Part 2 book “New developments in autism” has contents: Systemizing and empathizing in autism spectrum conditions, language and its development in autistic spectrum disorders, a partnership between parents and professionals,… and other contents.
Chapter Systemizing and Empathizing in Autism Spectrum Conditions Sally Wheelwright INTRODUCTION Autism spectrum conditions (ASCs) are diagnosed when a child or adult has abnormalities in a ‘triad’ of behavioural domains: social development, communication, and repetitive behaviour/obsessive interests (APA 1994; ICD-10 1994) In the past, cognitive developmental theories of autism have not attempted to account for the whole triad; rather they have focused on one or two of its components Here we present a new theory, empathizing–systemizing (E–S) theory, which does account for the whole triad E–S theory evolved from the mindblindness theory of autism MINDBLINDNESS THEORY The mindblindness theory of autism (Baron-Cohen 1995) proposed that in autism spectrum conditions, there are deficits in the normal process of empathizing, relative to mental age These deficits can occur by degrees Here we use the term ‘empathizing’ to encompass ‘theory of mind’, ‘mind-reading’, and taking the ‘intentional stance’ (Dennett 1987) Empathizing involves two major elements: (a) the ability to attribute mental states to oneself and others, as a natural way to understand agents (Baron-Cohen 1994a, 1994b; Leslie 1995; Premack 1990), and (b) having an emotional reaction that is appropriate to the other person’s mental state In this sense, it includes what is normally meant by the term ‘theory of mind’ (the attributional component) but it goes beyond this, to also include having some affective reaction (such as sympathy) Empathizing thus essentially allows us to make sense of the behaviour of another agent we are observing, predict what they might next, and how they might feel 155 156 / NEW DEVELOPMENTS IN AUTISM And it allows us to feel connected to another agent’s experience, and respond appropriately to them Since the first test of mindblindness in children with autism (Baron-Cohen, Leslie and Frith 1985), there have been more than 30 experimental tests The vast majority of these have revealed profound impairments in the development of their empathizing ability These are reviewed elsewhere (Baron-Cohen 1995; Baron-Cohen, TagerFlusberg and Cohen 1993), but include deficits in the following: • • • joint attention (Baron-Cohen 1989a) • understanding that ‘seeing-leads-to-knowing’ (Baron-Cohen and Goodhart 1994; Leslie and Frith 1988) • distinguishing mental from physical entities (Baron-Cohen 1989b; Ozonoff, Pennington and Rogers 1990) • • • • • making the appearance–reality distinction (Baron-Cohen 1989b) use of mental state terms in language (Tager-Flusberg 1993) production and comprehension of pretence (Baron-Cohen 1987; Wing and Gould 1979) understanding false belief (Baron-Cohen et al 1985) understanding beliefs about beliefs (Baron-Cohen 1989c) understanding complex emotions (Baron-Cohen 1991) showing concern at another’s pain (Yirmiya et al 1992) Some children and adults with Asperger syndrome (AS) only show their empathizing deficits on age-appropriate adult tests (Baron-Cohen et al 1997a, 1997b, 2001) This deficit in their empathizing is thought to underlie the difficulties such children have in social and communicative development (Baron-Cohen 1988; Tager-Flusberg 1993), and the development of imagination (Baron-Cohen 1987; Leslie 1987) EMPATHIZING–SYSTEMIZING (E–S) THEORY As explained above, we have defined empathizing so as to include both the recognition of mental states, and the appropriate emotional response to these A deficit in empathizing might account for the social and communication abnormalities that are diagnostic of autism, but such a deficit has little if anything to contribute to our understanding of the third domain of abnormality in the triad: the repetitive behaviour and obsessions For this reason, our view of autism is now broader, and suggests that alongside empathizing deficits, a different process is intact or even superior This is what we call systemizing Systemizing is the drive to analyse the variables in a system, to derive the underlying rules that govern the behaviour of a system Systemizing also refers to the drive to con- SYSTEMIZING AND EMPATHIZING IN ASD / 157 struct systems Systemizing allows you to predict the behaviour of a system, and to control it A system is defined as something that takes inputs, which can then be operated on in variable ways, to deliver different outputs in a rule-governed way There are at least six kinds of system, technical, natural, abstract, social, organizable and motoric, but all share this same underlying process which is monitored closely during systemizing: Below, an example from each of the six types of system is given: INPUT OPERATION OUTPUT (A) An example of a technical system: a sail INPUT OPERATION OUTPUT Sail Angle 10 degrees Speed slow Sail Angle 30 degrees Speed medium Sail Angle 60 degrees Speed fast (B) An example of a natural system: a flower INPUT OPERATION OUTPUT Rhododendron Mildly alkaline soil Light blue petals Rhododendron Strongly alkaline soil Dark blue petals Rhododendron Acidic soil Pink petals (C) An example of an abstract system: a number INPUT OPERATION OUTPUT Squared Cubed 27 Inverse 0.3 (D) An example of a social system: a constituency boundary INPUT OPERATION OUTPUT New York Inner city Small number of voters New York Whole city Medium number of voters New York Whole state Large number of voters 158 / NEW DEVELOPMENTS IN AUTISM (E) An example of an organizable system: a CD collection INPUT OPERATION OUTPUT CD collection Alphabetical Order on shelf A–Z CD collection Date of release Order on shelf 1980–2000 CD collection Genre Order on shelf: classical–pop (F) An example of a motoric system: a tennis stroke INPUT OPERATION OUTPUT Hit ball Top spin Ball bounces left Hit ball Back spin Ball bounces right Hit ball No spin Ball bounces forward As can be seen in the examples above, the process in systemizing is always the same One of the three elements (typically the input) is treated as a fixed feature (i.e it is held constant), whilst another of the three elements (typically the operation) is treated as a variable (i.e it can vary: think of a dimmer on a light switch) Merely observing the consequences of these two elements delivers you important information: the output changes from Output 1, to Output 2, to Output That is, you learn about the system Systemizing works for phenomena that are indeed ultimately lawful, finite and deterministic Note that the other way we systemize is when we are confronted by various outputs, and try to infer backwards from the output as to what the operation is that produces this particular output Systemizing is of almost no use when it comes to predicting the moment-bymoment changes in a person’s behaviour To predict human behaviour, empathizing is required Systemizing and empathizing are very different kinds of processes Empathizing involves attributing mental states to others, and responding with appropriate affect to the other’s affective state Empathizing covers not only what is sometimes called ‘theory of mind’, or ‘mentalizing’ (Morton, Frith and Leslie 1991), but also what is covered by the English words ‘empathy’ and ‘sympathy’ To see why you cannot systemize a person’s behaviour with much predictive power, consider the next example: INPUT OPERATION OUTPUT Jane Birthday Relaxes Jane Birthday Withdraws Jane Birthday Laughs Jane Birthday Cries SYSTEMIZING AND EMPATHIZING IN ASD / 159 Why does the same input (Jane) have such different outputs (behaviour) when the same operation (her birthday) is repeated? Someone who relies on systemizing to predict people’s behaviour would have to conclude that people are not clearly rule-governed This is a correct conclusion, but there is nevertheless an alternative way of predicting and making sense of Jane’s behaviour: via empathizing During empathizing, the focus is on the person’s mental state (including his or her emotion) Furthermore, during empathizing there is an appropriate emotional reaction in the observer to the other person’s mental state Without this extra stage, one could have a very accurate reading of the person’s emotion, a very accurate prediction of the other’s behaviour, but a psychopathic lack of concern about A’s mental state To complicate matters further, during empathizing, the observer does not expect lawful relationships between the person’s mental state and his or her behaviour The observer only expects that the person’s mental state will at least constrain their behaviour TESTING E–S THEORY The E–S theory of autism makes clear predictions about how people with ASCs should score on tests of empathizing and systemizing, relative to people without ASCs: people with ASCs should find empathizing tasks more difficult, whilst matching or even outperforming people without ASCs on systemizing tasks In fact, we can go further with our predictions relating to people without ASCs The extreme male brain (EMB) theory of autism (Baron-Cohen and Hammer 1997) holds that the cognitive profile seen in people with ASCs is an extreme variation of that seen in non-affected males So scores on tests of empathizing should follow this pattern: People with an ASC < Non-ASC males < Non-ASC females Whilst this picture is reversed for tests of systemizing: People with an ASC > Non-ASC males > Non-ASC females There is already some evidence for this predicted pattern of results For example, in the ‘Reading the Mind in the Eyes’ Test, females score higher than males, and people with AS score even lower than males (Baron-Cohen et al 1997b) In this empathizing test, participants have to choose the word that best describes what a person is thinking or feeling, just by looking at a picture of their eyes In the embedded figures task (EFT), which is a systemizing test, participants are asked to find a simple shape in a much more complex, colourful design (Jolliffe and Baron-Cohen 1997; Shah and Frith 1983) On the EFT, males score higher than females, and people with AS or HFA score even higher than males Note that this theory does not make any predictions about whether there will be a difference between how males and females with ASCs will score in comparison with each other 160 / NEW DEVELOPMENTS IN AUTISM The experiments presented here test the E–S theory using two approaches In Experiment 1, we tested the E–S theory using two self-report questionnaires: the systemizing quotient (SQ ) and the empathizing quotient (EQ ) In Experiment 2, we tested E–S theory using two cognitive tests: the Physical Prediction Questionnaire (PPQ ) and the Social StoriesTM Questionnaire (SSQ ) (Lawson, Baron-Cohen and Wheelwright 2004) EXPERIMENT Instruments The SQ was designed to be short, easy to complete and easy to score It is shown in Appendix 7.1 The SQ comprises 60 questions: 40 assessing systemizing and 20 filler (control) items Approximately half the items were worded to produce a ‘disagree’ response, and half an ‘agree’ response, for the systemizing response This was to avoid a response bias either way Following this, items were randomized An individual scores two points if they strongly display a systemizing response and one point if they slightly display a systemizing response There are 20 filler items (items 2, 3, 8, 9, 10, 14, 16, 17, 21, 22, 27, 36, 39, 46, 47, 50, 52, 54, 58, 59), randomly interspersed throughout the SQ , to distract the participant from a relentless focus on systemizing These questions are not scored at all The final version of the SQ has a forced-choice format, can be self-administered, and is straightforward to score, since it does not depend on any interpretation in the scoring The EQ , shown in Appendix 7.2, has a very similar structure to the SQ , in that it also comprises 60 questions, broken down into two types: 40 questions tapping empathy and 20 filler items (items 2, 3, 5, 7, 9, 13, 16, 17, 20, 23, 24, 30, 31, 33, 40, 45, 47, 51, 53, 56) Each of the empathy items scores one point if the respondent records the empathic behaviour mildly, or two if strongly (see below for scoring each item) Like the SQ , approximately half the items were worded to produce a ‘disagree’ response, and half an ‘agree’ response for the empathic response, to avoid a response bias either way Also, like the SQ , the EQ has a forced-choice format, can be self-administered and is straightforward to score Participants Two groups of participants (all of whom had given informed consent) were tested: Group comprised n=88 adults with AS (41 males, 47 females) All participants in this group had been diagnosed by psychiatrists using established criteria for autism or AS (APA 1994) They were recruited via several sources, including the National Autistic Society (UK), specialist clinics carrying out diagnostic assessments and adverts in newsletters/web-pages for adults with AS or high-functioning autism (HFA) Their mean age was 34.9 years (sd=12.0) They had all attended mainstream schooling and were SYSTEMIZING AND EMPATHIZING IN ASD / 161 reported to have an IQ in the normal range Their occupations reflected their mixed socio-economic status (SES) Group comprised n=278 normal adults (114 males, 164 females) taken from two sources: n=104 were drawn from the general public from the UK and Canada, and represented a mix of occupations, including professional, clerical and manual workers; n=174 were drawn from undergraduate students currently studying at Cambridge University or a local A Level college in Cambridge Students from a variety of disciplines were targeted An initial analysis found that there was no difference between the participants from the different sources so their results were pooled together The students had a mean age of 20.5 years (sd=6.5) and the non-students had a mean age of 41.3 years (sd=12.7) Method Participants were sent the SQ and EQ by post or completed online versions of the questionnaires Participants were instructed to complete the two questionnaires on their own, as quickly as possible, and to avoid thinking about their responses too long They could choose for themselves in which order to complete the questionnaires Participants in Group had the option to remain anonymous Scoring THE SQ ‘Strongly agree’ responses score two points, and ‘slightly agree’ responses score one point, on the following items: 1, 4, 5, 7, 13, 15, 19, 20, 25, 29, 30, 33, 34, 37, 41, 44, 48, 49, 53, 55 ‘Strongly disagree’ responses score two points, and ‘slightly disagree’ responses score one point, on the following items: 6, 11, 12, 18, 23, 24, 26, 28, 31, 32, 35, 38, 40, 42, 43, 45, 51, 56, 57, 60 The filler (control) questions score no points, irrespective of how the individual answers them Nevertheless, responses on the filler items were analysed for any systematic bias THE EQ ‘Strongly agree’ responses score two points, and ‘slightly agree’ responses score one point, on the following items: 1, 6, 19, 22, 25, 26, 35, 36, 37, 38, 41, 42, 43, 44, 52, 54, 55, 57, 58, 59, 60 ‘Strongly disagree’ responses score two points, and ‘slightly disagree’ responses score one point, on the following items: 4, 8, 10, 11, 12, 14, 15, 18, 21, 27, 28, 29, 32, 34, 39, 46, 48, 49, 50 Results Mean SQ and EQ results are shown in Table 7.1 Figure 7.1 shows the distribution of SQ scores from the AS group, non-AS males and non-AS females, and Figure 7.2 shows 162 / NEW DEVELOPMENTS IN AUTISM the EQ distribution Note that the curve from the AS/HFA group is only based on n=88, whilst the curves from the control males and females are based on n=278 The AS group is not split into males and females because of small numbers Table 7.1 Means and standard deviations for both groups on the SQ and EQ Group AS males (n = 47) AS females (n = 41) Combined AS group (n = 88) Non-AS males (n = 114) Non-AS females (n = 164) SQ score EQ score mean 38.9 16.6 sd 13.9 8.0 mean 37.2 18.0 sd 17.4 10.2 mean 38.1 17.3 sd 15.5 9.0 mean 30.3 38.8 sd 11.4 12.4 mean 24.1 47.4 9.9 11.6 mean 26.7 43.9 sd 10.9 12.6 sd Combined non-AS group (n = 278) 70 60 non-AS males non-AS females AS group Per cent of participants 50 40 30 20 10 SQ score Figure 7.1 The distribution of SQ scores 71 to 80 61 to 70 51 to 60 41 to 50 31 to 40 21 to 30 11 to 20 to 10 SYSTEMIZING AND EMPATHIZING IN ASD / 163 60 AS group 50 non-AS males Per cent of participants non-AS females 40 30 20 10 71 to 80 61 to 70 51 to 60 41 to 50 31 to 40 21 to 30 11 to 20 to 10 EQ score Figure 7.2 The distribution of EQ scores Separate ANOVAs were conducted on the SQ and EQ scores with two between subject factors (group: AS vs non-AS; and sex: males vs females) For the SQ , there was a significant main effect of group, F(1,362) = 54.9, p