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.     

Recognition of ‘Fortune of Others’ Emotions in Asperger Syndrome and High Functioning Autism

'Fortune of others' emotions, such as envy and gloating over the other's misfortune, are complex emotions experienced in situations where events are presumed to be desirable or undesirable for another person. The present paper explores the notion that individuals with AS and HFA are impaired in understanding of envy and gloating. We tested the ability of adults with AS/HFA to understand envy and gloating and compared their performance to that of age-matched healthy controls. The 'fortune of others' emotion task and an additional theory-of-mind (ToM) task were based on a task designed to assess ToM on the basis of eye gaze direction. Individuals with AS and HFA showed no difficulty on basic ToM conditions, but were impaired in their ability to identify envy and gloating. Furthermore, the ability to recognize these emotions was related to scores on a self-rating scale of perspective-taking ability and the ToM task.     

Recognition of Faux Pas by Normally Developing Children and Children with Asperger Syndrome or High-Functioning Autism

Most theory of mind (ToM) tests are designed for subjects with a mental age of 4–6 years. There are very few ToM tests for subjects who are older or more able than this. We report a new test of ToM, designed for children 7–11 years old. The task involves recognizing faux pas. Study 1 tested 7–9, and 11-year-old normal children. Results showed that the ability to detect faux pas developed with age and that there was a differential developmental profile between the two sexes (female superiority). Study 2 tested children with Asperger syndrome (AS) or high-functioning autism (HFA), selected for being able to pass traditional 4- to 6-year level (first- and second-order) false belief tests. Results showed that whereas normal 9- to 11-year-old children were skilled at detecting faux pas, children with AS or HFA were impaired on this task. Study 3 reports a refinement in the test, employing control stimuli. This replicated the results from Study 2. Some patients with AS or HFA were able to recognize faux pas but still produced them. Future research should assess faux pas production.     

Social Competence Intervention for Elementary Students with Aspergers Syndrome and High Functioning Autism

Despite frequent reports of academic success, individuals with high functioning autism or Aspergers Syndrome (HFA/AS) often manifest deficits in social abilities. These deficits can lead to daily difficulties, and negative long-term outcomes. Deficits in social competency are evident in this population from an early age, as children with HFA/AS present unique challenges relating to peers, interpreting complex contextual cues, and transitioning across settings. A paucity of social interventions exist that target elementary-age children with HFA/AS and their combination of core social competence deficit areas: theory of mind (ToM), emotional recognition, and executive functioning. The current study expanded on the Social Competence Intervention (for adolescents; SCI-A), as detailed in Stichter et al. (J Autism Dev Disorders 40:1067–1079, 2010), by adjusting the curriculum to meet the needs of an elementary population. Results indicate significant improvements on direct assessments measuring theory of mind and problem solving, and parent perceptions of overall social abilities and executive functioning for 20 students, aged 6-10, with HFA/AS. The elementary SCI program appears promising, however, additional replications are necessary including expansion to school settings.     

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.     

Differential activation of the amygdala and the 'social brain' during fearful face-processing in Asperger Syndrome

Impaired social cognition is a core feature of autism. There is much evidence showing people with autism use a different cognitive style than controls for face-processing. We tested if people with autism would show differential activation of social brain areas during a face-processing task. Thirteen adults with high-functioning autism or Asperger Syndrome (HFA/AS) and 13 matched controls. We used fMRI to investigate 'social brain' activity during perception of fearful faces. We employed stimuli known to reliably activate the amygdala and other social brain areas, and ROI analyses to investigate brain areas responding to facial threat as well as those showing a linear response to varying threat intensities. We predicted: (1) the HFA/AS group would show differential activation (as opposed to merely deficits) of the social brain compared to controls and (2) that social brain areas would respond to varied intensity of fear in the control group, but not the HFA/AS group. Both predictions were confirmed. The controls showed greater activation in the left amygdala and left orbito-frontal cortex, while the HFA/AS group showed greater activation in the anterior cingulate gyrus and superior temporal cortex. The control group also showed varying responses in social brain areas to varying intensities of fearful expression, including differential activations in the left and right amygdala. This response in the social brain was absent in the HFA/AS group. HFA/AS are associated with different patterns of activation of social brain areas during fearful emotion processing, and the absence in the HFA/AS brain of a response to varying emotional intensity.     

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。     

Narrative Discourse in Adults with High-Functioning Autism or Asperger Syndrome

We report a study comparing the narrative abilities of 12 adults with high-functioning autism (HFA) or Asperger Syndrome (AS) versus 12 matched controls. The study focuses on the use of referential expressions (temporal expressions and anaphoric pronouns) during a story-telling task. The aim was to assess pragmatics skills in people with HFA/AS in whom linguistic impairments are more subtle than in classic autism. We predicted no significant differences in general narrative abilities between the two groups, but specific pragmatic deficits in people with AS. We predicted they use fewer personal pronouns, temporal expressions and referential expressions, which require theory of mind abilities. Results confirmed both predictions. These findings provide initial evidence of how social impairments can produce mild linguistic impairments.     

Asperger's syndrome and autism: neurocognitive aspects

The objectives of this study were to see: (1) whether children with Asperger's Syndrome (AS) have similar neurocognitive deficits compared to nonretarded, or high-functioning autistic (HFA) children; and (2) whether the essential cognitive deficit among these children is in language or abstract problem solving. Subjects with AS, HFA, and a control group of socially impaired child psychiatric outpatient controls (OPC) were compared on a battery of neuropsychological tests. The results indicated that the AS and HFA groups differed little but that large differences from the OPC were observed on all tests. When the AS and HFA with FSIQ above 85 were compared to the OPC, outstanding deficits on motor coordination, language comprehension, and facial recognition were observed. Finally, some evidence is presented to suggest that the pattern of deficits of AS and HFA subjects varied by developmental level. The implications of these results for a neurological theory of autism are discussed.     

Inference processing in adolescents with Asperger syndrome: Relationship with theory of mind abilities

The aim of this study was to investigate the role of theory of mind competence in inference processing in adolescents with Asperger syndrome (AS). We sought to pinpoint the level at which AS individuals experience difficulty drawing inferences and identify the factors that account for their inference-drawing problems. We hypothesized that this difficulty could be related to a theory of mind (ToM) deficit. To test this hypothesis, we conducted an experiment investigating the processing of causal, predictive and pragmatic inferences. Participants also performed a second-order false-belief task. Ten adolescents with AS and ten controls matched for age, sex and verbal IQ took part in the study. Results indicated that the individuals with AS had greater difficulty processing inferences (both semantic and pragmatic) than the controls and that ToM could subtend inference-drawing. The findings are discussed in the light of the two main psychological theories: theory of mind and weak central coherence.     

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.     

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.     

The Empathy Quotient: An Investigation of Adults with Asperger Syndrome or High Functioning Autism, and Normal Sex Differences

Empathy is an essential part of normal social functioning, yet there are precious few instruments for measuring individual differences in this domain. In this article we review psychological theories of empathy and its measurement. Previous instruments that purport to measure this have not always focused purely on empathy. We report a new self-report questionnaire, the Empathy Quotient (EQ), for use with adults of normal intelligence. It contains 40 empathy items and 20 filler/control items. On each empathy item a person can score 2, 1, or 0, so the EQ has a maximum score of 80 and a minimum of zero. In Study 1 we employed the EQ with n = 90 adults (65 males, 25 females) with Asperger Syndrome (AS) or high-functioning autism (HFA), who are reported clinically to have difficulties in empathy. The adults with AS/HFA scored significantly lower on the EQ than n = 90 (65 males, 25 females) age-matched controls. Of the adults with AS/HFA, 81% scored equal to or fewer than 30 points out of 80, compared with only 12% of controls. In Study 2 we carried out a study of n = 197 adults from a general population, to test for previously reported sex differences (female superiority) in empathy. This confirmed that women scored significantly higher than men. The EQ reveals both a sex difference in empathy in the general population and an empathy deficit in AS/HFA.     

Somatic engagement alters subsequent neurobehavioral correlates of affective mentalizing

Socio‐emotional encounters involve a resonance of others'' affective states, known as affect sharing (AS); and attribution of mental states to others, known as theory‐of‐mind (ToM). Empathy necessitates the integration of both processes, yet their interaction during emotional episodes and subsequent generation of inferences on others'' affective states has rarely been tested. To address this, we developed a novel experimental design, wherein we manipulated AS by presenting nonverbal emotionally negative movies twice—each time accompanied by one of two soundtracks that accentuated either somatic cues or externally generated sounds. Movies were followed by questions addressing affective‐ToM (emotional inferences), cognitive‐ToM (inferences on beliefs and knowledge), and non‐ToM aspects. Results revealed a neural differentiation between AS, affective‐ToM, and cognitive‐ToM. AS movies activated regions that have been implicated in emotional (e.g., amygdala) and somatosensory processing, and synchronized brain activity between participants in the latter. Affective‐ToM activated the middle insula, limbic regions, and both ventral and dorsal portions of the medial prefrontal cortex (ventral medial prefrontal cortex [VMPFC] and dorsal medial prefrontal cortex [DMPFC], respectively), whereas cognitive‐ToM activated posteromedial and lateral–prefrontal and temporal cortices. Critically, AS movies specifically altered neural activation in AS and ToM‐related regions during subsequent affective‐ToM inferences, most notably in the DMPFC. Moreover, DMPFC–VMPFC connectivity correlated with affective‐ToM accuracy, when such questions followed AS movies. Our results associate empathic processes with designated neural activations and shed light on how neuro‐behavioral indices of affective ToM are shaped by preceding somatic engagement.     

Brief report: Thought disorder in asperger syndrome: Comparison with high-functioning autism

Asperger syndrome (AS) is a pervasive developmental disorder generally regarded as a variant of autism. While it has been included in the ICD-10 and DSM-IV as a distinct diagnostic entity, it is still unclear to what extent it differs from highfunctioning autism (HFA). Persons with HFA have been reported to show a variety of deficits of thought processes. Abnormalities such as poor reality testing, perceptual distortions, and areas of cognitive slippage have been described using the Rorschach inkblot test (Dykens, Volkmar, & Glick, 1991). Since AS has been conceptualized as a mild variant of autism, we hypothesized that persons with AS will have fewer abnormalities on the Rorschach test compared to persons with HFA. To test this hypothesis, we compared 12 subjects with AS (ICD-10, 10 male, mean age = 12.2±3.3 years, mean full-scale IQ = 99.6) with 8 subjects with HFA (ICD-10/DSM-III-R, 7 male, mean age = 12.2±3.8 years, mean fullscale IQ = 83.4) on the Rorschach test. AS subjects demonstrated a trend towards greater levels of disorganized thinking than the HFA group. They were also more likely to be classified as Introversive suggesting that AS subjects may have more complex inner lives involving elaborate fantasies. Also, AS subjects tended to be more focused on their internal experiences. However, overall, the Rorschach test was not found to differentiate the two diagnostic groups on the majority of structural variables. Implications of these findings are discussed with regard to the diagnostic validity of Asperger syndrome.     

The Autism-Spectrum Quotient (AQ) in Japan: A Cross-Cultural Comparison

The AQ (Autism-Spectrum Quotient) is a self-administered instrument for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. The AQ was administered in Japan to test whether the UK results would generalize to a very different culture. Three groups of subjects, adults with AS or HFA (n=57), adult controls (n=194), and University students (n=1050) were assessed. The adults with AS/HFA had a mean AQ score which was significantly higher than both the controls and the University students. Among the controls, males scored significantly higher than females. The similarity of results in both the general population and the clinical group across the two cultures was remarkable.     

Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism

Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people’s thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition.     

Neural processing associated with cognitive and affective Theory of Mind in adolescents and adults

Theory of Mind (ToM) is the ability to attribute thoughts, intentions and beliefs to others. This involves component processes, including cognitive perspective taking (cognitive ToM) and understanding emotions (affective ToM). This study assessed the distinction and overlap of neural processes involved in these respective components, and also investigated their development between adolescence and adulthood. While data suggest that ToM develops between adolescence and adulthood, these populations have not been compared on cognitive and affective ToM domains. Using fMRI with 15 adolescent (aged 11-16 years) and 15 adult (aged 24-40 years) males, we assessed neural responses during cartoon vignettes requiring cognitive ToM, affective ToM or physical causality comprehension (control). An additional aim was to explore relationships between fMRI data and self-reported empathy. Both cognitive and affective ToM conditions were associated with neural responses in the classic ToM network across both groups, although only affective ToM recruited medial/ventromedial PFC (mPFC/vmPFC). Adolescents additionally activated vmPFC more than did adults during affective ToM. The specificity of the mPFC/vmPFC response during affective ToM supports evidence from lesion studies suggesting that vmPFC may integrate affective information during ToM. Furthermore, the differential neural response in vmPFC between adult and adolescent groups indicates developmental changes in affective ToM processing.     

Cognitive variability in adults with ADHD and AS: Disentangling the roles of executive functions and social cognition

Attention-deficit/hyperactivity disorder (ADHD) and Asperger's Syndrome (AS) share a heterogeneous cognitive profile. Studies assessing executive functions (EF) and social cognition in both groups have found preserved and impaired performances. These inconsistent findings would be partially explained by the cognitive variability reported in these disorders. First, the present study explored the inter-individual variability in EF and social cognition in both patient groups. Second, we compared differential characteristics and commonalities in the cognitive profiles of EF and social cognition between ADHD, AS and control adults. We assessed 22 patients with ADHD, 23 adults with AS and 21 matched typically developing subjects using different measures of EF (working memory, cognitive flexibility and multitasking) and social cognition (theory of mind and decision-making). Group comparisons and multiple case series analyses (MCSA) were conducted. The between-group comparisons showed an EF deficit in working memory in ADHD and a theory of mind (ToM) impairment in AS. The MCSA evidenced that, compared to controls, ADHD patients had a higher inter-individual variability in EF, while individuals with AS had a more heterogeneous profile in social cognition tasks compared to both groups. Finally, the AS and ADHD groups presented higher task-related variability compared to controls and shared a common heterogeneous profile in EF. This is the first study to compare variability in EF and social cognition profiles of ADHD and AS. We propose that heterogeneity in EF performance is a link between ADHD and AS which may explain the overlap of symptomatology between both diagnoses. In addition, patients with AS seem to show a unique heterogeneous profile in ToM which may explain the low probability of finding AS symptoms in patients with ADHD.     

Reading minds versus following rules: dissociating theory of mind and executive control in the brain

The false belief task commonly used in the study of theory of mind (ToM) requires participants to select among competing responses and inhibit prepotent responses, giving rise to three possibilities: (1) the false belief tasks might require only executive function abilities and there may be no domain-specific component; (2) executive control might be necessary for the emergence of ToM in development but play no role in adult mental state inferences; and (3) executive control and domain-specific ToM abilities might both be implicated. We used fMRI in healthy adults to dissociate these possibilities. We found that non-overlapping brain regions were implicated selectively in response selection and belief attribution, that belief attribution tasks recruit brain regions associated with response selection as much as well-matched control tasks, and that regions associated with ToM (e.g., the right temporo-parietal junction) were implicated only in the belief attribution tasks. These results suggest that both domain-general and domain-specific cognitive resources are involved in adult ToM.