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Autism: More Than Meets the Eye

A close up of a young girl's eyeAutism spectrum disorder (ASD) is a wide spectrum, ranging from those with severe disabilities to highly functioning autism. Also, there are multiple subtypes of autism. Nevertheless, there are some common threads. People who are diagnosed with ASD are typically characterized by their early language delays, atypical social behavior, obsessive narrow interests, and repetitive routines. But over and over again, once you take the time to really get to know people on the spectrum, you see there is much more than meets the eye.

Let’s first consider social behavior. It’s true that the social behaviors of people with ASD are different. They typically include lack of eye contact and lack of spontaneous greetings and farewells, limited use of facial expressions and gestures, and speech that is flat in affect, unusual in rhythm, and often described as “robotic.” People with ASD report less interest and intrinsic enjoyment in engaging in social activities, and they are also less likely to care about managing their social impressions. One study found that people with ASD were less likely to laugh with other people for the purposes of facilitating social bonding, although they were just as likely as controls to spontaneously laugh at their own inner thoughts—which can come across as inappropriate in social situations.

But what are we to make of these findings? Some researchers focus on impairment, arguing that the atypical social behaviors among people with ASD are due to a lack of social motivation, empathy, or the ability to take the mental perspective of others (theory of mind). But I don’t believe these explanations tell the full story. The Austrian physician Hans Asperger noticed among his patients with ASD many years ago that they had a “surprisingly accurate and mature observation about people.” More recent research confirms that people with ASD do not differ from typically developing individuals in the intensity of their emotional reactions in response to the emotions of others (for instance, as when seeing a picture of an upset woman in a hospital room). Research also suggests that people with ASD are just as able as typically developing individuals to recognize basic facial expressions and reason about social information.

Also, multiple autobiographical accounts from people with high-functioning autism reveal feelings of loneliness and a strong desire to make meaningful friends. Many of these individuals work in occupations that require high levels of empathy and social connection, such as occupational therapy, nursing, general medical practice, and teaching and caregiving.

While people with ASD do tend to report less interest in engaging in superficial social activities, their attachment system and sex drive are intact. A recent study found that college students with “autistic-like traits” tended to report lower interest in short-term sexual liaisons and are much more interested in partner-specific investment and commitment to long-term romantic relationships. Therefore, people with ASD may just be more interested in forming meaningful, long-lasting relationships than fleeting flings. In this sense, people with ASD tend to resemble people who are highly introverted in that those who score high in either tend to find lower social reward in interacting with new people than those scoring higher on measures of extraversion. Indeed, ASD and introversion are extremely strongly correlated with each other.

When it comes to the “disorder” part of autism spectrum disorder (ASD), it seems there’s more going on than meets the eye.

An alternative perspective, which has gained a lot of research support in recent years, is that autism is merely a different way of processing incoming information rather than an impairment. Individuals with ASD have a greater attention to detail and tend to adopt a bottom-up strategy—they first perceive the parts of an object and then build up to the whole. As Uta Frith puts it, people with autism have difficulty “seeing the forest for the trees.” There is neurological evidence that the unique mind of the person with ASD is due in part to an excessive number of short-distance, disorganized local connections in the prefrontal cortex (required for attention to detail) along with a reduced number of long-range or global connections necessary for integrating information from widespread and diverse brain regions. As a result, people with high-functioning autism tend to have difficulty switching attention from the local to the global level.

This sometimes plays itself out in social communications. People with ASD focus on details in the environment most people find “irrelevant,” which can lead to some awkward social encounters. When people with ASD are shown photographs with social information (such as friends chatting) or movie clips from soap operas, their attention is focused much less on the people’s faces and eyes than the background scenery, such as light switches. Differences among infants in attention to social speech is a robust predictor of later developing social cognition, and a preference for geometric patterns early in life is considered a "risk factor" for autism. These findings are certainly important, considering that an early lack of attention to social information can deprive the developing child of the social inputs and learning opportunities they require to develop expertise in social cognition. It’s likely that from multiple unrewarding social interactions during the course of development, people with ASD learn that social interactions are unrewarding, and retreat even further into themselves.

Kate O’Connor and Ian Kirk argue that the atypical social behaviors found in people with ASD are more likely the result of a processing difference than a social deficit, and may represent a strategy to filter out too much sensory information. Indeed, people with ASD often report emotional confusion during social interactions, in which they interpret expressions, gestures, and body language to mean something different from or even the opposite of what the other person intended. Many people with ASD report that the eye region is particularly “confusing” and “frightening.”

Indeed, the eye region is very complex, transmitting a lot of information in a brief time span. For one thing, it’s always in motion (blinking, squinting, saccadic movement, and so on). But the eye region also can depict a wide range of emotions in rapid succession. It’s likely that over the course of many overwhelming interactions with people in the context of other sensory information coming in from the environment, people with ASD learn to look less at the eye region of faces. People with ASD do frequently report being distracted by sensory information in the environment, including background noise, fluorescent light, shiny objects, body movement, and smells.
 

Compellingly, studies have found that social skills can be significantly increased among people with ASD by giving them explicit instructions to pay attention to social information, increasing the relevance of social information, and increasing their motivation to pay attention to social information. In their book The Unwritten Rules of Social Relationships, Temple Grandin—a highly accomplished professor of animal science who has autism spectrum disorder—and journalist Sean Barron argue that it’s possible for people with ASD to learn strategies they can apply across a wide range of social situations. They note the following ten “unwritten rules of social relationships”:

  1. Rules are not absolute: They are situation-based and people-based.
  2. Not everything is equally important in the grand scheme of things.
  3. Everyone in the world makes mistakes. It doesn’t have to ruin your day.
  4. Honesty is different from diplomacy.
  5. Being polite is appropriate in any situation.
  6. Not everyone who is nice to me is my friend.
  7. People act differently in public than they do in private.
  8. Know when you’re turning people off.
  9. “Fitting in” is often tied to looking and sounding like you fit in.
  10. People are responsible for their own behaviors.

There’s even some evidence (although it’s highly tentative) that administration of the neuromodulator oxytocin can increase performance on a range of social cognitive tasks among people with ASD. As Coralie Chevallier and colleagues note, “the underlying competence to process social stimuli may be more spared than previously thought and atypical performance can be accounted for by differences in spontaneous attentional patterns.”

In recent years researchers have developed strength-based models of autism spectrum disorder to stand alongside and complement the traditional deficit model. Both approaches are important: people with ASD deserve the right to receive the resources they require to thrive, but they also deserve to be appreciated for their many strengths. One robust finding is that people with ASD have enhanced perceptual functioning.

People with ASD tend to perform better than people without ASD symptoms on IQ subtests that involve nonverbal fluid reasoning and the segmentation and reconstruction of novel visual designs. Individuals with ASD also perform better than controls on the Embedded Figures Task(EFT), which requires quick detection of a target within a complex pattern. The ASD tendency to see patterns as collections of details instead of as wholes helps people with ASD to segment and chunk visual information, freeing up visual working memory resources and allowing them to handle a higher perceptual load than typical adults.

This enhanced attention to detail also manifests itself in restricted interests. Tony Attwood found that all-consuming special interest areas are “a dominant characteristic, occurring in over 90 percent of children and adults with AS.” While most people may find it difficult to understand why anyone could possibly be so intensely fascinated with yellow pencils, pinball machines, paper bags, globes and maps, industrial fans, and the buttons on shoes, special interest areas have an immense emotional impact on people with ASD and form a core of their identity. It just so happens that these individuals often find themselves in a culture that doesn’t value their highly specialized passions. As Uta Frith points out, “A child who talks about electricity pylons all the time is more likely to be thought oddly fixated than one who talks about horses or football teams.” However, one can imagine an episode of The Twilight Zone where discussions about the latest basketball game get you weird stares in the men's gym locker room full of Aspys.

Mary Ann Winter-Messiers explored the impact of special interest areas (SIAs) among children with Asperger’s syndrome. She defined special interest areas as “passions that capture the mind, heart, time, and attention of individuals with AS [Asperger’s syndrome], providing the lens through which they view the world.” Her research team interviewed 2 girls and 21 boys with Asperger’s syndrome (aged 7 to 21) about their special interest areas. All of the participants talked enthusiastically about their areas at length and displayed extensive professional knowledge of their area that went way beyond what would be expected based solely on their ages. Major themes included transportation, music, animals, solitary sports (such as swimming), video games (such as role-playing games), fantasy motion pictures (Star Wars, vampire movies), woodworking, and art (Anime, Manga, sculpting). Many children used video games as a way to socially bond with others with similar interests.

As the researchers conducted their interviews, it became clear that the SIAs of people with Asperger’s were inextricably linked to their self-images. While the participants reported having a negative self-image in virtually every other area of their lives, they said that when they engaged in their special area they felt positive emotions, including enthusiasm, pride, and happiness. They also reported feeling more competent, in control, and self-confident. At the same time, the participants were hesitant about telling others about their area of interest out of fear of rejection, and many of the participants expressed frustration at being misunderstood. As one participant noted, “Well, if they’re not interested, I don’t really talk about airplanes at all . . . I just wish they’d think planes were cool.”

The researchers also noticed a distinct shift in speech patterns—including affect and animation—when participants shifted from any topic to talking about their special interest area. They noted a marked increase in the complexity of their responses and the sophistication of their vocabulary, word order, and syntax. For example, one participant named Charlie responded to general questions with “Uh, I don’t think so, just whatever,” but when he was asked about his favorite thing to play with, he suddenly became alive: “My favorite is a Yu-Gi-Oh! Card that combines with three Blue-Eyed White Dragons, and due to polymerization it forms those three into a three-headed dragon.”

In fact, the research team consistently observed that many of the so-called “impairments” of the participants diminished considerably when they talked about their SIA, including significant reductions in stress, self-stimulation, distraction, and body movement. They also observed heightened sensitivity to subtle social cues, eye contact, and expressive gestures. For instance, one participant only gave monosyllabic and repetitive answers to questions, but when the interviewer acknowledged his interest in trains, he suddenly made direct eye contact and came alive. The interviewer wrote that “he got so excited that you could barely understand his excited and hurried words.”

Also, while many of these children were thought to be “severely challenged” by intense sensory stimulation, they were able to persevere for hours at a time in their interactions with model airplane glue, modeling clay, horse manure, goat odors, sawdust, sweat, sticky or dirty hands, drum beats, and the bright lights, rapid movements, and loud, startling sounds of video games.

Winter-Messiers concluded that parents and educators should be more welcoming and encouraging of special interest areas because they form such a vital part of the self-image and motivation of children with Asperger’s. She notes that students can benefit from engagement of their special interest to deal with negative emotions, reduce anxiety, and calm themselves in stress- ful situations. She made a call for educators to finally take special interest areas (SIAs) seriously and see them “for the gold mine they are in helping our students progress toward their academic, social, emotional, communication, and behavioral goals.”

Winter-Messiers and colleagues argue that the first step toward increasing engagement is for teachers to discover their students’ areas of academic strength and consider how the curriculum can be modified to incorporate the student’s special interest area. For math, this can be as easy as placing stickers on a worksheet or working their area of interest into story problems. According to these researchers, “there is no limit to what they can accomplish when they are appropriately encouraged to use their SIAs [special interest areas] to improve their academic and social pursuits.”

They also point to crucial applications at home, in the community, and in the workforce. Again, Asperger was well ahead of his time when he noted that “we can see in the autistic person, far more clearly than with any normal child, a predestination for a particular profession from earliest youth. A particular line of work often grows naturally out of his or her special abilities.” Temple Grandin and Kate Duffy echo this sentiment: “Society loses out if individuals with autism spectrum disorders are not involved in the world of work or make other kinds of contributions to society.”

This research clearly shows that ability can grow out of seeming disability. In fact, those who appear to be the most severely disabled often demonstrate the highest levels of performance.

Source: https://blogs.scientificamerican.com/beautiful-minds/autism-more-than-meets-the-eye/

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