Social cognitive impairment and autism: What are we trying to explain?

Early psychological theories of autism explained the clinical features of this condition in terms of perceptual and sensory processing impairments. The arrival of domain-specific social cognitive theories changed this focus, postulating a ‘primary’ and specific psychological impairment of social cognition. Across the years, evidence has been growing in support of social cognitive and social attention explanations in autism. However, there has also been evidence for general non-social cognitive impairments in representational understanding, attention allocation and sensory processing. Here, I review recent findings and consider the case for the specificity and primacy of the social cognitive impairment, proposing that we should focus more explicitly on clinically valid features for insights on the integration of ‘social’ and ‘non-social’ cognition

Reconstructing children's understanding of mind: Reflections from the study of atypical development [Letter]

Carpendale & Lewis's (C&L's) theoretical reconstruction of the “theory of mind” problem offers new hope but still has far to go. The study of atypical development may provide some useful insights for dealing with the work ahead. In particular I discuss three issues – the boundary problem, the question of end states, and the issue of the centrality of triadic interaction

First evidence of the feasibility of gaze-contingent attention training for school children with autism

A number of authors have suggested that attention control may be a suitable target for cognitive training in children with autism spectrum disorder. This study provided the first evidence of the feasibility of such training using a battery of tasks intended to target visual attentional control in children with autism spectrum disorder within school-based settings. Twenty-seven children were recruited and randomly assigned to either training or an active control group. Of these, 19 completed the initial assessment, and 17 (9 trained and 8 control) completed all subsequent training sessions. Training of 120 min was administered per participant, spread over six sessions (on average). Compliance with the training tasks was generally high, and evidence of within-task training improvements was found. A number of untrained tasks to assess transfer of training effects were administered pre- and post-training. Changes in the trained group were assessed relative to an active control group. Following training, significant and selective changes in visual sustained attention were observed. Trend training effects were also noted on disengaging visual attention, but no convincing evidence of transfer was found to non-trained assessments of saccadic reaction time and anticipatory looking. Directions for future development and refinement of these new training techniques are discussed

Assessing subtypes of restricted and repetitive behaviour using the Adult Repetitive Behaviour Questionnaire-2 in autistic adults

Background The majority of previous research into restricted and repetitive behaviours (RRBs) has focussed on children, partly due to a lack of suitable measures for RRBs in adults. This study aimed to explore the psychometric properties of the Adult Repetitive Behaviour Questionnaire-2 (RBQ-2A) in a large sample of autistic adults using a self-report questionnaire method. Methods The RBQ-2A and Autism-Spectrum Quotient (AQ) were administered online. Data from 275 autistic adults aged 18–66 (M = 36.56, SD = 12.24; 100 men and 171 women) were analysed using polychoric principal components analysis (PCA). Reliability and validity were assessed using Cronbach’s alpha and correlation analyses. Results Background The majority of previous research into restricted and repetitive behaviours (RRBs) has focussed on children, partly due to a lack of suitable measures for RRBs in adults. This study aimed to explore the psychometric properties of the Adult Repetitive Behaviour Questionnaire-2 (RBQ-2A) in a large sample of autistic adults using a self-report questionnaire method. Methods The RBQ-2A and Autism-Spectrum Quotient (AQ) were administered online. Data from 275 autistic adults aged 18–66 (M = 36.56, SD = 12.24; 100 men and 171 women) were analysed using polychoric principal components analysis (PCA). Reliability and validity were assessed using Cronbach’s alpha and correlation analyses. Result

Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade

Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorders. They constitute a major barrier to learning and social adaptation, but research on their definition, cause, and capacity for change has been relatively neglected. The last decade of research has brought new measurement techniques that have improved the description of RRBs. Research has also identified distinctive subtypes of RRBs in autism spectrum disorders. Research on potential causal origins and immediate triggers for RRBs is still at an early stage. However, promising new ideas and evidence are emerging from neurobiology and developmental psychology that identify neural adaptation, lack of environmental stimulation, arousal, and adaptive functions as key factors for the onset and maintenance of RRBs. Further research is needed to understand how these factors interact with each other to create and sustain atypical levels of RRB. The literature indicates that RRBs have the potential to spontaneously reduce across time, and this is enhanced for those with increased age and cognitive and language ability. Research on interventions is sparse. Pharmacological treatments can be helpful in some children but have adverse side effects. Behavioral intervention methods provide the better intervention option with positive effects, but a more systematic and targeted approach is urgently needed. Evidence suggests that we will learn best from the last decade of research by taking a developmental perspective, by directing future research toward subtypes of RRBs, and by implementing early intervention targeted to improve RRBs before these behaviors become entrenched

Anxiety, intolerance of uncertainty and restricted and repetitive behaviour: insights directly from young people with ASD

In order to investigate the experience of anxiety and restricted and repetitive behaviours (RRB) in young people with ASD, 19 families with young people with ASD aged between 13 and 20 years completed questionnaire measures of RRB, anxiety, and intolerance of uncertainty. Ten young people also completed a novel semi-structured interview exploring an individualised example of an RRB. Findings demonstrated that young people with ASD can self-report and show insight in to their RRB, and replicated previous findings based on parent report showing a significant positive relationship between RRB and anxiety. This is the first evidence of young person self-report using both quantitative and qualitative data and indicates a range of reasons why young people may engage in RRB

Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD)

Background Both self-regulation and insistence on sameness (IS) are related to anxiety, which is a common feature of individuals with autism spectrum disorder (ASD). Here, we aimed to characterise the IS-self-regulation-anxiety interrelationship by investigating the potential contribution made by self-regulation, assessed via effortful control (EC), to the IS-anxiety relationship in a sample of adolescents and young adults with ASD. Method Seventy-one older adolescents and younger adults with ASD (49 males, 22 females; M age = 18.71 years, SD = 2.51, range 14.42–24.81) completed the Adult Repetitive Behaviour Questionnaire-2, Effortful Control Scale of the Adult Temperament Questionnaire and the DSM-5 Dimensional Anxiety Scales. Results IS was associated with both EC (r = −.39, p = .001) and anxiety (r = .45, p < .001), and anxiety was in turn associated with EC (r = −.44, p < .001). To characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of EC on anxiety, through IS (b = −.06; BCa 95% CI [−.13, −.02]), and indirect effect on anxiety through EC (b = 1.62; BCa 95% CI [.59, 3.24]) with the mediators accounting for 29.07 and 26.04% of the total effect, respectively. Conclusions Our study provides the first exploration of the IS-anxiety-self-regulation link in ASD. The finding that lower levels of self-regulation are related both to anxiety and IS behaviours points to self-regulation as a viable intervention target for both anxiety and IS behaviours

Are restricted and repetitive behaviours in two‐ and six‐year‐olds associated with emotional and behavioural difficulties?

Background: Restricted and repetitive patterns of behaviour (RRBs) serve an adaptive role in development. Elevated levels of RRBs beyond the early years, however, are associated with poorer outcome in language, cognition, and wellbeing, and are seen across a range of neurodevelopmental conditions. This study aimed to characterize the association of distinct RRB subtypes at two and six years of age, with internalising and externalising difficulties in a community sample of children. Methods: 485 parents reported on their child's insistence on sameness (IS) and repetitive sensory and motor (RSM) RRBs at two and six years of age using the Repetitive Behaviour Questionnaire (RBQ‐2). Emotional and behavioural difficulties were measured using the Strengths and Difficulties Questionnaire (SDQ) at age six. Results: Consistent with previous research, RRBs later in development better predicted emotional and behavioural difficulties at age six than RRBs earlier in development. Moreover, IS RRBs were selectively associated with internalising behaviours and RSM RRBs with externalising behaviours. Importantly, these selective associations depended on when RRBs were measured. Only IS RRBs at age six were significantly associated with internalising behaviour. By contrast, while more RSM RRBs at age six were associated with higher rates of externalising behaviours, higher rates of RSM RRBs at age two were associated with fewer externalising behaviours, adding further support to the previously reported adaptive role of RRBs in early behaviour regulation. Conclusion: Although there is a need for further research to provide a detailed profile of the adaptive periods for IS and RSM RRBs, the present findings support the potential utility of elevated RRBs as a signal for emotional and behavioural difficulties at age six