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The Triad of Impairments

 

(i) Difficulties with social interaction

Individuals with autism may have difficulties in forming relationships, making friends and often appear indifferent to other people. They often find small talk and chatting very difficult and often take what people say very literally.

 

 

(ii) Difficulties with verbal and non-verbal communication

Individuals with autism may have difficulties with basic communication and letting other people know what they think and feel. They find it difficult to make eye contact, often use repetitive speech and are anxious in social situations.

 

(iii) Lack of imaginative play

Individuals with autism may have difficulty with flexible thought which can include difficulty imagining alternative outcomes and finding it hard to predict what will happen next. This frequently leads to anxiety. This can present as an obsession with rigid routines and severe distress if routines are disrupted;

 

 

The exact cause of autism is as yet not known but most research shows that genetic factors are important. It is also evident from research that autism may be associated with a variety of conditions affecting brain development which occur before, during, or very soon after birth. Interestingly the authors of this study note that earlier research had found that parents of children with Asperger syndrome do worse on the eye task described in this research than matched controls suggesting that theory of mind deficiencies are in fact inherited.

 

 

 

 

Developing a theory of mind allows an individual to begin to understand other people, and to predict what other people are likely to do and believe. It is the ability to think about other peoples, or one's own thoughts.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Baron-Cohen et al argue that second order test can not be used as a demonstration that adults with autism and Asperger syndrome have an intact theory of mind because such tests have a ceiling effect. They have a ceiling effect because children with normal intelligence can pass such tests at about 6 years of age. In other words, these tests only measure as high as the skills of a normal 6 year old child.

 

 

 

 

 

 

Below is an example of a physical events strange story task.

 

Two enemy powers have been at war for a very long time. Each army has won several battles, but now the outcome could go either way. The forces are equally matched. However, the Blue army is stronger than the Yellow army in foot soldiers and artillery. But the Yellow army is stronger than the Blue army in air power. On the day of the final battle, which will decide the outcome of the war, there is a heavy fog over the mountains where the fighting is about to occur. Low-lying clouds hang above the soldiers. By the end of the day the Blue army have won.

 

Q: Why did the Blue army win?
Note that participants with autism and Asperger syndrome did not perform worse than ?normal? participants on these non-mentalist (physical) questions. It was the mental state tasks where participants with autism and Asperger syndrome performed less well. The non-mentalist questions are control questions and demonstrate that the participants with autism and Asperger syndrome can comprehend the questions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tourette syndrome is a neurological condition and is characterised by tics, involuntary and uncontrollable sounds and movements. Tourette syndrome is sometimes known as multiple tic disorder or tic spectrum disorder. It is also associated in the majority of cases with other behaviours, notably Obsessional Compulsive Disorder and Attention Deficit Disorder. Coprolalia (involuntary bad language), the most notorious but most misunderstood feature, affects only one person in ten.

 

The researchers note that the reason for using participants with Tourette syndrome was because of the similarities between autism, Asperger syndrome and Tourette syndrome. For example, they are all developmental disorders experienced since childhood, these disorders disrupt normal schooling and normal peer relations, they all have a significant genetic basis and all have been a associated with abnormalities in the frontal region of the brain.

 

 

 

The target word to describe the mental state behind each pair of eyes was generated by four judges (two male and two female). A foil word was selected that was the semantic opposite of the target word. These were then tested on a panel of eight judges (four male and four female). On the target words there was unanimous agreement by all of the raters. The full set of mental state terms (and their foils) is shown below. Note that the mental state terms include both basic and complex mental states.

 

 

 

 

 

 

In order to check the validity of the Eyes Task as a theory of mind task, participants in the two clinical groups (autism or Asperger Syndrome and Tourette syndrome) were also tested on Happe's Strange Stories. In the case of the participants with autism and Asperger Syndrome, this was part of a separate study carried out earlier. It was argued that if the Eyes Task was indeed measuring theory of mind, then performance on the Eyes Task should correlate with performance on Happe's strange stories.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The experimenters calculated that if a participant was simply guessing they would score 15 out of 25. Only 8 participants in the Autistic and Asperger condition performed better than this.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

At first the sample size does not seem large although it would have been difficult to have a much larger sample as high functioning adults are quite rare. However we can consider whether the results of such high functioning people with autism can be generalised to other people with autism.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Although the researchers note that sex differences could be due to genetic or socialisation factors Simon Baron-Cohen has gone on to argue that autism can be seen as an expression of a type extreme maleness which is genetic rather than being due to socialisation.

Home > Cognitive > Baron-Cohen et al. (autism) Study

Baron-Cohen et al. (autism)

Baron-Cohen, S., Jollife, T., Mortimore, C. & Robertson, M. (1997) Another advanced test of theory of mind: evidence from very high functioning adults with autism or Asperger syndrome.

 

Background

This study was investigating whether high functioning adults with autism and Asperger syndrome had deficiencies employing a theory of mind. Earlier research by Simon Baron-Cohen and others had demonstrated that children with autism had difficulties with first and second order tests, such as the Sally Anne test. However further research has suggested that adults with autism and Asperger syndrome can pass such tests.

Further research by Happe has demonstrated that adults with autism and Asperger syndrome had problems passing the strange stories task which involved participants understanding another person?s mental state.

Because the first and second order tests, as well as the strange stories task, were designed for children Baron Cohen et al. developed a new test called the ?Reading the mind in the Eyes Task (or Eyes Task for short). This advanced test aims to discover if high functioning adults with autism and Asperger syndrome do have problems with mind reading which it is argued is related to the ability to employ a theory of mind.

The term autism was originally introduced by the psychiatrist Kanner (1943) to describe a syndrome (a collection of symptoms) he observed in some of his child patients. Kanner identified the key features of autism, which include impairments in social interaction and communication skills, coupled with unusual interest patterns and stereotyped behaviours. He suggested that autism was an inborn defect, as he observed that symptoms were often present from a very young age.

Nowadays autism is characterised by a triad of impairments.

(i) difficulties with social interaction

(ii) difficulties with verbal and non-verbal communication

(iii) a lack of imaginative play. Autistic children also often display a restricted range of activities and interests and obsessive tendencies.

Symptoms in all these areas appear before 36 months of age and some people with autism have additional cognitive difficulties and many are intellectually impaired. Some people with autism have exceptional gifts, termed islets of ability, in one particular area, such as music or art. In most cases autism is a life-long condition, although the patterns of difficulties may change or become less severe as children grow up.

The term autism is now used as a general term to describe a wide spectrum of disorders from Asperger syndrome at one end through to individuals showing severe forms of autism at the other extreme.

Asperger syndrome is a form of autism used to describe people who are usually at the higher functioning end of the autistic spectrum. People with Asperger syndrome usually have fewer problems with language than those with autism, often speaking fluently, though their words can sometimes sound formal or stilted. People with Asperger syndrome do not usually have the accompanying learning disabilities associated with autism; in fact, people with Asperger syndrome are often of average or above average intelligence.

There have been many explanations for the origins of autism and attempts have been made to identify a core deficit which can account for the symptoms of autism.

According to Simon Baron-Cohen the core deficit of autism is the autistic person?s inability to employ a theory of mind. Having a theory of mind is the ability to understand that other people have independent minds of their own. This is therefore a cognitive deficit

Simon Baron-Cohen argues that impairments in the development of a theory of mind may underlie the social, communicative, and imaginative impairments of people with autism since a theory of mind is necessary for normal development in each of these three areas.

Baron-Cohen et al. have demonstrated using first-order tests of theory of mind that children with autism can not employ a theory of mind. An example of a first-order test is the Sally Ann test.

In this test the child is presented with two dolls (Sally and Anne) a marble, a box and a basket. Sally puts her marble in her basket and leaves the room. Anne then moves the marble from the basket to her box. Sally returns and the child is asked ?where will Sally look for the marble??

Baron Cohen et al. found that ?normal? 4 year old children could correctly state that Sally would look in her own basket whereas children with autism found this first-order belief task difficult (they would point to Anne?s box) which suggests that children with autism cannot employ a theory of mind.

However some research has been carried out on adults with autism who have been found to pass this first order theory of mind. Baron-Cohen et al argue though that if an adult with autism can pass this test this does not show that people with autism have an intact theory of mind as such tests could be passed by ?normal? 4 year old children.

Further research has also attempted to contradict Baron-Cohen?s argument, for example some studies have found that adults with Asperger syndrome or with high functioning autism can pass second-order theory of mind tests.

Second order theory of mind tests involve the participant reasoning about what one person thinks about another person?s thoughts. For example in the Sally Anne test this would involve asking the participant ?where does Anne think that Sally will look for the marble?? The correct answer is to say that Anne believes that Sally will look in her own basket. A number of studies have found that people with Asperger syndrome can pass this second order test which can also be passed by 6 year old normal children.

However Baron-Cohen et al. argue that because such test were designed for six year olds they can only demonstrate that the adults tested have theory of mind skills equivalent to those of a six year old. Six year old children with normal intelligence can pass such tests and therefore Baron Cohen et al. note that if an adult with autism of normal intelligence can pass a second order test all we can conclude is that they have an intact theory of mind skills at the level of a 6 year old.

Happe (1994) developed a more advanced theory of mind test called the strange stories task designed for the level of a normal 8-9 year old. This task involved story comprehension, where the key question in the task either concerned a character's mental states (the experimental condition) or physical events (the control condition). It was found that both adults with autism or Asperger syndrome had more difficulty with the mental state task than ?normal? control participants.

Below is an example of a mental state strange story task.

Sarah and Tom are going on a picnic. It is Tom's idea, he says it is going to be a lovely sunny day for a picnic. But just as they are unpacking the food, it starts to rain, and soon they are both soaked to the skin. Sarah is cross. She says, "Oh yes, a lovely day for a picnic alright!"

Is it true, what Sarah says?

Why does she say this?

Baron-Cohen et al argue that participants with autism and Asperger syndrome may have been less successful on the mental state tasks because their theory of mind deficiencies may have led to problems in appreciating some of the mental states employed in the Strange Stories test.

Baron-Cohen et al. developed a new test which is designed for adults ? the ?Reading the Mind in the Eyes Task? or Eyes Task for short. The task involved inferring the mental state of a person just from the information in photographs of a person's eyes. This test aims to assess mind reading and Baron-Cohen et al. argue that this is essentially the same as theory of mind.

 

 

Aim

The main aim of this experiment was to investigate if high functioning adults with autism or Asperger syndrome would be impaired on a theory of mind test called the ?Reading the Mind in the Eyes Task?

The researchers were also interested to find out if females would be better than males on the ?Reading the Mind in the Eyes Task?

 

 

Procedure/Method

Since the independent variable was not manipulated (it was the characteristics of the participants) the method used is a natural or quasi experiment. Quasi experiments take advantage of conditions which occur naturally.

The independent variable is the type of participants used ? participants with high functioning autism or Asperger syndrome, ?normal? participants and participants with Tourette syndrome.

The dependent variable is the performance on the advanced test of theory of mind (eyes task).

Three groups of participants were tested ? participants with high functioning autism or Asperger syndrome, ?normal? adults? and participants with Tourette syndrome.

Group 1 consisted of sixteen participants with high functioning autism or Asperger syndrome. They were all of normal intelligence. There were 13 men and 3 women. The participants were recruited using an advert in the National Autistic Society magazine as well as through clinics.

Group 2 consisted of fifty age-matched controls (25 male and 25 female) with no history of psychiatric disorder and presumed to be of normal intelligence. They were selected randomly from the subject panel held in the University Department.

Group 3 consisted of ten participants with Tourette syndrome recruited from a referral centre in London. These participants were also age matched with groups 1 and 2. There were eight men and two women, mirroring the sex ratio of group 1. They were all of normal intelligence.

All participants in group 1 (autism and Asperger syndrome) and 3 (Tourette syndrome) had been tested and found to be to be able to pass first and second order false belief tasks. This means that any failure on the Eyes Task could be attributed to problems with mind reading problems beyond that of a six year old.

It was expected that only participants in group1 (autism and Asperger syndrome) would be significantly impaired on the eye task.

The Eyes Task, the Strange Stories Task, and the two control tasks were presented in random order, to all participants and they were tested individually in a quiet room either in their own home, in a researcher?s clinic, or at a lab at the University.

The Eyes Task comprises of photographs of the eye region of 25 different male and female faces. The photographs were taken from magazines and were standardised in that they were all black and white, all from the same region of the face (from midway along the nose to just above the eyebrow) and all of the same size.

Each picture was shown for three seconds and participants were given a forced choice question between two mental states printed under each picture. The foil word was always the semantic opposite of the correct word. The Experimenter says to the subject" Which word best describes what this person is feeling or thinking?" The maximum score on this test is 25.

The full set of mental state terms (and their foils) is shown below. Note that the mental state terms include both basic and complex mental states.

To check whether deficits on the Eyes Task were due to other factors, the researchers administered two control tasks to the participants in Group 1 (autism or Asperger syndrome) - the gender recognition task and the basic emotion recognition task.

The Gender Recognition Task involved looking at the same sets of eyes in the experimental task, but this time identifying the gender of the person in each photograph. This is a social judgement without involving mind reading, and allowed the researchers to check if any deficits on the Eyes Task could be attributed to general deficits in face perception, perceptual discrimination, or social perception. This also had a maximum score of 25.

The Basic Emotion Recognition Task (Emotion Task) involved judging photographs of whole faces displaying the basic emotions. This was designed to check whether any deficits on the Eyes Task could be attributed to a deficit in basic emotion expression recognition. Six faces were used, testing the following basic emotions: happy, sad, angry, afraid, disgusted, and surprised.

 

 

Results/Findings

As predicted high functioning adults with autism or Asperger syndrome did have more difficulties with the Eye Task than both ?normal? adults and adults with Tourette syndrome.

Condition Mean score on the Eye Task
Adults with autism or Asperger syndrome 16.3
'Normal' adults 20.3
Adults with Tourette syndrome 20.4

 

It was also found that ?normal? adult males had more difficulties with the Eye Task than ?normal? adult females.

Condition Mean score on the Eye Task
'Normal' males 18.8
'Normal' females 21.8

 

On the Strange Stories Task none of the participants with Tourette syndrome made any mistakes whereas many of those participants with autism and Asperger syndrome had difficulties with this task.

On the Gender and Emotion Control Tasks, there were no differences between the groups.

 

 

Evaluation of Method/Procedure

The main strength of this experiment is the control of variables. Variables were controlled such as intelligence, sex and developmental disorders. The researchers were able to ensure that the differences between the scores of the three groups of participants were something to do with being autistic.

Furthermore the experiment was standardised in the way that every participant was tested in the same way. The use of standardised procedures in the way the photographs were presented ensured that the researchers could claim with some certainty that the independent variable which is the characteristics of autism was causing the dependent variable that is performance on the Eye Task.

The experiment also collected quantitative data in the form of scores on the Eye Tasks enabling the researchers to carry out sophisticated statistical analysis of the results.

It is possible to question the ecological validity of the experiment. Some of the participants were tested at a lab in a University and this strange situation may have had an effect on performance. Probably more importantly the Eye Task test can be questioned as it is an unusual task which is much simpler than the demands of real live social situations. For example in the real world stimuli are not static. The researchers do recognise this lack of ecological validity and provide anecdotal evidence that many of the participants with autism or Asperger syndrome find watching films difficult because they find it hard to understand the intentions or motives of the characters in the films.

The validity of the Eyes Task can be questioned. That is, is the Eye Task may not be actually measuring theory of mind. However, the researchers defend the validity in a number of ways. First, the target words are actual mental state terms. Secondly, these are not just emotion terms, but include terms describing cognitive mental states. This is therefore more than just an emotion perception test. Thirdly, the pattern of results from the Eyes Task mirrored the pattern of performance on the Happ? Strange Stories task - an existing advanced theory of mind task. Finally, the deficit on the Eyes Task was not mirrored on the two control tasks, suggesting that the poor performance by participants with autism or Asperger syndrome was not due to the stimuli being eyes, or to a deficit in extracting social information from minimal cues, or to a subtle perceptual deficit, or to basic emotion recognition. The researchers also noted that some of the participants with autism or Asperger syndrome had university degrees, yet scored poorly on the Eyes Task suggesting s this aspect of social cognition is independent of general intelligence.

 

 

Explanations

Baron-Cohen et al argue that the results of the study provide experimental evidence for subtle theory of mind deficits in individuals with autism or Asperger syndrome. They argue that the core deficit involved in Autism is the lack of an advanced theory of mind.

According to the researchers the finding of an impairment on the Eyes Task mirrors other difficulties that have been found in autism in relation to understanding the mentalistic significance of the eyes. For example, toddlers with autism have joint attention deficits, thought to reflect a failure to interpret gaze direction as a cue to the mental state of attention. Young children with autism have also been found to have difficulty in interpreting direction of gaze in terms of a person?s goals or desires and in terms of their intention to refer. They are also relatively blind to the importance of gaze direction as a cue to when someone is thinking.

Although there are a number of criticisms of Baron-Cohen?s explanations perhaps one of the strongest criticisms has come from people with autism. Many blogs written by people with autism note that we should recognise that studies such as this are providing us with a non-autistic person?s explanation of autism. The world of an autistic person may be very different from the world of a non autistic person and thus many autistic people do not accept Baron-Cohen et al. explanations.

The researchers also cautiously note that there may be sex differences in the rate of development of theory of mind in early childhood and that this may be the cause of female superiority in language development and male superiority in spatial skills.