A comparison of self-report and discrepancy measures of camouflaging: Exploring sex differences in diagnosed autistic versus high autistic trait young adults

Camouflaging describes masking or compensating for autistic traits and/or related difficulties. Some evidence suggests autistic females camouflage more than autistic males, potentially contributing to delayed or missed diagnosis. Studies predominantly adopt self-report measures of camouflaging, potentially reflecting a person's intent to camouflage without accurately measuring effectiveness (i.e., success in fulfilling the intended effect of minimizing the appearance of autistic traits) of camouflaging. Discrepancy scores between underlying cognitive difficulties (e.g., theory of mind) and observed autistic traits (henceforth camoToM ), or between self-reported autistic traits and observed autistic traits (henceforth camoSRS ), may provide a more accurate measure of camouflaging effectiveness. Three measures of camouflaging administered to autistic males (n = 46) and females (n = 40), and adults with equally high levels of autistic traits but no diagnosis (n = 45 males, n = 43 females) recruited from a large population-based sample were compared. Self-report measures of camouflaging were significantly correlated with camoSRS scores only. Both discrepancy scores were correlated with each other. Adults with high autistic traits, but no diagnosis, had higher discrepancy camouflaging scores than diagnosed adults, but self-reported scores were similar. Diagnosed females scored higher than diagnosed males across all camouflaging measures, but no sex difference occurred in the high trait group. This might indicate that autistic females have higher intentions and greater effectiveness when camouflaging, compared with autistic males. For camoSRS only, high trait males scored significantly higher than diagnosed males; no group difference occurred for females. These results suggest that, despite all participants intending to camouflage to some extent, effective camouflaging as measured by discrepancy scores is higher in undiagnosed high autistic trait individuals. One interpretation is that effective camouflaging reduces the likelihood of autism diagnosis in males and females with high autistic traits

Theory of mind and communication in autism

Recent work investigating the biological and cognitive nature of autism is reviewed. The hypothesis that autistic individuals suffer from a specific impairment in theory of mind, and the relevance of this notion to the diagnosis of Asperger's syndrome, is discussed. Theory of mind explanations of autism must account for the minority of autistic subjects who pass false belief tasks. Two possible accounts are considered; delay versus 'hacking'. A battery of theory of mind tasks was given to able autistic subjects, and to mentally handicapped and young normal controls. The results suggested the existence of subgroups: while some autistic subjects performed inconsistently (perhaps using task-specific strategies), others performed consistently well at first-order theory of mind tasks, and some passed an array of second-order tasks. Relevance theory suggests that understanding mental states is vital in communication. Communication tasks were therefore given, to explore the theory of mind abilities of the autistic subjects. Relevance theory predicted that subjects unable to attribute mental states would show literal understanding, subjects with first-order theory of mind would comprehend metaphor, but second-order theory of mind would be necessary to understand irony. These predictions were tested and confirmed with autistic subjects and normal children. The theory of mind hypothesis cannot explain the persistent real-life handicaps of autistics who understand mental states, nor account for the nonsocial peculiarities seen in autism. A deficit in central coherence is suggested as the source of these features. Results from a preliminary test of this hypothesis suggested that even autistic subjects who develop theory of mind ability are impaired at extracting context-dependent meaning. The implications of these findings for the diagnosis of Asperger's syndrome, the relations between the social and nonsocial impairments, and suggestions for further research are discussed

Quantifying compensatory strategies in adults with and without diagnosed autism

Background There is growing recognition that some autistic people engage in ‘compensation’, showing few behavioural symptoms (e.g. neurotypical social skills), despite continuing to experience autism-related cognitive difficulties (e.g. difficulties in social cognition). One way this might be achieved is by individuals consciously employing ‘compensatory strategies’ during everyday social interaction. However, very little is currently known about the broad range of these strategies, their mechanisms and consequences for clinical presentation and diagnosis. Methods We aimed to measure compensatory strategies in autism for the first time. Using a novel checklist, we quantified self-reported social compensatory strategies in 117 adults (58 with autism, 59 without autism) and explored the relationships between compensation scores and autism diagnostic status, autistic traits, education level, sex and age at diagnosis. Results Higher compensation scores—representing a greater repertoire of compensatory strategies—were associated with having an autism diagnosis, more autistic traits and a higher education level. The link between autism diagnostic status and compensation scores was, however, explained by autistic traits and education level. Compensation scores were unrelated to sex or age at diagnosis. Limitations Our sample was self-selected and predominantly comprised of intellectually able females; therefore, our findings may not generalise to the wider autistic population. Conclusions Together, our findings suggest that many intellectually able adults, with and without a clinical diagnosis of autism, report using compensatory strategies to modify their social behaviour. We discuss the clinical utility of measuring self-reported compensation (e.g., using our checklist), with important implications for the accurate diagnosis and management of autism and related conditions

Parenting strategies used by caregivers of children with ASD: Differential links with child problem behaviour

Here, we explored the structure of the ‘Parenting Strategies Questionnaire’, a new scale designed to measure parenting strategies for problem behaviour in ASD. We then examined links between child behaviour and parenting in a sample of 222 predominantly-UK parents of ASD children exhibiting behaviour found difficult or challenging. Analysis revealed three parenting subscales: Accommodation, Reinforcement Approaches and Reducing Uncertainty. Both Accommodation and Reducing Uncertainty were linked to child problem behaviour. Child factors explained up to 29% of the variance in Accommodation, with Socially Inflexible Non-compliance the strongest predictor, and up to 24% of the variance in Reducing Uncertainty, with Intolerance of Uncertainty the strongest predictor. Child factors were not related to Reinforcement Approaches. Longitudinal studies investigating these relationships are needed

Linearly integrating speed and accuracy to measure individual differences in theory of mind: Evidence from autistic and neurotypical adults

It has long been theorised that there is a direct link between individual differences in social cognition and behaviour. One of the most popular tests of this theory has involved examination of Theory of Mind (ToM) difficulties in Autism Spectrum Disorder (ASD). However, evidence for associations between ToM and social behaviour is mixed, both when testing the ToM explanation of ASD and when investigating individual differences in ToM in the general population. We argue that this is due to methodological limitations of many ToM measures, such as a lack of variability in task performance, inappropriate non-ToM control tasks, and a failure to account for general mental ability. To overcome these issues, we designed a novel task, which probed individual differences in ToM fluency through mental state attribution in response to cartoons (Cartoons Theory of Mind [CarToM] task). This task, enabling the linear combination of speed and accuracy, was used to quantify ToM ability and its association with self-reported (a)typical social behaviour in adults with and without ASD. In a large sample (N = 237), we found that having an ASD diagnosis and higher autistic traits predicted lower ToM ability, even after accounting for performance on a well-matched non-ToM condition and general mental ability. Overall, our findings provide fresh support for the existence of a link between individual differences in social cognition (specifically, ToM) and behaviour (specifically, autism). This has implications for social-cognitive theory and research, allowing large-scale, online assessment of individual differences in ToM in clinical groups and the general population

Anxiety and attentional bias to threat in children at increased familial risk for Autism Spectrum Disorder

Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n = 37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n = 15) and those who did not (HR-non ASD, n = 24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms

Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/‘pathological’ demand avoidance

A subset of individuals with autism spectrum disorder (ASD) resemble descriptions of extreme/‘pathological’ demand avoidance, displaying obsessive avoidance of everyday demands and requests, strategic or ‘socially manipulative’ behaviour and sudden changes in mood. Investigating challenging presentations using dimensional description may prove preferable to identifying subgroups. However, there remains an imperative to explore which behavioural traits appear most problematic to inform quantitative investigation. This study provides an in‐depth exploration of parent perspectives on maladaptive behaviour in children reported to have an autism spectrum diagnosis and features of extreme/‘pathological’ demand avoidance

Cognitive and affective associations with an ecologically valid test of theory of mind across the lifespan

Objectives: Many studies have demonstrated that theory of mind (ToM) ability declines with increasing age. Research has found that ToM-age associations are often mediated by other cognitive abilities particularly executive function. However, older adults rarely complain about real-world ToM difficulties. It has been suggested that older adults may perform better in real-world situations compared to experimental settings. Methods: We examined performance on the Strange Stories Film Task (SSFT) which has been designed to assess ToM using naturalistic, video scenarios. Sixty adults aged between 17-95 years old completed the SSFT, inhibitory control (Stroop) and working memory (Letter-Number Sequencing) measures, the basic empathy scale (cognitive and affective empathy), and the broad autism phenotype questionnaire. Results: ToM performance correlated significantly with age, whereas performance on a control task did not. Partial correlations and stepwise regression analyses demonstrated that performance on the three SSFT ToM measures was explained by a combination of executive function and empathy measures, with age explaining none of the variance. Conclusions: Using a naturalistic test of ToM, performance was shown to decline with age for ToM but not control scenarios. Across the lifespan, the variance in ToM performance was explained by cognitive abilities and empathy but not age. Age alone may not influence ToM ability, but may be associated with age-related changes in cognition and social-cognition