Theory of mind and central coherence in adults with high-functioning autism or Asperger syndrome

Episodic memory impairment and its influencing factors in individuals with autism spectrum disorder: systematic review and meta-analysis

Individuals with autism spectrum disorders (ASD) are considered to experience difficulties with episodic memory (EM), while studies on EM in ASD have shown inconsistent results. A meta-analysis of 65 episodic memory studies with a combined sample size of 1652 individuals with ASD and 1626 typically developing individuals was conducted to analyze factors that may affect EM in ASD. The results showed that ASD had a significant medium to large effect size decrease in EM ability. Age period, task type, and reporting method significantly reduced the observed heterogeneity while EM type did not reduce the observed heterogeneity. The results of the meta-regression revealed that it was verbal IQ rather than full-scale IQ that was significantly correlated with EM in individuals with ASD. These findings suggest that individuals with ASD have reduced EM abilities and the potential factors is still needed to be explored.

Comparing narrative storytelling ability in individuals with autism and fetal alcohol spectrum disorders

BACKGROUND

Narrative discourse, or storytelling, is used in daily conversation and requires higher-level language and social communication skills that are not always captured by standardised assessments of language. Many autistic individuals and individuals with fetal alcohol spectrum disorders (FASD) have difficulties with both social communication and language skills, and narrative discourse analysis offers an ecologically relevant approach to assessing those challenges.

AIMS

This study investigated narrative discourse in individuals with autism and FASD, as well as an age- and sex-matched comparison group.

METHODS AND PROCEDURES

Narratives from 45 adolescents and adults, 11 with autism, 11 with FASD and 23 age- and sex-matched comparison participants were elicited using a wordless storybook. They were then transcribed orthographically, formatted to the Systematic Analyses of Language Transcript (SALT) convention and scored based on the SALT Narrative Scoring Scheme (NSS), a standardised language analysis protocol. In addition to the NSS total score, which assesses the overall structure and cohesion of the narratives produced, local and global measures of language ability were also employed. The local language measures included the number of mental state and temporal relation terms produced, while the global language measures included mean length of utterance, total different words, total words, total utterances, rate of speech, the number of mazes (e.g., repetitions, 'um', 'uh' or self-corrections) per total word and the NSS total score.

OUTCOMES AND RESULTS

Using the SALT Language Sample Analysis tool, our results revealed that on global language measures, group differences were found on rate of speech, number of mazes per total words and the description of conflict/resolution in the narratives produced. The autism group produced significantly more mazes per total word and scored higher on the NSS conflict/resolution category score compared to the FASD and comparison groups. Both the autism and FASD groups spoke at a lower rate than the comparison group. On local language measures of narrative production, all groups were comparable, on average.

CONCLUSIONS AND IMPLICATIONS

While many aspects of narrative discourse in the autism and FASD groups were similar to each other and to the comparison group, we observed group differences on global measures of narrative production and significant individual variability within groups, suggesting that narrative abilities considered at an individual level may provide important clinical information for intervention planning. Future research should also consider additional variables that influence narrative discourse, such as motivation, distractibility or decision-making of individual participants.

WHAT THIS PAPER ADDS

What is already known on the subject Narrative discourse, or storytelling, is used in daily conversational interactions and reveals higher-level language skills that may not be well captured by standardised assessments of language. Many autistic individuals and individuals with fetal alcohol spectrum disorders (FASD) show difficulty with pragmatic and expressive language skills. What this paper adds to existing knowledge We found that many aspects of the narratives produced by the adolescents/young adults in the autism and FASD groups were comparable to each other and to the neurotypical group. However, the groups differed on three global measures of narrative production: rate of speech, number of mazes per total words and the description of conflict/resolution in the narratives produced. Also, significant variability was observed within groups, suggesting that narrative abilities should be considered at an individual level as opposed to their clinical groups. What are the potential or actual clinical implications of this work? This study showed that narrative discourse is an appropriate task that can be added to routine clinical assessments of language abilities in autistic adolescents/young adults as well as those with FASD or typical development and has the potential to reveal higher-level, real-world language skills. An important clinical implication of this study is that narrative language abilities should be considered at an individual level and individual-tailored interventions based on ability level due to the variability observed across individuals.

Examining whether adults with autism spectrum disorder encounter multiple problems in theory of mind: a study based on meta-analysis

Theory of mind (ToM) represents a complex ability, while persons with autism spectrum disorder (ASD) encounter difficulties in the processing of ToM. The present ToM-focused studies on adults with ASD report inconsistent results, possibly owing to the differences between tasks. For instance, different ToM-related tasks involve different cognitive abilities, but the development of these cognitive abilities is different among adults with ASD, thereby leading to different behaviors by the same individual with ASD in different tasks. Therefore, it is of vital significance to explore the potential reasons for inconsistencies in the existing studies based on the task classification perspective. Hence, this study primarily reviews the existing ToM tasks used in studies on adults with ASD; afterward, based on the forms and characteristics of the task, the current ToM tasks are classified into four categories-reading comprehension, perceptual scene comprehension, comprehensive scene comprehension , and self-other processing. Subsequently, a meta-analysis is undertaken to determine the difference in each ToM task category between the ASD group and the typically developing (TD) group. As a result, 110 research papers (including 3,205 adults with ASD and 3,675 TD adults) that fulfilled the stated criteria are examined in this study. The study findings suggest that adults with ASD demonstrate worse performance in terms of all four ToM task categories as compared to TD adults. Furthermore, compared with tasks of self-other processing and perceptual scene comprehension, adults with ASD perform worse in reading comprehension and comprehensive scene comprehension. This shows that the differences between tasks may exert a potential influence on the study results. Future studies should focus on different abilities involved in ToM processing and the choice of ToM tasks, in order to elucidate the critical problems of ToM in adults with ASD.

Here's the Story: Narrative Ability and Executive Function in Autism Spectrum Disorder

Background

Difficulties with narrative have been reported in individuals diagnosed with autism spectrum disorder (ASD), but the role of executive function on narrative ability has not been examined in ASD. In this study, we aimed to (1) examine whether narrative abilities of ASD children differed from neurotypical (NT) children who did not differ in age, sex, and IQ; and (2) investigate relations between executive function and narrative ability in ASD children.

Method

Narratives were elicited from 64 ASD children and 26 NT children using a wordless picture book and coded to derive several aspects of narrative ability such as propositions, evaluative devices, and self-repairs. Executive functions (specifically, inhibition and working memory) were measured using both experimenter-administered assessment and parent-report measures.

Results

Compared to NT children, ASD children produced fewer propositions but did not differ in their use of evaluative devices and self-repairs during narrative production. Greater inhibitory challenges related to more self-repairs involving repetition of story elements, whereas working memory did not relate to any of the measures of narrative ability among ASD children.

Conclusions

This study revealed that narratives by verbally fluent ASD children were shorter and less complex than those by NT children but did not differ in the specific features of narratives. Furthermore, although ASD children did not make more self-repairs than NT children, difficulty with inhibition was related to more self-repairs, indicating more dysfluent narrative production in ASD children, which has implications for intervention.

Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction

BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.

A constellation of eye-tracking measures reveals social attention differences in ASD and the broad autism phenotype

Background

Social attention differences, expressed through gaze patterns, have been documented in autism spectrum disorder (ASD), with subtle differences also reported among first-degree relatives, suggesting a shared genetic link. Findings have mostly been derived from standard eye-tracking methods (total fixation count or total fixation duration). Given the dynamics of visual attention, these standard methods may obscure subtle, yet core, differences in visual attention mechanisms, particularly those presenting sub-clinically. This study applied a constellation of eye-tracking analyses to gaze data from individuals with ASD and their parents.

Methods

This study included n = 156 participants across groups, including ASD (n = 24) and control (n = 32) groups, and parents of individuals with ASD (n = 61) and control parents (n = 39). A complex scene with social/non-social elements was displayed and gaze tracked via an eye tracker. Eleven analytic methods from the following categories were analyzed: (1) standard variables, (2) temporal dynamics (e.g., gaze over time), (3) fixation patterns (e.g., perseverative or regressive fixations), (4) first fixations, and (5) distribution patterns. MANOVAs, growth curve analyses, and Chi-squared tests were applied to examine group differences. Finally, group differences were examined on component scores derived from a principal component analysis (PCA) that reduced variables to distinct dimensions.

Results

No group differences emerged among standard, first fixation, and distribution pattern variables. Both the ASD and ASD parent groups demonstrated on average reduced social attention over time and atypical perseverative fixations. Lower social attention factor scores derived from PCA strongly differentiated the ASD and ASD parent groups from controls, with parent findings driven by the subset of parents demonstrating the broad autism phenotype.

Limitations

To generalize these findings, larger sample sizes, extended viewing contexts (e.g., dynamic stimuli), and even more eye-tracking analytical methods are needed.

Conclusions

Fixations over time and perseverative fixations differentiated ASD and the ASD parent groups from controls, with the PCA most robustly capturing social attention differences. Findings highlight their methodological utility in studies of the (broad) autism spectrum to capture nuanced visual attention differences that may relate to clinical symptoms in ASD, and reflect genetic liability in clinically unaffected relatives. This proof-of-concept study may inform future studies using eye tracking across populations where social attention is impacted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-022-00490-w.

Are Executive Dysfunctions Relevant for the Autism-Specific Cognitive Profile?

Executive functions (EF) have been shown to be important for the understanding of Autism Spectrum Disorder (ASD), but dysfunctions of EF are not autism-specific. The specific role of EF in ASD, its relationship to core autism characteristics, such as mentalizing, needs to be explored. Medline- and PsychINFO databases were searched for studies published between 1990 and 2020 that included measures of EF in ASD and typically developing control persons (TD) in combination with either Theory of Mind (ToM) or Weak Central Coherence (WCC) tasks. A pre-registered meta-analysis and cross-study regression was performed including a total of 42 studies (ASD n = 1,546, TD n = 1,206). Results were reported according to PRISMA guidelines. In all cognitive domains, the ASD group showed significantly reduced performance. Importantly, EF subdomains and ToM were not significantly correlated. This finding rules out a significant association between EF subdomains and ToM and questions the relevance of EF dysfunctions for the autism-specific feature of reduced mentalizing.

The relationship between alexithymia and theory of mind: A systematic review

Theory of Mind (ToM), the ability to represent the mental states of oneself and others, is an essential social skill disrupted across many psychiatric conditions. The transdiagnostic nature of ToM impairment means it is plausible that ToM impairment is related to alexithymia (difficulties identifying and describing one's own emotions), as alexithymia is seen across psychiatric conditions. Whilst many studies have examined links between alexithymia and ToM, results are mixed. Therefore, the purpose of this systematic review is to provide a taxonomy of ToM tests and assess their relationship with alexithymia. Tests are grouped according to whether they assess propensity to engage spontaneously in ToM or accuracy of ToM inferences, with tests further subdivided into those that do, and do not, require emotion recognition. A review of 63 suitable studies suggests that alexithymia is often associated with reduced ToM, and inaccurate ToM when tasks require emotion recognition. This latter finding appears due to impaired emotion recognition, rather than ToM impairment per se. Further directions and considerations for future research are discussed.

Understanding Social Communication Differences in Autism Spectrum Disorder and First-Degree Relatives: A Study of Looking and Speaking

This study examined narrative ability in ASD and parents across two contexts differing in structure and emotional content, and explored gaze patterns that may underlie narrative differences by presenting narrative tasks on an eye tracker. Participants included 37 individuals with ASD and 38 controls, 151 parents of individuals with ASD and 63 parent controls. The ASD and ASD parent groups demonstrated lower narrative quality than controls in the less structured narrative task only. Subtler, context-dependent differences emerged in gaze and showed some associations with narrative quality. Results indicate a narrative ability profile that may reflect genetic liability to ASD, and subtle links between visual attention and complex language skills that may be influenced by ASD genetic risk.

The Witness-Aimed First Account (WAFA): A new technique for interviewing autistic witnesses and victims

LAY ABSTRACT

Autistic people may be more likely to be interviewed by police as a victim/witness, yet they experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall information from memory. Police interviewing techniques do not take account of these differences, and so are often ineffective. We developed a new technique for interviewing autistic witnesses, referred to a Witness-Aimed First Account, which was designed to better support differences in the way that autistic witnesses process information in memory. The Witness-Aimed First Account technique encourages witnesses to first segment the witnessed event into discrete, parameter-bound event topics, which are then displayed on post-it notes while the witness goes onto freely recall as much information as they can from within each parameter-bound topic in turn. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored autistic and non-autistic witnesses' recall when the events were witnessed in a random (nonsensical) order. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were 'scrambled', disrupting the event's narrative structure; the other video was watched intact. Although both autistic and non-autistic witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from both autistic and non-autistic witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve witnesses' accounts within a legally appropriate, non-leading framework.

Linguistic markers of autism in girls: evidence of a "blended phenotype" during storytelling

Background

Narrative abilities are linked to social impairment in autism spectrum disorder (ASD), such that reductions in words about cognitive processes (e.g., think, know) are thought to reflect underlying deficits in social cognition, including Theory of Mind. However, research suggests that typically developing (TD) boys and girls tell narratives in sex-specific ways, including differential reliance on cognitive process words. Given that most studies of narration in ASD have been conducted in predominantly male samples, it is possible that prior results showing reduced cognitive processing language in ASD may not generalize to autistic girls. To answer this question, we measured the relative frequency of two kinds of words in stories told by autistic girls and boys: nouns (words that indicate object-oriented storytelling) and cognitive process words (words like think and know that indicate mentalizing or attention to other peoples' internal states).

Methods

One hundred two verbally fluent school-aged children [girls with ASD (N = 21) and TD (N = 19), and boys with ASD (N = 41) and TD (N = 21)] were matched on age, IQ, and maternal education. Children told a story from a sequence of pictures, and word frequencies (nouns, cognitive process words) were compared.

Results

Autistic children of both sexes consistently produced a greater number of nouns than TD controls, indicating object-focused storytelling. There were no sex differences in cognitive process word use in the TD group, but autistic girls produced significantly more cognitive process words than autistic boys, despite comparable autism symptom severity. Thus, autistic girls showed a unique narrative profile that overlapped with autistic boys and typical girls/boys. Noun use correlated significantly with parent reports of social symptom severity in all groups, but cognitive process word use correlated with social ability in boys only.

Conclusion

This study extends prior research on autistic children's storytelling by measuring sex differences in the narratives of a relatively large, well-matched sample of children with and without ASD. Importantly, prior research showing that autistic children use fewer cognitive process words is true for boys only, while object-focused language is a sex-neutral linguistic marker of ASD. These findings suggest that sex-sensitive screening and diagnostic methods-preferably using objective metrics like natural language processing-may be helpful for identifying autistic girls, and could guide the development of future personalized treatment strategies.

Attentional Mechanisms in Autism, ADHD, and Autism-ADHD Using a Local-Global Paradigm

OBJECTIVE

Cognitive flexibility or attentional set-shifting capacity has long been considered a core area of executive dysfunction for individuals with autism. Whether these difficulties are due to higher-level attentional difficulties associated with comorbid ADHD remains unclear.

METHOD

The current study compared the performance of 48 participants with autism, ADHD, autism-ADHD, and a comparison group ( N = 12 per group) on a set-shifting task, which included a local-global paradigm.

RESULTS

Results of this study revealed that participants with attentional difficulties (autism + ADHD and ADHD alone) exhibited a significant shifting cost (difference between maintaining and shifting attention).

CONCLUSION

Attentional difficulties associated with ADHD may be associated with an enhanced attentional shifting cost. Implications of these results were discussed in relation to screening for ADHD symptoms in studies of individuals with autism which seek to determine the neuropsychological profile of this condition.

Assessing social-pragmatic inferencing skills in children with autism spectrum disorder

By utilizing the Pragma test this study investigated how sixteen five- to ten-year-old children with autism spectrum disorder (ASD) and sixteen typically developing (TD) children comprehended contextually challenging scenarios demanding 1) contextual inference with theory of mind (ToM), 2) contextual inference without ToM, 3) relevant use of language, 4) recognition of feelings, and 5) understanding false beliefs. The study also compared children's ability to explain their own correct answers. In addition, this study evaluated the sensitivity of three different methods for discriminating the children with ASD from the TD children: 1) the Pragma test, 2) the Social Interaction Deviance Composite (SIDC) of Children's Communication Checklist-2 (CCC-2), and 3) the Theory of Mind subtest of the Developmental Neuropsychological Assessment, Second edition (NEPSY-II). The results showed that children with ASD differed from TD children in questions demanding context utilization. However, the demand of mind-reading in utterance interpretation increased the difference between groups. Compared to TD children, children with ASD had more difficulties in explaining how they had used context to arrive at the correct answer. The discrimination power for detecting children with ASD from TD children was excellent in the Pragma test, good in the SIDC CCC-2 and fair in the Theory of Mind subtest of NEPSY-II. This study showed that by using contextually sensitive materials, such as the Pragma test, it is possible to detect the social-pragmatic inferencing difficulties of high-functioning children with ASD in structured test situations and not only in real-life situations or by using parental reports.

What's the story? A computational analysis of narrative competence in autism

Individuals with autism spectrum disorder demonstrate narrative (i.e. storytelling) difficulties which can significantly impact their ability to form and maintain social relationships. However, existing research has not comprehensively documented these impairments in more open-ended, emotionally evocative situations common to daily interactions. Computational linguistic measures offer a promising complement to traditional hand-coding methods of narrative analysis and in this study were applied together with hand coding of narratives elicited with emotionally salient scenes from the Thematic Apperception Test. In total, 19 individuals with autism spectrum disorder and 14 typically developing controls were asked to tell stories about six images from the Thematic Apperception Test. Both structural and qualitative aspects of narrative were assessed using a hand-coding system and Latent Semantic Analysis, an automated computational measure of semantic similarity. Individuals with autism spectrum disorder demonstrated significant difficulties with the use of complex syntax to integrate their narratives and problems explaining characters' intentions. These and other key narrative skills were strongly related to narrative competence scores derived from Latent Semantic Analysis, which also distinguished the autism spectrum disorder group from controls. Together, results underscore key narrative impairments in autism spectrum disorder and support the promise of Latent Semantic Analysis as a valuable tool for the quantitative assessment of complex language abilities.

Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

PURPOSE

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied "story goodness" coding system.

METHOD

Narrative samples were analyzed for distinct aspects of story goodness and rated by naïve readers on dimensions of story goodness, accuracy, cohesiveness, and oddness. Adolescents with high-functioning ASD were compared with adolescents with typical development (TD; n = 15 per group). A second study compared narratives from adolescents across three groups: ASD, TD, and youths with "optimal outcomes," who were diagnosed with ASD early in development but no longer meet criteria for ASD and have typical behavioral functioning.

RESULTS

In both studies, the ASD group's narratives had lower composite quality scores compared with peers with typical development. In Study 2, narratives from the optimal outcomes group were intermediate in scores and did not differ significantly from those of either other group. However, naïve raters were able to detect qualitative narrative differences across groups.

CONCLUSIONS

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

Noticing the unusual: a self-prompt strategy for adults with autism

Purpose

– There is a substantial lack of research focusing on how to support the social understanding of high-functioning adults with autism (HFA). The perspectives of three adults with HFA were used to develop and implement self-prompt systems to increase knowledge and awareness of social situations. The paper aims to discuss these issues.

Design/methodology/approach

– Semi-structured interviews and diaries were used to support individuals to reflect on video-based and real-life social situations, within a qualitative participatory case study design. Qualitative data were analyzed thematically.

Findings

– Participants developed and used a self-prompt system to support their social understanding in a range of situations. “Noticing the unusual” in social situations, consideration of the potential impact of others’ behavior on them personally, and guessing the intention of others were identified as useful strategies. Basing social judgments on the facial expressions of others was not useful.

Research limitations/implications

– This was a small-scale study with only three high-functioning participants and so the research needs to be extended to a wider group.

Practical implications

– There is considerable potential for this approach to be used with adults accessing support services because the strategies identified can be easily applied and personalized.

Social implications

– Independent, unplanned use of the self-prompt strategy enabled participants to reduce dependence on others in social situations through supporting their independent thinking and actions.

Originality/value

– This study moves away from a deficit-focussed model of intervention to one that seeks to uncover strengths in order to empower individuals to use their existing knowledge.

Narrative performance of optimal outcome children and adolescents with a history of an Autism Spectrum Disorder (ASD)

Autism Spectrum Disorders (ASDs) have traditionally been considered a lifelong condition; however, a subset of people makes such significant improvements that they no longer meet diagnostic criteria for an ASD. The current study examines whether these "optimal outcome" (OO) children and adolescents continue to have subtle pragmatic language deficits. The narratives of 15 OO individuals, 15 high-functioning individuals with an ASD (HFA), and 15 typically developing (TD) peers were evaluated. Despite average cognitive functioning, the ASD group produced narratives with fewer central "gist" descriptions, more ambiguous pronominal referents, idiosyncratic language, speech dysfluency (more repetitions and self-corrections), and were less likely to name story characters. The OO participants displayed only very subtle pragmatic and higher-level language deficits (idiosyncratic language and self-correction dysfluency).

Pragmatics abilities in narrative production: a cross-disorder comparison

We aimed to disentangle contributions of socio-pragmatic and structural language deficits to narrative competence by comparing the narratives of children with autism spectrum disorder (ASD; n = 25), non-autistic children with language impairments (LI; n = 23), and children with typical development (TD; n = 27). Groups were matched for age (6½ to 15 years; mean: 10;6) and non-verbal ability; ASD and TD groups were matched on standardized language scores. Despite distinct clinical presentation, children with ASD and LI produced similarly simple narratives that lacked semantic richness and omitted important story elements, when compared to TD peers. Pragmatic errors were common across groups. Within the LI group, pragmatic errors were negatively correlated with story macrostructure scores and with an index of semantic-pragmatic relevance. For the group with ASD, pragmatic errors consisted of comments that, though extraneous, did not detract from the gist of the narrative. These findings underline the importance of both language and socio-pragmatic skill for producing coherent, appropriate narratives.

Social cognition, face processing, and oxytocin receptor single nucleotide polymorphisms in typically developing children

Recent research has provided evidence of a link between behavioral measures of social cognition (SC) and neural and genetic correlates. Differences in face processing and variations in the oxytocin receptor (OXTR) gene have been associated with SC deficits and autism spectrum disorder (ASD) traits. Much work has examined the qualitative differences between those with ASD and typically developing (TD) individuals, but very little has been done to quantify the natural variation in ASD-like traits in the typical population. The present study examines this variation in TD children using a multidimensional perspective involving behavior assessment, neural electroencephalogram (EEG) testing, and OXTR genotyping. Children completed a series of neurocognitive assessments, provided saliva samples for sequencing, and completed a face processing task while connected to an EEG. No clear pattern emerged for EEG covariates or genotypes for individual OXTR single nucleotide polymorphisms (SNPs). However, SNPs rs2254298 and rs53576 consistently interacted such that the AG/GG allele combination of these SNPs was associated with poorer performance on neurocognitive measures. These results suggest that neither SNP in isolation is risk-conferring, but rather that the combination of rs2254298(A/G) and rs53576(G/G) confers a deleterious effect on SC across several neurocognitive measures.

The biopsychosocial processes in autism spectrum disorder

Background

Autism is a disorder characterized by pervasive social and communicative impairments, repetitive and stereotyped behaviors and restricted interests. Its causes and effects have been researched from various neurocognitive theoretical perspectives and with the aid of neuroimaging technology. We aimed to describe biopsychosocial processes characteristic of the Autism Spectrum Disorders.

Method

Literature review using Medline and Scopus databases published between 2001 and 2011, with the keywords "autism", "theory of mind", "executive functions", "central coherence" and “fMRI”.

Results

The studies found were plotted and organized into tables and an explanatory diagram of the main findings was produced.

Conclusions

The most popular neurocognitive theories are still unable to fully explain the characteristics of the complications that autistic spectrum disorder causes to the quality of life of individuals living with autism. The association of clinical research and neuroimaging may contribute to a better understanding of the functioning of the brain affected by the disorder.

The big picture: storytelling ability in adults with autism spectrum conditions

Previous work on story-telling ability in autism spectrum conditions (ASC) has found a pattern of relatively intact use of story grammar in ASC narratives; however, prior analysis has concentrated primarily on whether specific story components are included, rather than how they are included. The present study analyzes an existing narrative dataset, concentrating on the kind of information that individuals with and without high functioning autism or Asperger syndrome include about story elements such as setting, character, conflict, and resolution. This analysis showed that individuals with ASC are biased toward providing local over global details about each element, regardless of whether the element involved mental content. These results are discussed in terms of the Weak Central Coherence and Hyper-Systemizing theories.

Confusion and inconsistency in diagnosis of Asperger syndrome: a review of studies from 1981 to 2010

This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder.

Diagnosing autism spectrum disorders in elderly people

BACKGROUND

As autism spectrum disorders (ASD) have largely been neglected in old-age psychiatry, the objective of the present paper is to describe the diagnostic process in elderly patients.

METHODS

A systematic review of the literature on ASD in older age was undertaken and illustrated by a case series of three elderly patients first diagnosed with ASD in later life by a tertiary mental health clinic.

RESULTS

The search of the literature only yielded three papers on late-life ASD, while the review of the available diagnostic procedures among adults suggests some relevance for screening instruments (Autism Questionnaire), diagnostic instruments (Module 4, Autism Diagnostic Observation Schedule), and neuropsychological examination to profile impairments. Nonetheless, the case reports clearly showed that taking a thorough history with the patient, corroborated and supplemented by a close relative or caregiver who has known the patient for at least ten years, still remains the most important diagnostic tool.

CONCLUSION

The three case studies show that in clinical practice ASD can easily be missed in elderly individuals presenting with comorbid psychiatric disorders, potentially causing iatrogenic damage. Although further research on phenotyping and diagnosing ASD in older people is warranted, the most important step at this point is to create a greater awareness of the possibility of ASD in old age among health-care professionals working with people in this age group.

Adults with autism spectrum disorders and ADHD neuropsychological aspects

The purpose of the present study was to assess which types of neuropsychological deficits appear to be most commonly associated with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) in adults. The effect of the combination of ASD with ADHD (ASD/ADHD) was also studied. One hundred and sixty-one adult individuals (≥18 years of age) were included in the study. None had full scale IQ less than 71. The neuropsychological investigations included measures of intellectual ability, learning and memory, attention/executive function and theory of mind. The three diagnostic groups showed reduced performance in most cognitive domains. However, within these domains differentiating distinct features could be seen. The dysfunctions of the ASD/ADHD group cannot be seen as a summary of the dysfunctions found in the ASD and ADHD groups. The ADHD seemed to have the most severe neuropsychological impairments of the three groups. No domain-specific deficit typical of any of the diagnostic groups was found.

Neurological soft signs in juvenile patients with Asperger syndrome, early-onset psychosis, and healthy controls

AIM

The study of neurological soft signs (NSS) in patients with Asperger syndrome may help us to elucidate the neurological basis of this disorder and to clarify its relationship with other neurodevelopmental disorders. The goal of this study was to compare the prevalence of NSS in a sample of patients with Asperger syndrome, early-onset psychosis and healthy controls.

METHOD

NSS were assessed by means of the Neurological Evaluation Scale in a sample of 29 patients with Asperger syndrome (mean age = 12.86 ± 2.58 years), 30 patients with first-episode early-onset psychoses (mean age 14.17 ± 1.02 years) and 30 healthy controls (mean age 12.33 ± 2.69 years).

RESULTS

Significant group differences were found between Asperger syndrome patients and healthy controls both in all the Neurological Evaluation Scale subscales and in the Neurological Evaluation Scale total score. There were no significant differences between both groups of patients in any of the Neurological Evaluation Scale scores.

CONCLUSIONS

NSS are more prevalent in Asperger syndrome than in healthy controls. The NSS profile was not disorder-specific in our samples of patients with Asperger syndrome and early-onset psychoses.

No evidence for impaired perception of biological motion in adults with autistic spectrum disorders

A central feature of autistic spectrum disorders (ASDs) is a difficulty in identifying and reading human expressions, including those present in the moving human form. One previous study, by Blake et al. (2003), reports decreased sensitivity for perceiving biological motion in children with autism, suggesting that perceptual anomalies underlie problems in social cognition. We revisited this issue using a novel psychophysical task. 16 adults with ASDs and 16 controls were asked to detect the direction of movement of human point-light walkers which were presented in both normal and spatially scrambled forms in a background of noise. Unlike convention direction discrimination tasks, in which walkers walk 'on the spot' while facing left or right, we added translatory motion to the stimulus so that the walkers physically moved across the screen. Therefore, while a cue of coherent, translatory motion was available in both the normal and scrambled walker forms, the normal walker alone contained information about the configuration and kinematics of the human body. There was a significant effect of walker type, with reduced response times and error when the normal walker was present. Most importantly, these improvements were the same for both participant groups, suggesting that people with ASDs do not have difficulty integrating local visual information into a global percept of the moving human form. The discrepancy between these and previous findings of impaired biological motion perception in ASDs are discussed with reference to differences in the age and diagnosis of the participants, and the nature of the task.

Impaired recognition of emotions from body movements is associated with elevated motion coherence thresholds in autism spectrum disorders

Recent research has confirmed that individuals with autism spectrum disorder (ASD) have difficulties in recognizing emotions from body movements. Difficulties in perceiving coherent motion are also common in ASD. Yet it is unknown whether these two impairments are related. Thirteen adults with ASD and 16 age- and IQ-matched typically developing (TD) adults classified basic emotions from point-light and full-light displays of body movements and discriminated the direction of coherent motion in random-dot kinematograms. The ASD group was reliably less accurate in classifying emotions regardless of stimulus display type, and in perceiving coherent motion. As predicted, ASD individuals with higher motion coherence thresholds were less accurate in classifying emotions from body movements, especially in the point-light displays; this relationship was not evident for the TD group. The results are discussed in relation to recent models of biological motion processing and known abnormalities in the neural substrates of motion and social perception in ASD.

Avaliação da linguagem oral e escrita em sujeitos com Síndrome de Asperger

OBJETIVO: avaliar e caracterizar provas fonoaudiológicas de linguagem oral e escrita de sujeitos com Síndrome de Asperger comparativamente a um grupo de sujeitos com desenvolvimento típico. MÉTODOS: avaliou-se 44 sujeitos que constituíram dois grupos: o grupo Asperger, composto por 22 sujeitos diagnosticados por equipe multidisciplinar como portadores de Síndrome de Asperger, conforme os critérios do DSM-IV; e o grupo de comparação, denominado grupo de baixo risco para alterações do desenvolvimento, também com 22 participantes, pareados com os sujeitos do grupo Asperger segundo a idade cronológica. Todos os sujeitos eram do sexo masculino, com idade cronológica entre 10 e 30 anos e quociente intelectual maior ou igual a 68 e foram submetidos à Prova de Consciência Fonológica, Teste de Vocabulário por Imagem Peabody, Prova de Leitura de Palavras e Pseudopalavras, Prova de Compreensão de Leitura, Prova de Escrita sob Ditado de Palavras e Pseudopalavras, Prova de Escrita Semidirigida de Textos. RESULTADOS: a análise estatística revelou diferenças estaticamente significantes entre as medianas da prova de consciência fonológica e entre as médias do teste de vocabulário por imagem Peabody e prova de compreensão de leitura nos dois grupos estudados (p<0,05). CONCLUSÃO: na avaliação da linguagem oral e escrita, o grupo de sujeitos com Síndrome de Asperger caracterizou-se por um desempenho pior do que o grupo de sujeitos de baixo risco para alterações do desenvolvimento nas provas fonoaudiológicas de consciência fonológica, teste de vocabulário por imagem Peabody e prova de compreensão de leitura, o que caracteriza prejuízo em níveis fonológico, semântico e pragmático da linguagem.

A multi-component social skills intervention for children with Asperger syndrome: the Junior Detective Training Program

BACKGROUND

The study aimed to investigate the effectiveness of a new multi-component social skills intervention for children with Asperger syndrome (AS): The Junior Detective Training Program. This 7-week program included a computer game, small group sessions, parent training sessions and teacher handouts.

METHOD

Forty-nine children with AS were recruited to participate and randomly assigned to intervention (n = 26) or wait-list control (n = 23) conditions.

RESULTS

Relative to children in the wait-list group, program participants showed greater improvements in social skills over the course of the intervention, as indicated by parent-report measures. Teacher-report data also confirmed that children receiving the intervention made significant improvements in social functioning from pre- to post-treatment. Treatment group participants were better able to suggest appropriate emotion-management strategies for story characters at post-intervention than at pre-intervention, whereas control participants were not. However, there was no difference in the improvements made by children in the intervention and control conditions on facial expression and body-posture recognition measures. Follow-up data suggested that treatment gains were maintained by children at 5-months post-intervention.

CONCLUSIONS

The Junior Detective Training Program appeared to be effective in enhancing the social skills and emotional understanding of children with AS. Limitations and suggestions for future research are discussed.