From SFARI: 

Diagnosis of autism is based on a core set of symptoms in each of three domains — social interest, language ability and repetitive behaviors — and differences among individuals with the disorder are often considered a question of degree. But the vast diversity of genetic profiles that appear to underlie the disorder often prompts researchers to call it ‘the autisms,’ emphasizing the disorder’s heterogeneity.

In a 2010 study, researchers took thorough medical histories for 252 individuals with autism and performed a statistical analysis to see if certain symptoms are more likely than others to occur together². They identified four categories: sensory problems, immune system issues, neurodevelopmental delay and repetitive behaviors.

In the new study, the same researchers reanalyzed the data from all 252 participants to see whether they are more likely to have symptoms that fall into one category and not the others. The participants cluster into four discrete groups, the study found: those with immune abnormalities, along with sleep disruption and sensory sensitivity, but with little developmental delay; those with sleep and sensory deficits, but no immune abnormalities; those with pronounced repetitive behavior; and those who have a combination of all symptoms described in the other three groups and more severe developmental delay.

Read more here. 

“Because my parents presumed my competence, they included me in the family, they believed I was able to understand what I already knew I could: anything a girl my age would.”

From SFARI:

To better understand the interaction between autism, intellectual disability and language, researchers in the new study compared the language ability of 36 children with both autism and intellectual disability, 26 children with intellectual disability only and 34 typically developing controls. Children were matched on the basis of mental age, independent of language ability. The mean age for children with autism was about 7 years; those with intellectual disability were about 6.5 years old and controls were about 3 years old.

The researchers used a number of measures to rate expressive language, or speaking ability, and receptive language, the ability to understand the speech of others, in each of the children. These measures included both direct tests and parental-report questionnaires.

Overall, children with autism and intellectual disability have lower scores in receptive language than do those with intellectual disability alone, who themselves score lower than controls. There is no statistically significant difference in expressive language between children with autism and intellectual disability compared with children with intellectual disability alone; but, again, both groups score lower than controls.

This suggests that, overall, children with autism have stronger expressive than receptive language skills, whereas this trend is reversed in the other two groups. Specifically, about 34 percent of children with autism and intellectual disability have better expressive compared with receptive language, the study found. By contrast, 54 percent of children with intellectual disability only and 44 percent of controls have better receptive than expressive language.

The researchers also looked at whether the children’s ability to engage the attention of others, called joint attention, and their understanding of symbols was related to their language ability. These two factors account for 81 percent of the variation in receptive language scores and 72 percent of the variation in expressive language scores among the children with autism, the study found. For example, children with autism who have more difficulty with joint attention have lower language scores than those with better joint attention ability.

Fascinating; this highlights the important role of shared or joint attention in the acquisition and functional use of language, both expressive and receptive and supports our assertion that it should be the foundation for assessment and intervention. 

Read the rest here. 

From Science Daily:

The children in the study were randomly assigned to medication alone for six months or medication plus a structured training program for their parents for six months. Parent training included regular visits to the clinic to teach parents how to respond to behavior problems to help children adapt to daily living situations. The study medication, risperidone, is approved for the treatment of serious behavioral problems in children with autism.

“In a previous report from this trial, we showed that the combined treatment was superior to medication alone in reducing the serious behavioral problems,” said Scahill. “In the current report, we show that combination treatment was better than medication alone on measures of adaptive behavior. We note that both groups — medication alone and combined treatment group — demonstrated improvement in functional communication and social interaction. But the combined group showed greater improvement on several measures of everyday adaptive functioning.”

As he posits in this TED Talk, the brain evolved exclusively to control movement, so studying brain functions, such as executive functioning, is futile without also considering how those functions might influence and be influenced by sensory/motor processing. 

This equation is absolutely brilliant, and so beautifully illustrates one of the primary differences we see in kids with sensory processing challenges: without well-integrated, well-coordinated information from the senses, children don’t develop the same richly varied database of information about how things work, including, sometimes, their own bodies. Instead, these intelligent kids compensate by depending on their memory, rather than dynamic in-the-moment processing, which typically presents as rigidity, inflexibility, or “stereotyped” behaviors. Though I’m reluctant to make such a dehumanizing comparison, there’s an analogy to the “brain” of a supercomputer, which is able to maintain a large database of static “rules” to guide specific actions, but flounders when challenged to generalize those rules to a novel variation.

These children are not, of course, automatons, but are using their own best-available strategy to solve the problem of feeling a sense of mastery and control over their own experiences. Unfortunately, this strategy is often insufficient to the demands of moving though an inherently unpredictable and variable world. And so, in the kind of work we do, we typically aim to support the child to develop a more robust and varied database by following their interests, engineering the activity and interaction from the inside to enhance their processing and scaffold their success. 

Here are two articles, both from Science Daily, describing research that demonstrates how poorly standardized tests predict academic ability in kids with autism and Aspergers.  

 IQ Scores Fail to Predict Academic Performance in Children With Autism

New data show that many children with autism spectrum disorders have greater academic abilities than previously thought. In a study by researchers at the University of Washington, 90 percent of high-functioning children with autism spectrum disorders showed a discrepancy between their IQ score and their performance on reading, spelling and math tests.

 (…) 

 Little is known about how these children actually perform in regular classrooms, which has implications for how to assign support services. Since IQ scores in the general population reliably predict academic performance — as measured by standardized tests for word reading, spelling and basic number skills — Estes and her colleagues thought the same would be true in their sample of 30 high-functioning 9 year olds with autism spectrum disorders.

“What we found was astounding: 27 out of the 30 children — that’s 90 percent — had discrepancies between their IQ score and scores on at least one of the academic achievement tests,” Estes said. “Some scored higher and some scored lower than what their IQ score would predict.”

To the researchers’ surprise, 18 of the 30 children tested higher than predicted on at least one of the academic tests. This was especially true for spelling and word reading. Across the three academic tests, 18 of the 30 children scored lower than what their IQs would predict, suggesting a learning disability.”

 These findings shouldn’t be so surprising, given how dependent IQ tests are on receptive and expressive language and, no matter what inter-rater reliability claims can be made, on a positive rapport between tester and student. 

The researchers also didn’t compare IQ and achievement test scores with actual school participation or performance, which would provide a valuable dimension to this picture, especially since they noted a positive correlation between social skills and academic performance. Shared or joint attention is a foundation for both social interactions and the ability to learn implicitly through observation of others.

Read the whole article here. 

Level and Nature of Autistic Intelligence: What About Asperger Syndrome?

(…) Both autistic and Asperger individuals display uneven profiles of performance in commonly used intelligence test batteries such as Wechsler scales, and their strongest performances are often considered evidence for deficits.

However, this study reports that Asperger individuals’ scores are much higher when they are evaluated by a test called Raven’s Progressive Matrices, which encompasses reasoning, novel problem-solving abilities, and high-level abstraction. By comparison, scores for non-Asperger individuals are much more consistent across different tests. Interestingly, Asperger participants’ performance on Raven’s Matrices was associated with their strongest peaks of performance on Wechsler.

(…) 

According to co-author Michelle Dawson, “while we know autistics process information atypically, very little thought has gone into how to fairly assess their abilities. In fact there is so little understanding of what autistics do well that their strong abilities are often regarded as dysfunctional. Here we have again found that measurable strengths in autistic spectrum individuals are not “isolated islets of abilities” as previously thought, but are in fact representative of autistics’ intellectual abilities. This in turn raises questions about how we can provide autistics with the kinds of information they can process well, as we do with non-autistic individuals. We consider the effort to understand and encourage autistic strengths to be of paramount importance. “

Based on these results, the authors emphasize that autistic spectrum intelligence is atypical, but also genuine, general, and underestimated.

Again, these findings should not be so surprising, but really highlight the need to look at the individual differences of each child (i.e. unique strengths and challenges) rather than trying to create a better academic mold in which to stuff all children.    

Read more here. 

From Science Daily: 

Linguists and psychologists have debated how much the parts of the brain that mediate direct sensory experience are involved in understanding metaphors. George Lakoff and Mark Johnson, in their landmark work ‘Metaphors we live by’, pointed out that our daily language is full of metaphors, some of which are so familiar (like “rough day”) that they may not seem especially novel or striking. They argued that metaphor comprehension is grounded in our sensory and motor experiences.

New brain imaging research reveals that a region of the brain important for sensing texture through touch, the parietal operculum, is also activated when someone listens to a sentence with a textural metaphor. The same region is not activated when a similar sentence expressing the meaning of the metaphor is heard.

Embodied cognition strikes again! I find this interesting, as it is commonly believed that individuals with autism and Asperger’s have difficulty processing metaphors. Could we trace this, too, back to a lack of effective connectivity between the senses? For those individuals who lack a rich and nuanced sensory database for the visual, auditory, and tactile senses associated with a label, such as “rough,” is it any wonder that the word might lack in rich and nuanced meaning?

Read the full article here.  

Edited to clarify, with apologies: it is certainly not my intention to over-generalize. In my experience, there are as many variations of autism as there are individuals who have the diagnosis. There, are, however, some patterns of differences that cause significant functional challenges, confusion, and frustration for the children I work with. This research sparked my interest and caused me to speculate about receptive processing of language and a possible connection to sensory integration because it would suggest an alternative to the typical rote method of teaching.

From Science Daily: 

Two vital parts of mentally organizing the world are classification, or the understanding that similar things belong in the same category; and induction, an educated guess about a thing’s properties if it’s in a certain category. There are reasons to believe that language greatly assists adults in both kinds of tasks. But how do young children use language to make sense of the things around them? It’s a longstanding debate among psychologists.

A new study in Psychological Science, a journal of the Association for Psychological Science, challenges the predominant answer. “For the last 30 to 40 years it has been believed that even for very young children, labels are category markets, as they are for adults,” explains psychologist Vladimir M. Sloutsky, who authored the paper with Ohio State University colleague Wei Deng. According to this theory, if you show anyone an oblong, scaled, limbless swimming thing and say it’s a dog (its label), both adults and children will believe it’s a dog (in that category of four-legged domesticated mammals) and should behave like a dog — bark or wag its tail.

The study confirms that many adults do use labels this way. But children do not. “Our research suggests that very early in development labels are no different from other features,” says Sloutsky. “And the more salient features may completely overrule the label.” You insist the swimming thing is a dog. The child weighs all the evidence — and “dog” is no more important than scales or swimming — and concludes it’s a fish.

To test their hypothesis, the psychologists showed pictures of two imaginary creatures to preschoolers and college undergraduates. Both animals had a body, hands, feet, antennae, and a head. The “flurp” was distinguished by a pink head that moved up and down; the “jalet” had a blue sideways-moving head. The heads were salient — the only moving part. During training, the subjects learned what a flurp or a jalet looked like.

Then the experimenters changed some of the features, keeping the head consistent with most of them, and asked participants to supply the missing label. They also showed creatures with characteristics and a name, and the subjects had to predict — induce — the missing part. Both adults and children did best when the head was consistent with the name.

The difference arose when the head was a jalet’s but label was “flurp,” or vice-versa. Then, most of the adults went with the label (we accept that a dolphin is a mammal, even though it looks and swims like a fish). The children relied on the head for identification. Regardless of its name, a thing with a jalet’s head is a jalet.

This is interesting for a number of reasons. First, it seems to call into further question the rote skill-and-drill-flashcard-style learning utilized in behavioral models of intervention. If, developmentally, children are processing the sensory, motor, and affective attributes and affordances of an object in order to learn how to classify it, this would be best facilitated in the context of guided, hands-on exploration with a supportive adult. The study’s authors agree:

Sloutsky says the findings could inform teaching and communicating with children. “If saying something is a dog does not communicate what it is any more than saying it is brown, then labeling it is necessary but by no means sufficient for a child to understand.” Talking with young children, “we need to do more than just label things.” 

The second reason I find this interesting is more speculative; I have often wondered whether many of the hallmark symptoms of autism and the secondary deficits observed in sensory processing disorder, such as language delay and alleged theory of mind differences might be traced back to poorly integrated processing (i.e. rather than thinking of these as primary deficits, that they are the result of piecemeal processing and the resulting spotty connectivity between sensory memory stores). For example, in this case, if a child is taking in the visual shape of the duck, but not forming pathways that connect and integrate that information with the texture of the feathers, the quack, or the characteristic waddle, flap, and swimming motions of a duck, how much more challenging would it be for them to acquire the functional, working hypothesis of “duckness” required to label a novel creature with the label, “duck?”  

Read the full article here. 

From Jon Brock’s Cracking the Enigma research blog, an unpacking of the phenomenon of reversed pronouns in children with and without autism. 

“You made a circle”, exclaimed Ethan, looking up from his drawing.

“You did make a circle”, his mum acknowledged, ignoring the fact that, not for the first time, Ethan had reversed the pronoun, saying “you” when he should have said “I”. 

Ethan was one of six children from Providence, Rhode Island taking part in a study of child language development. Every couple of weeks, a researcher from Brown University would visit him and his mum at home, record, and then transcribe their conversations in painstaking detail. The transcriptions would show that Ethan was a prolific reverser of pronouns; frequently saying “you” when he meant “I” and “your” instead of “my” or “mine”. This curious habit began as soon as pronouns entered his vocabulary and he was still reversing pronouns when, just before his third birthday, the study came to an end.

Ethan’s language skills were otherwise exceptionally good. When assessed at 18 months, his scores put him in the top 1% for children his age. However, some years after the study finished, it transpired that Ethan had Asperger syndrome.

(…) 

Say it again

Kanner’s explanation for pronoun reversal in autism came from another observation - that children with autism often repeat entire phrases verbatim, inappropriately and out of context. This so-called ‘echolalia’ would lead to reversals as the pronouns are repeated exactly as heard. British child psychiatrist, Michael Rutter gave the example of a hungry child requesting a biscuit by echoing the phrase “Do you want a biscuit?” The pronoun was reversed but the biscuit was obtained.

Consistent with this explanation, Evans and Demuth noted that Ethan was indeed most likely to reverse pronouns when imitating an utterance that somebody else had previously made. “Dad gave me that ring”, for example, was clearly a reversal but was almost certainly something his mum had said previously.

Case closed one might think.

However, even using the most generous criteria, imitations accounted for less than half of Ethan’s recorded reversals. What’s more, in contrast to the child in Rutter’s example, he actually made relatively few reversals during requests. For example, when asking for his bottle, he said “I want bottle”, using “I” correctly (even though the sentence wasn’t fully formed).

An alternative perspective

Further analyses revealed two final clues. First, as well as using “you” to refer to himself, Ethan occasionally used “I” to refer to other people (something Naima very rarely did). Second, reversed pronouns were more likely to occur in sentences that contained multiple pronouns. For example, at aged 22 months, Ethan was recorded saying “I got you out” when he should have said “You got me out”.

 These observations suggest that his problem lay, not in understanding the principles of which pronoun to use, but in applying those principles during a conversation. His difficulties were pragmatic rather than conceptual. More precisely, Evans and Demuth propose that Ethan’s pronoun reversal reflected difficulty in referential perspective taking - in choosing the right word given who was being referred to at any given moment in the conversation.

This account of Ethan’s pronoun reversal fits nicely with research suggesting that autistic children have difficulty with other linguistic terms that depend on the speaker’s perspective.

In an intriguing study published last year, Peter Hobson and colleagues at University College London (Hobson et al. 2010) found that children with autism were competent at using “here” and “there” to refer to locations near or far from themselves. However, the same children struggled to follow similar instructions given by two other people – a task that required them to consider the speaker’s perspective to work out which locations “here” and “there” referred to.

(…) 

Wrapping up

Ethan’s pronoun reversal is particularly intriguing in the light of his Asperger syndrome diagnosis. However, it would be unwise to assume that he is representative of all individuals on the autism spectrum. His difficulties do not seem to be explicable in terms of either a lack of relevant linguistic experience or a tendency to echo phrases verbatim, but these may still be contributory factors, and could well explain pronoun reversal in other autistic individuals. Indeed, as noted earlier, Ethan’s error patterns are quite different to some other examples in the autism literature.

Perhaps then the reason pronoun reversal is so common in autism is that there are multiple factors associated with autism that each contribute to difficulties producing and understanding pronouns. Working out why autistic children reverse pronouns may involve looking at the evidence on a case-by-case basis.

I find this research incredibly fascinating, since it’s such a ubiquitous part of communicating with children with autism and, so often, represents a primary concern (and cause of frustration) for their parents. In my anecdotal experience, even the most diligent of corrective measures typically fails to produce lasting change. Instead, the child often begins to self-correct, quite spontaneously, and this seems to coincide with the point in development in which they begin to develop a differentiated sense of self, specifically, a sense of agency and ability to act and impact on the world. 

It’s well worth clicking through to read the post in it’s entirety, do so here.