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

Sukhareva's (1930) 'Toward the problem of the structure and dynamics of children's constitutional psychopathies (Schizoid forms)': a translation with commentary

This article constitutes a translation from the Russian of G.E. Sukhareva's research report entitled (in English) 'Toward the problem of the structure and dynamics of children's constitutional psychopathies (Schizoid forms)', which she delivered at the 'behavioral' conference in Leningrad in early 1930. Lev Vygotsky also presented on 'difficult children' in the same session of this conference. Sukhareva worked as a clinician for many years in residential and out-patient psychiatric settings at the Psycho-Neurological Institute in Moscow. This is (at least) the third of Sukhareva's publications on schizoid children, preceding her subsequent work on schizophrenia and oligophrenia (intellectual disability). Here she offers new case material, and further theoretical elaboration, concerning children diagnosed as schizoid, who closely resembled what we now think of as autistic children. We include background information useful to contextualize this work historically, and commentary on some of the questions raised for the 'history of autism' by Sukhareva's work.

Autismus: Ein Überblick über Lernvoraussetzungen und Fördermaßnahmen

Zusammenfassung. Autistische Schülerinnen und Schüler besitzen häufig geringere schulische Kompetenzen als nicht-autistische Schülerinnen und Schüler. Zugleich bestehen große Unterschiede in den schulischen Kompetenzen zwischen autistischen Schülerinnen und Schülern. Nicht selten weisen sie schulische Kompetenzen auf, die niedriger sind, als es aufgrund ihrer kognitiven Fähigkeiten zu erwarten wäre. Um zu verstehen, welche Faktoren das Lernen autistischer Schülerinnen und Schüler beeinflussen, wird in diesem Artikel ein Überblick über die Lernvoraussetzungen autistischer Schülerinnen und Schüler gegeben. Der Überblick zeigt, dass es autistischen Schülerinnen und Schülern schwerfallen kann, Vorwissen abzurufen und in Lernsituationen aktiv anzuwenden, Lernprozesse aufgrund von Einschränkungen in den exekutiven Funktionen angemessen zu steuern, verbale und visuelle Informationen im Arbeitsgedächtnis zu verarbeiten, kognitive und metakognitive Lernstrategien spontan anzuwenden, sich mit Lerninhalten auseinanderzusetzen, die nicht ihren eigenen Interessen entsprechen, und lernabträgliche Emotionen mittels geeigneter Strategien zu regulieren. Um autistische Schülerinnen und Schüler im Lernen zu unterstützen, werden Fördermaßnahmen zu den einzelnen Lernvoraussetzungen vorgestellt. Implikationen für Forschung und Praxis werden diskutiert.

Multifaceted empathy differences in children and adults with autism

Although empathy impairments have been reported in autistic individuals, there is no clear consensus on how emotional valence influences this multidimensional process. In this study, we use the Multifaceted Empathy Test for juveniles (MET-J) to interrogate emotional and cognitive empathy in 184 participants (ages 8-59 years, 83 autistic) under the robust Bayesian inference framework. Group comparisons demonstrate previously unreported interaction effects between: (1) valence and autism diagnosis in predictions of emotional resonance, and (2) valence and age group in predictions of arousal to images portraying positive and negative facial expressions. These results extend previous studies using the MET by examining differential effects of emotional valence in a large sample of autistic children and adults with average or above-average intelligence. We report impaired cognitive empathy in autism, and subtle differences in emotional empathy characterized by less distinction between emotional resonance to positive vs. negative facial expressions in autism compared to neurotypicals. Reduced emotional differentiation between positive and negative affect in others could be a mechanism for diminished social reciprocity that poses a universal challenge for people with autism. These component- and valence- specific findings are of clinical relevance for the development and implementation of target-specific social interventions in autism.

Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production

There has been a focus on autistic-led and participatory research in autism research, but minimal discussion about whether the field is hospitable to autistic involvement. While the focus on participatory and/or autistic-led research is abundantly welcome, a wider conversation should also happen about how autistic people are treated in the process of knowledge creation. As such, I present a critical reflection on my experiences of academia as an autistic autism researcher. I open by questioning whether I am an academic, an activist, or an advocate before discussing my journey through academia, and my exposure to dehumanizing, objectifying, and violent accounts of autism. I highlight how the construction of objectivity has resulted in a failure to question the validity of these dehumanizing accounts of autism, which are regarded as "scientifically-sound" by virtue of their perceived "objectivity." Furthermore, I discuss how the idea of objectivity is used to side-line autistic expertise in disingenuous ways, especially when this knowledge challenges the status-quo. Despite claiming to be value-free, these dehumanizing accounts of autism embody social and cultural values, with a complete lack of transparency or acknowledgment. I then discuss how these dehumanizing accounts and theories-entangled in values-reverberate into autistic people's lives and come to be ways of constituting us. Following this, I discuss the rationality of the anger autistic people feel when encountering these accounts, and instead of urging people to distance themselves from these emotions, I discuss the value of "leaning-in" as a radical act of dissent in the face of research-based violence. I then make a call to action urging all those who write or speak about autism to engage reflexively with how their values shape their understanding and construction of autistic people. Lastly, I conclude by answering my opening question: I have emerged as an advocate, activist, and academic. For me, belonging to the autistic community, acknowledging our marginalization, and recognizing our suffering within society means that hope for a better and just future has always, and will always underpin my work.

Examination of professional biases about autism: how can we do better?

This paper lends a critical eye to six common assumptions/biases about autism that may influence neuropsychologists in their clinical work. These biases are based on research as well as the historical roots of the study of autism. Our goal is to encourage curiosity and reflection on these biases in order to improve neuropsychological service delivery for people on the autism spectrum. Methods: We argue that psychologists should strive to understand the function of behaviours observed with autism in order to offer helpful supports. We explore the assertions that autism is not a dichotomous or linear construct and that the use of high and low functioning descriptors are not useful nor appreciated by the autism community. We discuss the widely held beliefs that individuals on the autism spectrum lack theory of mind, empathy and social motivation. Importantly, people on the autism spectrum are telling us that the dialogue about them around theory of mind and empathy is a human rights issue. Finally, we discuss the role of standardized testing. Conclusions: Through an exploration of research literature, the writings of scholars and advocates on the autism spectrum, and personal, clinical and research experience we encourage our profession to take a leadership role in examining biases and changing the clinical and research landscape so that it better reflects respectful discourse for individuals on the autism spectrum. This is critical to reduce the stigma that continues to be associated with autism and has a negative affect on mental health and quality of life.

Preserved Perspective Taking in Free Indirect Discourse in Autism Spectrum Disorder

Perspective taking has been proposed to be impaired in persons with autism spectrum disorder (ASD), especially when implicit processing is required. In narrative texts, language perception and interpretation is fundamentally guided by taking the perspective of a narrator. We studied perspective taking in the linguistic domain of so-called Free Indirect Discourse (FID), during which certain text segments have to be interpreted as the thoughts or utterances of a protagonist without explicitly being marked as thought or speech representations of that protagonist (as in direct or indirect discourse). Crucially, the correct interpretation of text segments as FID depends on the ability to detect which of the protagonists "stands out" against the others and is therefore identifiable as implicit thinker or speaker. This so-called "prominence" status of a protagonist is based on linguistic properties (e.g., grammatical function, referential expression), in other words, the perspective is "hidden" and has to be inferred from the text material. In order to test whether this implicit perspective taking ability that is required for the interpretation of FID is preserved in persons with ASD, we presented short texts with three sentences to adults with and without ASD. In the last sentence, the perspective was switched either to the more or the less prominent of two protagonists. Participants were asked to rate the texts regarding their naturalness. Both diagnostic groups rated sentences with FID anchored to the less prominent protagonist as less natural than sentences with FID anchored to the more prominent protagonist. Our results that the high-level perspective taking ability in written language that is required for the interpretation of FID is well preserved in persons with ASD supports the conclusion that language skills are highly elaborated in ASD so that even the challenging attribution of utterances to protagonists is possible if they are only implicitly given. We discuss the implications in the context of claims of impaired perspective taking in ASD as well as with regard to the underlying processing of FID.

Do animated triangles reveal a marked difficulty among autistic people with reading minds?

LAY ABSTRACT

Autistic people are thought to have difficulty with mentalising (our drive to track and understand the minds of other people). Mentalising is often measured by the Frith-Happé Animations task, where individuals need to interpret the interactions of abstract shapes. This review article collated results from over 3000 people to assess how autistic people performed on the task. Analysis showed that autistic people tended to underperform compared to non-autistic people on the task, although the scale of the difference was moderate rather than large. Also, autistic people showed some difficulty with the non-mentalising as well as mentalising aspects of the task. These results raise questions about the scale and specificity of mentalising difficulties in autism. It also remains unclear how well mentalising difficulties account for the social challenges diagnostic of autism.

A Quick Measure of Theory of Mind in Autistic Adults: Decision Accuracy, Latency and Self-Awareness

Autistic adults often experience difficulties in taking the perspective of others, potentially undermining their social interactions. We evaluated a quick, forced-choice version of the Adult Theory of Mind (A-ToM) test, which was designed to assess such difficulties and comprehensively evaluated by Brewer et al. (2017). The forced-choice version (the A-ToM-Q) demonstrated discriminant, concurrent, convergent and divergent validity using samples of autistic (N = 96) and non-autistic adults (N = 75). It can be administered in a few minutes and machine-scored, involves minimal training and facilitates large-scale, live, or web-based testing. It permits measurement of response latency and self-awareness, with response characteristics on both measures enhancing understanding of the nature and extent of perspective taking difficulties in autistic individuals.

Neuropsychological predictors of driving hazard detection in autism spectrum disorder and ADHD

Driving is a neuropsychologically complex task; this can present challenges for individuals with neurodevelopmental disorders (NDDs) such asautism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Deficits in theory of mind (ToM) and executive function (EF) are common features of ASD and ADHD, respectively, and may influence driving processes such as hazard perception. No studies have directly examined the neuropsychological contributions to hazard detection among drivers with ASD compared to ADHD.In the current study, 48 participants ages 16-30 years (13 ASD, 17 ADHD, 18 typically developing (TD)) completed a driving simulator task in which they encountered hazards in the driving environment. Hazards varied in whether they were social (contained a human component) or nonsocial (were physical objects) to examine the contribution of ToM and social processing to hazard response. Additionally, participants completed a neuropsychological battery targeting ToM and EF/attention skills (cognitive tasks and self-report measures).Within the ASD group, participants responded relatively slower to social compared to nonsocial hazards; no effect of hazard type was observed in the ADHD or TD groups. Additionally, measures of ToM and EF were correlated with driving performanceamong ASD participants; within the ADHD group, only self-reported behavior regulation was associated with driving performance. Broadly, this suggests that cognitive factors such as ToM and EF impact driving hazard performance in ASD and ADHD. The results of the study have implications for developing driving intervention programs for individuals with NDDs.

Disturbances of Shared Intentionality in Schizophrenia and Autism

Schizophrenia and autism are today considered complex spectrum disorders characterized by difficulties in social behavior. Drawing on recent advances in collective or shared intentionality studies, we present a novel theoretical approach to these social difficulties by exploring them from the angle of shared intentionality. We begin by describing two forms of shared intentionality: joint intentionality and we-intentionality. Joint intentionality crucially relies on the agents' mentalizing abilities such as mind reading and the ability to factor in (or "to be moved" by) their partner's intentions in deliberation and action planning. By contrast, we-intentionality relies on the agents' capacity to understand themselves as group members and to adopt the group's perspective. In schizophrenia spectrum disorders, we propose that joint intentionality remains unaffected, but we-intentionality may be impaired. In severe autism spectrum disorder (i.e., infantile autism), we propose that both forms of shared intentionality are impaired. We suggest that the source of the problems affecting we-intentionality in schizophrenia spectrum disorders lies primarily in trait-like, anomalous self-experiences. In severe autism spectrum disorder, we suggest that problems with mind reading, the ability to "be moved" by others' intentions, and with the capacity for perspective-taking impede both forms of shared intentionality.

What Do New Findings About Social Interaction in Autistic Adults Mean for Neurodevelopmental Research?

Deficit-based accounts of social and communication abilities continue to dominate autism research. However, emerging findings suggest that this view may be overly simplistic and discount the two-way nature of interaction. Here we discuss the reconceptualization of social cognition to consider such difficulties as examples of bidirectional, multifaceted misattunement between autistic and nonautistic individuals. Aligned with progressive theoretical frameworks, emerging empirical research indicates that mismatches in communication styles can contribute to autistic social difficulties and the important role that nonautistic difficulties play. We highlight two areas of future research with the aim of providing empirical support for the views that the autistic community has proposed over the past 2 decades. We discuss the impact of such a paradigm shift on a number of levels, including how bridging the gap between different interaction styles can reduce stigma and increase understanding. Adopting such a framework will provide radical opportunities for transformative societal changes and education around inclusion.

Naïve Theories of Biology, Physics, and Psychology in Children with ASD

Theory of mind is defined as the understanding that mental states predict and explain people's behaviors. It develops around the age of 4 but seems to remain deficient in people with ASD, whereas other forms of naïve understanding remain intact. This study compares children with ASD to neurotypical children on tasks measuring naïve psychology, physics, and biology (biological parts). Results suggest that children with ASD only underperform on an implicit false belief task. Performances in naïve biology and physics were equivalent across the two groups and uncorrelated to performance on the false belief task. This confirms that naïve physics and biological reasoning are intact in children with ASD but that tracking false beliefs is challenging for this population.

Judging meaning: A domain-level difference between autistic and non-autistic adults

We tested whether autistic adults would show selective difficulties across several tests of inferencing and social understanding in the context of average-range core language ability. One-hundred and ninety-one participants completed an online battery, and data were analysed using confirmatory factor analysis. Results showed that vocabulary knowledge was separate from other measures, which collectively formed a 'receptive communication' factor. Autistic people underperformed on the 'receptive communication' factor but showed more advanced vocabulary knowledge than non-autistic participants. Lower performance among autistic adults on the test battery predicted face-to-face communication difficulties measured by self-report and researcher ratings, with moderate effect sizes. Follow-up analysis indicated three further findings. We hypothesized that differences would arise from an isolated 'theory of mind' difficulty in autistic people, but instead the data suggested more general information-processing differences when making judgements about communicative stimuli. Second, substantial group differences on a test of implied meaning were only partly explained at the factor level, suggesting that multiple cognitive influences underpinned these differences. Finally, autistic women tended to perform better than autistic men. Our results support the idea of a subtle domain-level difference in pragmatics in autistic people, while questioning the basis of this difference and highlighting substantial variability in skills across groups.

Neurotype-Matching, but Not Being Autistic, Influences Self and Observer Ratings of Interpersonal Rapport

The Double Empathy Problem suggests that communicative difficulties between autistic and non-autistic people are due to bi-directional differences in communicative style and a reciprocal lack of understanding. If true, there should be increased similarity in interaction style, resulting in higher rapport during interactions between pairs of the same neurotype. Here, we provide two empirical tests of rapport, with data revealing whether self- and observer- rated rapport varies depending on the match or mismatch in autism status within a pair. An additional opportunity afforded by these data is to examine the effect of the autism status of the rater on the perceived rapport between matched and mismatched pairs. In Study 1 72 participants were allocated to one of three dyad conditions: autistic pairs (n = 24), non-autistic pairs (n = 24) and mixed pairs (n = 12 autistic; n = 12 non-autistic). Each participant completed three semi-structured interactions with their partner, rating rapport after each interaction. Non-autistic pairs experienced higher self-rated rapport than mixed and autistic pairs, and autistic pairs experienced higher rapport than mixed pairs. In Study 2 (n = 80) autistic and non-autistic observers rated interactional rapport while watching videoed interactions between autistic pairs, non-autistic pairs, and mixed pairs (n = 18, a subset of participants in Study 1). Mixed pairs were rated significantly lower on rapport than autistic and non-autistic pairs, and autistic pairs were rated more highly for rapport than non-autistic pairs. Both autistic and non-autistic observers show similar patterns in how they rate the rapport of autistic, non-autistic, and mixed pairs. In summary, autistic people experience high interactional rapport when interacting with other autistic people, and this is also detected by external observers. Rather than autistic people experiencing low rapport in all contexts, their rapport ratings are influenced by a mismatch of diagnosis. These findings suggest that autistic people possess a distinct mode of social interaction style, rather than demonstrating social skills deficits. These data are considered in terms of their implications for psychological theories of autism, as well as practical impact on educational and clinical practice.

Autistic People Do Enhance Their Selves

We investigated whether autistic people are less prone to self-enhance (i.e., portray themselves in socially desirable ways). Autistic (N = 130) and non-autistic (N = 130) participants first responded to social desirability items using the standard instruction to endorse each item as true or false about themselves. Then, all participants read an explanation of what social desirability items measure before responding again to the social desirability items. Self-enhancement was operationalized as participants endorsing more social desirability items before learning the explanation than after. All participants endorsed significantly more social desirability items before learning the explanation than after, F _subjects(1,258) = 57.73, p < .001, η² _p = .183; F _items(1,34) = 43.04, p < .001, η² _p = .559). However, autistic and non-autistic participants did not significantly differ in how many items they endorsed, either before or after reading the explanation, indicating that autistic people are as susceptible to social desirability and self-enhancement as non-autistic people are. Our results challenge the claim that autistic people are immune to reputation management.