34 _ A Developmental Approach to Autism a Lisa L. Travis and Marian D. Sigman INTRODUCTION ‘Autism is one of the most wellinvestgated developmental disorders. The reasons for the Intensive research effort are easy to grasp for those with interests in cognition, language, evelopment, or psychopathology, Autism presents truly puzzling, sometimes even paradox- inally uneven profile of abilities. Because itis uneven, this profile holds promise for revealing surprising insights ito the functioning of both normal and abnormal minds. ‘Autism is best known for presenting a dissociation between social and cognitive func- ‘ioning, with social abilities being more impaired than cognitive ones. Recent research has ‘begun to revel that autism is also characterized by many olher more specific dissociations in functioning. One way that these dissociations are brought into sharper reli is through the pplication of a developmental perspective, This involves considering how different abilities se related to each other at different points in development both in autistic and in typically eyeloping individuals. By applying this approach, researchers have uncovered finer level Associations in functioning that offer both a clearer picture of autism and intriguing cles nto the nature of normal development. This chapter emphasizes the functional dissociation in autism that are apparent from a developmental perspective. Classification and Diagnosis of Autism ‘Menifying criteria for classification of autism involve separating core symptoms, those hat are universal and specific to autism, from associated or secondary symptoms. The current ‘consensus inthe field, reflected in the curent diagnostic standard, the fourth edition ofthe ‘ia Tavvand Marin. Sigman » Culdan Adlecn Pca, Neaopnehanc Isat, Use of (ati a oe Anse, Ls Angels, Cabo 90081759 aboo of DvlopmentlPaychpatolog, Second Eton, ete by Ama J. Samet, Miche Lewis 2 ‘Scaame M. Mile, Kio Asem Penn Pulte New York. 2000 onod ‘Lisa 1 Travis and Marian D. Signy Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychitie ‘Association, 1994), identifies three cote sets of symptoms in autism: impaired reciprocal social interaction, delayed language, and aberrant activities. Aberrant activities include an abnow. rally restrited range of interests, rgid adherence to routines, and motor stereotypes. Eide. siological esearch reveals that these three core impairments are associated (Wing & Gould, 1979), indicating that autism thus defined is true syndrome and not simply a conjunction of independent symptoms, Syraptoms that are characteristic of autism, but not considered to be ‘corey are mental retardation, uueven profiles on 1Q test batterie, savant abilities, abnormalities fof attention, impaired eros-modal integration, and self-injurious behavior. One associated symptom, that of mental retardation, bears special consideration. Approximately 755 of individuals with autism exhibit some degree of mental retardation (Ruter, 1979). ‘Although autism represents «true syndrome, the boundaries separating it from other Aisorders are by no means clea, For example, the distinctions between autism, Asperger's syndrome, and semantic~pragmatc disorder are stil a matter of debate (Happé, 1995). Aso, ‘many individuals who fail t9 meet diagnostic criteria for autism nevertheless present many autistic symptoms, These individuals are typically classed as having Pervasive Develop- ‘mental Disorder (PDD). The term autistic spectrum is sometimes used to signi the range of ‘disorders tht share symptoms with autism. Etiology ‘The efology of autism isnot yet well understood. Research has established that psycho> logical or socal stressors do not cause autism, focusing attention squarely on biological _underpinniags. However, it now appears unlikely that autism is caused by any single organic factor. Rather, there is probably a heterogeneous set of biological factors and multiple eausal paths tat may result in autism. The search for biological underpinnings has revealed that ‘autism is sisociated with a numberof other organi conditions, suchas prenatal and obsesic complications, the onset of epilepsy in adolescence or adulthood, and two genetic disorders, tuberous slerosis and Fragile X syndrome (fora review, see ilberg & Coleman, 1992). The reasons for these links are not yet understood, Tn contrast, twin and family studies show clear evidence for a genetic component 0 autism (for a review, see Bailey eta, 1995). Monozygotic twins are much more likely tobe concordant for autism than dizygotic twins, and siblings of children with autism bave an increased tsk of developing autism. There is also evidence that symptoms characteristic of autism, such as language and communication impairments, are more common in families of — childven with autism. No specific genes have yet been identified as potential candidates for links to autism, though researchers ae actively pursuing this goal ‘Whatever the original causes of autism, they are undoubtedly ted to behavior through abnormalities in bain structure and funetion. Almost every major brain structure has been suggested asa possible mediator of the particular patterns of behavior seen in autism, and 2 ‘wide variety of brain abnormalities have boen identified (Fora review, see Waterhouse, Fein, & ‘Modal, 1996). The challenge in this area of research is o identify which brain dysfunctions ‘are causally and developmentally primary. Complicating the issue is the fact that brait abpormaliies may arise from aberrant input from other structures, oF as a secondary Conse” ‘quence of aberrant experiences during development. For example, the base socal impair ‘ents in autism may result in quite diferent kinds and amounts of social experience For peonle ‘with autism starting early in childhood. The lak ofthis “expected” input may play ole it ‘a Developmental Approach to Autism a ‘rin organization. Researchers are actively attempting to tease apart the primary and second- ny brain abnormalities in autism, and significant progress in this aeais likly tobe fortheom jag in the near future as a result of advances in brain imaging technology. SOCIAL AND EMOTIONAL DEVELOPMENT Although social functioning is the area of moet savers impairment in autism, esearch has seated that not all aspects of social functioning are equally affected. Surprising dissoiations {social abilities are evident from an early age, For example, important early social achieve- ‘nents that are largely spared in autism are attachment relationships and self-xecogniion However, other achievements normally liked to these bebaviors are disrupted, Early Responsiveness, rom birth, human infants are particularly responsive to human faces and voices. Inthe fiat months of life, they begin to engage in face-to-face affective sharing and tor-taking, ‘episodes that are thought to ly th foundations for lator communication and social reation- ships. Bocause autism is typically not diagnosed until the third or fourth year, we do not yet [now whether these carly forms of social exchange are disrupted in autism. Although re- searchers ace actively seeking to fll his gap, the low incidence of autism inthe population makes this ask extremely difficult. Retrospective examination of home videotapes of children laser diagnosed as autistic suggests that there may be early appearing deficits: however, this database is currently very small (Kubicek, 1980; Osterling & Dawson, 1993). Whether cfildren with autism engage in normal social interactions during infancy and only display ‘sherrnt social functioning later on, er whether their socal interactions are disopted from the starts 2 critical issue for theories of autism, The answer to this question would also provide information about continuity in normal social development. Early Social Relationships and Communicative Behaviors ‘Toward the end of the first year, there isa fundamental reorganization in a typically developing child's social and emotions life. One important change is that the child begins to ‘aticjpate more actively in the attachment relationship. The child begins to show distress in the absence of the primary caregiver, to show greater comfort in her presence, and to seek ‘sxtively to maintain contact. A second important change is tha new form of communicative tehavior emerges, in which the infant begins to communicate with a partner about aspects of the world external tothe dyad, This newfound communicative skill takes thre distinct Form ‘requesting or eliciting aid in obtaining objecs,afilitive interactions in which the aim i ‘chieve or maintain ongoing interaction, and joint attention. Joint attention involves the use of ‘ye contact and gestures to coordinate the atention of oneself and another with respect to ‘hind object or event. In addition, the infant stats to use social referencing utilizing the ‘motional expressions of other people as sources of information about objets and evens in the word In autism, this developmental reorganization is clearly disrupted. Indoed, the fist clear ‘Signs of autism involve the failure to show the patterns of social, communicative, andos ‘Lisa Travis and Marlan D. Signag mesial sponses that ypcally emerge this. so at chien with ats fy take advates in socal and communicative Sinctonng this pont in developmen. Rai, {appear he echevomentsnhese areas are ot integrated witheachofherasthe rig ‘ype devlopoent Pete is now clear evidence that chilren with autism establish tachment relationship, 1 spate reunion episodes dened Wo ates atachent, children with autism ae Ue cally developing cen in seeing contac and confor fom hicareivers on ae ccaing nts behvior twtr surgi tan tangy ePaper, Oxon Masin-Cok, 191 Sigman & Unger, 1984). Tas presrvan of the atachnent raion Ship inthe fc of severe dsption in cter reas of scl funeonings good evidence fri stats fundamental behavioral stem. owere chiliven wil antsm apes tbe ptt dependent on ei caregiver ip init an seaetre thir teraction’. When caregivers ae instoted play wth el chien wih atismas hey normally wold supirglyfew dilerenes are found between ther Imeractons snd those of eagivers with ell age (MA) muched cle. They ‘engage in similar amounts of looking, smiling, vocalizing, and mutual play. In contrast, when caregivers ate instructed not to initiate ineractions, differences become very apparent. While ‘mast typicily developing and mentally retarded (MR) children will spontaneously engage their caregivers in play, children with aatism are typically content to play alone (Kasar, ‘Sigman, & Yirmiya, 1993), These studies suggest that children with autism are socially responsive when adults engage thera in interactions, bat they may have particular difficlies | initiating interactions. In interactions with thie caregivers and with other adults, abnormalities in social com: munication are also apparent, Fr example, children with autism ar less likely to coordinate ‘expressions of positive affect with communicative behaviors such as looking a the caregiver {Daveson lil, Spences, Glper, de Watson, 1990; Snow, Herzig, & Shapiro, 1987). Children ‘with autsn have great dificulty establishing joint attention. This difficulty is manifested bath Jn childrens failure to initiate joint stention with others and to respond to others initiation attempts Gundy, Sigman, Ungerer, & Sherman, 1986). When children with autism do engage {njoint attention, they are less likely to engage in eye contact and to display positive affectthan | se MA matched conls (Kesar, Sigman, Many, & Yims 1990, Tn contrast, requesting is a communicative function that is relatively intact in autism. ‘Although children with autism show some deficits in requesting relative to typically develop ing and developmentally delayed controls these deficits are much smaller than those in joint atention eg, Loveland & Landry, 1986; Mundy et a, 1986; Mundy, Sigman, & Kast, 1994; Sigman & Ruskin, 1999), Not only do children with autism generate requests spon: ‘neously, but also their requests ave well organized in that they are just as Likely as conta subjects to establish eye contact while requesting (Mundy et a, 1986). They are also at Compliant as control samples in responding to simple requests made by others (Mundy et al 1986). Thus, one communicative function, requesting, appears to be relatively intact in children with autism, while another, joint attention, is severely affected 4 ‘Another aspect of social communication tat is impaired in autism is socia referencing. ‘Typically developing infants begin to use the emotional expressions of aduls as sources of information about their environments toward the end of the first year (eg, Campos Sternberg, 1981; Gunnar & Stone, 1984) A parent's expression of fear or pleasure toward a ambiguous object will influence whether a child approaches or withdraws from it. Sigma Kasai, Kwon, and Yirmiya (1992) compared autistic, typically developing, and MR chilies” responses to an ambiguats object, inthis case, a mechanical robot They found large dille= [4 Developmental Approsch to Autism oe ences hetwcen autistic and other children inthe amount of time spent looking at adults’ faces fn this situation. In fact, the majority of children with autism did not look even once to the ult, Probably a a result of failing to encounter the emotional signals expressed by aduls, they were also more likely than the other groups to approach the robo Self-Awareness In typically developing children, the second and third years of life involve a second sbstantial reorganization in social and emotional functioning. One aspect of this reorganiza- tin is the emergence of self-ecognition, as measured by the ability to sel-demtify from & rigor image (Brooks-Gunn & Lewis, 1984). At about the same time, children develop incresing awareness oftheir own behavior and its relation to social standards (Bullock & Ltkenhaus, 1988). These developments give rise to new emotions. Selfrecognition bility is associated with the emergence of self-conscious emotions, such as embarrassment (Lewis, Sullivan, Stanger, & Weiss, 1989), and the realization that others evaluate one’s behavior ‘guns standards gives rset the complex emotions of shame and pride (Lewis, 1992). These advances bring « concomitant increase in socialization pressure from parents, who require shildren to take increasing responsibilty for regulating their own behavior. tthe same time, ‘more sophisticated understanding of emotional states in others gives rise to behavior that fs imd at influencing these stats, including both prosocal behavior, such as comforting, and liberate aterpts to hur. ‘Again, in autism, the aspects of functioning that are normally integrated at this point in evelopment appear tobe dissociated. Although sel-recognition is not delayed in relation to ‘ther cognitive abilities, complex emotions, seli-egulation, and prosocial and antisocial behavior ar all affected by autism In the classic test of sel-recogntion ability, an experimenter sureptitiously dabs some rouge ona child's nose and ater exposes the child toa mirorto see whether the child responds by touching his or her nose. Although children with autism show evidence of self-recognition by touching their noses in this situation they filo exhibit the coy behavior and positive affect that ypically developing children exhibit when discovering the unexpected spo (e.g, Dawson ‘& McKissick, 1984; Spiker & Ricks, 1984), One interpretation ofthis behavior is that children With autism lack awareness of, or concem for, ther people's perceptions of them, ‘Such lack of regard for other" evaluations oftheir behavior is also evident in situations Where children with autism are involved in mastering challenging tasks. Kasari, Sigman, ‘Baumgartner, and Stipek (1993) studied the behavior of autistic, MR, and typically developing shildren as they completed puzzles in the presence of their caregivers and an experimenter. All ‘groups smiled equally in response to completing challenging task. However, childen with ‘utism were significantly ess likely to combine smiling with ooking to an adult. Prosocial Behaviors and Peer Interactions Clinical reports suggest that both prosocial and antisocial behavior ae less common in ¢hildren wit autism than in other groups (Lor, 1993). Although children may leam to engage ‘nroains that comprise prosocial aes, spontaneous demonstrations of prosocal behavior are fare. One laboratory study of prosocial behavior in older individuals with autism found Support for these observations. They were less likely to cooperate and share than control646 {sa TL Travis and Marlon D. Sig ‘subjects, though they were equally likely to help in cleaning up, a more routine task (Sigman @ Ruskin, 1999), Older children with autism also show less empathy than other children, although the differences are small (Yirmiya, Sigman, Kasari, & Mundy, 1992). They ‘occasionally do things that are hurtful o others, but these actions are usually ats7buted Yo fck ‘of understanding rater than to malice. Cinial reports and laboratory research also indicate that childs with autism fil to engage in deceit, though one study has demonstrated that they fare capable of deliberately acting to sabotage another's goals Sodian & Frith, 1992). ‘One common form of prosucil behavior is attempting to comfort another in ditress, Even before children become competent at comforting, they find displays of distress capt ing and diturbing. Sigman et a. (1992) found striking differences between children with ‘autism and typically developing and MR children in their responses to displays of distress by theit parents or by an experimenter, Children with autism altended much less to the person exhibiting distress than did typically developing and MR chen. Some children with autism failed to look even once at the adult who was displaying distress, while all ofthe other children looked. ‘An important developmental task of the preschool and schoo! yeas is forming relation ships with ers and acquiring skills for successful pee interaction, Observations of teachers and parent suggest that children with autism interact very lite with their peers and tend tobe ‘Socially inept. A recent study of the peer interactions of children with autism on the playe ‘ground provides support for these cliniesl impressions (Sigman & Ruskin, 1999). Children With autism were found to spend less time in socal play than other developmentally delayed Children. This finding primavly reflected their failure to approach others. Their approaches ‘were no ore likely tobe rejected by poe, and once they entered interactions, children with, autism were as able as thei peers to maintain them, ‘Emotional Expressiveness and Understanding ‘The shit to display clear emotions also appears to be impaired in autism. Yirniya, ‘Kasati, Sigman, and Mundy (1989) found that ebildren with autism were more likely to show expressions that were mixtures of two emotions than were othe chien. They also orca- sionally showed blends of postive and negative emotions, which never occurred inthe ‘comparison groups. When older children with autism ae instructed to assume a particular expression, orto imitate the expression of anther, ther displays ae rated as poorer examples fof the expression than are those of control subjects (Macdonald ct al 1989; Loveland etal 1994), People with autism also appear to have difficlty integrating various aspects of ‘emotionalexpression, such a gestures, vocalizations, and facial expressions into meaningful wholes (Hobson, 1986a,). ‘As children grow older, they become capable of reflecting on and verbalizing thet knowledge of emotions and the circumstances that give rise to them. High-functioning children with autism also make substantial gains in this area. Older high-fumctioning chiles ‘ith autism are able to demonstrate understanding of emotion words by describing instances in which they have experienced a panicular emotion (Capps, Yirmiya, & Sigman, 199% Jaedicke, Storoschuk, & Lord, 1994). However, their descriptions appear to lak spontaneity and are more general than those of nonautistic control subjects , ‘With increasing age, individuals with autism tend to develop increasing socal interest However, even the most intelligent individuals with autism are socially odd thoughout thei ives Conversational exchanges pose difficulties even for highly able adults with ats 4 ‘ADevelopmental Approach to Autism ‘a ‘willbe described in more desl in the section on language. They have dilfcuty following sul rules of socal engagement, such as those conceming politeness, familiarity and sats. ‘While typically developing individuals require some tutoring regarding these social rules in sfildhood, they use them quite flexibly and productively in novel situations in adulthood. By ‘ones, individuals with autism appear to learn social rules by rot, with the result that they apply them inflexibly and often incorrectly. As Frith (1989) points ou, these soci impalr- ents also have a postive side: They can be described as honesty, innocence, or guilelessness. Nevertheles, these characteristics ate sign that individual th autiem never achieve normal fevels of social competence In summary, the course of social development in sutism deviates from normal develop- spent in several ways, Major reorganizations occurring in the frst and second years in normal development are altered in autism. Not all forms of social functioning are impaired. For ‘example, self-recognition and the atachmeat relationship arc mostly spared In contrast social ‘emotions such as pride and empathy do not appear to emerge at all omy. Like typically ‘éeveloping children, older individuals with autism acquire the ability to reflect on theit ‘emotional and social lives, but their skils in this area may never equal those of typically ‘eveloping individuals, COGNITIVE DEVELOPMENT As in the case of social development, cognitive development in autism proceeds un- ‘evenly, The most severe impairments appear in socal cognitive abilities such the understand- ing of false beliefs, However, cognitive deficits in autism are not restricted (othe domain of social cognition, and not all aspects of social cognition are impaired Early Representation ‘The nature and timing of early developmental milestones in representational ability are important issues in cognitive development that are still actively debated. Although we do not Jet have a firmly grounded, widely accepted account of representation change in normal ‘evelopment, recent research has focused attention on major sills occuring at about 9 and 18, months of age. At about age 9 months, a number of changes signal the emergence of newfound representational competence, roughly corresponding to declarative memory. More evidence fr recall memory, as opposed to recognition, is apparent in infants’ everyday behavior (Ashmead & Perlmutter, 1980) At this stage, infants” representations appear to include more Spatial and contextual information, and to accommodate crost-medal associations more sffectively (Schacter & Moscovitch, 1984), The increasing ability to maintain nonperceptual representations of events over time i also evident in the emergence of deferred imitation (Metzof, 1988) Although te earliest forms ofthese abilities are evident prior to 9 months of ‘the improvement at 9 months is rapid and dramatic (Mander, 1988). At about 18 months, a Second shift is evident in infants’ representational competence. Perhaps the clearest sign of thi shifts the rapid increase in use of communicative symbols, including words and gestures. Other signs ofthis change are increase in the amount of pretend play and the ability to solve object permanence tasks involving invisible displacement, Meltzo and Gopnik (1989) sug- ‘ttt these changes represent the emergence ofa “hypothetical” reprosentational ability, "hich allows infants to manipulate their representations in order to go beyond remembering8 Lisa L. Travis and Marlan D. Sigman what was in order to make inferences about what must have occurred and to consider shay sight be. ‘We have relatively litle evidence regarding early representational development in a ‘ism, Because autism is aot diagnosed until relatively late, the youngest subjects studied typically have mental ages ofa eas 18 months, with ie reslt that dere i ite information ‘egatding delay or disruption of the 9-month sift. The fct thatthe youngest samples studied Perform aswell 3s MA-matched controls on tests of object permanence and mental problem Solving (Sigman & Ungerer, 19846) suggests that children with autism do not have Tong. lasting impsirments in abilities that normally emerge around 9 months. Tn conrast, ther is reason to believe thatthe representational abilities that normally emerge at 18 months may be impaired in autism, because the two major advances associated ‘with these bilities, pretend play and communicative words and gesture, area leas substan- tilly delayed or, in some cases, completely absent (e.g, Mundy, Sigman, Ungerer, & Sher. ‘man, 1987; Rigut, Taylor, Benaroya, & Klein, 1981; Sigman & Ungerer, 19846). Imitation, ‘another key indicator of early representational ability, is also impaired in autism (fora review, see Smith & Bryson, 1994). Concrete Operational Abilities Children with autism perform as well as MA matched controls on tests of seriation, conservation, and hierarchical classification (Shulman, Yirmiya, & Greenbaum, 1995: Vie. riya, Sigman, & Zacks, 1994; Yirmiya & Shulman, 1996), but they are impaired on clase jusion yroblems (Shulman et a, 1995) and appearance-reality problems (Baron-Cohen, 19898). Ths particular pattern of stengths and weaknesses is not well understood. What bas tracted mich more attention ae the striking dei of people with autism in certain kinds of perspective taking specifically those requiring understanding of false belief. Perspective Taking Perspictve taking takes many forms, from the very simple, such as assessing whether oF not an object is visible to another, tothe complex, such a understanding that another persons Fikely to havea false belief Somewhat surprisingly, children with autism do not have genera problems with perspective taking, Individuals with autism are not impaired in their ability to ‘assess how a simple visual array appears to another person, alough they show some impairments in tasks involving more complex arrays (Baron-Cohen, 1989b; Tan & Haris, 1991; Virmiya etal, 1994). These strengths indicate that not all aspects of perspective taking ability areimpsicd in autism, contrary to what would be expected if individuals with autism — failed to appreciate the foct tha different people represent the world in different Ways. In contrast, one particular kind of perspectve-taking task, the false-beief task, i 98> cially diffi for people with autism. In one of the classic versions of this task he subjest i {ntoduced wo two charecters, Sally and Ann, Sally puts a marble in abasket and then leavesthe room. While she is gone, Ann moves the marble to a new location. Te subject is then esked ‘where Sally will ]ook forthe marble when she returns. The corect answer is that Sally will Took where she hid the marble, and not where the subject knows it to be truly located. TAS presents challenging task because it requires a firm understanding ofthe fact than anothel person can have a mental representation that is both different from reality and different fom |A Developmental Approach te Auton oo ‘one's own, This task is not mastered by ypically developing children until they are about 4 of age. However, children with autism with mental ages well above 4 year perform iy of false-boief tasks. Many carefully comolled studies have attempted to isolate the fource of ther dificulty and have produced results suggesting that the problem is specific to the understanding of mental sates (Tora review, see Happé & Frith, 1995; for an altemative imerpretation, see Hughes & Russel, 1993). Categorization ‘A numberof the characteristic behaviors of autism suggest abnormalities i ctegoriza- sion, Clinicians ae acutely aware that people with autism often have great difficulty generaliz- ing from teaining experiences. For example, they may fail to generalize a newly eared skill {ross settings of trainers. They also tend to exhibit an insistence on sameness in daily routines, tod overly narow interests. For example, Francesca Happé describes one high-funetioning ‘nan with autism who bad an extreme interest inthe color ofthe doors of juvenile courts in {ifferent towns in England. When asked why he did not inquire about the door colors of adult ‘courts he responded, ‘They bare me to teats” (Happé, 1995, p. 37). Such peculiarities suggest that people with autism may be “carving the word a ts joints” in an abnormal manne. this is tue, it doesnot appear to be based on @ failure to develop natural objoct cate tories. Children with autism show MA-appropriate performance on tasks assessing their Understanding of basic and superordiate level categories (Tager-Flusberg 1985; Ungerer & Sigman, 1987) and can demonstrate a grasp of even more absiract ontological distinctions, suchas the difference between animales and inanimates (Baron-Cohen, 1990. The database on xerofanon nai iil her sin bat spe tt ny ipso eyo sub, Executive Function Executive faction (EF) sa general term referring to abroad st of abilities. TWwo under- lying themes in EF are organization of goal-directed behavior and integration of information {fom a variety of sources, such as perception and memory, in order to select an appropriate response. Thus, EF abilities includ planning, inhibiting prepotent responses, controling im- pulses, engaging in an organized search, and maintaining or flexibly switching response sets Although EF is typically associated with the frontal lobes, damage to other brain reas can also alec EF, lnvestigations of EF in subjects with autism of various ages and abilities have found de- ‘its inthe use of a numberof different tasks (ora review, sce Pennington & Ozonoff 1996). For example, subjects with autism are more prone t© perseverative responding and have ‘itfcaty inhibiting prepotent responses. An excellent ilustration of tis problem is found in a lank devised by Hughes and Russel (1993). Children with autism were simply asked to point to ‘an empty box in order to win a candy contained in another box. They were unable to inhibit thei tendency o point ro the desired candy, in spite of showing evidence of understanding the ask and repeatedly filing to win it in this manner. Hughes and Russel tvibuted ths pattern ‘o he inability of children with autism to disengage from the object and use internal rues to ‘de behavior. Other EF impairments include atenton sifting (Courchesne et al, 1994) and ‘working memory (Benneto, Pennington, & Rogers, 1996)[Not only are EF deficits found consistently, but they are also usually quite large. Becanss the effects are large and consistent, EF tasks are better than other tasks, including false-belgg ‘sks, at differentiating between persons with autism and other groups (Ozona, Peni & Rogers 199). In adtion, EF impairments in autism are not ameliorated by developmen (Ozonoff & McEvoy, 1994), ‘Takea asa whol, the pattern of cognitive deficits in autism presents a puzzling prof, ‘Specific deficits are clealy found in social cognition, namely, in imitation and perspective taking. However, closer examination ofthese deficits does not support the view that they ane ‘simply due to the fact that socal information processing is involved. For example, children with autism seem to do well on simple visual pespective-taking tasks but poorly on false. belief tasks. Some nonsocial, conerete operational abilities ae also more impaired than others, ‘Because EF is implicated in nearly every cognitive ask, itis somewhat suprising that children ‘with autism, who have substantial BF deficits, exhibit as much competence as they do ona variety of cognitive tasks. Many different explanations for this uneven profile are offered by ‘competing theories of autism, as will be discussed in the concluding section ofthis chaps, LANGUAGE DEVELOPMENT Language and communication problems ar one ofthe hallmark characteristics of aun, Asin othe domains of functioning, impairments are not uniform: Cenain aspects of language emo sete than ober. The parte of uneveanes in funetioning is quite consistent with the unevenness found in social and cognitive abies, Essentially, those aspects of language that invole an appreciation of ts social communicative funtion pose the most fc fr {ndvidwals with autism 7 About al of hldeen with autism nover develop functional language. Language dovel ‘opment is comelated with inteligence; tus, childen inthe normal or near-normal range of {ntlignce are mos likly to develop langusge (Stone & Caro-Martnez, 1990). Even peple with autem who eventualy achieve god language ae substantially delayed i their anguage evelopment. For the most part, acquisition of vocabulary and grammar in autism proceeds normaly (©, TagrFlosborg, 1993; TagerFusbrg, Calkins, Nolin, Anderson, & Chadwick Dias, 1990)-Forexample, in longitudinal study ferl language in autistic and Down's ein, “TgerFiberg found that tration of form classes in spontaneous speech, and onde of emergence of grammatical morpemes in both groups were lke that of typically developing children However, she found some evidence of lack of flexibly in language use in the ‘sample wit autism, characteristic tht appears o persist roughout development in attic Aanguage. 3 Insite of the relatively normal cous of vocabulary and grammatical development, he language system in autism is far from intact. The missing ingredient in the system ragmais—the integration of language withthe socal contest in order to achieve effective ommunzaon, Aue spech exhibits some characterise pecullarios that ar related 08 fundamental pragmatic defi. These inclu echolalia, pronoun reversal, and ack of po- ‘ate prosody. People with autism engage in sited, swkard conversations. Although te ‘ay be fay efectve in ransmiving and receiving bare fats, they do nt achieve the s008 ‘exchangeof information tha is characteristic of normal conversations. As ares conven tional fw is disrupted and misinerpettions ae frequent. The nana partners often withthe feeling that communication was not achieved. “A pevslopmcntal Approach to Autism ot Far those individuals with autism who do develop language, grammar and vocabulary ‘develop quite normally, though slowly, but the ability to engage in conversational exchanges jj impaired from the earliest stages of development onward. Some aspects of conversational fmpairment are inability to master rules of politeness, and dificalty maintaining conversa- tional Tow and constructing informative messages. The particulars of autistic language have smaty parallels in the social and eognitive deficits deseibed earlier. THEORIES OF AUTISM ‘Throghout this review, five themes are apparent in many ofthe phenomena observed in tis: disorders of affect, attention, initiation, integration, and representation. For example, inition problems are evident in children's interactions with peers and caregivers, and in a tendency toward perseverative responding in nonsocial contexts. Falures of attention are apparent in social contexts such asin lack of joint attention, in failure to respond to distress and to engage in social referencing, and in woasocial contexts such as overly narrow"interests, Individuals with autism appear to have difficulty processing and conveying emotional infor- ‘ation in both verbal and nonverbal channels. Integration dificulis ae apparent in the lack of ability to-combine displays of affect wth other communicative behavior, and in difficulty ppeciating the relationships berwoen gestural, vocal, and facial displays in others. Represen- taionldifcultis are suggested by the lek of pretend play and diffieulies with understand ing false belief. These themes are representative not only of the major phenomena to be ‘explained in autism, butals ofthe major theoretical accounts of autism, Each theory of autism fends to emphasize one theme as primary, with causal and developmental links from the primary deficit to the other themes. For example, aceording to Peter Hobson (1989, 1993), the primary deficit autism isan inability to make affective contact with other people. This deficit is present from early in infancy, and precludes experiences that are essential for normal social and cognitive develop- ment. An alternative account, proposed by Courchesne and his colleagues (1994), is that snentional impairments are primary causes of autism. In suppor of this postion, Courchesne preseats data from adolescents and adults with autism in a variety of attention shifting tasks Showing that individuals with autism take longer to disengage and refocus attention than ‘ontrol subjects but are nt impaired in maintaining attentional focus. Qzonoft (1995) suggests that BP impairments consisting of an inability use an on-line mental representation in order to suide behavior may be primary causes of autism. She links this impairment toa variety of Azfcits found in autism, including emotion perception, imitation, and pretend play. The accounts discussed so fa are in agreement that autism involves failure to develop ‘nomial representations in both socal and cognitive domains. They explain this failure in terms of lowerlevel dysfunctions that disrupt the input from which these representations are erved. In contrast, two ditional theories propose that in autism, the innate capacity to frm. erin specifically social representations is lacking ‘One ofthe most inflental accounts i Leslie's “theory of mind” proposal, which centers ‘xound a modular theory of mind mechanism (ToMM), specialized for the processing repre- ‘entatons of mental states (Leslie, 1987; Leslie & Roth, 1993). These mental state representa- lions are called metarepresentarions. According to Leslie, autism involves an inability to form Imetarepresetations, resulting ina failure to appreciate mental slates in oneself and others. Am indirect consequence is thatthe ToMM lacks its proper input, and thus eannot derive a “theory of mind,” which isan unconscious appreciation ofthe relation between mental sates« Lisa 1, Travis and Marian D. Sigman land behavior The child with autism is stuck with behaviorist interpretations ofthe social ‘world Altheagh these interpretation are adequate for some purposes, they are incapable of eating with cases such as false belief and pretend play ‘A second representational account of autism centers around a proposed disruption of ‘representations underlying imitation (MeltzofT& Gopnik, 1993; Rogers & Pennington, 199), ‘According t these accounts, autism may result from developmental consequences of an inability to perceive self-other correspondences. ‘Uta Fh offers an information-provessing account of autism that isnot dependent on, specific forns of representation, but rather on a general information-processing force that “pplics very broadly to a variety of cognitive operations (Frith, 1989). Frith argues that ‘ypicaly developing individuals have a strong drive to seck underlying pater and regu. Javtes in all kinds of information. According to Feith in autism, the drive for coherence ‘unusually weak. In support of this theory ae findings showing that children with autism excel in tasks requiring the suppression of information about global organization such as block design and cearching for embedded figures (Shah & Frith, 1983; Asarnow, Tanguay, Bot, & ‘Freeman, 187). According to Frith, a weak drive for central coberence would naturally ‘impede progress toward developing a theory of mind, because the achievement ofa theory of ‘mind is dependent on drawing exceptionally broad and abstract generalizations. CONCLUSIONS Rescarch on autism has often been described as exemplifying the usefulness of the developmental psychopethology approach o understanding typical and atypical development. “The primary reason i tha the bidirectional flow of ideas and information between the domains of autism nd normal development is particularly clear. This bidirectional flow bas beea pastculaly useful in identifying unexpected dissocations in functioning in autism. Investig {or have identified important normal developmental achievements, such as atachment,self= recognition, object permanence, conservation, acquisition of grammatical morphemes, and so fon, and have gone on to investigate whether these achievements are spared or disrupted in ‘Autism. This has allowed the identification of unexpected cissociations between abilities tha ‘normally develop together, such as requesting and joint attention, self-ecognition and the self: Conscious emotions, and the pragmatic and grammatical aspects of language, In tur, these issocations provide a particularly valuable window onto normal development by suggesting thatsome relationships among normally coincident developmental achievements may be me fundamental than others. ‘Acknownapcwnrs. 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