Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people

Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person’s social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples’ lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories—specifically the social model of disability, social identity theory, and minority stress model—to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples’ lived experiences and reduce disparities in their mental health outcomes

Reference production in young speakers with and without autism: Effects of discourse status and processing constraints

We examine the referential choices (pronouns/zeros vs. names/descriptions) made during a narrative by high-functioning children and adolescents with autism and a well-matched typically developing control group. The process of choosing appropriate referring expressions has been proposed to depend on two areas of cognitive functioning: a) judging the attention and knowledge of one’s interlocutor, and b) the use of memory and attention mechanisms to represent the discourse situation. We predicted possible group differences, since autism is often associated with deficits in a) mentalizing and b) memory and attention, as well as a more general tendency to have difficulty with the pragmatic aspects of language use. Results revealed that some of the participants with autism were significantly less likely to produce pronouns or zeros in some discourse contexts. However, the difference was only one of degree. Overall, all participants in our analysis exhibited fine-grained sensitivity to the discourse context. Furthermore, referential choices for all participants were modulated by factors related to the cognitive effort of language production

Learning Through Experience

Professor Bennetto is a member of the Department of Clinical and Social Psychology

Multisensory integration and temporal synchrony in autism

Thesis (Ph. D.)--University of Rochester. Department of Clinical and Social Sciences in Psychology, 2013.Multisensory integration is the process by which individuals combine information from multiple sources (e.g., vision, audition, touch) to produce a unique and unitary percept that produces a more accurate experience. Individuals with autism frequently show difficulty in multisensory integration tasks, and as a result may have difficulty locating and identifying stimuli in “noisy” sensory environments. This may be especially harmful during early development, when much of what is learned about language and communication depends on the ability to locate a speaker and identify what they are saying. A crucial aspect of multisensory integration in typical individuals is the ability to perceive and utilize temporal synchrony cues between two streams of information. Previous work strongly suggests that temporal synchrony detection may be altered in individuals with autism, but the effect of such a deficit on localization and identification of multisensory events has not been clearly studied. The present study examined the ability of individuals with autism to utilize temporal cues while locating and discriminating social and nonsocial audiovisual stimuli. Twenty children and adolescents with high functioning autism and twenty well matched controls completed audiovisual localization and discrimination tasks presented with varying levels of audiovisual asynchrony. In Experiment 1, participants viewed side by side videos (of either a person speaking or a ball bouncing), one of which matched the sound they heard and one of which was mismatched at varying levels of asynchrony. Results from an adaptive paradigm revealed that individuals with autism showed a differential pattern of sensitivity to audiovisual asynchrony compared to controls when viewing social versus nonsocial stimuli. In particular, when using audiovisual synchrony to locate stimuli, individuals with autism showed a pattern of differentially larger TWIs for nonsocial compared to social stimuli in comparison to the pattern seen in the the control group. For Experiment 2, participants completed a discrimination task, in which they were asked to discriminate small differences in auditory stimuli during a social and nonsocial task. The videos for the stimuli were presented at varying levels of asynchrony and discrimination thresholds were determined for each level. Results from this experiment showed that individuals with autism showed enhanced auditory discrimination at baseline, and that they utilized temporal synchrony cues similarly to controls when discriminating audiovisual stimuli. In combination, the results of this study place emphasis on the role of orientation and attention in audiovisual integration in autism, and show largely intact processing of temporal cues when task complexity is minimized. These results have implications for our theoretical understanding of the etiology of autism as well as expression and development of clinical symptoms

Quantifying interpersonal coordination in autism spectrum disorder and its role in social connectedness and social functioning.

Thesis (Ph. D.)--University of Rochester. Department of Clinical and Social Sciences in Psychology, 2017.Autism spectrum disorder (ASD) is defined by social and communication deficits in the areas of social-emotional reciprocity, understanding and producing social cues, and developing close relationships. This study investigated differences in interpersonal coordination a possible explanation for social communication symptoms in ASD. Interpersonal coordination refers to the tendency for social partners to non-consciously align the form and timing of their behaviors. It is a well-established phenomenon in normative social interactions from early infancy, and has been shown to foster feelings of connectedness between social partners, enhance the ability to process and relate to social cues, and play an important role in social development. A small body of research has provided some evidence of atypical interpersonal coordination in ASD. Through a series of five aims, the current study comprehensively examined interpersonal coordination in high functioning children and adolescents with ASD, in comparison to well-matched typically developing peers. Interpersonal coordination was quantified while children participated in natural conversational tasks with their mothers and with unfamiliar adults, using measurements based on both human judgments and automated video analysis. This study also evaluated the extent to which engaging in interpersonal coordination was associated with interaction quality and other aspects of social functioning that are impaired in ASD. Broadly, results demonstrated that interpersonal coordination is reduced in children with ASD relative to their typically developing peers, across the modalities of conversational content, body movement, and facial affect. Results also showed significant associations between interpersonal coordination and social outcomes, including rapport with interaction partners, autism symptom severity, and several domains of everyday social functioning. This study is therefore suggestive of disruptions in this automatic, fundamental social process in children with ASD, which may account for social communication symptoms and difficulties with interpersonal relationships. Implications include a need for increased focus by researchers and clinicians on the social use of movement in ASD, within the context of dynamic social interactions

Audiovisual Integration During Language Comprehension:The Neural Basis of Social Communication in Autism and Typical Development

Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Graduate Studies in Neuroscience, 2011.Nonverbal information, such as motion cues from the lips, face, hands, and body, contributes significantly to social communication as it provides helpful information for understanding a speaker’s communicative intent. Consequently, difficulty interpreting or using nonverbal cues early in development may contribute to later social communication impairments. Abnormal attention to and use of nonverbal cues is a commonly reported trait in individuals with autism spectrum disorders, but little is known about the neurobiological underpinnings of this deficit. This thesis aimed to examine the neural basis for (1) the interpretation of biological motion cues, and (2) the integration of biological motion with simultaneously occurring speech. Using functional magnetic resonance imaging, we measured blood-oxygen level dependent signal as participants viewed silent videos of communicatively meaningful and meaningless gestures. Three groups of participants were recruited: typical adults, typically developing children, and children with high functioning autism. In all three groups, direct comparison of the meaningful and meaningless conditions showed that meaningful gestures preferentially recruit a left hemisphere dominant network, including inferior frontal gyrus, superior temporal sulcus/gyrus, and limbic regions. Meaningless gestures, on the other hand, preferentially recruited a right lateralized network of fronto-parietal action processing regions. Comparisons between groups showed that the neural circuitry subserving biological motion processing is well developed by late childhood. Moreover, there were no significant differences between the two groups of children, suggesting preservation of function in the neural network underlying perception and identification of biological motion in individuals with high functioning autism. To investigate the neural networks underlying audiovisual integration, we designed an object identification task that was presented using unimodal speech descriptions alone, unimodal gesture descriptions alone, or bimodal speech-gesture combinations. Regions demonstrating increased activity during the bimodal integration task were identified using direct comparison of the speech-gesture condition versus the two combined unimodal conditions. Consistent with previously reported findings, typical adults had increased activity selectively in the superior temporal region, bilaterally. For typically developing children, however, activity in this region was constrained to the left hemisphere, with additional clusters in occipital regions. Of particular interest, children with high functioning autism showed increased cortical response associated with the bimodal condition exclusively in the occipital cortex. Moreover, signal change in the superior temporal region was negatively correlated with a measure of autism-related social deficits. Results demonstrate that the superior temporal region of the human brain is involved in multiple roles. It is likely that activity in this region is modulated based on the network of cortical and subcortical regions with which it communicates. Overall, these studies shed light on the neural network subserving social perception, the development of this network in children, and the changes in network function associated with autism spectrum disorder

Visuospatial processing style in autism and Down syndrome : pathways to social functioning

Thesis (Ph. D.)--University of Rochester. Dept. of Clinical and Social Sciences in Psychology, 2009.The present study aimed to examine patterns of visuospatial processing style and social functioning across groups of children with autism spectrum disorders (ASDs), children with Down syndrome (DS), and children with typical development. The primary hypothesis was that particular patterns of social functioning and play would coincide with a detail-focused visuospatial processing style in the children with ASDs, while contrasting patterns would be present with a globally-focused processing style in DS. The children with typical development were expected to fall between these two groups on a continuum representing two extremes of visuospatial processing style. Participants were 18 children with ASDs, 18 children with DS, and 18 typically developing children. The children with ASDs were matched on mean nonverbal and verbal mental age to the typically developing controls, and the two clinical groups were matched on mean chronological age. Overall, results confirmed the predicted patterns across the groups. The children with ASDs evidenced a detail-focused visuospatial processing style in concert with a reduced frequency of attempts to share information and attention with others, as well as play that was more object-based. In contrast, the children with DS showed a globally-focused visuospatial processing style that was present alongside relatively enhanced social functioning and increased frequency of pretend play. The data in the present study support evidence of the hypothesized contrasting profiles of visuospatial processing style, social functioning, and play in children with autism spectrum disorders and children with Down syndrome, and suggest that these strengths and weaknesses should be considered in treatment and educational planning

Gesture production as a predictor of treatment outcomes for children with autism in early intensive behavioral intervention

Thesis (Ph. D.)--University of Rochester. Department of Clinical and Social Sciences in Psychology, 2015.Predictors of treatment outcomes for children with autism spectrum disorders have been extensively studied, but less is known about the individual differences that may explain variation in response to early intervention. Measuring nonverbal communication may provide a way for better characterizing some of these differences and understanding their role in predicting treatment outcomes. The present study used a theoretically grounded, multi-method approach for measuring nonverbal communication, specifically gesture production, as a predictor of treatment outcomes for children with autism enrolled in early intensive behavioral intervention. Caregiver report, standardized clinician assessments, and micro-analytic coding of videotaped interactions were used to represent gesture production. Treatment outcomes were also represented with diverse methods to obtain a comprehensive measure of change. Gesture production was then used to evaluate the extent to which differences in early nonverbal communication predicted variability in how children with autism changed during the course of early intervention. After controlling for initial levels of each treatment outcome measure and speech production, the results indicated that gesture production significantly accounted for additional variance in cognitive ability, adaptive behavior, and autism symptom severity at both one and two-year follow-up assessments. Different measures of gesture production were then evaluated to determine their relative utility in predicting change during the course of intervention. The results indicated that a more diverse and nuanced description of children’s early nonverbal communication served as the strongest predictor of individual treatment outcomes. Finally, structural equation models examined the extent to which early gesture predicted variability in the amount of change observed at follow-up assessments. A latent construct comprised of multiple measures of gesture was successfully derived and significantly predicted variability in treatment outcome change. This effect remained even after controlling for initial standing on a latent treatment outcome construct and caregiver report of speech production. These results suggest that early gestural communication can be used to predict how children with autism change during the course of intervention. Delineating differences in nonverbal communication could inform clinical decisions about the selection and focus of specific interventions and increase the probability of positive outcomes for a broader range of children with autism

A proposed model of intelligence and its implications for children with Autism Spectrum Disorder

Thesis (Ph. D.)--University of Rochester. Department of Clinical and Social Sciences in Psychology, 2016.Although research indicates that IQ tests are reliable and valid measures of cognition when administered to individuals with autism spectrum disorder (ASD), it also reveals that such tests have unusual psychometric properties in this population, notably low intercorrelation among subtests, distinctive patterns of strengths and weaknesses, and overprediction of everyday functioning. A comprehensive explanation for these differences has yet to be offered. This study evaluates a new model of the structure of intelligence in the ASD population that, if confirmed, would help account for the differences. A threedomain model is proposed, consisting of language ability, perceptual ability, and social ability, with each ability further broken down into a fluid reasoning component and crystalized knowledge component. Fifty-three children with ASD, ages 6-12, with full scale IQ scores above 50, were assessed on a standardized IQ test (Stanford-Binet Intelligence Test, 5th Edition), a test of social skills (NEPSY-II), and parent-rated adaptive behavior (Vineland Adaptive Behavior Scales II), social skills (Social Skills Improvement System – Rating Scales), and executive functioning (BRIEF). Factor scores were estimated from 6 items (Verbal Knowledge, Verbal Fluid Reasoning, Nonverbal Knowledge, and Nonverbal Fluid Reasoning from the SB-5; Affect Recognition and Theory of Mind from the NEPSY-II), and a path analysis was conducted to test the fit of a model relating these factors to (1) constructs representing cognitive abilities and adaptive abilities, (2) constructs representing the components of the new model proposed in this study (language abilities, perceptual abilities, and social abilities), and (3) constructs representing the impact of executive functioning on the new model. On the whole, results supported the use of the SB-5 with school-age children with ASD. The proposed model was partially supported with the inclusions of social skills and only 4 subtests of the SB-5 predicting adaptive behavior as well as the full IQ test. The inclusion of executive functioning in the model as an additional construct of cognition was not supported

Integration of Gesture and Speech in Real-Time Reference Resolution

Poster given at the The 18th Annual CUNY Sentence Processing Conference, March 31st-April 2nd, 2005. Location: Tuscon, AZ