Autism and Abstract Thinking

One of the assumptions commonly made about autistic people is that they tend to be "concrete thinkers."  Since the mild/Asperger's end of the autism spectrum is full of mathematicians, engineers, computer scientists, and linguists, who reason in highly symbolic, abstract ways through highly abstract material, this assumption has always baffled me.

But over the years, I've got some sense of where it comes from.

For many people, abstraction is synonymous with fuzziness, flexibility, and open-endedness. Because autistic people tend to be rigid, ritualistic, precise, pendantic, and/or detail-focused, and because many of them don't do well when faced with open-ended questions or open-ended tasks assigned to them by other people, they do not look like abstract thinkers according to this notion of "abstract." All too often, for example, people forget that the concept of "polygon" is no less abstract than the concept of "love."

In addition, many people, especially in education, conflate logical inferencing with the sorts of inferencing that good readers engage in when making sense of a text.  Many of these texts require the sorts of social inferences and bridging inferences (integration of background knowledge) with which autistic children tend to struggle. These are not the same as inferring the contrapositive or doing a reductio ad absurdum.

People also easily confuse labels with concepts--e.g., the word "triangle" with the concept of triangle. As a result, they assume that a child who doesn't know the label for a given concept also doesn't understand the concept.  Many labels for abstract concepts and logical processes are difficult for autistic children to pick up on their own: they often require explicit vocabulary instruction that other children don't need. Unless and until they receive such instruction, many people will assume that they don't understand the underlying abstractions--e.g., that if he doesn't know the word "because," he doesn't understand causality.

Finally, people tend to conflate concrete vs. figurative language with concrete vs. abstract concepts.  While it's true that individuals with autism tend to interpret language concretely, this entails nothing about their ability to form abstract concepts.  In fact, the tendency by autistic children to interpret language concretely isn't a conceptual difficulty with nonliteral language per se, but the result of a combination of deficits in social reasoning and deficits in vocabulary and idioms. For example, a child who assumes that "stuck" always means physically "stuck" has probably simply never learned the more metaphorical meaning of stuck.  

The remedy for much of this (which I flesh out in detail in Students with Autism) should be obvious: direct, systematic instruction, especially in language and in social knowledge; instruction that makes no a priori assumptions about the child's capacity for abstract reasoning. 

Early Works by Barry Prizant: Laying the groundwork for disbelief in FC

(Cross-posted at FacilitatedCommunication.org).

Reading up on another autism pseudoscience, “gestalt language processing,” has taken me to some early work on echolalia by Barry Prizant. Most of this work isn’t accessible through any of the three university libraries I have access to, so Prizant has done me a big favor by making it available on his website.

As I’ll discuss below, the presence on BarryPrizant.com of Prizant’s work on echolalia is actually rather surprising. That’s because of Prizant’s current support for the variant of FC known as “Spelling to Communicate,” or S2C.

Signs of Prizant’s support for S2C were evident at least by 2015, with the first edition of his book, Uniquely Human. I discussed this book three years ago in a blog post entitled Uniquely Human: Laying the groundwork for belief in FC, and two years ago, Prizant stumbled upon my post and left this comment:

So who are you? At least clearly a died-in-the wool [sic], Lovaasian/Skinnerian kool-aid drinker. Why don't you ask me about what you say directly rather than cowardly taking pot shots, as is so common amongst so many ABA folks. I just ran across this joke of an analysis, and your comments and false assumptions are laughable. Dr. Barry Prizant

It wasn’t clear to me what I had gotten wrong. My discussion centered on cases where the facilitated person repeats words that are at odds with the words that are being facilitated out of them.  I cited the infamous No More No More scene from the film The Reason I Jump, in which the movie’s voiceover, quoting statements attributed to a facilitated non-speaking autistic individual by the name of Naoki Higashida, explicitly dismisses the clearly intentional, echoic protests (“No more! No more!”) of the person being subjected to the S2C variant of FC, who appears eager to stop pointing to the letterboard and get out of the sun, which is clearly in her eyes.

Was I mistaken in saying that Prizant supported FC, which, I argued, contradicted what he’d said about echolalia? Or was I wrong about what he’d said about echolalia?

Prizant’s “Uniquely Human Podcast” has clarified things for me. At least four of its episodes (16, 35, 86, and 101) promote and platform S2C, and in the most recent one Prizant brings up echolalia. He does so explicitly in response to his critics, faulting us for being unaware that his earlier research found forms of echolalia that “were highly automatic and not intentional” and for having “no understanding of the continuum between automatic and intentional.”

The odd thing, however, is that the Uniquely Human book, in both its 2015 edition and the expanded 2022 edition, says that

[M]ost of the time, with careful listening and a bit of detective work, it becomes clear that the child is communicating—in the child’s own unique way.

Indeed, the articles that Prizant is best known for, those echolalia articles from the early 1980s, argue against the then-prevailing sentiment among autism experts that echolalia is primarily reflexive and meaningless. In his 1980s articles, Prizant identified eight interactive/communicative uses of echolalia that had previously gone unrecognized. These include two categories into which “No More! No More!” could easily fall: “requests” and “protests”.

Several decades later in Uniquely Human, Prizant alludes to a type of echolalia that appears nowhere in his earlier studies: “unreliable forms of echolalia.” While he does not define it, the name suggests that Prizant considers it a subtype of the “unreliable speech” that he and other S2C proponents claim is involved whenever what’s spoken conflicts with what’s typed. According to S2C proponents, whenever there’s a conflict between speech and S2C-generated text, we should assume that the latter is what the person actually intends to communicate—just as The Reason I Jump’s voiceover advises. No matter that S2C-generated text is highly susceptible to facilitator control, while speech is relatively immune—except in this fictional scene from the movie Being John Malkovich, whose patent absurdity makes it the exception that proves the rule. And no matter, moreover, that S2C proponents steadfastly refuse to conduct the sorts of rigorous message-passing tests that would establish whether a facilitator is controlling the S2Ced individual.

Given all this, what’s surprising about the presence on Prizant’s website of his earlier works is that some of what’s in them adds to the evidence against the validity of S2C.

First, while allowing that some echolalia can be automatic, the greatest emphasis of the 1980s version of Prizant, by far, is on echolalia as communicative. Indeed, Prizant and his co-authors found that the majority of the echolalia they observed was interactive and/or communicative (Prizant & Duchan, 1981; Prizant & Rydell, 1984). Prizant stresses how “Until recently, the predominant position was that echoic utterances are produced automatically with little or no communicative intent” (Prizant, 1983). And he underscores the importance of considering broader context and consulting caregivers to determine whether echolalia that might appear meaningless might in fact be meaningful (Schuler & Prizant, 1985). It’s hard to believe, therefore, that the Prizant of the 1980s would have thought that a contradiction or incompatibility between repeated speech (e.g., “No more! No more!”) and S2C-generated text (“We could finally tell each other we really felt”) was sufficient grounds for dismissing the former as meaningless and automatic.

Second, the Prizant of the 1980s found automatic echolalia to be characteristic of the “lowest functioning group of verbal autistic children, who remain echolalic for extended periods of time.” (Prizant, 1983). Prizant attributed the absence of “instances of more automatic and meaningless echoing” in earlier accounts of autism to “the sample of autistic individuals described, which did not include the more severely retarded.” (Schuler & Prizant, 1985). Reflexive echolalia, Prizant proposed, co-occurs with immature language and brain development (Schuler & Prizant, 1985). All this puts the Prizant of the 2000s in a bind with respect to the speech-to-typing conflict in S2C. If S2C is valid, then any speech at odds with the S2Ced messages must be reflexive; but if that speech is reflexive, the child is likely to be too low functioning to be the author of the S2Ced output.

Third, and perhaps most problematic for the Prizant of the 2000s, the Prizant of the 1980s attributed echolalia to “abilities in motor ability and rote memory which exceed linguistic comprehension and productive linguistic abilities.” (Prizant, 1983). In highlighting the differences between autistic echolalia and echolalia in typically developing children, he writes:

In contrast to more advanced object cognition… and relatively normal, even superior, perceptual-motor and memory skills, conceptual limitations in social cognition and related areas appear to be the core of the autistic syndrome. This discrepancy explains some aspects of autistic echoing as preintentional communication patterns are coupled with normal, relatively sophisticated speech imitation and memory skills. (Schuler and Prizant, boldface mine).

In other words, echolalia—especially early, automatic, non-communicative echolalia—is, per Prizant, the result of superior sensorimotor skills and limitations in social cognition. This is the exact opposite of what, some four decades later, he claims is going on in S2C. In S2C, according to not just Prizant but all S2C proponents, S2Ced individuals have deficits in sensorimotor function and intact or superior social cognition. Indeed, this is their basis for their claims that an S2Ced person’s speech is unintentional, non-communicative, and, in some cases, merely reflexive echolalia—at least whenever it’s at odds with what the person types.

What do we make of Prizant’s 180-degree turn?

Prizant’s early claims were based on objective observations of behavioral interactions; it’s unclear where his current claims are coming from. The most obvious explanation is that Prizant has fallen for naïve realism: the seeing-is-believing fallacy that leads naïve observers, including some autism experts with degrees in psychology, to think that S2C is real because it looks real to them. Indeed, it looks real to me is more or less what Prizant claimed in his letter to the American Speech-Language Hearing Association (ASHA) asking ASHA to retract its position statement against S2C and RPM (the FC variant from which S2C descended).

Prizant’s website contains no retractions of anything of his earlier positions. Instead, the commentary on the download page for the echolalia articles respects the spirit of this early work:

In our social-pragmatic research using early video analysis of echolalia used in natural activities, we were able to document that echolalia served a variety of functions for children.

And:

The following articles and chapters reflected our efforts to look at echolalia from a developmental perspective, and eventually shifted the perspectives of echolalia as an undesirable behavior to a multi-faceted, developmental phenomenon.

Perhaps Prizant is hoping people won’t look too closely and notice how this four decades’ old work, which has withstood the test of time, has also laid some of the groundwork for disbelief in something that has failed/will fail the test of time: namely, FC/S2C.

REFERENCES

Prizant, B. (1983). Language acquisition and communicative behavior in autism: Toward an understanding of the ‘whole’ of it. Journal of Speech and Hearing Disorders, 48, 296–307. https://doi.org/10.1044/jshd.4803.

Prizant, B. M., & Duchan, J. F. (1981). The functions of immediate echolalia in autistic children. The Journal of speech and hearing disorders, 46(3), 241–249. https://doi.org/10.1044/jshd.4603.241

Prizant, B., & Rydell, P. J. (1984). An analysis of the functions of delayed echolalia in autistic children. Journal of Speech and Hearing Research, 27, 183–192. https://doi.org/10.1044/jshr. 2702.183

Schuler, A. L., & Prizant, B. M. (1985). Echolalia. In Communication problems in Autism (pp. 163–184). Springer.

Tell Them It’s Not Hate Speech: FC, facilitator crimes, and the ethically compromised world of disability studies

(Cross-posted at FacilitatedCommunication.org).

Shortly after Netflix released it, just a few weeks ago, the latest facilitated communication documentary became a viral hit. But unlike the other popular, feature-length FC documentaries (Spellers, The Reason I Jump, Deej, Far From the Tree, Wretches and Jabberers, Understanding Autism, A Mother’s Courage, and Autism is a World), this one, Tell Them You Love Me, is critical of FC. That is, instead of presenting facilitated communication as a way to unlock purportedly intact language and literacy skills in non-speaking individuals with intellectual impairments, it shows, with excerpts of Dr. Howard Shane’s message-passing tests in Prisoners of Silence, how facilitators can completely control the facilitated messages.

Might this explain why so many of the pro-FC documentaries won various film festival awards while Tell Them You Love Me, as director Nick August-Perna writes in a recent account, was turned down even for a festival screening?

Gentle but painful emails trickled in from Sundance, SXSW, Tribeca, Sheffield, all letting me know that “after careful consideration,” because of the “massive number of submissions,” they would not be programming the film. And though it was funded in the U.K., not one European festival took the film. Some of these major festivals were transparent about being nervous about the subject matter, while others just sent formulaic responses. One major U.S. festival programmer initially watched the film and wrote me an effusive email saying she couldn’t stop thinking about it and wanted to make sure the world premiere was still available. This is almost always a sure sign. We had a premiere! But after many weeks of silence, I got word that they would be passing. She explained that internal conversations had revealed hesitations from within the programming team. They had “concerns.” They wanted it to be more focused on race while simultaneously including more experts in the disability world. The cautious tone of the rejection email was miles away from the delighted and viscerally positive reaction to the film I received just a month earlier.

Nor, despite “the best sales team a documentary filmmaker could want” was there any interest from networks; they gave “even less feedback than the festivals about why” they weren’t interested. No interest, that is, until Netflix finally bit.

What could all this nervousness and hesitation and concern possibly have been about? Should the documentary really have been “more focused on race”? Judging from the viewer comments I’ve seen so far, that will ring resoundingly false to anyone who watches it. More compelling is the notion that the film should have included “more experts in the disability world.”

This brings us to one of the most baffling things about facilitated communication. Despite its having been thoroughly debunked in the 1990s, and despite all the evidence that facilitators are (however unwittingly) hijacking the voices of some of our most vulnerable citizens, groups that you’d think would be concerned about FC instead appear to support it. I’m thinking, specifically, of self-styled autism and disability rights advocates.

In a couple of old blog posts (here and here), I’ve discussed the widespread support of autism advocates for FC, noting how this enables these folks to:

• minimize the differences between non-speaking autistics and themselves, thus combating the criticism, made frequently by autism parents, that they cannot speak for those at the other end of the autism spectrum

• promote the idea that autism is a difference, not a disorder, except inasmuch as disability is some sort of social construct (as in: give everyone a letterboard and a facilitator, and any apparent disorders disappear).

But I haven’t yet addressed the support for FC by disability rights individuals—a support that shows up in the large number of pro-FC articles in disability studies journals: Disability & Society and, especially, Disability Studies Quarterly, which alone has published four pro-FC articles since 2011 (see the references below).

It’s high time to fill that void.

One of the most vociferous, pro-FC disability journal articles comes from the person at the epicenter of Tell Them That You Love Me, the person who gets, by far, the most air time of all: a former Rutgers ethics professor by the name of Anna Stubblefield. As Janyce explained in an earlier piece, Stubblefield is a Syracuse-trained facilitator whose mother, Sandra McClennen, “was a first-generation facilitator and disciple of Douglas Biklen (who brought FC to the U.S. from Australia).”

And as we learn in Tell Them You Love Me, and also in an earlier New York Times exposé, Stubblefield fell in love with one of her clients and used facilitated communication to obtain consent to perform sex acts upon him, one session lasting for hours. Based on these acts and testimony from expert witnesses that FC is a discredited technique and that her client could not have given consent, Stubblefield was found guilty of two counts of first-degree aggravated sexual assault. Although the court overturned Stubblefield's conviction on appeal because of a technicality, she ultimately plead guilty to two counts of third degree assault rather than face a second trial.

One key detail that was left out of the documentary was an article published by Stubblefield the same year in which she began performing sexual acts on her client: an article in Disability Studies Quarterly entitled  “Sound and fury: When opposition to facilitated communication functions as hate speech.”

The article makes a number of claims common to most pro-FC manifestos, namely:

• Autism and other intellectual disabilities are movement disorders that impede the ability to point to things.

• Since communication methods other than FC haven’t helped some people communicate much, FC is a reasonable alternative for communication.

• Individuals whose facilitators no longer touch them must ipso facto be communicating independently.

• Testimonials elicited through facilitation count as evidence for FC.

• It’s unreasonable to insist that every time someone is subjected to FC the facilitation should be validated with a message passing test.

• “FC has been validated as an effective means of communication for some people.”

All of these claims have been debunked by research cited elsewhere on this site, for example here, so I won’t dwell on them in this post.

What’s perhaps more relevant to the question at hand, namely the attempted suppression of Tell Them You Love Me, is Stubblefield’s take on hate speech. This purportedly includes the following—with my annotations added, italicized, in brackets.

• “dismissing the words of an FC user as unworthy of consideration.” [All the evidence strongly indicates that the words of an FC user are actually the words of the facilitator.]

• presuming that FC users are intellectually impaired. [All the available evidence suggests that the typical FC user is communicatively impaired, though not necessarily more generally cognitively impaired.]

• “ignor[ing] explanations other than intellectual impairment for the unreliability of speech and pointing in FC users.” [A straw man. Or perhaps Stufflefield is confusing “ignoring” with “finding fault with.”]

• “the refusal to seriously consider or provide evidence to refute substantiated argumentation that challenges one's prior beliefs, while issuing unproven assertions that undermine the words of those making or providing evidence for the challenge.” [Isn’t pretty much everyone guilty of this behavior— according to those who most vehemently disagree with them?]

• “assert[ing] that withholding access to FC protects the rights of people who cannot speak.” [This one speaks for itself.]

• “denigrating FC supporters” [Denigrating supporters of things one thinks are a really bad idea is routine behavior.]

• “suggesting that open discussion about FC should be suppressed.” [Another straw man. Plus, it’s those who call FC criticism “hate speech” who are the ones calling for the suppression of open discussion.]

Stubblefield also cites three specific examples of hate speech:

• A statement by Van Acker (2006) that “FC is predicated on the mistaken assumption that many individuals with severe communicative disorders (e.g., those with autism or severe and profound mental retardation) have a level of ‘undisclosed literacy’ that can be ‘tapped’ through this procedure.”

• Jacobson et al.’s (1995) statement that “the everyday facility with which people with autism or mental retardation use a language (e.g., spoken, written, or pictorial) is an accurate depiction of their ability to do so and that there is no clinically significant phenomenon that inhibits the overt production of communication and ‘masks’ normative communication.”

• Jacobson et al.’s (1995) statement that “that there is a strong presumptive relationship, in general, between overt production and actual ability is a cornerstone of psychological assessment methodology, statistics, and psychometrics.”

All I can say is I’m glad Stubblefield hasn’t been put in charge of moderating discussions in psychology and special education, let alone deciding what gets published.

Stubblefield also notes that “Fear mongering claims about FC and false sexual abuse allegations have been a staple of anti-FC rhetoric for years.” Perhaps she would now include her own case as yet another example.

And perhaps her colleagues in disability advocacy would as well. As Mark Sherry reports in an article in Disability & Society, the reaction to this case by disability studies scholars was uniformly in support of Stubblefield:

In all of the posts I saw, there was never a suggestion that people reach out to the family, even though many disability studies scholars met the victim’s brother when he read the victim’s purported paper at the Society for Disability Studies conference. In my opinion, the welfare of the disabled victim should have been paramount. I saw these scholars advocate on behalf of Stubblefield, who is a white, non-disabled woman, but I never saw anything to support the black disabled man who was the victim of this sexual assault. I even witnessed disability scholars soliciting contributions to her legal defense fund, but I never saw a single effort to support the victim. In my view, this response to rape is not only misdirected, it is unethical and shameful. The lack of concern for the victim and his family was chilling, disturbing, and alarming.

Sherry continues:

While the judge said the case was not about facilitated communication per se, many of Stubblefield’s defenders in disability studies stridently defended it, almost as a matter of faith. This was a mistake – facilitated communication is a practice that is demonstrably unscientific and unreliable. Their personal and financial support for Stubblefield must also be called into question. Stubblefield was convicted by a jury of her peers, after a five-week trial, and is now a registered (and incarcerated) sex offender. Given that the courts have found her guilty, it is incumbent upon disability studies scholars to critically examine their support for Stubblefield. Were they inadvertent rape apologists?

Sherry leaves that question unanswered, and so do I. All I can come up with is that, as some sort of accident of history, the field of disability studies was hijacked early on by some of FC’s most fervent believers. Perhaps, by now, they’ve had enough cumulative influence on society in general and on the entertainment industry in particular to have been able to suppress films like Tell Them You Love Me. And perhaps if the gears of history were rewound back, say, to 1980, things could have turned out differently.

I’ll end with two points:

First, there’s the reaction to Tell Them You Love Me by FC’s other most fervent believers: the devotees of Rapid Prompting Method and Spelling to Communicate. Are we hearing cries from them that Stubblefield was unfairly prosecuted because the facilitated consent was actual consent? Or insistent claims that RPM and S2C are different from FC because “no one is touching anyone”? Neither. Instead, there’s deafening silence. It’s as if they’ve all gotten together and decided that the less said, the sooner this movie goes away, and the sooner this movie goes away, the better it is for all of them.

For anyone who truly cares about disability rights, however, Tell Them You Love Me is an absolutely must-see. And this takes us to my final point: If you haven’t seen it yet, watch it tonight. Tell everyone you know to watch it. It’s one of the most fascinating, if disturbing, documentaries currently out there—right up there with Prisoners of Silence.

---

REFERENCES

Ashby, C., Jung, E., Woodfield, C., Vroman, K., & Orsati, F. (2015). ‘Wishing to go it alone’: The complicated interplay of independence, interdependence and agency. Disability & Society, 30(10), 1474–1489. doi:10.1080/09687599.2015.1108901

Biklen, D., Morton, M. W., Saha, S. N., Duncan, J., Gold, D., Hardordottir, M., Karna, E., O’Connor, S., & Rao, S. (1991). I AMN OT A UTISTIVC ON THJE TYP. Disability, Handicap & Society, 6, 161–179. doi:10.1080/02674649166780231

Jacobson, J., Mulick, J., and Schwartz, A. 1995. "A History of Facilitated Communication: Science, Pseudoscience, and Antiscience Science Working Group on Facilitated Communication." American Psychologist 50, 750-765

McKee, A., & Gomez, A. (2020). The voices of typers: Examining the educational experiences of individuals who use facilitated communication. Disability Studies Quarterly, 40(4). Advance online publication. doi:10.18061/dsq.v40i4.6981

Savarese, R. J., & Savarese, E. T. (2011). The superior half of speaking: An introduction. Disability Studies Quarterly, 30(1). Advance online publication. doi:10.18061/dsq.v30i1.1062

Sherry, M. (2016). Facilitated communication, Anna Stubblefield and disability studies. Disability & Society, 31(7), 974–982. https://doi.org/10.1080/09687599.2016.1218152

Stock, B. (2011). Mixed messages: Validity and ethics of facilitated communication. Disability Studies Quarterly, 31(4). Advance online publication. doi:10.18061/dsq.v31i4.1725

Stubblefield, A. (2011). Sound and fury: When opposition to facilitated communication functions as hate speech. Disability Studies Quarterly, 31(4). Advance online publication. doi:10.18061/dsq.v31i4.1729

Van Acker, Richard. 2006. Outlook on Special Education Practice. Focus on Exceptional Children 38, 8-18.

Wilson, M., de Jonge, D., de Souza, N., & Carlson, G. (2014, January). Facilitated communication training: Exploration of perceptions of ability and reducing physical support. Disability Studies Quarterly, 34(1). Advance online publication. doi:10.18061/dsq.v34i1.1741

Recapping some reasons why language is impaired in autism—and why degree of impairment correlates with autism severity

 …With some implications for FC. [Cross-posted at FacilitatedCommunication.org].

For infants to pick up language, they need to tune into it. That means preferentially tuning into the sounds of speech over non-speech sounds. Furthermore, they need to link speech sounds to meaning. This means tuning into the people who make those sounds—and, especially, to their eyes: where a speaker’s eyes are pointing indicates who the speaker is speaking to and/or what they speaking about. Speech, people, eyes: these are the key ingredients of social stimuli.

The less a child tunes into social stimuli, therefore, the less he or she will pick up language. The earlier in development this process is derailed, the greater the effects on language. At least eight studies of children 6 months and younger who are “at risk for autism”—that is, infants with an older autistic sibling—show that, in autism, this derailment begins early in development (bold-face added):

• Jones and Klin (2013): “infants later diagnosed with autism spectrum disorders (ASDs) exhibit mean decline in eye fixation from 2 to 6 months of age, a pattern not observed in infants who do not develop ASD.”

• Lloyd-Fox et al. (2013): “In a functional near-infrared spectroscopy study, infants aged 4–6 months at risk for autism showed less selective neural responses to social stimuli (auditory and visual) than low-risk controls…. Further, these differences closely resemble known patterns of neural atypicality in children and adults with autism.”

• Lloyd-Fox et al. (2017): “At 4-6 months, infants who went on to develop ASD at 3 years (N = 5) evidenced reduced activation to visual social stimuli relative to low-risk infants (N = 16) across inferior frontal (IFG) and posterior temporal (pSTS-TPJ) regions of the cortex. Furthermore, these infants also showed reduced activation to vocal sounds and enhanced activation to non-vocal sounds within left lateralized temporal (aMTG-STG/pSTS-TPJ) regions compared with low-risk infants and high-risk infants who did not develop ASD (N = 15).”

• Blanco et al. (2023): “infants at elevated likelihood of ASD showed attenuated responses to visual social stimuli in several cortical regions compared to infants at typical likelihood. Individual brain responses to visual social stimuli were associated with later autism traits... These outcomes support our previous observations showing atypical social brain responses in infants at elevated likelihood of ASD and align with later atypical brain responses to social stimuli observed in children and adults with ASD.” (Average age: 166 days).

• Blasi et al. (2015): “we used functional MRI to examine cortical sensitivity to auditory stimuli in infants at high familial risk for later emerging ASD (HR group, N = 15), and compared this to infants with no family history of ASD (LR group, N = 18)… Whereas LR infants showed early specialisation for human voice processing in right temporal and medial frontal regions, the HR infants did not. Similarly, LR infants showed stronger sensitivity than HR infants to sad vocalisations in the right fusiform gyrus and left hippocampus.”

• Jones et al. (2016): “High-risk infants who met criteria for ASD at 24 months showed shorter epochs of visual attention, faster but less prolonged neural activation to faces, and delayed sensitization responses (increases in looking) to faces at 6 months; these differences were less apparent at 12 months. These findings are consistent with disrupted engagement of sustained attention to social stimuli.”

• Chawarska et al. (2013): “6-month-old infants later diagnosed with ASD attended less to the social scene, and when they did look at the scene, they spent less time monitoring the actress in general and her face in particular.“

• Mastro et al. (2002):

  • “Fifteen home movies from the first 6 months of life of children who later received a diagnosis of ASD were compared with home movies of 15 normal children… found significant differences between the two groups for the items in the social attention and the social behavior areas; on the contrary, there were no differences in nonsocial attention.”

  • “The significant differences in items regarding interest in other persons confirm that children with ASD reveal a preference for nonsocial stimuli. Attention toward objects does not distinguish autistic from normal infants: object exploration, involving a few activity patterns, such as mouthing, waving, and banging, tended to be the same in both groups. This result probably means that attention is not implicated as a primary function but as an elective function only toward social stimuli. In short, infants with autism exhibited a specific qualitative pattern of attention, highly consistent with theories predicting that ASD children have a specific deficit in attending social stimuli.”

These patterns continue in older autistic children:

• Adamson et al. (2021). “Toddlers with ASD usually appeared aware of a new sound, often alerting to and orienting toward it. But compared to TD toddlers and toddlers with DD, they alerted and oriented less often to speech, a difference not found with the other sounds. Furthermore, toddlers with ASD were far less likely to spontaneously try to share the sound with the parents and to engage with the parent and the sound when parents tried to share it with them.” (Average age: 22.6 months).

• Kuhl et al. (2005): “In this study, we examined social and linguistic processing of speech in preschool children with autism spectrum disorder (ASD) and typically developing chronologically matched (TDCA) and mental age matched (TDMA) children. The social measure was an auditory preference test that pitted 'motherese' speech samples against non-speech analogs of the same signals. The linguistic measure was phonetic discrimination assessed with mismatch negativity (MMN), an event-related potential (ERP). As a group, children with ASD differed from controls by: (a) demonstrating a preference for the non-speech analog signals, and (b) failing to show a significant MMN in response to a syllable change.” (Average age: 45.31 months).

• Klin (1991): “[Participants] were given a choice between their mothers' speech and the noise of superimposed voices (a sound effect obtained in a busy canteen). Data were obtained utilizing a specially designed automated and computerized device which recorded the children's responses in their own homes. In contrast to comparison groups of mentally retarded and normally developing children who showed the expected strong preference for their mothers' speech, the autistic children actively preferred the alternative sound or showed a lack of preference for either audio segment. These results suggest that such abnormal reactions to speech are a feature of these children's overall disregard to people.” (Average age: 63.5 months.)

• Dawson et al (1998): “It was found that, compared to children with Down syndrome or typical development, children with autism more frequently failed to orient to all stimuli, and that this failure was much more extreme for social stimuli. Children with autism who oriented to social stimuli took longer to do so compared to the other two groups of children. Children with autism also exhibited impairments in shared attention.” (Average age: 64.6 months)

• Magreli et al. (2013): “While the two groups orient overtly to facial expressions, children with ASC do so to a lesser extent. Children with ASC differ importantly from TD children in the way they respond to speech cues, displaying little overt shifting of attention to speaking faces. When children with ASC orient to facial expressions, they show reaction times and first fixation lengths similar to those presented by TD children. However, children with ASC orient to speaking faces slower than TD children. These results support the hypothesis that individuals affected by ASC have difficulties processing complex social sounds and detecting intermodal correspondence between facial and vocal information.” “The impairment in social orienting to speech sound seems more severe than that observed with facial expressions.”  (Average age: 6.08 years).

• Čeponienė et al., (2003): “Acoustically matched simple tones, complex tones, and vowels were presented in separate oddball sequences, in which a repetitive "standard" sound was occasionally replaced by an infrequent ‘deviant’ sound differing from the standard in frequency (by 10%)… The sensory sound processing was intact in the high-functioning children with autism and was not affected by sound complexity or ‘speechness.’ In contrast, their involuntary orienting was affected by stimulus nature. It was normal to both simple- and complex-tone changes but was entirely abolished by vowel changes. These results demonstrate that, first, auditory orienting deficits in autism cannot be explained by sensory deficits and, second, that orienting deficit in autism might be speech-sound specific.” (Average age: 8.4 years).

• Lepistö et al. (2005): “involuntary orienting to sound changes, as reflected by the P3a ERP, was more impaired for speech than non-speech sounds in the children with autism, suggesting deficits particularly in social orienting. This has been proposed to be one of the earliest symptoms to emerge, with pervasive effects on later development.”

In addition, the degree to which these individuals tune in is correlated with autism severity, especially in terms of social symptoms like joint attention:

• Lloyd-Fox et al. (2017): “The degree of activation to both the visual and auditory stimuli correlated with parent-reported ASD symptomology in toddlerhood.”

• Blasi et al. (2015): “Also, in the HR group only, there was an association between each infant's degree of engagement during social interaction and the degree of voice sensitivity in key cortical regions.”

• Kuhl et al. (2005): “Participants with a strong preference for non-speech analogs tended to score lower on measures of initiating joint attention and expressive language.”

The connection to autism severity, together with the connection between attending to social stimuli and learning language, adds to the evidence I discussed in my last post: the evidence against the assumption that those who are most likely to be subjected to FC/RPM/S2C understand the sophisticated linguistic content that is attributed to them.

It’s worth noting, however, that one standard measure of autism severity, the ADOS Calibrated Severity Score (Gotham et al., 2009), controls for language levels, and thereby factors out the correlation between autism severity and language skill. To see the connection between language and autism severity, therefore, one must use raw, un-calibrated ADOS scores, or other measures—for example the various measures of social attention explored in the 15 studies reviewed here.

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REFERENCES:

Adamson, L. B., Bakeman, R., Suma, K., & Robins, D. L. (2021). Autism Adversely Affects Auditory Joint Engagement During Parent-toddler Interactions. Autism research : official journal of the International Society for Autism Research, 14(2), 301–314. https://doi.org/10.1002/aur.2355

Blanco, B., Lloyd-Fox, S., Begum-Ali, J., Pirazzoli, L., Goodwin, A., Mason, L., Pasco, G., Charman, T., Jones, E. J. H., Johnson, M. H., & BASIS/STAARS Team (2023). Cortical responses to social stimuli in infants at elevated likelihood of ASD and/or ADHD: A prospective cross-condition fNIRS study. Cortex; a journal devoted to the study of the nervous system and behavior, 169, 18–34. https://doi.org/10.1016/j.cortex.2023.07.010

Blasi, A., Lloyd-Fox, S., Sethna, V., Brammer, M. J., Mercure, E., Murray, L., Williams, S. C., Simmons, A., Murphy, D. G., & Johnson, M. H. (2015). Atypical processing of voice sounds in infants at risk for autism spectrum disorder. Cortex; a journal devoted to the study of the nervous system and behavior, 71, 122–133.

Čeponienė, R., Lepistö, T., Shestakova, A., Vanhala, R., Alku, P., Näätänen, R., & Yaguchi, K. (2003). Speech-sound-selective auditory impairment in children with autism: they can perceive but do not attend. Proceedings of the National Academy of Sciences of the United States of America, 100(9), 5567–5572. https://doi.org/10.1073/pnas.0835631100

Chawarska, K., Macari, S., & Shic, F. (2013). Decreased spontaneous attention to social scenes in 6-month-old infants later diagnosed with autism spectrum disorders. Biological psychiatry, 74(3), 195–203. https://doi.org/10.1016/j.biopsych.2012.11.022

Dawson, G., Meltzoff, A. N., Osterling, J., Rinaldi, J., & Brown, E. (1998). Children with autism fail to orient to naturally occurring social stimuli. Journal of autism and developmental disorders, 28(6), 479–485. https://doi.org/10.1023/a:1026043926488

Dziuk, M. A., Gidley Larson, J. C., Apostu, A., Mahone, E. M., Denckla, M. B., & Mostofsky, S. H. (2007). Dyspraxia in autism: association with motor, social, and communicative deficits. Developmental medicine and child neurology, 49(10), 734–739. https://doi.org/10.1111/j.1469-8749.2007.00734.x

Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of autism and developmental disorders, 39(5), 693–705. https://doi.org/10.1007/s10803-008-0674-3

Jones, E. J., Venema, K., Earl, R., Lowy, R., Barnes, K., Estes, A., Dawson, G., & Webb, S. J. (2016). Reduced engagement with social stimuli in 6-month-old infants with later autism spectrum disorder: a longitudinal prospective study of infants at high familial risk. Journal of neurodevelopmental disorders, 8, 7. https://doi.org/10.1186/s11689-016-9139-8

Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504(7480), 427–431. https://doi.org/10.1038/nature12715

Klin A. (1991). Young autistic children's listening preferences in regard to speech: a possible characterization of the symptom of social withdrawal. Journal of autism and developmental disorders, 21(1), 29–42. https://doi.org/10.1007/BF02206995

Kuhl, P. K., Coffey-Corina, S., Padden, D., & Dawson, G. (2005). Links between social and linguistic processing of speech in preschool children with autism: behavioral and electrophysiological measures. Developmental science, 8(1), F1–F12. https://doi.org/10.1111/j.1467-7687.2004.00384.x

Lepistö, T., Kujala, T., Vanhala, R., Alku, P., Huotilainen, M., & Näätänen, R. (2005). The discrimination of and orienting to speech and non-speech sounds in children with autism. Brain research, 1066(1-2), 147–157. https://doi.org/10.1016/j.brainres.2005.10.052

Lloyd-Fox, S., Blasi, A., Elwell, C. E., Charman, T., Murphy, D., & Johnson, M. H. (2013). Reduced neural sensitivity to social stimuli in infants at risk for autism. Proceedings. Biological sciences, 280(1758), 20123026. https://doi.org/10.1098/rspb.2012.3026

Lloyd-Fox, S., Blasi, A., Pasco, G., Gliga, T., Jones, E. J. H., Murphy, D. G. M., Elwell, C. E., Charman, T., Johnson, M. H., & BASIS Team (2018). Cortical responses before 6 months of life associate with later autism. The European journal of neuroscience, 47(6), 736–749. https://doi.org/10.1111/ejn.13757

Maestro, S., Muratori, F., Cavallaro, M. C., Pei, F., Stern, D., Golse, B., & Palacio-Espasa, F. (2002). Attentional skills during the first 6 months of age in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 41(10), 1239–1245. https://doi.org/10.1097/00004583-200210000-00014

Magrelli, S., Jermann, P., Noris, B., Ansermet, F., Hentsch, F., Nadel, J., & Billard, A. (2013). Social orienting of children with autism to facial expressions and speech: a study with a wearable eye-tracker in naturalistic settings. Frontiers in psychology, 4, 840. https://doi.org/10.3389/fpsyg.2013.00840

Mostofsky, S. H., & Ewen, J. B. (2011). Altered connectivity and action model formation in autism is autism. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry, 17(4), 437–448. https://doi.org/10.1177/1073858410392381

Torres, E. B., Brincker, M., Isenhower, R. W., Yanovich, P., Stigler, K. A., Nurnberger, J. I., Metaxas, D. N., & José, J. V. (2013). Autism: the micro-movement perspective. Frontiers in integrative neuroscience, 7, 32. https://doi.org/10.3389/fnint.2013.00032