosodic patterns in comparison to a group with learning disabilities (LD) and a typically-developing (TD) comparison group. Overall, we found that both the ASD and LD groups were significantly worse at perceiving and imitating prosodic patterns than the TD comparison group. Similar to previous studies using non-imitative speech, participants with ASD showed a significantly longer duration of utterances than the two comparison groups when attempting to imitate an intonation pattern. The implications of differences in duration of utterances are discussed. This study also highlights the importance of using clinical comparison groups in studies of language performance in individuals with ASD.

Auditory processing in autism spectrum disorder: a review

For individuals with autism spectrum disorder or 'ASD' the ability to accurately process and interpret auditory information is often difficult. Here we review behavioural, neurophysiological and imaging literature pertaining to this field with the aim of providing a comprehensive account of auditory processing in ASD, and thus an effective tool to aid further research. Literature was sourced from peer-reviewed journals published over the last two decades which best represent research conducted in these areas. Findings show substantial evidence for atypical processing of auditory information in ASD at behavioural and neural levels. Abnormalities are diverse, ranging from atypical perception of various low-level perceptual features (i.e. pitch, loudness) to processing of more complex auditory information such as prosody. Trends across studies suggest auditory processing impairments in ASD are most likely to present during processing of complex auditory information and are more severe for speech than for non-speech stimuli. The interpretation of these findings with respect to various cognitive accounts of ASD is discussed and suggestions offered for further research.