Brief report: the relationship between visual acuity, the embedded figures test and systemizing in autism spectrum disorders

Regional differences in field dependent-independent cognitive styles in Saudi Arabia

BACKGROUNDS

The primary aim of this study was two-fold: to assess the reliability of the Leuven Embedded Figure Test (L-EFT) in Saudi Arabia (Study 1), and to explore regional differences in independent-interdependent cognitive styles among adults in various regions of Saudi Arabia (Study 2).

METHOD

Both Study-1 and Study-2 were structured cross-sectionally. Study 1 involved 360 participants (97 % female) with a median age of 22.51 ± 3.45. Participants completed a demographic questionnaire and the L-EFT task. The mean response time for accurate responses, speed-accuracy trade-off, Cronbach's alpha reliability, Guttman split-half coefficient, and 2 × 2 ANOVA (to examine the influence of specialty and age) were evaluated using SPSS 24. In Study 2, the authors compared these evaluations between residents of Riyadh (60 participants) and Al-Kharj (60 participants) in Saudi Arabia.

RESULTS

In Study-1, the L-EFT demonstrated satisfactory psychometric properties (α = 0.79, Guttman-split-half = 0.72), with item-test correlations for all items exceeding 0.15. Study-1 found no significant impact of academic specialty on mean response time, regardless of their major (scientific studies:M = 6.68, SD = 2.54) humanities:M = 6.81, SD = 2.11). In Study 2, no significant differences were observed in mean response times between individuals residing in Riyadh and those in Al-Kharj [t(112) = 1.68, p = 0.09, 95 % CI (-0.06, 0.73)].

CONCLUSION

The scale demonstrates suitability for use in the Saudi Arabian population. However, further research is needed to compare L-EFT scores across different cultures. Moreover, future studies could also explore the influence of various socio-cultural factors on field-dependent-independent cognitive styles.

Association between Autism Spectrum Disorder (ASD) and vision problems. A systematic review and meta-analysis

AIM

To conduct a systematic review and meta-analysis assessing whether vision and/or eye disorders are associated with Autism Spectrum Disorder (ASD).

METHOD

Based on a pre-registered protocol (PROSPERO: CRD42022328485), we searched PubMed, Web of Knowledge/Science, Ovid Medline, Embase and APA PsycINFO up to 5th February 2022, with no language/type of document restrictions. We included observational studies 1) reporting at least one measure of vision in people of any age with a diagnosis of ASD based on DSM or ICD criteria, or ADOS; or 2) reporting the prevalence of ASD in people with and without vision disorders. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Random-effects meta-analyses were used for data synthesis.

RESULTS

We included 49 studies in the narrative synthesis and 46 studies in the meta-analyses (15,629,159 individuals distributed across multiple different measures). We found meta-analytic evidence of increased prevalence of strabismus (OR = 4.72 [95% CI: 4.60, 4.85]) in people with versus those without ASD (non-significant heterogeneity: Q = 1.0545, p = 0.7881). We also found evidence of increased accommodation deficits (Hedge's g = 0.68 [CI: 0.28, 1.08]) (non-significant heterogeneity: Q = 6.9331, p = 0.0741), reduced peripheral vision (-0.82 [CI: -1.32, -0.33]) (non-significant heterogeneity: Q = 4.8075, p = 0.4398), reduced stereoacuity (0.73 [CI: -1.14, -0.31]) (non-significant heterogeneity: Q = 0.8974, p = 0.3435), increased color discrimination difficulties (0.69 [CI: 0.27,1.10]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890), reduced contrast sensitivity (0.45 [CI: -0.60, -0.30]) (non-significant heterogeneity: Q = 9.9928, p = 0.1890) and increased retinal thickness (=0.29 [CI: 0.07, 0.51]) (non-significant heterogeneity: Q = 0.8113, p = 0.9918) in ASD.

DISCUSSION

ASD is associated with some self-reported and objectively measured functional vision problems, and structural alterations of the eye, even though we observed several methodological limitations in the individual studies included in our meta-analyses. Further research should clarify the causal relationship, if any, between ASD and problems of vision during early life.

PROSPERO REGISTRATION

CRD42022328485.

A rule-based theoretical account of social stories to address the double empathy problem

Social Stories™ (SS) is one of the most popular and researched interventions for autistic children. To date, research that focuses on outcomes has been prioritized over the investigation of the psychological mechanisms that inform the intervention. In this article we consider theoretical accounts proposed thus far which could underpin SS. We argue that mechanisms that are based on social deficit theories lack validity, and propose a rule-based theoretical account to inform a strengths-based approach toward conceptualizing the mechanisms that underpin SS. We apply this account to the 'double-empathy problem' to propose that SS can be adapted to involve all parties in the development and delivery of SS support by adopting a rule-based perspective. We use the example of systemizing (the drive to analyze and explore systems in terms of 'if-and-then' rules), which is proposed to be a relative autistic strength, as a form of rule-based thinking that can provide a theoretical account of SS and a framework to address the double-empathy problem.

Figure-Disembedding Is Inferior in Non-autistic Compared to Autistic Individuals but Can Be Improved by Training

Background

Figure-disembedding is one of the most discussed visuo-cognitive functions, in which individuals with Autism Spectrum Disorder (ASD) have been reported to outperform non-autistic individuals. A local processing bias has been assumed to underlie such superior performance patterns. The aim of the current study is to investigate whether processing preferences can be modified by procedural priming.

Method

The current study used a procedural priming task (Navon figures) to induce more local or global processing in 25 autistic and 21 typically developing (TD) control participants, using hierarchical figures preceding the figure-disembedding task.

Results

Participants with ASD outperformed non-autistic individuals in the unprimed baseline task version. The performance was not modulated by priming in either direction (toward a local or global processing style) in both groups. However, the performance of TD control participants was improved by training to the same level as that observed in the ASD group.

Conclusion

Figure-disembedding performance in ASD is superior to that in TD control participants and robust against procedural priming or training. In contrast, performance in the TD control group can be improved up to the level of the ASD group. Any studies reporting superiority in individuals with ASD in figure-disembedding should consider training effects when evaluating group differences.

Can EEG Correlates Predict Treatment Efficacy in Children with Overlapping ASD and SLI Symptoms: A Case Report

Evaluation of the rehabilitation efficacy may be an essential indicator of its further implementation and planning. The research aim is to examine whether the estimation of EEG correlates of auditory-verbal processing in a child with overlapping autism spectrum disorder (ASD) and specific language impairment (SLI) symptoms may be a predictor of the treatment efficacy in conditions when behavioral tests do not show improvement during the time course. The prospective case report reports follow-up results in a child aged 36 to 66 months. During continuous integrative therapy, autism risk index, cognitive, speech-language, sensory, and EEG correlates of auditory-verbal information processing are recorded in six test periods, and their mutual interrelation was analyzed. The obtained results show a high statistically significant correlation of all observed functions with EEG correlates related to the difference between the average mean values of theta rhythm in the left (F1, F3, F7) and right (F2, F4, F8) frontal region. The temporal dynamics of the examined processes point to the consistency of the evaluated functions increasing with time flow. These findings indicate that EEG correlates of auditory-verbal processing may be used to diagnose treatment efficacy in children with overlapping ASD and SLI.

Special treatment of prediction errors in autism spectrum disorder

For autistic individuals, sensory stimulation can be experienced as overwhelming. Models of predictive coding postulate that cortical mechanisms disamplify predictable information and amplify prediction errors that surpass a defined precision level. In autism, the neuronal processing is putting an inflexibly high precision on prediction errors according to the HIPPEA theory (High, Inflexible Precision of Prediction Errors in Autism). We used an apparent motion paradigm to test this prediction. In apparent motion paradigms, the illusory motion of an object creates a prediction about where and when an internally generated token would be moving along the apparent motion trace. This illusion facilitates the perception of a flashing stimulus (target) appearing in-time with the apparent motion token and is perceived as a predictable event (predictable target). In contrast, a flashing stimulus appearing out-of-time with the apparent motion illusion is an unpredictable target that is less often detected even though it produces a prediction error signal. If a prediction error does not surpass a given precision threshold the stimulation event is discounted and therefore less often detected than predictable tokens. In autism, the precision threshold is lower and the same prediction errors (unpredictable target) triggers a detection similar to that of a predictable flash stimulus. To test this hypothesis, we recruited 11 autistic males and 9 neurotypical matched controls. The participants were tasked to detect flashing stimuli placed on an apparent motion trace either in-time or out-of-time with the apparent motion illusion. Descriptively, 66% (6/9) of neurotypical and 64% (7/11) of autistic participants were better at detecting predictable targets. The prediction established by illusory motion appears to assist autistic and neurotypical individuals equally in the detection of predictable over unpredictable targets. Importantly, 55% (6/11) of autistic participants had faster responses for unpredictable targets, whereas only 22% (2/9) of neurotypicals had faster responses to unpredictable compared to predictable targets. Hence, these tentative results suggest that for autistic participants, unpredictable targets produce an above threshold prediction error, which leads to faster response. This difference in unpredictable target detection can be encapsulated under the HIPPEA theory, suggesting that precision setting could be aberrant in autistic individuals with respect to prediction errors. These tentative results should be considered in light of the small sample. For this reason, we provide the full set of materials necessary to replicate and extend the results.

Atypical visual processing in a mouse model of autism

Human social cognition relies heavily on the processing of various visual cues, such as eye contact and facial expressions. Atypical visual perception and integration have been recognized as key phenotypes in individuals diagnosed with autism spectrum disorder (ASD), and may potentially contribute to impediments in normal social development, a hallmark of ASD. Meanwhile, increasing studies on visual function in ASD have pointed to detail-oriented perception, which has been hypothesized to result from heightened response to information of high spatial frequency. However, mixed results of human studies have led to much debate, and investigations using animal models have been limited. Here, using BTBR mice as a model of idiopathic ASD, we assessed retinal stimulus processing by full-field electroretinogram and found impaired photoreceptor function and retina-based alterations mostly in the cone pathway. Using the optokinetic reflex to evaluate visual function, we observed robustly enhanced visual response to finer spatial details and more subtle contrasts at only higher spatial frequencies in the BTBR mice, under both photopic and scotopic conditions. These behavioral results, which are similar to findings in a subset of ASD patients, indicate a bias toward processing information of high spatial frequencies. Together, these findings also suggest that, while enhancement of visual behaviors under both photopic and scotopic conditions might be due to alterations in visual processing common to both rod and cone pathways, these mechanisms are probably downstream of photoreceptor function.

The Relation Between Autistic Traits, the Degree of Synaesthesia, and Local/Global Visual Perception

Synaesthesia is highly prevalent in autism spectrum disorder. We assessed the relation between the degree of autistic traits (Autism Spectrum Quotient, AQ) and the degree of synaesthesia in a neurotypical population, and hypothesized both are related to a local bias in visual perception. A positive correlation between total AQ scores and the degree of synaesthesia was found, extending previous studies in clinical populations. Consistent with our hypothesis, AQ-attention to detail scores were related to increased performance on an Embedded Figures Task and reduced susceptibility to visual illusions. We found no relation between autistic traits and performance on a motion coherence task, and no relation between synaesthesia and local visual perception. Possibly, this relation is reserved for supra-threshold synaesthetes.

Superior Disembedding in Children with ASD: New Tests Using Abstract, Meaningful, and 3D Contexts

Since its initial development, the embedded figures test (EFT) has been used extensively to measure local–global perceptual style. However, little is known about the perceptual factors that influence target detection. The current study aimed to investigate disembedding in children with and without ASD, aged 8–15 years, using the newly developed, stimulus-controlled L-EFT, M-EFT and D-EFT. Firstly, results revealed superior disembedding for children with ASD, irrespective of the type of target or embedding context, although the ASD group took more time in both the M-EFT and D-EFT. Secondly, the number of target lines continuing into the context proved more of a hindrance for the controls. Taken together, these findings provide strong evidence to support the notion of superior disembedding in ASD.

Proficiency of individuals with autism spectrum disorder at disembedding figures: A systematic review

OBJECTIVE

This systematic review examines the proficiency and visual search strategies of individuals with autism spectrum disorders (ASD) while disembedding figures and whether they differ from typical controls and other comparative samples.

METHODS

Five databases, including Proquest, Psychinfo, Medline, CINAHL and Science Direct were used to identify published studies meeting the inclusion and exclusion criteria.

RESULTS

Twenty articles were included in the review, the majority of which matched participants by mental age. Outcomes discussed were time taken to identify targets, the number correctly identified, and fixation frequency and duration.

CONCLUSIONS

Individuals with ASD perform at the same speed or faster than controls and other clinical samples. However, there appear to be no differences between individuals with ASD and controls for number of correctly identified targets. Only one study examined visual search strategies and suggests that individuals with ASD exhibit shorter first and final fixations to targets compared with controls.

Autism As a Disorder of High Intelligence

A suite of recent studies has reported positive genetic correlations between autism risk and measures of mental ability. These findings indicate that alleles for autism overlap broadly with alleles for high intelligence, which appears paradoxical given that autism is characterized, overall, by below-average IQ. This paradox can be resolved under the hypothesis that autism etiology commonly involves enhanced, but imbalanced, components of intelligence. This hypothesis is supported by convergent evidence showing that autism and high IQ share a diverse set of convergent correlates, including large brain size, fast brain growth, increased sensory and visual-spatial abilities, enhanced synaptic functions, increased attentional focus, high socioeconomic status, more deliberative decision-making, profession and occupational interests in engineering and physical sciences, and high levels of positive assortative mating. These findings help to provide an evolutionary basis to understanding autism risk as underlain in part by dysregulation of intelligence, a core human-specific adaptation. In turn, integration of studies on intelligence with studies of autism should provide novel insights into the neurological and genetic causes of high mental abilities, with important implications for cognitive enhancement, artificial intelligence, the relationship of autism with schizophrenia, and the treatment of both autism and intellectual disability.

Is 20/20 vision good enough? Visual acuity differences within the normal range predict contour element detection and integration

Contour integration (CI) combines appropriately aligned and oriented elements into continuous boundaries. Collinear facilitation (CF) occurs when a low-contrast oriented element becomes more visible when flanked by collinear high-contrast elements. Both processes rely at least partly on long-range horizontal connections in early visual cortex, and thus both have been extensively studied to understand visual cortical functioning in aging, development, and clinical disorders. Here, we ask: Can acuity differences within the normal range predict CI or CF? To consider this question, we measured binocular visual acuity and compared subjects with 20/20 vision to those with better-than-20/20 vision (SharpPerceivers) on two tasks. In the CI task, subjects located an integrated shape embedded in varying amounts of noise; in the CF task, subjects detected a low-contrast element flanked by collinear or orthogonal high-contrast elements. In each case, displays were scaled in size to modulate element visibility and spatial frequency (4-12 cycles/deg). SharpPerceivers could integrate contours under noisier conditions than the 20/20 group (p = .0002), especially for high spatial frequency displays. Moreover, although the two groups exhibited similar collinear facilitation, SharpPerceivers could detect the central target with lower contrast at high spatial frequencies (p <. 05). These results suggest that small acuity differences within the normal range--corresponding to about a one line difference on a vision chart--strongly predict element detection and integration. Furthermore, simply ensuring that subjects have normal or corrected-to-normal vision is not sufficient when comparing groups on contour tasks; visual acuity confounds also need to be ruled out.

Autistic characteristics in adults with epilepsy and perceived seizure activity

The prevalence of autism spectrum disorders in epilepsy is approximately 15%-47%, with previous research by Wakeford and colleagues reporting higher autistic traits in adults with epilepsy. The aim of this study was to investigate autistic characteristics and their relationship to having seizures by employing two behavioral assessments in two samples: adults with epilepsy and controls.

METHOD

The study employed the Social Responsiveness Scale - Shortened (SRS-S) (patients with epilepsy (n=76), control (n=19)) and the brief Repetitive Behavior Scale - Revised (RBS-R) (patients with epilepsy (n=47), control (n=21)). This study employed a unique method to quantify the extent to which autistic characteristics are related to perceived mild seizure activity. Adults with epilepsy were instructed to rate their usual behavior on each assessment and, at the same time, rate their behavior again when they perceived that they were having mild seizure activity.

RESULTS

Significantly higher SRS-S scores were related to having a diagnosis of epilepsy and were perceived by adults with epilepsy to increase during mild seizure activity. These scores positively correlated with antiepileptic drug control. No difference was found for RBS-R scores in adults with epilepsy compared with controls.

CONCLUSION

Together, these results suggest that adults with epilepsy have higher autistic characteristics measured by the social responsiveness scale, while sameness behaviors remain unimpaired. The autistic characteristics measured by the social responsiveness scale were reported by adults with epilepsy to be more severe during their mild seizure activity.

Normal Visual Acuity and Electrophysiological Contrast Gain in Adults with High-Functioning Autism Spectrum Disorder

A common neurodevelopmental disorder, autism spectrum disorder (ASD), is defined by specific patterns in social perception, social competence, communication, highly circumscribed interests, and a strong subjective need for behavioral routines. Furthermore, distinctive features of visual perception, such as markedly reduced eye contact and a tendency to focus more on small, visual items than on holistic perception, have long been recognized as typical ASD characteristics. Recent debate in the scientific community discusses whether the physiology of low-level visual perception might explain such higher visual abnormalities. While reports of this enhanced, "eagle-like" visual acuity contained methodological errors and could not be substantiated, several authors have reported alterations in even earlier stages of visual processing, such as contrast perception and motion perception at the occipital cortex level. Therefore, in this project, we have investigated the electrophysiology of very early visual processing by analyzing the pattern electroretinogram-based contrast gain, the background noise amplitude, and the psychophysical visual acuities of participants with high-functioning ASD and controls with equal education. Based on earlier findings, we hypothesized that alterations in early vision would be present in ASD participants. This study included 33 individuals with ASD (11 female) and 33 control individuals (12 female). The groups were matched in terms of age, gender, and education level. We found no evidence of altered electrophysiological retinal contrast processing or psychophysical measured visual acuities. There appears to be no evidence for abnormalities in retinal visual processing in ASD patients, at least with respect to contrast detection.

The relationship between level of autistic traits and local bias in the context of the McGurk effect

The McGurk effect is a well-known illustration that demonstrates the influence of visual information on hearing in the context of speech perception. Some studies have reported that individuals with autism spectrum disorder (ASD) display abnormal processing of audio-visual speech integration, while other studies showed contradictory results. Based on the dimensional model of ASD, we administered two analog studies to examine the link between level of autistic traits, as assessed by the Autism Spectrum Quotient (AQ), and the McGurk effect among a sample of university students. In the first experiment, we found that autistic traits correlated negatively with fused (McGurk) responses. Then, we manipulated presentation types of visual stimuli to examine whether the local bias toward visual speech cues modulated individual differences in the McGurk effect. The presentation included four types of visual images, comprising no image, mouth only, mouth and eyes, and full face. The results revealed that global facial information facilitates the influence of visual speech cues on McGurk stimuli. Moreover, individual differences between groups with low and high levels of autistic traits appeared when the full-face visual speech cue with an incongruent voice condition was presented. These results suggest that individual differences in the McGurk effect might be due to a weak ability to process global facial information in individuals with high levels of autistic traits.

Visuo-spatial performance in autism: a meta-analysis

Visuo-spatial skills are believed to be enhanced in autism spectrum disorders (ASDs). This meta-analysis tests the current state of evidence for Figure Disembedding, Block Design, Mental Rotation and Navon tasks in ASD and neurotypicals. Block Design (d = 0.32) and Figure Disembedding (d = 0.26) showed superior performance for ASD with large heterogeneity that is unaccounted for. No clear differences were found for Mental Rotation. ASD samples showed a stronger local processing preference for Navon tasks (d = 0.35); less clear evidence for performance differences of a similar magnitude emerged. We discuss the meta-analysis results together with other findings relating to visuo-spatial processing and three cognitive theories of ASD: Weak Central Coherence, Enhanced Perceptual Functioning and Extreme Male Brain theory.

Autism spectrum traits in normal individuals: a preliminary VBM analysis

In light of the new DSM-5 autism spectrum disorders diagnosis in which the autism spectrum reflects a group of neurodevelopmental disorders existing on a continuum from mild to severe expression of autistic traits, and recent empirical findings showing a continuous distribution of autistic traits in the general population, our voxel based morphometry study compares normal individuals with high autistic traits to normal individuals with low autistic traits. We hypothesize that normal individuals with high autistic traits in terms of empathizing and systemizing [high systemizing (HS)/low empathizing (LE)] share brain irregularities with individuals that fall within the clinical autism spectrum disorder. We find differences in several social brain network areas between our groups. Specifically, we find increased gray matter (GM) volume in the orbitofrontal cortex, the cuneus, the hippocampus and parahippocampus and reduced GM volume in the inferior temporal cortex, the insula, and the amygdala in our HS/LE individuals relative to our HE/LS (low autistic traits in terms of empathizing and systemizing) individuals.

Brief report: visual acuity in children with autism spectrum disorders

Recently, there has been heightened interest in suggestions of enhanced visual acuity in autism spectrum disorders (ASD) which was sparked by evidence that was later accepted to be methodologically flawed. However, a recent study that claimed children with ASD have enhanced visual acuity (Brosnan et al. in J Autism Dev Disord 42:2491-2497, 2012) repeated a critical methodological flaw by using an inappropriate viewing distance for a computerised acuity test, placing the findings in doubt. We examined visual acuity in 31 children with ASD and 33 controls using the 2 m 2000 Series Revised Early Treatment Diabetic Retinopathy Study chart placed at twice the conventional distance to better evaluate possible enhanced acuity. Children with ASD did not demonstrate superior acuity. The current findings strengthen the argument that reports of enhanced acuity in ASD are due to methodological flaws and challenges the reported association between visual acuity and systemising type behaviours.

Enhanced olfactory sensitivity in autism spectrum conditions

Background

People with autism spectrum conditions (ASC) report heightened olfaction. Previous sensory experiments in people with ASC have reported hypersensitivity across visual, tactile, and auditory domains, but not olfaction. The aims of the present study were to investigate olfactory sensitivity in ASC, and to test the association of sensitivity to autistic traits.

Methods

We recruited 17 adult males diagnosed with ASC and 17 typical adult male controls and tested their olfactory sensitivity using the Alcohol Sniff Test (AST), a standardised clinical evaluation of olfactory detection. The AST involves varying the distance between subject and stimulus until an odour is barely detected. Participants with ASC also completed the Autism Spectrum Quotient (AQ) as a measure of autism traits.

Results

The ASC group detected the odour at a mean distance of 24.1 cm (SD =11.5) from the nose, compared to the control group, who detected it at a significantly shorter mean distance of 14.4 cm (SD =5.9). Detection distance was independent of age and IQ for both groups, but showed a significant positive correlation with autistic traits in the ASC group (r =0.522).

Conclusions

This is the first experimental demonstration, as far as the authors are aware, of superior olfactory perception in ASC and showing that greater olfactory sensitivity is correlated with a higher number of autistic traits. This is consistent with results from previous findings showing hypersensitivity in other sensory domains and may help explain anecdotal and questionnaire accounts of heightened olfactory sensitivity in ASC. Results are discussed in terms of possible underlying neurophysiology.

Visual processing in adolescents with autism spectrum disorder: evidence from embedded figures and configural superiority tests

The embedded figures test has often been used to reveal weak central coherence in individuals with autism spectrum disorder (ASD). Here, we administered a more standardized automated version of the embedded figures test in combination with the configural superiority task, to investigate the effect of contextual modulation on local feature detection in 23 adolescents with ASD and 26 matched typically developing controls. On both tasks both groups performed largely similarly in terms of accuracy and reaction time, and both displayed the contextual modulation effect. This indicates that individuals with ASD are equally sensitive compared to typically developing individuals to the contextual effects of the task and that there is no evidence for a local processing bias in adolescents with ASD.