Adults with autism show increased sensitivity to outcomes at low error rates during decision-making

Decision-making in autism: A narrative review

LAY SUMMARY

Many autistic people report difficulties with real-life decision-making. However, when doing decision-making tests in laboratory experiments, autistic people often perform as well or better than non-autistic people. We review previously published studies on autistic people's decision-making, across different types of tests, to understand what type of decision-making is more challenging. To do this, we searched four databases of research papers. We found 104 studies that tested, in total, 2712 autistic and 3189 comparison participants on different decision-making tasks. We found that there were four categories of decision-making tests that were used in these experiments: perceptual (e.g. deciding which image has the most dots); reward learning (e.g. learning which deck of cards gives the best reward); metacognition (e.g. knowing how well you perform or what you want); and value-based (e.g. making a decision based on a choice between two outcomes that differ in value to you). Overall, these studies suggest that autistic and comparison participants tend to perform similarly well at perceptual and reward-learning decisions. However, autistic participants tended to decide differently from comparison participants on metacognition and value-based paradigms. This suggests that autistic people might differ from typically developing controls in how they evaluate their own performance and in how they make decisions based on weighing up the subjective value of two different options. We suggest these reflect more general differences in metacognition, thinking about thinking, in autism.

Choice behavior in autistic adults: What drives the extreme switching phenomenon?

BACKGROUND

Previous studies reported that autistic adolescents and adults tend to exhibit extensive choice switching in repeated experiential tasks. However, a recent meta-analysis showed that this switching effect was non-significant across studies. Furthermore, the relevant psychological mechanisms remain unclear. We examined the robustness of the extreme choice-switching phenomenon, and whether it is driven by a learning impairment, feedback-related aspects (e.g., avoiding losses), or alternatively a different information sampling strategy.

METHODS

We recruited an online sample of 114 US participants (57 autistic adults and 57 non-autistic). All participants performed the Iowa Gambling task, a four-option repeated choice task. Standard task blocks were followed by a trial block with no feedback.

RESULTS

The findings replicate the extreme choice switching phenomenon (Cohen's d = 0.48). Furthermore, the effect was found with no difference in average choice rates denoting no learning impairment, and was even observed in trial blocks with no feedback (d = 0.52). There was no evidence that the switching strategy of autistic individuals was more perseverative (i.e., that similar switching rates were used in subsequent trial blocks). When adding the current dataset to the meta-analysis, the choice switching phenomenon is significant across studies, d = 0.32.

CONCLUSIONS

The findings suggest that the increased choice switching phenomenon in autism may be robust and that it represents a distinct information sampling strategy and not poor implicit learning (or a bias in the sensitivity to losses). Such extended sampling may underlie some of the phenomena previously attributed to poor learning.

What Is Social about Autism? The Role of Allostasis-Driven Learning

Scientific research on neuro-cognitive mechanisms of autism often focuses on circuits that support social functioning. However, autism is a heterogeneous developmental variation in multiple domains, including social communication, but also language, cognition, and sensory-motor control. This suggests that the underlying mechanisms of autism share a domain-general foundation that impacts all of these processes. In this Perspective Review, we propose that autism is not a social deficit that results from an atypical "social brain". Instead, typical social development relies on learning. In social animals, infants depend on their caregivers for survival, which makes social information vitally salient. The infant must learn to socially interact in order to survive and develop, and the most prominent learning in early life is crafted by social interactions. Therefore, the most prominent outcome of a learning variation is atypical social development. To support the hypothesis that autism results from a variation in learning, we first review evidence from neuroscience and developmental science, demonstrating that typical social development depends on two domain-general processes that determine learning: (a) motivation, guided by allostatic regulation of the internal milieu; and (b) multi-modal associations, determined by the statistical regularities of the external milieu. These two processes are basic ingredients of typical development because they determine allostasis-driven learning of the social environment. We then review evidence showing that allostasis and learning are affected among individuals with autism, both neurally and behaviorally. We conclude by proposing a novel domain-general framework that emphasizes allostasis-driven learning as a key process underlying autism. Guided by allostasis, humans learn to become social, therefore, the atypical social profile seen in autism can reflect a domain-general variation in allostasis-driven learning. This domain-general view raises novel research questions in both basic and clinical research and points to targets for clinical intervention that can lower the age of diagnosis and improve the well-being of individuals with autism.

A review of executive functioning challenges and strengths in autistic adults

Objective: There has been a steady rise in research characterizing executive functioning (EF) impairments in autistic individuals but limited research investigating EF strengths. This review provides a summary of current EF research in autistic adults with a focus on EF challenges and strengths and potential sources of heterogeneity in research findings. New avenues for addressing gaps in our understanding of EF strengths are proposed.Method: A review of the EF literature was conducted. One hundred twenty-four studies of inhibition, working memory, cognitive flexibility, fluency, planning, decision-making, and subjective measures of EF in autistic adults were included.Results: Autistic adults with average intellectual functioning demonstrate difficulties with cognitive flexibility, phonemic fluency, and working memory. Strengths in planning, decision-making, and semantic verbal fluency were evident in some but not all studies. Findings regarding inhibition are inconclusive. Key findings across each EF domain are discussed and sources of potential heterogeneity across studies were evaluated. The type of measure used appears to contribute to heterogeneous findings. Subjective EF measures revealed more consistent findings of deficits in autistic adults than objective EF measures.Conclusions: Research reveals areas of EF weaknesses as well as strengths in autistic adults. Unlike EF challenges, EF strengths are not well understood. Future research identifying EF strengths is needed to improve services and supports for autistic adults. Further investigation of potential factors that interact with or constrain EF such as comorbid disorders, verbal ability, sensory processing, and other factors specific to autism will be critical to move the field forward and increase understanding of how EF is related to everyday functioning in autistic adults.

The effect of autism on information sampling during decision-making: An eye-tracking study

Recent research has highlighted a tendency for more rational and deliberative decision-making in individuals with autism. We tested this hypothesis by using eye-tracking to investigate the information processing strategies that underpin multi-attribute choice in a sample of adults diagnosed with autism spectrum condition. We found that, as the number of attributes defining each option increased, autistic decision-makers were speedier, examined less of the available information, and spent a greater proportion of their time examining the option they eventually chose. Rather than indicating a more deliberative style, our results are consistent with a tendency for individuals with autism to narrow down the decision-space more quickly than does the neurotypical population.

Jumping to conclusions in autism: integration of contextual information and confidence in decision-making processes

Individuals with Autism spectrum condition (ASC) present cognitive biases and a difficulty to integrate emotional responses in decision-making, which is necessary for adequate social functioning. Thus, understanding the underlying mechanisms of the altered decision-making in individuals with ASC may eventually have a positive impact on their social functioning. The Picture decision task was employed to observe the effect of new information (fragments of an incomplete picture), interpretative context (verbal cues), and the level of confidence on decision-making processes. Our study administered the task to 49 children with ASC and 37 children with Typical Development (TD). Children with TD showed a higher probability of success when an interpretative context was given. Conversely, children with ASC had an equal probability of success regardless of whether an interpretative context was provided or not. In addition, unlike children with TD, the level of confidence did not allow predicting the probability of successful decisions in children with ASC. Finally, children with ASC had more probability of jumping to conclusions, a decision made quickly with only one fragment of the picture while being completely sure of it. These results are discussed in light of current cognitive and emotional theories on ASC.

Learning with individual-interest outcomes in Autism Spectrum Disorder

Recent work has suggested atypical neural reward responses in individuals with Autism Spectrum Disorder (ASD), particularly for social reinforcers. Less is known about neural responses to restricted interests and few studies have investigated response to rewards in a learning context. We investigated neurophysiological differences in reinforcement learning between adolescents with ASD and typically developing (TD) adolescents (27 ASD, 31 TD). FMRI was acquired during a learning task in which participants chose one of two doors to reveal an image outcome. Doors differed in their probability of showing liked and not-liked images, which were individualized for each participant. Participants chose the door paired with liked images, but not the door paired with not-liked images, significantly above chance and choice allocation did not differ between groups. Interestingly, participants with ASD made choices less consistent with their initial door preferences. We found a neural prediction-error response at the time of outcome in the ventromedial prefrontal and posterior cingulate cortices that did not differ between groups. Together, behavioural and neural findings suggest that learning with individual interest outcomes is not different between individuals with and without ASD, adding to our understanding of motivational aspects of ASD.

Sunk Cost Effect in Individuals with Autism Spectrum Disorder

The sunk cost effect, an interesting and well-known decision bias, is pervasive in real life and has been studied in various disciplines. In this study, we modified a task exemplifying the sunk cost effect and used it to evaluate this behavior in individuals with autism spectrum disorder (ASD). The control group exhibited a typical sunk cost effect in our task. We found that the sunk cost effect was lower in the ASD group than in the control group. The results agree with previous evidence of reduced sensitivity to context stimuli in individuals with ASD and extend this finding to the context of the sunk cost effect. Our findings are useful in addressing the practical implications on their socioeconomic behavior.

Abnormal functional activation and maturation of ventromedial prefrontal cortex and cerebellum during temporal discounting in autism spectrum disorder

People with autism spectrum disorder (ASD) have poor decision-making and temporal foresight. This may adversely impact on their everyday life, mental health, and productivity. However, the neural substrates underlying poor choice behavior in people with ASD, or its' neurofunctional development from childhood to adulthood, are unknown. Despite evidence of atypical structural brain development in ASD, investigation of functional brain maturation in people with ASD is lacking. This cross-sectional developmental fMRI study investigated the neural substrates underlying performance on a temporal discounting (TD) task in 38 healthy (11-35 years old) male adolescents and adults with ASD and 40 age, sex, and IQ-matched typically developing healthy controls. Most importantly, we assessed group differences in the neurofunctional maturation of TD across childhood and adulthood. Males with ASD had significantly poorer task performance and significantly lower brain activation in typical regions that mediate TD for delayed choices, in predominantly right hemispheric regions of ventrolateral/dorsolateral prefrontal cortices, ventromedial prefrontal cortex, striatolimbic regions, and cerebellum. Importantly, differential activation in ventromedial frontal cortex and cerebellum was associated with abnormal functional brain maturation; controls, in contrast to people with ASD, showed progressively increasing activation with increasing age in these regions; which furthermore was associated with performance measures and clinical ASD measures (stereotyped/restricted interests). Findings provide first cross-sectional evidence that reduced activation of TD mediating brain regions in people with ASD during TD is associated with abnormal functional brain development in these regions between childhood and adulthood, and this is related to poor task performance and clinical measures of ASD. Hum Brain Mapp 38:5343-5355, 2017. © 2017 Wiley Periodicals, Inc.

Understanding self-reported difficulties in decision-making by people with autism spectrum disorders

Autobiographical accounts and a limited research literature suggest that adults with autism spectrum disorders can experience difficulties with decision-making. We examined whether some of the difficulties they describe correspond to quantifiable differences in decision-making when compared to adults in the general population. The participants (38 intellectually able adults with autism spectrum disorders and 40 neurotypical adults) were assessed on three tasks of decision-making (Iowa Gambling Task, Cambridge Gamble Task and Information Sampling Task), which quantified, respectively, decision-making performance and relative attention to negative and positive outcomes, speed and flexibility, and information sampling. As a caution, all analyses were repeated with a subset of participants ( n_ASD = 29 and n_neurotypical = 39) who were not taking antidepressant or anxiolytic medication. Compared to the neurotypical participants, participants with autism spectrum disorders demonstrated slower decision-making on the Cambridge Gamble Task, and superior performance on the Iowa Gambling Task. When those taking the medications were excluded, participants with autism spectrum disorders also sampled more information. There were no other differences between the groups. These processing tendencies may contribute to the difficulties self-reported in some contexts; however, the results also highlight strengths in autism spectrum disorders, such as a more logical approach to, and care in, decision-making. The findings lead to recommendations for how adults with autism spectrum disorders may be better supported with decision-making.

Beta2-containing neuronal nicotinic receptors as major actors in the flexible choice between conflicting motivations

Beside a critical role in nicotine addiction, the role of nicotinic receptors in cognitive or emotional processes remains difficult to elucidate, mostly because of a lack of specificity of compounds and because they up or down regulate easily. Using knockout mice may be one key to elucidate the role of nicotinic receptors stimulated by their endogenous ligand acetylcholine. We and others have previously explored the behaviour of mice knockout for the beta2-subunit containing nicotinic receptor - β2*nAChRs - β2(-/-) mice. These mice exhibit a particular kind of hyperactive locomotion, with profound deficits in cognitive and social interaction tasks, only when they have to show flexible choices. We wonder here whether the latter is due to a lack of motor control - i.e. motor impulsivity, a lack of estimation of reward value - i.e. cognitive impulsivity, and/or a lack of appropriate ranking or choice between different motivations. We designed behavioural tasks allowing the study of these distinct processes in mice. Our current results highlight the important role of β2*nAChRs in flexible behaviours in conflicting situations, such as social contact, spatial exploration and food consumption. They also show that the cognitive deficits exhibited by β2(-/-) mice cannot be explained by impaired inhibitory behaviours. Although social cognition is considerably enriched in humans as compared to rodents, we provide here novel data for the neurobiology of flexible social behaviours that could ultimately be useful for humans. Indeed, the ability to show flexible behaviours and to display adapted social interactions is profoundly impaired in a myriad of psychiatric disorders.

Probabilistic reinforcement learning in adults with autism spectrum disorders

BACKGROUND

Autism spectrum disorders (ASDs) can be conceptualized as disorders of learning, however there have been few experimental studies taking this perspective.

METHODS

We examined the probabilistic reinforcement learning performance of 28 adults with ASDs and 30 typically developing adults on a task requiring learning relationships between three stimulus pairs consisting of Japanese characters with feedback that was valid with different probabilities (80%, 70%, and 60%). Both univariate and Bayesian state-space data analytic methods were employed. Hypotheses were based on the extant literature as well as on neurobiological and computational models of reinforcement learning.

RESULTS

Both groups learned the task after training. However, there were group differences in early learning in the first task block where individuals with ASDs acquired the most frequently accurately reinforced stimulus pair (80%) comparably to typically developing individuals; exhibited poorer acquisition of the less frequently reinforced 70% pair as assessed by state-space learning curves; and outperformed typically developing individuals on the near chance (60%) pair. Individuals with ASDs also demonstrated deficits in using positive feedback to exploit rewarded choices.

CONCLUSIONS

Results support the contention that individuals with ASDs are slower learners. Based on neurobiology and on the results of computational modeling, one interpretation of this pattern of findings is that impairments are related to deficits in flexible updating of reinforcement history as mediated by the orbito-frontal cortex, with spared functioning of the basal ganglia. This hypothesis about the pathophysiology of learning in ASDs can be tested using functional magnetic resonance imaging.

Neuroeconomic approaches to mental disorders

The pervasiveness of decision-making in every area of human endeavor highlights the importance of understanding choice mechanisms and their detailed relationship to underlying neurobiological function. This review surveys the recent and productive application of game-theoretic probes (economic games) to mental disorders. Such games typically possess concrete concepts of optimal play, thus providing quantitative ways to track when subjects' choices match or deviate from optimal. This feature equips economic games with natural classes of control signals that should guide learning and choice in the agents that play them. These signals and their underlying physical correlates in the brain are now being used to generate objective biomarkers that may prove useful for exposing and understanding the neurogenetic basis of normal and pathological human cognition. Thus, game-theoretic probes represent some of the first steps toward producing computationally principled, objective measures of cognitive function and dysfunction useful for the diagnosis, treatment, and understanding of mental disorders.

Beyond the numbers: expanding the boundaries of neuropsychology

Beyond the Numbers: Expanding the Boundaries of Neuropsychology was Dr Perry's 2007 presidential address in the annual conference of the National Academy of Neuropsychology. In his address he discussed the achievements of the science of neuropsychology and highlighted some areas that exemplified the expansion of the boundaries of neuropsychology. These areas are: (i) the study of neuropsychological functioning in new or non-traditional populations, particularly seemingly healthy people and people with non-brain diseases; (ii) the interface of cognition and genetics; (iii) the use of the process approach as a means of understanding brain functioning; and (iv) a translational application to the science of neuropsychology.