Simon Baron-Cohen

Does the autistic child have a “theory of mind” ?

Abstract We use a new model of metarepresentational development to predict a cognitive deficit which could explain a crucial component of the social impairment in childhood autism. One of the manifestations of a basic metarepresentational capacity is a ‘theory of mind’. We have reason to believe that autistic children lack such a ‘theory’. If this were so, then they would be unable to impute beliefs to others and to predict their behaviour. This hypothesis was tested using Wimmer and Perners puppet play paradigm. Normal children and those with Downs syndrome were used as controls for a group of autistic children. Even though the mental age of the autistic children was higher than that of the controls, they alone failed to impute beliefs to others. Thus the dysfunction we have postulated and demonstrated is independent of mental retardation and specific to autism.

The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians.

Currently there are no brief, self-administered instruments for measuring the degree to which an adult with normal intelligence has the traits associated with the autistic spectrum. In this paper, we report on a new instrument to assess this: the Autism-Spectrum Quotient (AQ). Individuals score in the range 0–50. Four groups of subjects were assessed: Group 1: 58 adults with Asperger syndrome (AS) or high-functioning autism (HFA); Group 2: 174 randomly selected controls. Group 3: 840 students in Cambridge University; and Group 4: 16 winners of the UK Mathematics Olympiad. The adults with AS/HFA had a mean AQ score of 35.8 (SD = 6.5), significantly higher than Group 2 controls (M = 16.4, SD = 6.3). 80% of the adults with AS/HFA scored 32+, versus 2% of controls. Among the controls, men scored slightly but significantly higher than women. No women scored extremely highly (AQ score 34+) whereas 4% of men did so. Twice as many men (40%) as women (21%) scored at intermediate levels (AQ score 20+). Among the AS/HFA group, male and female scores did not differ significantly. The students in Cambridge University did not differ from the randomly selected control group, but scientists (including mathematicians) scored significantly higher than both humanities and social sciences students, confirming an earlier study that autistic conditions are associated with scientific skills. Within the sciences, mathematicians scored highest. This was replicated in Group 4, the Mathematics Olympiad winners scoring significantly higher than the male Cambridge humanities students. 6% of the student sample scored 327plus; on the AQ. On interview, 11 out of 11 of these met three or more DSM-IV criteria for AS/HFA, and all were studying sciences/mathematics, and 7 of the 11 met threshold on these criteria. Test—retest and interrater reliability of the AQ was good. The AQ is thus a valuable instrument for rapidly quantifying where any given individual is situated on the continuum from autism to normality. Its potential for screening for autism spectrum conditions in adults of normal intelligence remains to be fully explored.

The Empathy Quotient: An Investigation of Adults with Asperger Syndrome or High Functioning Autism, and Normal Sex Differences.

Empathy is an essential part of normal social functioning, yet there are precious few instruments for measuring individual differences in this domain. In this article we review psychological theories of empathy and its measurement. Previous instruments that purport to measure this have not always focused purely on empathy. We report a new self-report questionnaire, the Empathy Quotient (EQ), for use with adults of normal intelligence. It contains 40 empathy items and 20 filler/control items. On each empathy item a person can score 2, 1, or 0, so the EQ has a maximum score of 80 and a minimum of zero. In Study 1 we employed the EQ with n = 90 adults (65 males, 25 females) with Asperger Syndrome (AS) or high-functioning autism (HFA), who are reported clinically to have difficulties in empathy. The adults with AS/HFA scored significantly lower on the EQ than n = 90 (65 males, 25 females) age-matched controls. Of the adults with AS/HFA, 81% scored equal to or fewer than 30 points out of 80, compared with only 12% of controls. In Study 2 we carried out a study of n = 197 adults from a general population, to test for previously reported sex differences (female superiority) in empathy. This confirmed that women scored significantly higher than men. The EQ reveals both a sex difference in empathy in the general population and an empathy deficit in AS/HFA.

Gaze Perception Triggers Reflexive Visuospatial Orienting

This paper seeks to bring together two previously separate research traditions: research on spatial orienting within the visual cueing paradigm and research into social cognition, addressing our tendency to attend in the direction that another person looks. Cueing methodologies from mainstream attention research were adapted to test the automaticity of orienting in the direction of seen gaze. Three studies manipulated the direction of gaze in a computerized face, which appeared centrally in a frontal view during a peripheral letter-discrimination task. Experiments 1 and 2 found faster discrimination of peripheral target letters on the side the computerized face gazed towards, even though the seen gaze did not predict target side, and despite participants being asked to ignore the face. This suggests reflexive covert and/or overt orienting in the direction of seen gaze, arising even when the observer has no motivation to orient in this way. Experiment 3 found faster letter discrimination on the side the computerized face gazed towards even when participants knew that target letters were four times as likely on the opposite side. This suggests that orienting can arise in the direction of seen gaze even when counter to intentions. The experiments illustrate that methods from mainstream attention research can be usefully applied to social cognition, and that studies of spatial attention may profit from considering its social function.

Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism.

Most theory of mind (ToM) tests are designed for subjects with a mental age of 4–6 years. There are very few ToM tests for subjects who are older or more able than this. We report a new test of ToM, designed for children 7–11 years old. The task involves recognizing faux pas. Study 1 tested 7–9, and 11-year-old normal children. Results showed that the ability to detect faux pas developed with age and that there was a differential developmental profile between the two sexes (female superiority). Study 2 tested children with Asperger syndrome (AS) or high-functioning autism (HFA), selected for being able to pass traditional 4- to 6-year level (first- and second-order) false belief tests. Results showed that whereas normal 9- to 11-year-old children were skilled at detecting faux pas, children with AS or HFA were impaired on this task. Study 3 reports a refinement in the test, employing control stimuli. This replicated the results from Study 2. Some patients with AS or HFA were able to recognize faux pas but still produced them. Future research should assess faux pas production.

Is There a "Language of the Eyes"? Evidence from Normal Adults, and Adults with Autism or Asperger Syndrome

Previous work suggests that a range of mental states can be read from facial expressions, beyond the “basic emotions”. Experiment 1 tested this in more detail, by using a standardized method, and by testing the role of face parts (eyes vs. mouth vs. the whole face). Adult subjects were shown photographs of an actress posing 10 basic emotions (happy, sad, angry, afraid, etc.) and 10 complex mental states (scheme, admire, interest, thoughtfulness, etc.). For each mental state, each subject was shown the whole face, the eyes alone, or the mouth alone, and were given a forced choice of two mental state terms. Results indicated that: (1) Subjects show remarkable agreement in ascribing a wide range of mental states to facial expressions, (2) for the basic emotions, the whole face is more informative than either the eyes or the mouth, (3) for the complex mental states, seeing the eyes alone produced significantly better performance than seeing the mouth alone, and was as informative as the whole face. In Experim...

Prevalence of autism-spectrum conditions: UK school-based population study

BACKGROUND Recent reports estimate the prevalence of autism-spectrum conditions in the UK to be 1%. AIMS To use different methods to estimate the prevalence of autism-spectrum conditions, including previously undiagnosed cases, in Cambridgeshire. METHOD We carried out a survey of autism-spectrum conditions using the Special Educational Needs (SEN) register. A diagnosis survey was distributed to participating schools to be handed out to parents of all children aged 5-9 years. The mainstream primary school population was screened for unknown cases. RESULTS The prevalence estimates generated from the SEN register and diagnosis survey were 94 per 10 000 and 99 per 10 000 respectively. A total of 11 children received a research diagnosis of an autism-spectrum condition following screening and assessment. The ratio of known:unknown cases is about 3:2 (following statistical weighting procedures). Taken together, we estimate the prevalence to be 157 per 10 000, including previously undiagnosed cases. CONCLUSIONS This study has implications for planning diagnostic, social and health services.

Infants with Autism: An Investigation of Empathy, Pretend Play, Joint Attention, and Imitation.

Systematic studies of infants with autism have not been previously carried out. Taking advantage of a new prospective screening instrument for autism in infancy (S. Baron-Cohen et al., 1996), the present study found that, compared with developmentally delayed and normally developing children, 20-month-old children with autism were specifically impaired on some aspects of empathy, joint attention, and imitation. Infants with autism failed to use social gaze in the empathy and joint attention tasks. Both the infants with autism and the infants with developmental delay demonstrated functional play, but very few participants in either group produced spontaneous pretend play. In the developmental delay group, but not the autism group, pretend play was shown following prompting. The implications of these findings for developmental accounts of autism and for the early diagnosis of the disorder are discussed.

Social and pragmatic deficits in autism: Cognitive or affective?

Autism is characterized by a chronic, severe impairment in social relations. Recent studies of language in autism also show pervasive deficits in pragmatics. We assume, uncontroversially, that these two deficits are linked, since pragmatics is part of social competence. This paper reviews the literature describing these deficits, and then considers two different psychological theories of these phenomena: the Affective theory and the Cognitive theory. Although the Affective theory makes better sense of the results from emotional recognition tasks, the Cognitive theory predicts the particular pattern of impaired and unimpaired social skills in autism, as well as the pragmatic deficits. These two theories might usefully be integrated in the future.

A screening instrument for autism at 18 months of age: a 6-year follow-up study

OBJECTIVES A population of 16,235 children aged 18 months was screened using the Checklist for Autism in Toddlers (CHAT) to identify childhood autism (CA). Two further screening procedures were conducted at age 3 and 5 years. The population was followed up at age 7 years in order to establish the sensitivity, specificity, and positive predictive value of the instrument. METHOD A brief checklist assessing joint attention and pretend play behaviors was administered by primary health care practitioners when the children were 18 months old. Follow-up methods included screening through parents and health practitioners and checking medical and educational records. RESULTS Nineteen cases of CA were successfully identified by the CHAT at 18 months. At follow-up a total of 50 cases of CA were identified via all surveillance methods. Thus, the CHAT has a sensitivity of 38% and a specificity of 98% for identifying CA. The positive predictive value of the instrument was maximized by concentration on the highest-risk group. Repeated screening 1 month later increased the positive predictive value to 75% for identification of CA but reduced the sensitivity to 20%, although the specificity was close to 100%. The screen also identified cases of pervasive developmental disorder as well as children with language and other developmental disorders. CONCLUSIONS The CHAT can be used to identify cases of autism and related pervasive developmental disorders at 18 months of age. It is emphasized that the CHAT is not a diagnostic instrument but can identify potential cases of autism spectrum disorders for a full diagnostic assessment.