Abstract
This chapter surveys the core attention and socio-cognitive deficits of autism. It begins by discussing the key characteristics as reflected in the standard diagnostic criteria and screening tools. It then turns to research on attention-related differences in infants and toddlers later diagnosed with autism, including diminished attention to voices and faces, diminished eye contact, stimulus over-selectivity, and difficulties with attention shifting and joint attention. It then turns to later-stage socio-cognitive difficulties, particularly issues with emotional and cognitive perspective-taking, weak central coherence, executive function, and complex information processing. It concludes with a discussion of comorbidities like sensory issues, motor control difficulties, and intellectual impairment; of other skills that may be intact; and of open questions about central vs. peripheral symptoms of autism.
TopIntroduction
In this chapter, we turn away from the language deficits discussed in the previous chapter, most of which are no longer included as core symptoms of autism. Instead, we will focus here on those deficits that are considered core. There are four reasons for getting a handle on what these core-symptoms are before returning to the main focus of this book.
First, there is, and always has been, widespread misinformation about what exactly autism is—especially in the popular media and in books and movies targeted to lay people. As we saw with language in the first chapter, autism encompasses a huge spectrum of functioning level and a heterogeneous range of specific traits. This, unfortunately, has led to many false generalizations about what autism is—generalizations, for example, claiming that all people with autism are intellectually impaired, or that all people with autism have intact or superior intellects.
Second, the fact that a significant proportion of individuals experience a regression—one that sometimes manifests, at least to untrained eyes, as a sudden onset of autism—has led many people to conclude that autism can be caused by post-natal environmental factors like vaccines.
Third, the general mystery surrounding what is going on in the heads of nonverbal and minimally verbal autistic individuals, along with the wishful thinking these people can often inspire, particularly in their parents, has led many people to view autism as a kind of locked-in syndrome: one in which the autistic person is at least as intellectually and socially capable as non-autistic people are, but is locked inside an uncooperative body. As we will see, however, social and socio-cognitive deficits are pervasive in autism, while body control issues are peripheral.
Finally, and most importantly, most of what we discuss in terms of core symptoms will inform our subsequent discussion of the root causes of the language problems in autism and of what sorts of techniques and tools are best poised to address them.
Key Terms in this Chapter
Social Stimuli: Environmental stimuli that carry social information. People’s voices, faces and, especially, their eyes, are common sources of social stimuli. Multiple studies show attention to social stimuli to be diminished in autism starting in infancy.
Joint Attention: When two individuals consciously focus on the same item. Joint attention takes two forms: receptive joint attention (RJA), in which one person follows another person’s attentional lead, and initiating joint attention (IJA), in which one person tries to get the other person to follow his or her attentional lead.
False-Belief Test: A test of the ability to calculate another person’s false belief. A common type of false belief test involves an unexpected location change, as in the so-called “Sally-Anne” test: Sally moves a marble from a basket to a box while Anne is out of the room, such that Anne believes, falsely, that the marble is still in the basket.
Attention Shifting: The ability to disengage attention from one stimulus in order to focus on another, whether in different spatial locations or different modalities (visual vs. auditory). Multiple studies show attention shifting to be impaired in autism. Attention shifting difficulties may make it hard to follow fast-moving conversations.
Stimulus Overselectivity: A tendency to attend to a narrower range of stimuli: e.g., with a stimulus that has visual and auditory components, to attend to just the visual component or, within a complex stimulus that is entirely visual, to attend to a single detail rather than to the big picture. Multiple studies show stimulus overselectivity to be a feature of autism.
Cognitive Flexibility: The ability to switch between mental processes—e.g., to sort cards first by one criterion (shape), and then, in response to changes in implicit feedback, by another criterion (color). Several studies show this shifting ability to be impaired in autism.
Perspective Taking: The ability to intuit or calculate the perspective of another person, particularly when that person’s perspective, including their state of knowledge, is different from one’s own. Multiple studies suggest that automatic, intuitive perspective taking, also called “mentalizing,” is impaired in autism.
Executive Function (EF): The cognitive control of attention and behavior, including the ability to shift attention as needed. Multiple studies show EF impairments in autism.
Theory of Mind: The ability to intuit or calculate other people’s thoughts and feelings. Theory of Mind includes perspective taking but is often used in a broader sense to include the ability to infer people’s emotions from facial expressions and tones of voice.
Weak Central Coherence: A preference for local over global information processing, including an enhanced ability to discriminate between specific stimuli and a greater difficulty generalizing across stimuli. Put in lay terms, it is a tendency to miss the forest for the trees.