For years, theory of mind has been a popular explanation for the social and communicative deficits in children with autism. With a well established theory of mind, young children have difficulty understanding the thought processes, goals, and behaviors of other people. Not being able grasp the intentions of others provides a sincere disability in social interaction. And yet, theory of mind does not come without its controversy. Several tasks have been created in order to test for theory of mind in children around four years of age. Some examples include the Sally-Anne false belief test, the “Smarties” test, and the picture-reality test. Though research has been pretty conclusive that children with autism show difficulty passing all three of these tasks, it is important to understand some of the criticism surrounding them.

To begin with, the tasks may be very difficult to understand. I can attest to this, as I tried to present a Sally-Anne task to my class last semester. In order to successfully complete the task, children need to follow the plot line of the story, keep the actions of the two dolls separate, understand the language used in the task, and exhibit inhibitory control. Mastering all of these things at once is amazingly difficult for any four year old child. I am only slightly embarrassed to admit that I myself had trouble distinguishing the two dolls. If the child is lacking in any of these required areas, then the tasks are not really testing what they claim to be.

For example, understanding the language is amazingly important in these tasks. Little differences such as “where will Sally look” and “where should Sally look,” are asking for two completely different answers. If the child is unable to correctly translate the language being used, then the theory of mind tasks are actually a study of language ability and not theory of mind.

In the article by Tager-Flusber, the researcher explains the close connection between language ability and the development of theory of mind. Autistic children are far more likely to pass the theory of mind tasks if they have higher language skills. Tager-Flusher also explains why implicit and explicit measures are important in testing theory of mind and language abilities.Many children fail the theory of mind tasks when they are done using verbal responses, but subsequently pass the task when answers are collected from eye gaze. This may mean that children who typically fail the false belief tasks actually have a sense of theory of mind, but lack the language ability to express their understanding.

A second issue with the theory of mind tasks is the necessary skill of inhibitory control. Many of the theory of mind tasks require children to point to the correct location of an object (Point to wear Sally will look). Accurately pointing is a response that is well reinforced in children from a very young age. If children lack inhibitory control, they may find themselves pointing to the actual location of the marble before they have properly made sense of the question being asked to them. In this instance, children are failing the tasks because they have poor executive functioning, and not because they lack a theory of mind

To get around some of these problems, researchers are starting to use more eye gaze tasks to study theory of mind. By coding eye gaze instead of verbal or other physical responses, researchers are able to avoid some of these issues. Another promising feature of using eye gaze is that it allows theory of mind tasks to be given to even younger children. If deficits in theory of mind are used to help diagnose autism, and the tasks can be given to younger children, it follows that we may be able to diagnose autism at a much younger age. Earlier diagnosis means earlier interventions and perhaps better outcomes. Though theory of mind continues to have some problems, it remains one of the most promising ways for diagnosing and understanding a lot of the problems in autism. This new research on eye gaze is a promising advancement in better understanding the theory of mind deficit.

If you want to read more about the some new violation of expectation methods using eye gaze and theory of mind, this one is kind of fun.

One of the hardest issues for parents of an autistic child is finding out if their child actually has autism. Though the current diagnostic standards require that children show some deficits before the age of three, many parents have suspicions much earlier in their child’s development (check out current DSM criteria). In fact, early detection of autistic symptoms is so prevalent that current revisions of the DSM have removed the use of a specific age, replacing it with this statement: Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) (check out the proposed revisions for the new DSM). The reason for this change is important. Many of the stereotypical deficits seen in autism can be hard to notice, or even nonexistent in young children. For example, many children with autism exhibit some difficulty with communication and language production. By three years old, little to no use of language is a serious sign of autism. And yet, there is nothing peculiar about a one year old with limited to no speech. So how do we know what to look for and when to start looking if we suspect there may be a problem?

The truth is, the earlier we can intervene with a child with autism, the better. Early interventions have proved quite influential in creating a better prognosis in the long run. In fact, some intervention programs have been shown to provide preschoolers with a 20 point increase in IQ score when enforced 30-40 hours a week for 1-4 years. (Read more about these interventions and more in the Landa article) Other intervention programs have found successful ways to facilitate communication in children with little speech. The Picture Exchange Communication System teaches children how to use cards of pictures to communicate what they want. The benefits of intervention are obvious, but the question still remains, how do we know when it’s time to start using them?

As the Landa article explains, many parents who suspect that something might be wrong with their child are told by their physicians to initiate the famous “wait and see” technique. This can be a serious problem because it puts parents in an especially difficult situation. No parent wants to diagnose their typically developing child with autism, and yet delaying early intervention to a child that ends up receiving a diagnosis can be just as painful. Landa discusses some “red flags” that parents can keep an eye out for when suspecting autism. These include things like lack of response to name, repetitive body movements, and lack of showing. Many of these signs can be helpful, but they can also just induce worry in parents, as many kids grow out of these behaviors.

So long story short, there is no answer. Basically all we can really say is that the earlier a child enters intervention, the better. As for deciding if a child even needs intervention, well that’s left to the parents to decide. Many parents may err towards safety and get their child help, even if they are not sure it’s necessary. Others, with less education about autism or without the money to pay for such extensive (and, let’s be honest, expensive) interventions, may decide to wait until they are sure. Current research is trying its hardest to establish some early diagnostic criteria, but this proves to be a difficult and tedious task. As for now, we have to depend on parents to know where to draw the line of what’s typical development and what isn’t. There is no right answer, and there is definitely no easy answer.

Just call me Rara

The best part of being a psychology major is the amazing amount of random facts you can crack out at parties. You just drop a bomb like, did you know vaccines don’t cause autism, and you are officially the life of the party. Since the birth of my niece I have really been able to up my game. I am the magician and she is my beautifully dressed side kick. We started our act right after her birth when we performed a pulmar grasp in front of a crowd. Within a year we were really turning heads with some fun displays of object permanence. Now, at 16 months, I have decided that Isabela is a trained professional and it is time for us to move on to more sophisticated tricks.

Last weekend I went home with the intention of teaching her an extraordinary amount of new words. Babies saying new words are always a show stopper. Before we started training, Isabela showed me what she could already do. I yawned condescendingly when she said mama and dada. I was unimpressed with her “more, more” and “alllllll done.” But like the true magician she is, Isabela was saving the best for last. First you must understand that we have two Labradors who are sisters. To the untrained eye they are one in the same, but not to Isabela.When prompted, where is Roxy? Where is Daisy? Isabela can point to the correct dog. What a champ.

Now understanding that Isabela is obviously a genius, I decided we were ready for her to learn my name. We practiced day in and day out with absolutely no results. I chanted: Sara, Sara, Sara. Nothing. I said “Isabela, say Sara, say Sara.” Nothing. And then one day something amazing happened. She said Rara. I’ll take it! I came back to Charlottesville feeling like a winner. Isabela knows who I am.

My excitement was short lived when the next day my sister called me to say Isabela’s been going around calling her dog (Roxy) Rara. I was so disappointed. I can’t believe I rewarded her with a popsicle.

Fortunately for me, the next day I read the article by Baron-Cohen (1997) and learned a little something about the Speaker’s Direction of Gaze strategy. Baron-Cohen and his colleagues surmise that infants utilize this strategy to learn the meaning of new words. The SDG strategy says that children look to what the speaker is gazing at (instead of what the child is gazing at) to see what the new word is referring to. I say shoe, Isabela will follow my gaze to see what object I’m talking about. What a remarkably simple and yet complicated finding. One could easily assume that infants use the Listener’s Direction of Gaze strategy. This would mean that every time we want to teach a new word, we would have to wait until the infant spontaneously gazed at the shoe before yelling SHOE SHOE SHOE! To be honest, this blew my mind. Because of the SDG strategy, Isabela was able to name the correct dog. Obviously when we say "Where is Roxy," we all look at Roxy.

This also explains why Isabela doesn’t understand why I am Rara. When teaching her my name, we lacked any sense of joint attention. We were not connected on one object. We did not share a beautiful moment where our eyes met. In fact, after I would say Sara she would look up at me inquisitively, perhaps searching for my gaze. Where was I looking? At her.

It seems clear that any disruption in using this method can inhibit its effects. Obviously this seems to be a lasting problem for children with autism. With an aversion to eye gaze, many autistic children are lacking a crucial step in understanding language. They are making up for this issue by utilizing the LDG strategy. But, as mentioned before, the LDG has its faults. Language acquisition now becomes temperamental and confusing. Baron-Cohen (1997) explains that even when autistic children learn new words, they might not understand what these words are referring to. If language learning can be so specific that Isabela can’t understand that I am referring to myself, then we must appreciate how difficult it is to teach language to a child averse to gaze. Perhaps language delays in children in autism are the cause of many different factors. They may have the ability to communicate, but have extreme difficulty in learning the words. It is definitely something to think about.

As for me, I suppose I owe Isabela another chance at learning my name. This time I will have my sister yell SARA every time Isabela looks at me. I will keep you updated.

It is clear to most that autism entails at least some form of social dysfunction at every level on the spectrum. Be it a debilitating response to touch or a subtle aversion to eye gaze, social impairments are an obvious problem for people with autism. It only makes sense then that if we can find out what mechanisms are malfunctioning then we can make our best efforts to correct them.

So what’s the cause of this dysfunction? Well we are not that sure yet, but Pelphrey and Morris have an idea.

As discussed in their article, the STS region of the brain seems to have significant importance in a person’s ability to interpret social interactions. To test this idea, Pelphrey and Morris monitored the STS region of the brain in response to goal directed behavior. In the study an attention grabber flashed on the screen, eliciting the animated person’s attention. The animation then had two choices; look at the attention grabber or don’t. When the animated figure attended to the checker board, the STS region in the observer responded with increased brain activity. But interestingly enough, even higher levels were elicited when the animated figure looked away from the attention grabber. Simply put, the STS was surprised!

So what does this mean? The STS region of the brain has expectations when participating in social interactions. The human brain has the ability to perceive the actions of others before they happen.

When it comes to studying autism this seems to be an important component. When people diagnosed with autism participated in the same experiment, their STS region did not discriminate between a congruent response and an incongruent response. This seems to imply that people with autism are deficient in social interaction at the neural level.

After reading this article, I thought to myself one thing: let’s retrain the STS region in order to help facilitate social interactions in people with autism.

The idea is not completely absurd as many other studies have shown that even infants can be trained to produce brain functions more advanced than expected for their age. For example, the famous “sticky mittens” experiment enabled children who were too young to grasp on their own, the ability to reach for things. When the infants received this new found ability to “grasp,” they were suddenly able to better perceive the goals and actions of other people in similar grasping situations. More amazingly, these results were able to generalize to other goal directed situations. Similar results are revealed in Sommerville’s study where they gave children canes to reach distant objects.

If infants with lower brain functioning can be taught to perceive and interpret the goal’s and actions of other people, why can’t we use similar techniques to alter the brain functioning of people with autism? Obviously much more research is necessary, but based on the infant studies, we already know that social interactions can be fostered and encouraged using early training. If comparable manipulations can be devised to fit their specific dysfunctions, perhaps these training devises can be added to early intervention programs for autistic children. If we can train autistic children have to read differences in eye gaze and facial expressions perhaps the STS region of the brain will start to respond in similar ways to typically developing children. Even though many parts of social interactions seem not to come naturally to autistic people, why shouldn’t we be able to teach them?

Why am I always on the bad guy's team?

Two years ago I started volunteering in a local kindergarten class. The class consisted of seven rambunctious boys who tested my youth with their high energy and extreme enthusiasm for Star Wars. It was there that I was first introduced to a young man, let’s call him Billy, who had recently been diagnosed with Aspergers syndrome. Knowing what little I knew about autism at the time, I was amazed at Billy’s high verbal skills and keen interest in socializing with the other boys.

The more time I spent with Billy, however, the more problems I realized he was having. Even today, after reading Temple Grandin’s accounts of her childhood and the Rogers and Ozonof (2005) article on sensory dysfunction, I think there was more to Billy’s situation than I understood at the time.

When it came to speaking, Billy was a master. One day I sneezed and he sat me down and gave me an extensive overview of the body’s immune system. I was impressed, to say the least. He knew more about white blood cells then I did. And yet as I read Temple’s autobiography I can’t help but recall things that I thought very little of at the time. To begin with, Billy and I had this ten minute discussion without our eyes ever meeting. He used hand gestures to help describe the flow of blood and stood up excited when he told me about bacteria, but never once did he look at me or make note that I was still there. In fact, I think I could have left and he wouldn’t have noticed. As Temple describes it, I think he was in his “inner world,” blocking out much of his surroundings. Additionally, in reading Temple’s autobiography I made another interesting realization. As I said earlier, Billy had no trouble talking, but there was something a bit bizarre about his speech. I must thank Temple for now, two years later, explaining to me what it was. Billy was exhibiting little to no change in his intonation. His voice was flat and steady as he spoke in an almost robotic sort of way. Now let me explain to you how our conversation ended. Right around the white blood cells attacking the invader germs, Billy noticed a piece of lint falling from the ceiling. For the next three minutes he followed it around the room. When it finally hit the floor he went and played Legos, as if nothing had ever happened.

As for social interactions, Billy had a fondness for being around his peers. The other boys seemed to notice little to nothing of Billy’s condition and included him in everything they did. When they played Lego Star Wars, they would pass him a car and yell “YOU’RE ON THE GOOD GUY’S TEAM.” Let’s note that I was always on the bad guy’s team. Billy had fun participating, but when the boys got too rambunctious you could find him sitting in the corner, rocking back and forth, spinning the wheel of his car over and over again. Quite often when the class got too loud you would find Billy standing in place rocking himself or spinning the wheel of his car. Call it under arousal or over arousal, but it seems pretty clear to me that there was a threshold for how much stimulation Billy could handle. I can’t help but think of the boy from Autism: The Musical who was playing outside with the girls at school. He ran around the carelessly with them, but soon he stopped. He covered his ears and stood alone, presumably to block out some of his world as the kids continued to play around him.

The article by Rogers and Ozonof seems inconclusive in determining if children with Autism are experiencing under arousal or over arousal. Was Billy spinning rocking back and forth to calm himself or was he needing some more arousal? There seems to be a lot of contradicting information out there. To start with, Metz (1967) claims that autistic children have a preference for higher volume sounds than normally developing children. Presumably this means that autistic children are experiencing under arousal. Perhaps things such as flapping and rocking are means to provide more stimulation. In contrast, Hutt, Hutt, Lee, and Ounsted (1964) concluded in their study that children with autism experienced high levels of activation in their brain stem during and EEG. Unlike Metz, they concluded that stereotyped behavior, was a means of suppressing some of the over arousal they were experiencing.

So where do we go from here? It seems obvious to most that there is some sense of sensory dysfunction in children with autism. Temple, Billy, and Wyatt all exhibited such problems. But with such varying (and quite dated) information, I think it is important for us to go further, conducting more studies on the topic, in order to better understand what children with autism are really experiencing.

Why our children shouldn't like Jenny McCarthy

Today on Oprah I watched Jenny McCarthy give an exposé about how to be the happiest people we can. It was shortly after that I began to think, what isn’t Jenny McCarthy an expert on these days? Dabbling in every facet of the media, including TV, radio, books, and interactive weight loss video games, McCarthy has made quite a name for herself. In response, McCarthy has done the honorable thing of utilizing her fame for the betterment of mankind. The notion was nice, but unfortunately for our children she has selected the wrong area to claim to be an expert in.

McCarthy is in strong support of a link between Autism Spectrum Disorder and infant vaccinations. In response to her own child’s diagnosis of autism following his vaccinations, McCarthy has spent a great deal of time and money trying to find a connection between the two things. It is important to note that McCarthy was not the first person to suspect such a correlation. In 1998, a group of researchers published an article implying that the “environmental trigger” of vaccinations may be responsible for some of the witnessed developmental delays found in their participants (Wakefield et al., 1998). As one can assume, the results created a sense of panic among parents worldwide. Who would risk giving their child autism!? However, in the years since the publication some curious information has been discovered. Many of the authors have retracted their names, presumably because the study may have been a little fudged. Newer research has found no connection between the MMR vaccine and developing autism.

So if vaccines don’t cause autism, why are we still mad at Jenny McCarthy?

Despite a lack of evidence, McCarthy continues to raise awareness of the dangers of vaccinating children. On her website, which you can see here, McCarthy makes several claims which include: vaccinations have dangerous ingredients, there are too many, and we give them to children too early. Let’s do one at a time, shall we.

McCarthy is particularly interested in “cleaning up” vaccinations. She states very clearly on her website that you should never allow your child to receive a vaccine that contains the preservative Thimerosal. If this is your only reason for avoiding vaccinations, then fear not! As of 2001, nearly all vaccines created for use in children are Thimerosal free (Miller & Reynold, 2009). In addition, following much concern of the etiology of autism, recent studies have found no evidence that Thimerosal may be to blame

McCarthy also worries that there are currently too many vaccinations and we use them too early. This seems particularly silly to me, as too many vaccinations seems like a fair trade off for too many life threatening diseases. Vaccinations are not mindless injections we give to our children for fun. Vaccinations are, in my opinion, one of the greatest advancements of all time. At an early age, our children are vaccinated against about fourteen different diseases that include everything from polio to measles (Miller & Reynold, 2009). Since the fear of autism has been on the rise, we have experienced a decline in the number of children receiving vaccines. What’s the affect? Not a decrease in autism, but an increase in preventable diseases.

Finally, McCarthy proposes that perhaps vaccinations are not all bad, but we need to spread out the time frame for receiving them. This seems particularly harmless until you consider the onset of many of the diseases we’re vaccinating against. In order for vaccinations to be effective at preventing diseases, they need to be applied before exposure can happen (Miller & Reynold, 2009). The earlier one gets vaccinated, the better chance they have at avoiding the disease.

What worries me is not Jenny McCarthy’s persistent search for an answer. She obviously has positive intentions and wants nothing more than to spread hope to the millions of people impacted by autism. I fear however, that she is doing more harm than good with her incessant ranting about vaccinations. With very little known about the actual cause(s) of autism, many people are clinging to her claims in a desperate attempt to make sense of their situation. As a result, we are risking the lives of every child who does not receive vaccinations in addition to wasting a lot of money and energy that could be focused on finding the real cause of autism.