Verbal Thinking and Inner Speech Use in Autism Spectrum Disorder

Interdisciplinary approaches to understanding the inner speech, with emphasis on the role of incorporating clinical data

Neuroscience has largely conceptualized inner speech, sometimes called covert speech, as being a part of the language system, namely, a precursor to overt speech and/or speech without the motor component (impoverished motor speech). Yet interdisciplinary work has strongly suggested that inner speech is multidimensional and situated within the language system as well as in more domain general systems. By leveraging evidence from philosophy, linguistics, neuroscience and cognitive science, we argue that neuroscience can gain a more comprehensive understanding of inner speech processes. We will summarize the existing knowledge on the traditional approach to understanding the neuroscience of inner speech, which is squarely through the language system, before discussing interdisciplinary approaches to understanding the cognitive, linguistic and neural substrates/mechanisms that may be involved in inner speech. Given our own interests in inner speech after brain injury, we finish by discussing the theoretical and clinical benefits of researching inner speech in aphasia through an interdisciplinary lens.

Mental rotation and language in autism spectrum disorder

Though visuospatial skills are often considered a relative strength in autism spectrum disorder (ASD), unexplained difficulties relative to neurotypical (NT) peers have also been observed. Dissociations between spatial cognition and language skills in ASD may explain these difficulties given that these systems are linked in NT individuals. The current study examined performance on a mental rotation task that systematically varied stimulus features and the degree to which performance was associated with language in ASD relative to NT peers. Participants were children and young adults with ASD and 25 pairwise age- and IQ-matched NT peers (p's>0.53). The mental rotation task involved four conditions: two-dimensional (2D) abstract figures, three-dimensional (3D) abstract figures, 2D common objects, and 3D common objects. Structural language was measured using the grammar subscale from the Test of Language Development: Intermediate adapted for Norwegian. Mixed-effects model results indicated that autistic individuals were less accurate and had slower reaction time across mental rotation task conditions than NT peers. Language was associated with mental rotation accuracy for both groups across conditions, but with reaction time only for the NT group. The current study demonstrated selective associations between language and performance on a classic spatial cognition task in autistic individuals. Namely, there was a dissociation between language and in-the-moment efficiency in the ASD group, and this dissociation may reflect a broader dissociation between visuospatial and language systems.

To What Extent is the Contribution of Language to Learning via Instructions Modulated by the Expression of Autism Traits?

Language plays a fundamental role in enabling flexible, goal-directed behaviour. This study investigated whether the contribution of language to instruction encoding is modulated by the expression of autism traits, as measured by the Autism Spectrum Quotient (ASQ) questionnaire. Participants (N = 108) completed six choice reaction time tasks, with each task consisting of six stimulus-response mappings. During an instruction phase preceding each task, participants performed either a verbal, non-verbal or no distractor task. Participants made more errors in the verbal distractor task condition, but this detrimental effect did not differ significantly between the high (top 33%) and low (bottom 33%) ASQ groups. Hence, the contribution of language to instruction encoding does not appear to be modulated by the expression of autism traits.

A computational model of inner speech supporting flexible goal-directed behaviour in Autism

Experimental and computational studies propose that inner speech boosts categorisation skills and executive functions, making human behaviour more focused and flexible. In addition, many clinical studies highlight a relationship between poor inner-speech and an executive impairment in autism spectrum condition (ASC), but contrasting findings are reported. Here we directly investigate the latter issue through a previously implemented and validated computational model of the Wisconsin Cards Sorting Tests. In particular, the model was applied to explore potential individual differences in cognitive flexibility and inner speech contribution in autistic and neurotypical participants. Our model predicts that the use of inner-speech could increase along the life-span of neurotypical participants but would be reduced in autistic ones. Although we found more attentional failures (i.e., wrong behavioural rule switches) in autistic children/teenagers and more perseverative behaviours in autistic young/older adults, only autistic children and older adults exhibited a lower performance (i.e., fewer consecutive correct rule switches) than matched control groups. Overall, our results corroborate the idea that the reduced use of inner speech could represent a disadvantage for autistic children and autistic older adults. Moreover, the results suggest that cognitive-behavioural therapies should focus on developing inner speech skills in autistic children as this could provide cognitive support throughout their whole life span.

Efficiency of attentional processes in attention network theory and autistic symptoms in adolescents with autism spectrum disorder

BACKGROUND

Attentional impairments in children with Autism Spectrum Disorder (ASD) have been studied extensively, particularly in toddlers and young children. Attentional processes in teenagers with ASD are not fully understood, nor are the relationships between attentional deficits and ASD symptoms in this group.

METHOD

The aim of this study was to measure the attentional characteristics that attention network theory posits as being related to attention processes: alerting, orientating, and executive attention. We included 37 adolescents (aged 12-20) with ASD and Wechsler IQ in the normal range (≥70) and 37 neurotypical counterparts (NT) matched in terms of age, gender, and IQ. Symptoms of ASD were measured using the Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) and Autism Diagnostic Interview - Revised (ADI-R).

RESULTS

The adolescents with ASD reacted more slowly in all task conditions of the Attention Network Test and committed more errors in six of seven task conditions of this test. There were no group differences in the effects of alerting, orienting, and executive attention. We found moderate correlations of the effect of executive attention with three scales of ADOS-2 (communication, social functioning, and restricted behavior), as well as with the social scale and restricted behavior of ADI-R.

CONCLUSION

The results indicate that adolescents with ASD performed tasks requiring alerting and orienting attention less efficiently than their counterparts in terms of correctness and reaction time. The relationships between executive attention measures and communication and social affect is discussed.

Cognitive processes in autism: Repetitive thinking in autistic versus non-autistic adults

LAY ABSTRACT

A core feature of autism is the tendency to do the same activity or behaviour repetitively. We wanted to find out if autistic people also experience repetitive thinking, for example, having the same thoughts repeatedly. We thought that there would be a link between repetitive behaviour and repetitive thinking. We asked 54 autistic people and 66 non-autistic people to complete questionnaires measuring repetitive behaviours and obsessive thinking. Next, participants were trained by a researcher to record their thoughts using a structured paper form. They then completed 5 days of thought recording, which they did each time a random alarm sounded on their mobile phone. We found that autistic people had more repetitive thoughts than non-autistic people, but they did not report having more negative or visual thoughts compared with non-autistic people. Autistic people who had more repetitive thoughts during the 5 days of thought recording did not report more repetitive behaviour. However, autistic people who reported more obsessive thinking, for example, more negative and unwanted thoughts, also reported higher levels of repetitive behaviour. We conclude that some repetitive behaviours may be linked to anxiety and that more research is needed to better understand repetitive behaviours in autism.

Thinking in pictures in everyday life situations among autistic adults

Autistic individuals are often described as thinking in pictures. The aim of this study was to investigate the phenomenological characteristics of mental representations and inner experiences of autistic individuals. A total of 39 autistic adults and 80 control adults answered an online questionnaire. Autistic participants reported a more frequent use of visual mental representations than controls for different types of everyday situations. Moreover, autistic individuals defined their visual mental representations as more detailed than control participants. Furthermore, when describing their inner experiences, autistic participants used perceptive visual themes whereas control participants relied more on the description of events and memories. Our results support the hypothesis that some autistic individuals indeed “think in pictures”. We discuss the impact of such a visual way of thinking in daily life.

Planning in Children with Autism Spectrum Disorder: The Role of Verbal Mediation

This study examined verbal mediation during planning in school-age children with autism spectrum disorder (ASD) relative to age- and nonverbal IQ- matched typically developing peers using a dual-task paradigm. Analyses showed no group differences in performance. However, in the condition intended to disrupt verbal mediation, language skills were associated with planning performance for the TD group, but not the ASD group. Upon examining ASD subgroups with versus without comorbid structural language impairment, children with ASD and normal language appeared to rely on verbal mediation to a greater degree than children with ASD and language impairment, but to a lesser degree than TD peers. Thus, the role of verbal mediation in planning for children with ASD differs depending on language status.

Brief Report: Visuospatial and Spoken Language Recall in Autism: Preliminary Findings

Challenges to verbal encoding may affect the ability of autistic individuals to express their ideas. Therefore, visuospatial expression may represent a person's knowledge and skills more accurately than spoken language. To test this hypothesis, we asked seven autistic adults to linguistically retell and visuospatially reenact several animated clips. On average, visuospatial responses contained more correct elements than spoken responses. The level of intention of the three stimulus categories did not systematically affect response accuracy. Participants who produced visuospatial responses before spoken responses and those who had watched a greater number of stimuli assigned higher intentionality to shapes in the animations that were designed to elicit mentalizing. The modality used for expression may affect accuracy of responses by autistic individuals.

Inner Speech Moderates the Relationship Between Autism Spectrum Traits and Emotion Regulation

Inner speech processes are thought to be associated with decreases in cognitive performance in autism spectrum disorder (ASD). Although verbal thinking is also a key component in emotional responses, no studies have investigated whether inner speech is linked to emotion regulation in ASD. The aim of this study was to investigate whether inner speech moderates the relationship between ASD traits and emotion regulation strategies. Our results indicate that only the evaluative/motivational form of inner speech moderates the relationship between ASD traits and cognitive reappraisal; inner speech processes did not moderate the association between ASD traits and expressive suppression. These findings are a first step to further investigate the role of inner speech in affective and self-regulatory processes in ASD.

The Relationship Between Language and Planning in Children With Language Impairment

Purpose This study examined the relationship between language and planning, a higher order executive function skill, in children with specific language impairment (SLI) and typically developing (TD) children. We hypothesized differences between groups in planning performance and in the role of verbal mediation during planning. Method Thirty-one children with SLI and 50 TD age-matched peers (8-12 years) participated in the study. We assessed language ability via a standardized language measure and planning via a dual-task Tower of London paradigm with 3 conditions: no secondary task (baseline), articulatory suppression secondary task (disrupted verbal mediation), and motor suppression secondary task (control for secondary task demand). Results We found similar overall accuracy between children with SLI and TD peers on the Tower of London. Children with SLI executed trials more slowly at baseline than TD peers but not under articulatory suppression, and children with SLI spent less time planning than TD children at baseline and under articulatory suppression. There was a significant interaction among group, language ability, and planning time under articulatory suppression. Children with SLI who had relatively better language ability spent less time planning than children with SLI who had poorer language ability when verbal mediation was disrupted. This pattern was reversed for TD children. Conclusions This study provides evidence for a relationship between language and planning, yet this relationship differed between children with SLI compared to TD peers. Findings suggest that children with SLI use nonlinguistic perceptual strategies to a greater degree than verbal strategies on visuospatial planning tasks and that intervention might address strategy use for planning.

Role of Inner Speech on Serial Recall in Children with ASD: A Pilot Study Using the Luria Hand Test

This study was conducted to investigate the relation between the effect of articulatory suppression on the serial recall and severity of social impairments among children with autism spectrum disorders (ASD). The Luria hand test (LHT) was administered to evaluate the capacity for serial recall in 13 children with ASD. The LHT was administered under three conditions: control, under articulatory suppression, and under spatial suppression. Performance on the LHT of children with ASD was significantly lower in terms of both articulatory suppression and the spatial suppression condition. Moreover, the severity of social impairment in children with ASD was related to individual differences of effects of articulatory suppression on the LHT, but not with effects of spatial suppression. These results support the notion that dialogic inner speech which mediates complex cognitive abilities has inherently social origins.

Interfering With Inner Speech Selectively Disrupts Problem Solving and Is Linked With Real-World Executive Functioning

PURPOSE

According to Vygotskian theory, verbal thinking serves to guide our behavior and underpins critical self-regulatory functions. Indeed, numerous studies now link inner speech usage with performance on tests of executive function (EF). However, the selectivity of inner speech contributions to multifactorial executive planning performance and links with real-world functioning are limited. Therefore, the present study seeks to fill this gap in our knowledge.

METHOD

Fifty-one adults completed the Tower of London under 2 conditions, (a) articulatory suppression and (b) foot tapping, and provided self-ratings of real-world executive functioning (utilizing the Behavior Rating Inventory of Executive Function-Adult Version; Roth, Isquith, & Gioia, 2006).

RESULTS

Interfering with inner speech selectively disrupted Tower of London performance over and above a simultaneous motor task (i.e., foot tapping). Furthermore, this selectivity in performance was linked with real-world self-monitoring.

CONCLUSION

These results provide further evidence for specific links between verbal thinking and EF (particularly using multifactorial tasks of planning) and suggest that inner speech might serve as a key intervention target in clinical disorders where EF deficits are prominent.