A Second Look at Faces

In a previous post (Looking at Faces) I reported on one of a growing number of studies that investigate why people with autism have social difficulties. This research shows that - unlike people without autism - individuals with autism spectrum disorders tend to avoid looking at pictures of faces. Obviously, if you are avoiding looking at people, you will be at a major disadvantage when trying to learn social skills. But why would they avoid faces?

Some have looked at arousal and have theorized that other people make those with autism anxious - therefore, resulting in avoiding others. But when researchers have looked at arousal, they often get mixed results. A new yet-to-be published study seems the help explain these puzzling results.

Natalia Kleinhans and her colleagues had people with and without autism look at pictures of faces (see sample) at two different times. They monitored their brain activity through an fMRI (which assesses brain function). What they found was that the first time they showed the picture of a face both groups had increased arousal in the amygdala (a part of the brain involved with fear and anger). A new, unfamiliar face may be mildly anxiety producing for anyone because of all the new features to consider. However, when they showed the picture a second time, the control group habituated - meaning, they did not have the same hyperarousal response. However, the people with autism did not habituate, and continued to show hyperarousal. Without getting use to faces, people with autism may experience stimulus overload each time they see a person. This study may help make sense of why people with autism avoid faces.

Reference
Kleinhans, N. M., Johnson, L. C., Richards, T., Mahurin, R., Greenson, J., Dawson, G., et al. (in press). Reduced neural habituation in the amygdala and social impairments in Autism Spectrum Disorders. American Journal of Psychiatry.

Looking at Faces

The characteristic social deficits of people with autism are studied in a number of ways. A recent study used an innovative technology as well as a unique comparison. The researchers compared eye gaze at pictures among people with autism, those with Williams Syndrome (which is characterized by over socialness) and those without a diagnosis. Look at the photo on the right. There is a human face embedded in the lower right corner of each photo. The colored spots in the photo represent the amount of time each group look at the parts of the photo. Can you match photos "a" (top), "b" (middle), and "c" (bottom) with the correct group?

They found that people with Williams Syndrome looked primarily at faces (photo "b" - middle), undiagnosed persons looked primarily at faces but scanned other aspects as well (photo "c" - bottom), and those with autism primarily looked at aspects of the photo other than the face (photo a - top). This interesting study helps us look at the world through the eyes of people with autism and gives us a glimpse into their world.

Reference

Riby, D., & Hancock, P. (2009). Do faces capture the attention of individuals with Williams Syndrome or autism? Evidence from tracking eye movements. Journal of Autism and Developmental Disorders, 39(3), 421-431.

Autism Controversies

A new book by Paul A. Offit, M.D. takes a look at many of the controversies surrounding the nature and treatment of autism (Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure). Of particular interest is his discussion of how people make arguments for and against particular approaches, including how celebrities use their status to promote ideas that may or may not be backed by science. See an excerpt by clicking the link below.
http://cup.columbia.edu/book/978-0-231-14636-4/autisms-false-prophets/excerpt

Early Intervention

In class I note the landmark study by Lovaas (1987) (UCLA Young Autism Project Model) that studied the effects of using applied behavior analysis (ABA) with very young children with autism (younger than 3 1/2 years of age). [now referred to as Early and Intensive Behavioral Intervention - EIBI] In that study, Lovaas suggested that almost half of the children "recovered" from their autism - meaning that several years later teachers could not tell them apart from their students without autism. That study - now over 20 years old - generated a great deal of controversy. Over the years, over 20 studies have sought to replicate Lovaas' (1987) original study. Several new reviews look at progress to date (see references below).

First, the original study did not randomly assigned children to the treatment groups. This is a potential problem because we do not know if children who received the intensive intervention (40 hours per week for 2 years) were somehow different from those who did not - potentially affected the outcomes. Newer studies have attempted to remedy this problem.

Second, the study used educational placement as an outcome measure. This is a problem because where a child is placed (for example, in a regular class or a special education class) has more to do with the educational philosophy of the school than the abilities of the child. Other studies use IQ scores as well as adaptive and maladaptive behavior as outcomes.

Third, many people questioned whether or not 40 hours per week for 2 years (which is very expensive) was necessary. More recent work suggests that the range may be more like 30-40 hours per week to achieve optimal results.

To date, these newer studies generally support the effectiveness of EIBI for some children with autism. Researchers are now examining the characteristics of children that may predict the best outcomes (for example, language ability). Overall, the treatment progress seems to greatly improve for some children if early intensive behavioral intervention is implemented properly.

References
Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with autism. Research in Developmental Disabilities, 30(1), 158-178.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.

Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project Model. Journal of Autism and Developmental Disorders, 39(1), 23-41.

Playtime

Play is considered a fundamental activity of childhood. In addition to being fun, play is thought to be crucial to developing important cognitive and social skills. This leads us to an important question. Do children with autism play and if so is their play different from other children?

Researchers in the UK studied the play of children with and without autism (ages 7 to 14 years). Note two things about this study. First, these are not very young children. Second, the researchers matched children by their language abilities. This means that the children with autism had language abilities that were similar to children their own (chronological) age - making them different from many children with autism who have delayed language skills. They matched the two groups to see if something other than language delays contributed to play skills. It is important to know this when you try to make generalizations about the play of all children with autism.

They found that both groups could play - meaning they could use toys to represent things and stories. For example, both groups could pretend that dolls were people and could make up stories for them. However, the children with autism showed less creativity in their play and, unfortunately appeared to have less "fun" when they played. They had the cognitive ability to represent toys as other objects, but seemed to enjoy this play less than children without autism.

Could this lack of enjoyment be related to their social deficits? In other words, although they could understand what was expected of them, was the lack of social interest interfering with what makes play fun?

Reference

Hobson, R., Lee, A., & Hobson, J. (2009). Qualities of symbolic play among children with autism: A social-developmental perspective. Journal of Autism and Developmental Disorders, 39(1), 12-22.