Autism: The Empathizing-Systemizing (E-S) Theory

The genetic and environmental origins of emotional and cognitive empathy: Review and meta-analyses of twin studies

Empathy is considered a cornerstone of human social experience, and as such has been widely investigated from psychological and neuroscientific approaches. To better understand the factors influencing individual differences in empathy, we reviewed and meta-analyzed the behavioral genetic literature of emotional empathy- sharing others' emotions (k=13), and cognitive empathy- understanding others' emotions (k = 15), as manifested in twin studies. Results showed that emotional empathy is more heritable, 48.3 % [41.3 %-50.6 %], than cognitive empathy, 26.9 % [18.1 %-35.8 %]. Moreover, cognitive empathy as examined by performance tests was affected by the environment shared by family members, 11.9 % [2.6 %-21.0 %], suggesting that emotional understanding is influenced, to some degree, by environmental factors that have similar effects on family members beyond their genetic relatedness. The effects of participants' age and the method used to asses empathy on the etiology of empathy were also examined. These findings have implications for understanding how individual differences in empathy are formed. After discussing these implications, we suggest theoretical and methodological future research directions that could potentially elucidate the relations between genes, brain, and empathy.

Autism trait prevalence in treatment seeking adolescents and adults attending specialist gender services

Background.

To assess the prevalence of autism traits in individuals accessing gender affirming treatments, we conducted a cross-sectional survey in the regional specialist gender services in Northern Ireland.

Methods.

One hundred and twenty-three individuals (38 adolescents and 69 adults) currently attending or who previously attended specialist gender services in Northern Ireland were recruited. Fifty-six individuals assigned male at birth (AMAB) and 66 individuals assigned female at birth (AFAB) took part in the study. Main outcome measures: Autism Quotient (AQ), Cambridge Behavior Scale (EQ), and RAADS-14.

Results.

Autism trait prevalence rates of 19.5% (AQ); 25.4% (RAADS-14); and 35.8% (poor empathy traits). A combined measure comprising all three provided a prevalence of 17.2%. There were no mean differences in the scores between AMAB (assigned male at birth) individuals and AFAB (assigned female at birth) individuals.

Conclusions.

Autism traits present additional challenges during the assessment and treatment of individuals with gender dysphoria. Autism screening tools can aid in the identification of individual with additional needs.

Exploring the familial role of social responsiveness differences between savant and non-savant children with autism

Savant syndrome is a phenomenon whereby individuals with cognitive impairments have one or more outstanding abilities, inconsistent with their general intellectual functioning. Approximately 50% of savant individuals have autism spectrum disorder (ASD), and 10–30% of people with ASD have savant skills. To shed additional light on this considerable overlap, we compared autistic traits as measured by the Social-Responsiveness-Scale (SRS) between 712 children with at least one reported savant skill, as determined by designated questions from the ADI-R questionnaire (savant group), and 2,032 non-savant children from the Simons-Simplex-Collection (SSC) database. We also examined SRS scores of the parents of these children and compared parent-child differences in SRS scores between the savant and non-savant groups. Savant children had significantly lower SRS scores (less deficiencies) compared to non-savant children (P < 0.05), while no such differences were observed among their parents. Further intra-familial analyses revealed weak pairwise-correlations (r = −0.015–0.141) between SRS scores of parents and their children, and significantly larger parent-child differences in standardized SRS scores within savant families (P < 0.05). These findings suggest that the less severe autistic traits among savant children with ASD compared to other people with ASD is not likely to be a familial trait.

Application of the Still-Face Paradigm in Early Screening for High-Risk Autism Spectrum Disorder in Infants and Toddlers

Background: Although autism spectrum disorder (ASD) can currently be diagnosed at the age of 2 years, age at ASD diagnosis is still 40 months or even later. In order to early screening for ASD with more objective method, behavioral videos were used in a number of studies in recent years. Method: The still-face paradigm (SFP) was adopted to measure the frequency and duration of non-social smiling, protest behavior, eye contact, social smiling, and active social engagement in high-risk ASD group (HR) and typical development group (TD) (HR: n = 45; TD: n = 43). The HR group was follow-up until they were 2 years old to confirm final diagnosis. Machine learning methods were used to establish models for early screening of ASD. Results: During the face-to-face interaction (FF) episode of the SFP, there were statistically significant differences in the duration and frequency of eye contact, social smiling, and active social engagement between the two groups. During the still-face (SF) episode, there were statistically significant differences in the duration and frequency of eye contact and active social engagement between the two groups. The 45 children in the HR group were reclassified into two groups after follow-up: five children in the N-ASD group who were not meet the criterion of ASD and 40 children in the ASD group. The results showed that the accuracy of Support Vector Machine (SVM) classification was 83.35% for the SF episode. Conclusion: The use of the social behavior indicator of the SFP for a child with HR before 2 years old can effectively predict the clinical diagnosis of the child at the age of 2 years. The screening model constructed using SVM based on the SF episode of the SFP was the best. This also proves that the SFP has certain value in high-risk autism spectrum disorder screening. In addition, because of its convenient, it can provide a self-screening mode for use at home. Trial registration: Chinese Clinical Trial Registry, ChiCTR-OPC-17011995.

Increased grey matter volume of the right superior temporal gyrus in healthy children with autistic cognitive style: A VBM study

The empathizing-systemizing model describes human cognitive style using empathizing (the drive to identify another's mental state and respond appropriately) and systemizing (the drive to assess or construct rule-based systems). 'Brain type' was envisioned to explain individual differences in cognitive style based on the discrepancy of the two drives. In this model, individuals with autism spectrum disorder (ASD), a neurodevelopmental disorder, have extremely stronger systemizing. Revealing the underlying mechanisms of individual differences in cognitive style might contribute to elucidation of the pathology of ASD. We used voxel-based morphometry to compare the brain structures among the brain types (those who have stronger empathizing, those who have equally stronger drive to both, and those who have stronger systemizing) in 207 healthy children (age range: 5-15). Results showed that children with stronger systemizing had significantly greater grey matter volume of the right superior temporal gyrus (rSTG) than the others. The brain region, a distinctive brain structure of those with stronger systemizing, was overlapped with that of children with ASD. The rSTG is involved in detailed perceptual processing in social cognition, which is partially related to stronger systemizing. Our results contribute to elucidation of the underlying mechanisms of individual differences in cognitive style.

Low Salivary Testosterone Level Is Associated With Efficient Attention Holding by Self Face in Women

Capacity to recognize one’s own face (hereinafter referred to as self face) is a fundamental component of various domains of social cognition such as empathy in humans. Previous research has demonstrated that a high level of androgen suppresses empathic behavior and social brain function. Taking these into consideration, we hypothesized that people with high androgen level show reduced response to self face. The present study examined this hypothesis by investigating the association between attentiveness towards self face, as assessed by a psychophysiological experiment, and salivary testosterone concentration. The attentional responses to self face was measured by a modified Go/NoGo task. In this task, self face or unfamiliar other’s face was presented simultaneously with Go or NoGo signal. In go trials, participants had to divert their attention from the face to a peripheral target. The reaction time (RT) for peripheral target detection in each condition was measured. In addition to behavioral data, saliva samples were collected to assay salivary testosterone concentration. The index of potency of self face to hold viewer’s attention that was computed based on RT data was regressed against salivary testosterone concentration in men and women separately. The analyses revealed that self face holds visuospatial attention more effectively in women with low than high salivary testosterone level, but no such trend was observed in men. This pattern of results indicates that low testosterone level is associated with a pronounced response to self face as we hypothesized and raises the possibility that multiple aspects of self-face processing are under the influence of endocrinological function.

Autistic Traits and Prosocial Behaviour in the General Population: Test of the Mediating Effects of Trait Empathy and State Empathic Concern

Although the core characteristics associated with autistic traits are impaired social interactions, there are few studies examining how autistic traits translate into prosocial behaviour in daily life. The current study explored the effect of autistic traits on prosocial behaviour and the mediating role of multimodal empathy (trait empathy and state empathic concern). The results showed that autistic traits reduced prosocial behaviour directly and indirectly through complex mediation by multimodal empathy. The findings revealed the internal mechanism of autistic traits impeding prosocial behaviour and expanded our understandings of social behaviour in autism spectrum conditions (ASCs) and autistic traits in the general population. Furthermore, the results have implications for social adaptability interventions for individuals with ASCs and high levels of autistic traits.

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.

Aging, sex and cognitive Theory of Mind: a transcranial direct current stimulation study

Aging is accompanied by changes in cognitive abilities and a great interest is spreading among researchers about aging impact on social cognition skills, such as the Theory of Mind (ToM). Transcranial direct current stimulation (tDCS) has been used in social cognition studies founding evidence of sex-related different effects on cognitive ToM task in a young people sample. In this randomized, double-blind, sham-controlled study, we applied one active and one sham tDCS session on the medial prefrontal cortex (mPFC) during a cognitive ToM task, including both social (i.e., communicative) and nonsocial (i.e., private) intention attribution conditions, in sixty healthy aging individuals (30 males and 30 females). In half of the participants the anode was positioned over the mPFC, whereas in the other half the cathode was positioned over the mPFC. The results showed that: (i) anodal tDCS over the mPFC led to significant slower reaction times (vs. sham) for social intention attribution task only in female participants; (ii) No effects were found in both females and males during cathodal stimulation. We show for the first time sex-related differences in cognitive ToM abilities in healthy aging, extending previous findings concerning young participants.

Perceived Barriers and Existing Challenges in Participation of Children with Autism Spectrum Disorders: "He Did Not Understand and No One Else Seemed to Understand Him"

Social participation is one of the most important predictors of the children's physical and mental health. Although it is evidenced that children with autism spectrum disorder (ASD) have restricted social participation, it is unclear which factors play a significant role. This research aimed to uncover perceived barriers of social participation by involving 26 stakeholders including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Using thematic analysis yielded three themes including (a) difficulty understanding social situations; (b) maladaptive behaviours; and (c) conflicting priorities and restricted nature of training. This project was the first study to involve key stakeholders to highlight barriers of social participation among individuals with ASD.

Prediction and Mismatch Negativity Responses Reflect Impairments in Action Semantic Processing in Adults With Autism Spectrum Disorders

The neurophysiological mechanisms underlying motor and language difficulties in autism spectrum disorders (ASD) are still largely unclear. The present work investigates biological indicators of sound processing, (action-) semantic understanding and predictive coding and their correlation with clinical symptoms of ASD. Twenty-two adults with high-functioning ASD and 25 typically developed (TD) participants engaged in an auditory, passive listening, Mismatch Negativity (MMN) task while high-density electroencephalography (EEG) was recorded. Action and non-action words were presented in the context of sounds, which were either semantically congruent with regard to the body part they relate to or semantically incongruent or unrelated. The anticipatory activity before sound onset, the Prediction Potential (PP), was significantly reduced in the ASD group specifically for action, but not for non-action sounds. The early-MMN-like responses to words (latency: 120 ms) were differentially modulated across groups: controls showed larger amplitudes for words in action-sound compared to non-action contexts, whereas ASD participants demonstrated enlarged early-MMN-like responses only in a pure tone context, with no other modulation dependent on action sound context. Late-MMN-like responses around 560 ms post-stimulus onset revealed body-part-congruent action-semantic priming for words in control participants, but not in the ASD group. Importantly, neurophysiological indices of semantic priming in ASD participants correlated with the extent of autistic traits as revealed by the Autism Spectrum Quotient (AQ). The data suggest that high-functioning adults with ASD show a specific deficit in semantic processing and predictive coding of sounds and words related to action, which is absent for neutral, non-action, sounds.

Design Elements During Development of Videogame Programs for Children with Autism Spectrum Disorder: Stakeholders' Viewpoints

Introduction: Research has demonstrated that videogame programs can be an effective intervention targeting social challenges among children with autism spectrum disorder (ASD). Despite the rapid growth in developing videogame programs, incorporation of stakeholders' views has been limited. Objective: This project aimed to identify the design elements that should be considered during development of videogame programs for children with ASD, from the perspectives of stakeholders. Materials and Methods: We involved 26 stakeholders, including parents of children with ASD, youth with ASD, and clinicians working with individuals with ASD in focus groups and interviews. Results: Thematic analysis yielded three themes: (1) addressing heterogeneity and diverse needs; (2) mirroring real world; and (3) teaching strategies. Conclusion: Incorporating these elements during development of videogame programs can help enhance the outcomes for children with ASD. By including stakeholders' voices, it is assumed that the developed videogame programs may serve as user-friendly and engaging tools to potentially complement traditional interventions when overcoming social difficulties in individuals with ASD.

AMBRA1, Autophagy, and the Extreme Male Brain Theory of Autism

The extreme male brain theory of autism posits that its male bias is mediated by exaggeration of male-biased sex differences in the expression of autism-associated traits found in typical populations. The theory is supported by extensive phenotypic evidence, but no genes have yet been described with properties that fit its predictions. The autophagy-associated gene AMBRA1 represents one of the top genome-wide “hits” in recent GWAS studies of schizophrenia, shows sex-differential expression, and has been linked with autism risk and traits in humans and mice, especially or exclusively among females. We genotyped the AMBRA1 autism-risk SNP in a population of typical humans who were scored for the dimensional expression of autistic and schizotypal traits. Females, but not males, homozygous for the GG genotype showed a significant increase in score for the single trait, the Autism Quotient-Imagination subscale, that exhibits a strong, significant male bias in typical populations. As such, females with this genotype resembled males for this highly sexually dimorphic, autism-associated phenotype. These findings support the extreme male brain hypothesis and indicate that sex-specific genetic effects can mediate aspects of risk for autism.

Differential Contributions of Empathy to Math Achievement in Women and Men

Mathematics forms a foundation for the science, technology, engineering and mathematics (STEM) fields. While considerable work has identified the individual cognitive and external systemic factors that influence math achievement, less is known about personality-like traits that might contribute to success in mathematics, especially among women. This study examines two such traits: systemizing – the tendency to analyze systems and extract underlying rules that govern their behavior – and empathizing – the ability to identify with another’s emotions and respond appropriately. Recently Escovar et al. (2016) found that empathizing was a negative predictor of math skills in children, especially among girls, suggesting that women with higher empathy might be particularly disposed to lower math performance. In the first study, 142 participants (71 female) completed two standardized measures of math achievement and questionnaires to gauge the tendency to empathize and systemize. Surprisingly, higher empathy was associated with better math performance in women, while men displayed the expected pattern of lower empathy being related to higher math scores. In a second study, we extend this finding in women (n = 121) to show that individuals who report higher mathematics achievement in university level course work also have higher empathy scores. Further, while positive attitudes toward mathematics tended to decline from elementary school to college, women whose attitudes increased had higher empathy scores than those who declined. Together, these results suggest that while the tendency to empathize is associated with worse math performance in childhood, it may become a protective factor as women progress through their mathematics education.

Action Semantic Deficits and Impaired Motor Skills in Autistic Adults Without Intellectual Impairment

Several studies indicate the functional importance of the motor cortex for higher cognition, language and semantic processing, and place the neural substrate of these processes in sensorimotor action-perception circuits linking motor, sensory and perisylvian language regions. Interestingly, in individuals with autism spectrum disorder (ASD), semantic processing of action and emotion words seems to be impaired and is associated with hypoactivity of the motor cortex during semantic processing. In this study, the relationship between semantic processing, fine motor skills and clinical symptoms was investigated in 19 individuals with ASD and 22 typically-developing matched controls. Participants completed two semantic decision tasks involving words from different semantic categories, a test of alexithymia (the Toronto Alexithymia Scale), and a test of fine motor skills (the Purdue Pegboard Test). A significant Group × Word Category interaction in accuracy (p < 0.05) demonstrated impaired semantic processing for action words, but not object words in the autistic group. There was no significant group difference when processing abstract emotional words or abstract neutral words. Moreover, our study revealed deficits in fine motor skills as well as evidence for alexithymia in the ASD group, but not in neurotypical controls. However, these motor deficits did not correlate significantly with impairments in action-semantic processing. We interpret the data in terms of an underlying dysfunction of the action-perception system in ASD and its specific impact on semantic language processing.

Scanpath similarity measure reveals not only a decreased social preference, but also an increased nonsocial preference in individuals with autism

We compared scanpath similarity in response to repeated presentations of social and nonsocial images representing natural scenes in a sample of 30 participants with autism spectrum disorder and 32 matched typically developing individuals. We used scanpath similarity (calculated using ScanMatch) as a novel measure of attentional bias or preference, which constrains eye-movement patterns by directing attention to specific visual or semantic features of the image. We found that, compared with the control group, scanpath similarity of participants with autism was significantly higher in response to nonsocial images, and significantly lower in response to social images. Moreover, scanpaths of participants with autism were more similar to scanpaths of other participants with autism in response to nonsocial images, and less similar in response to social images. Finally, we also found that in response to nonsocial images, scanpath similarity of participants with autism did not decline with stimulus repetition to the same extent as in the control group, which suggests more perseverative attention in the autism spectrum disorder group. These results show a preferential fixation on certain elements of social stimuli in typically developing individuals compared with individuals with autism, and on certain elements of nonsocial stimuli in the autism spectrum disorder group, compared with the typically developing group.

Sex-Differences in Children Referred for Assessment: An Exploratory Analysis of the Autism Mental Status Exam (AMSE)

The autism mental status exam is an eight-item observational assessment that structures the way we observe and document signs and symptoms of ASD. Investigations of test performance indicate strong sensitivity and specificity using gold-standard assessment as reference standard. This study aims to explore potential sex differences in AMSE test performance and observations of 123 children referred for autism assessment. Results indicates more language deficits in females with ASD than in males with ASD and less sensory symptoms in females compared to males with ASD. The AMSE performance is similar in identifying ASD and non-ASD in females compared to males. Less disruptive behaviors in females, might cause a need for a bigger hit to other areas of development to raise concern.

Intuitive Moral Reasoning in High-Functioning Autism Spectrum Disorder: A Matter of Social Schemas?

Using a schema-theoretical perspective in the field of moral cognition, we assessed response behavior of adolescent (n = 15) and adult (n = 22) individuals with Autism Spectrum Disorder (ASD) in comparison with adolescent (n = 22) and adult (n = 22) neurotypically developed controls. We conceptualized the Intuitive Moral Reasoning Test-in five moral dilemmas, participants had to choose between two alternative actions and assess their decision with respect to emotional valence, arousal, moral acceptability and permissibility from both the perspective of the acting person and then of the victim. Patients with ASD displayed a different decision and response behavior, particularly when the dilemmas were based on extreme life situations in combination with a social schema involving close social relationships.

Enhanced auditory disembedding in an interleaved melody recognition test is associated with absolute pitch ability

Absolute pitch (AP) and autism have recently been associated with each other. Neurocognitive theories of autism could perhaps explain this co-occurrence. This study investigates whether AP musicians show an advantage in an interleaved melody recognition task (IMRT), an auditory version of an embedded figures test often investigated in autism with respect to the these theories. A total of N = 59 professional musicians (AP = 27) participated in the study. In each trial a probe melody was followed by an interleaved sequence. Participants had to indicate as to whether the probe melody was present in the interleaved sequence. Sensitivity index d′ and response bias c were calculated according to signal detection theory. Additionally, a pitch adjustment test measuring fine-graded differences in absolute pitch proficiency, the Autism-Spectrum-Quotient and a visual embedded figures test were conducted. AP outperformed relative pitch (RP) possessors on the overall IMRT and the fully interleaved condition. AP proficiency, visual disembedding and musicality predicted 39.2% of variance in the IMRT. No correlations were found between IMRT and autistic traits. Results are in line with a detailed-oriented cognitive style and enhanced perceptional functioning of AP musicians similar to that observed in autism.

The "Reading the Mind in the Eyes" Test in Autism-Spectrum Disorders Comparison with Healthy Controls: A Systematic Review and Meta-analysis

We conducted a meta-analysis of 18 studies to establish whether a relation exists between Reading the Mind in the Eye Test (RMET) performance and intelligence quotient (IQ) in individuals diagnosed with autism-spectrum disorders (ASD) and controls, taking into account relevant characteristics such as age, gender, and autism quotient. Our findings indicate that RMET performance was better in controls compared with those diagnosed with ASD. We found that RMET performance is dependent on full and verbal IQ and age in controls. However, RMET performance is negatively correlated with performance IQ in individuals diagnosed with ASD. These results suggest that the methodology applied by ASD when taking the RMET is different from control individuals and might depend less on verbal abilities.

A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability

Background

Non-suicidal self-injury (NSSI) describes a phenomenon where individuals inflict deliberate pain and tissue damage to their bodies. Self-injurious behaviour is especially prevalent across the autism spectrum, but little is understood about the features and functions of self-injury for autistic individuals without intellectual disability, or about the risk factors that might be valuable for clinical usage in this group.

Methods

One hundred and three autistic adults who responded to an online advertisement were classified as current, historic or non-self-harmers in accordance with responses to the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT). Multinomial regression aimed to predict categorisation of participants in accordance with scores on tests of autistic traits, alexithymia, depression, anxiety, mentalising and sensory sensitivity. Linear regression examined relationships between these predictors and the range, frequency, lifetime occurrence and functional purposes of NSSI. Qualitative analysis explored the therapeutic interventions that participants had found helpful, and what they wished people understood about self-injury.

Results

Current, historic and non-self-harming participants did not differ in age, age at diagnosis, male-to-female ratio, level of employment or education (the majority qualified to at least degree level). The most common function of NSSI was the regulation of low-energy affective states (depression, dissociation), followed by the regulation of high-energy states such as anger and anxiety. Alexithymia significantly predicted the categorisation of participants as current, historic or non-self-harmers, and predicted use of NSSI for regulating high-energy states and communicating distress to others. Depression, anxiety and sensory-sensitivity also differentiated participant groups, and sensory differences also predicted the range of bodily areas targeted, lifetime incidence and frequency of NSSI. Sensory differences, difficulty expressing and identifying emotions also emerged as problematic in the qualitative analysis, where participants expressed the need for compassion, patience, non-judgement and the need to recognise diversity between self-harmers, with some participants perceiving NSSI as a practical, non-problematic coping strategy.

Conclusions

Alexithymia, depression, anxiety and sensory differences may place some autistic individuals at especial risk of self-injury. Investigating the involvement of these variables and their utility for identification and treatment is of high importance, and the voices of participants offer guidance to practitioners confronted with NSSI in their autistic clients.

Gender differences in empathic responses to others' economic payoffs: an event-related potentials study

Although gender differences in empathy have been well established through measuring subjective outcomes, some studies of the neural mechanisms of pain empathy have not found gender differences. This inconsistent evidence may be caused by different research methods or different paradigms. The present study adopted a different approach from the pain empathy paradigm to examine gender differences in empathic responses to others' economic payoffs using event-related potentials. The results showed that the N2 amplitudes in female participants were more negative than those in male participants, indicating a greater female than male susceptibility to facial expressions at the early stage of empathy. The LPP amplitudes for male participants were found to be more positive in the observation condition (involving no self-interest) than in the participation condition (involving self-interest), but there was no significant difference in the LPP amplitudes for the female participants between the two conditions. The results suggest that females' empathic responses are more likely to be elicited automatically by the perception of others' emotional states. In contrast, males' empathic responses are more likely to be mediated by self-interest, which subsequently reduces their empathic responses.

Diagnosis and treatment of ASD in women in secure and forensic hospitals

Purpose

The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.

Design/methodology/approach

A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.

Findings

Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.

Research limitations/implications

The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.

Practical implications

First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.

Social implications

To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.

Originality/value

The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.

Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition

BACKGROUND

Individuals with autism spectrum disorder (ASD) tend to show deficits in engaging with humans. Previous findings have shown that robot-based training improves the gestural recognition and production of children with ASD. It is not known whether social robots perform better than human therapists in teaching children with ASD.

AIMS

The present study aims to compare the learning outcomes in children with ASD and intellectual disabilities from robot-based intervention on gestural use to those from human-based intervention.

METHODS AND PROCEDURES

Children aged six to 12 with low-functioning autism were randomly assigned to the robot group (N = 12) and human group (N = 11). In both groups, human experimenters or social robots engaged in daily life conversations and demonstrated to children 14 intransitive gestures in a highly-structured and standardized intervention protocol.

OUTCOMES AND RESULTS

Children with ASD in the human group were as likely to recognize gestures and produce them accurately as those in the robot group in both training and new conversations. Their learning outcomes maintained for at least two weeks.

CONCLUSIONS AND IMPLICATIONS

The social cues found in the human-based intervention might not influence gestural learning. It does not matter who serves as teaching agents when the lessons are highly structured.