Theory of mind, severity of autistic symptoms and parental correlates in children and adolescents with Asperger syndrome

This study addresses the theory of mind (ToM) ability of Asperger's syndrome/high-functioning autism (AS/HFA) children and their parents and the severity of the autistic symptoms. Fifty-three families, each consisting of a mother, father and a child, participated in this study (N=159). The 53 children in the sample included 25 children diagnosed with AS/HFA and 28 typically developing (TD) children. The Social Attribution Task (SAT) and tests assessing autistic symptoms were used. AS/HFA children had lower scores than TD children on three of the SAT indices (Person, ToM Affective, and Salience). Fathers of AS/HFA children did not have lower scores than fathers of TD children on the SAT task, whereas mothers of AS/HFA children had lower scores on the Person index, a pattern similar to seen in their children, suggesting a possible genetic contribution of mothers to ToM deficit in AS/HFA children.     

Children with high functioning autism show increased prefrontal and temporal cortex activity during error monitoring

Evidence exists for deficits in error monitoring in autism. These deficits may be particularly important because they may contribute to excessive perseveration and repetitive behavior in autism. We examined the neural correlates of error monitoring using functional magnetic resonance imaging (fMRI) in 8–12-year-old children with high functioning autism (HFA, n = 11) and typically developing children (TD, n = 15) during performance of a Go/No-Go task by comparing the neural correlates of commission errors versus correct response inhibition trials. Compared to TD children, children with HFA showed increased BOLD fMRI signal in the anterior medial prefrontal cortex (amPFC) and the left superior temporal gyrus (STempG) during commission error (versus correct inhibition) trials. A follow-up region of-interest analysis also showed increased BOLD signal in the right insula in HFA compared to TD controls. Our findings of increased amPFC and STempG activity in HFA, together with the increased activity in the insula, suggest a greater attention towards the internally driven emotional state associated with making an error in children with HFA. Since error monitoring occurs across different cognitive tasks throughout daily life, an increased emotional reaction to errors may have important consequences for early learning processes.     

Relationships among Repetitive Behaviors, Sensory Features, and Executive Functions in High Functioning Autism

This study examined the relationship between repetitive behaviors and sensory processing issues in school-aged children with high functioning autism (HFA). Children with HFA (N = 61) were compared to healthy, typical controls (N = 64) to determine the relationship between these behavioral classes and to examine whether executive dysfunction explained any relationship between the variables. Particular types of repetitive behavior (i.e., stereotypy and compulsions) were related to sensory features in autism; however, executive deficits were only correlated with repetitive behavior. This finding suggests that executive dysfunction is not the shared neurocognitive mechanism that accounts for the relationship between restricted, repetitive behaviors and aberrant sensory features in HFA. Group status, younger chronological age, presence of sensory processing issues, and difficulties with behavior regulation predicted the presence of repetitive behaviors in the HFA group.     

Teachers’ perspectives of the sexuality of children with autism spectrum disorders

Individuals with autism spectrum disorders (ASD) experience sexuality issues, but there are very few studies looking at sexuality and autism. The present study aims to examine teachers’ perceptions of sexual behaviors of 56 children with low functioning autism (LFA) and 20 children with high functioning autism (HFA) or Asperger Syndrome (AS). Teachers perceived children with LFA as exhibiting less socially acceptable behaviors, as possessing lessened awareness of privacy related rules, and as having more limited knowledge of typical sexual responses and behaviors in comparison to children with HFA or AS. However, teachers expressed more concerns for children with HFA or AS. These findings should be taken into consideration when designing intervention programs targeting sexuality of individuals with ASD.     

Brief report: Should Asperger syndrome be excluded from the forthcoming DSM-V?

Asperger syndrome (AS) is a pervasive developmental disorder, characterized by social impairments and focused, circumscribed interests and activities in the absence of significant language impairment and cognitive delay. Since its inclusion in the DSM-IV, there has been a dramatic increase in its recognition both in children and adults. Some recent studies suggest that there may be differences between AS and high-functioning autism (HFA) on behavioural, cognitive and neurobiological levels. As the majority of studies so far have generally failed to demonstrate a clear distinction between AS and HFA, some researchers have called for eliminating AS from the forthcoming DSM-V. This paper reports some interesting differences between the conditions on different levels and argues for more experimental studies on AS, modifications of its diagnostic criteria, and for its continued retention in the diagnostic manual.     

An Examination of Handedness and Footedness in Children with High Functioning Autism and Asperger Syndrome

Motor control deficits have been documented in children with high functioning autism and Asperger syndrome (HFA/AS), but the extent to which these disorders affect the children's footedness must be delineated. Twelve typically developing (TD) children and 12 children with HFA/AS, ages 6-9?years, were recruited. Motor control skills were assessed through a variety of footedness tasks to determine location and nature of impairment, regarding motor dominance. Overall, greater inconsistencies in dominance arose in children with HFA/AS, through disparities in measures of preference. Results will have broader implications for understanding motor impairments in children with HFA/AS as determined by comparing performance on footedness tasks, as well as for the design of interventions to account for these deficits.     

Visual search for basic emotional expressions in autism; impaired processing of anger,fear and sadness,but a typical happy face advantage

Facial expression recognition was investigated in 20 males with high functioning autism (HFA) or Asperger syndrome (AS), compared to typically developing individuals matched for chronological age (TD CA group) and verbal and non-verbal ability (TD V/NV group). This was the first study to employ a visual search, “face in the crowd” paradigm with a HFA/AS group, which explored responses to numerous facial expressions using real-face stimuli. Results showed slower response times for processing fear, anger and sad expressions in the HFA/AS group, relative to the TD CA group, but not the TD V/NV group. Reponses to happy, disgust and surprise expressions showed no group differences. Results are discussed with reference to the amygdala theory of autism.     

孤独症和Asperger综合征儿童的心灵理论对照研究

目的探讨孤独症和Asperger综合征(AS)儿童的心理推测能力。方法应用表情识别和虚假信念课题分别对21例高功能孤独症(HFA)儿童、54例AS儿童和70名正常健康儿童进行测试。结果表情识别题中, HFA组通过率明显低于正常组(P<0．01),AS组与正常组无显著差异;虚假信念题通过率为正常儿童组>AS组> HFA组(P<0．01)。结论 HFA和AS儿童基本能识别简单表情,但存在理解虚假信念的缺陷,说明他们的心理推测能力低下。     

Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism

OBJECTIVE: To describe the clinical characteristics of children given a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) by expert clinicians and to compare these to the clinical characteristics of children given a diagnosis of autism and Asperger syndrome (AS). METHOD: Two hundred sixteen children with autism, 33 with AS, and 21 with PDD-NOS were compared on measures of level of functioning (communication, daily living and social skills, IQ, and age of acquisition of language) and on various symptoms of autism (impaired communication and reciprocal social interaction and a preference for repetitive and stereotyped activities). RESULTS: In terms of level of functioning measures, the PDD-NOS children had scores that were between those of the children with autism and those of the children with AS. In contrast, the PDD-NOS group had fewer autistic symptoms, especially repetitive stereotyped behaviors, than both the autism and AS groups (chi2 = 11.06, p =.004). Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors. CONCLUSIONS: With some revision to current diagnostic criteria, a more homogenous atypical group with significant impairments in social-communication but fewer repetitive behaviors can be differentiated from the more nonspecific PDD-NOS group. This differentiation may lead to better reliability in diagnosis and to further progress in studies of etiology.     

Obsessive-compulsive behaviors in parents of multiplex autism families

Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive-compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive-compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive-compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive-compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies.     

Social and non-social deficits in children with high-functioning autism and their cooperative behaviors

The persistent deficits in social communication and social interactions of individuals with high-functioning autism (HFA) may impair their cooperative behaviors. This study investigated the relationship between social and non-social deficits in children with HFA and the cooperative behaviors of such children. Theory of mind (ToM), executive function, and central coherence of children with HFA and typically developing (TD) children, aged 6–12 years, were investigated, and the effects of these social and non-social deficits on children's cooperativeness were examined. The classical prisoner's dilemma game (PDG) and cooperative implemental tasks were used to assess children's cooperativeness. ToM was measured using a series of classical false belief tasks and the face test. The Wisconsin Card Sorting Task (WCST) and the Embedded Figures Test (EFT) were administered to assess executive function and central coherence, respectively. The results showed that there was no significant difference in cooperation in PDG between HFA and TD children, while cooperation in children with HFA in the interruption period of the implemental tasks was significantly lower than that of TD children. Children with HFA had social deficits and had more poorly developed ToM than TD children, and executive function in children with HFA was poorer than that in TD children. Different types of deficits were predictive of HFA children's degree of cooperation on different tasks: the social perceptual component of ToM and executive function predicted children's cooperativeness in the PDG, and executive function predicted HFA children's cooperativeness during the interruption period of an implemental task. By contrast, central coherence did not predict either of the two types of cooperation. It might indicate that the two different types of cooperative tasks may require different mental abilities.     

A Comparison of Repetitive Behaviors in Aspergers Disorder and High Functioning Autism

In this study we compared 33 IQ and age matched pairs of individuals with Aspergers Disorder (ASP) and high functioning autism (HFA) on measures of repetitive behavior. On the Repetitive Behavior Scale-Revised (RBS-R), the ASP and HFA groups showed no differences in RBS-R Intensity score (severity) score or Frequency score (number of problems present). This suggests that the two groups are similar with respect to␣the intensity or severity of repetitive behaviors and the presence of repetitive behaviors. At the item level there were no differences on scales typically associated with autism (Stereotyped Behavior) and ASP (Restricted Interests). Similarly, there were no differences between the groups on the Aberrant Behavior Checklist Stereotypy scale. These findings add to the body of literature showing that HFA and ASP fail to differ with respect to repetitive behaviors. The implications of the findings for neurobiologic and genetic studies are discussed.     

A Comparative Study of the Use and Understanding of Self-Presentational Display Rules in Children with High Functioning Autism and Asperger’s Disorder

The use and understanding of self-presentational display rules (SPDRs) was investigated in 21 children with high-functioning autism (HFA), 18 children with Asperger's disorder (AspD) and 20 typically developing (TD) children (all male, aged 4- to 11-years, matched on mental age). Their behaviour was coded during a deception scenario to assess use of SPDRs; understanding of SPDRs was assessed via three real/apparent emotion-understanding vignettes. The children with HFA and AspD used less effective SPDRs than the TD children, but there were no group differences in understanding SPDRs. The children with HFA and AspD did not differ on their use or understanding of SPDRs, and the results are discussed in relation to the similarities and differences between these diagnostic conditions.     

Brief Report: Cognitive Flexibility and Focused Attention in Children and Adolescents with Asperger Syndrome or High-Functioning Autism as Measured on the Computerized Version of the Wisconsin Card Sorting Test

The aim of the present study was to assess mental flexibility and set maintenance of a group of individuals with Asperger syndrome (AS) or high-functioning autism (HFA) (N = 13; mean age 16,4), as compared with a matched group of typically developing children and adolescents (N = 13; mean age 15,6) on the computerized version of the Wisconsin Card Sorting Test (WCST). The participants in the AS/HFA group performed less well than the controls on all categories of the WCST, but the differences did not reach conventional statistical significance on most categories of the WCST. On the category failure to maintain set, however, the AS/HFA participants performed significantly less well than the controls, suggesting a deficit of focused attention.     

Residual Difficulties with Categorical Induction in Children with a History of Autism

In two experiments, typically developing (TD) children, high-functioning children with autism (HFA) and children with a history of autism who have achieved optimal outcomes (OOs), matched on age (M = 13 years) and nonverbal IQ, were asked to extend properties of categories to new items (categorical induction). All groups demonstrated some knowledge of category structure by extending at above-chance levels; however, the TD group extended more consistently than the OO and HFA groups. More consistent extenders had higher lexical and nonverbal IQ scores (Experiment 1) or higher pragmatics scores (Experiment 2). Thus, even very high functioning individuals with autism, or with an OO, still exhibit residual difficulties with category knowledge and extension; moreover, category tasks relate to a variety of verbal and nonverbal abilities. The difficulty these groups had with categorical induction may be related to their difficulty with generalization more widely; future research should investigate this possibility.     

Restricted and Repetitive Behaviors in Individuals with a History of ASDs Who Have Achieved Optimal Outcomes

Studies of autism spectrum disorders (ASDs) suggest that restricted and repetitive behaviors (RRBs) are particularly difficult to remediate. We examined present and past RRBs in 34 individuals who achieved optimal outcomes (OOs; lost their ASD diagnosis), 45 high-functioning individuals with ASD (HFA) and 34 typically developing (TD) peers. The OO group exhibited minimal residual RRBs at the time of the study. All OO participants were reported to have at least one RRB in early childhood and almost 90 % met the RRB cutoff for ASD in early childhood, but RRBs were not more present in the OO than the TD group at the time of the study. History of RRBs in the HFA and OO groups differed only in oversensitivity to noise and insistence on sameness. Reports of current behavior indicated that RRB’s had almost totally disappeared in the OO group. Thus, although RRB’s were present in the OO group in childhood, they resolved along with social and communication deficits.     

Brief Report: The Impact of Subcortical Band Heterotopia and Associated Complications on the Neuropsychological Functioning of a 13-year-old Child

Motor impairment in children with Asperger syndrome (AS) or high functioning autism (HFA) has been reported previously. This study presents results of a quantitative assessment of neuromotor skills in 14–22 year old HFA/AS. Sixteen HFA/AS and 16 IQ-matched controls were assessed by the Zurich Neuromotor Assessment (ZNA). The HFA/AS group showed strongest impairments of dynamic balance skills and diadochokinesis. Motor abilities were associated with degree of social withdrawal in the full sample and severity of current autistic symptoms in the HFA/AS group. Similar motor patterns as in younger children were found in the older adolescents. The association of autistic symptoms with motor performance points towards an essential role of motor impairment in autism spectrum disorders.     

Repetitive and Stereotyped Behaviors in Children with Autism Spectrum Disorders in the Second Year of Life

This study examined repetitive and stereotyped behaviors (RSB) in children with autism spectrum disorders (ASD, n = 50), developmental delays without ASD (DD; n = 25) and typical development (TD, n = 50) between 18 and 24 months of age. Children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects, body, and sensory behaviors during a systematic behavior sample than both the DD and TD groups. RSB with objects were related to concurrent measures of symbolic capacity and social competence in the second year and predicted developmental outcomes as well as severity of autism symptoms at 3 years in children with communication delays. RSB in the second year appear to be important for early identification and prediction of developmental outcomes.     

How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism

Conversation is a primary area of difficultly for individuals with high-functioning autism (HFA) although they have unimpaired formal language abilities. This likely stems from the unstructured nature of face-to-face conversation as well as the need to coordinate other modes of communication (e.g. eye gaze) with speech. We conducted a quantitative analysis of both verbal exchange and gaze data obtained from conversations between children with HFA and an adult, compared with those of typically developing children matched on language level. We examined a new question: how does speaking about a topic of interest affect reciprocity of verbal exchange and eye gaze? Conversations on generic topics were compared with those on individuals’ circumscribed interests, particularly intense interests characteristic of HFA. Two opposing hypotheses were evaluated. Speaking about a topic of interest may improve reciprocity in conversation by increasing participants’ motivation and engagement. Alternatively, it could engender more one-sided interaction, given the engrossing nature of circumscribed interests. In their verbal exchanges HFA participants demonstrated decreased reciprocity during the interest topic, evidenced by fewer contingent utterances and more monologue-style speech. Moreover, a measure of stereotyped behaviour and restricted interest symptoms was inversely related to reciprocal verbal exchange. However, both the HFA and comparison groups looked significantly more to their partner's face during the interest than generic topic. Our interpretation of results across modalities is that circumscribed interests led HFA participants to be less adaptive to their partner verbally, but speaking about a highly practiced topic allowed for increased gaze to the partner. The function of this increased gaze to partner may differ for the HFA and comparison groups.     

Social attribution in children with high functioning autism and Asperger syndrome: An exploratory study in the Chinese setting

The present study aimed to examine social attribution in children with high-functioning autism (HFA) and Asperger's syndrome (AS). A sample of 20 boys (9 with HFA and 11 with AS) and 20 age-matched controls were recruited for this study. All participated in two tasks measuring social attribution ability, the conventional Social Attribution Task (SAT) and a modified version with animals rather than shapes (mSAT). They also completed a battery of neuropsychological tests. Compared to typically developing controls, children with autism spectrum disorders were impaired on some measures in both SATs. However, group differences in ‘theory-of-mind’ indices were only significant in the mSAT, with the ASD group performing more poorly than controls. In addition, the scores in person index of both versions of the SAT correlated with executive function in children with HFA/AS. The current study found the mSAT paradigm was especially sensitive to ToM difficulties in young Chinese children with HFA/AS. Social attribution in children with HFA/AS, unlike neurotypical children, was related to executive function ability, suggesting these psychological domains are not distinct in children with autism spectrum disorders.