Social Perception in Children with Autism: An Attentional Deficit?

Journal of Autism and Developmental Disorders, Vol. 27, No. 3, 1997

Social Perception in Children with Autism: AnAttentional Deficit?1

Karen Pierce2

University of California, San Diego

Katherine S. GladSan Diego State University/University of California, San Diego

Laura SchreibmanUnivesity of California, San Diego

Research suggests that the attentional deficits found in children with autismmay be related to impairments in social functioning (e.g., Courchesne et al,1994a, 1994b; Lewy & Dawson, 1992; Schreibman & Lovaas, 1973). In thepresent investigation, 14 children with autism, 14 mentally handicapped, and14 typically functioning children participated in a study designed to investigatethe effects of number of social cues on the ability to interpret social situations.Participants were shown videotaped vignettes of child-child interactions inwhich the number of cues leading to the correct interpretation of the storyvaried from one to four (i.e., tone, content, nonverbal, or nonverbal withobject). Subjects were then asked a series of questions which varied in degreeof complexity. Overall, results indicated that children with autism performedas well as both groups of comparison subjects on general attention questions(i.e., identification of number and gender of interactants) and social perceptionquestions relating to stories containing one cue. However, children with autismperformed more poorly than both comparison groups on social perceptionquestions relating to stories containing multiple cues. Results are discussed interms of an attentional dysfunction hypothesis of autism.

1Special thanks to Tim Coy and to all of the children who participated in this study.2Address all correspondence to Karen Pierce, University of California, San Diego, Departmentof Psychology—0109, 9500 Gilman Drive, La Jolla, California 92093-0109.

265

0162-3257/97/0600-0265$12.50/0 © 1997 Plenum Publishing Corporation

In Kanner's (1943) seminal paper describing infantile autism, he empha-sized social deficits and severe lack of responsivity to the environment asbeing characteristic of this population. Every clinical description of the phe-nomenology of autism since Kanner's has considered the deficits in socialresponse and social behavior primary to the disorder. Therefore, it is criticalto understand the variables that may be responsible for these deficits. Sev-eral authors have pursued the idea that an attentional dysfunction may un-derlie important aspects of autistic symptomology (e.g., C. B. Burke, 1991;J. C. Burke & Cerniglia, 1990; Courchesne et al., 1994a, 1994b; Dawson& Lewy, 1989; Kinsbourne, 1987; Lovaas, Koegel, & Schreibman, 1979;Pierce, Glad, & Schreibman, 1995; Mundy, Sigman, & Kasari, 1990;Schreibman & Lovaas, 1973; Wainwright-Sharp & Bryson, 1993).

Findings from a wide array of behavioral research suggest that indi-viduals with autism exhibit attentional deficits and that these deficits maybe related to other areas of functioning, such as social perception. At thebehavioral level, research shows that autistic individuals have deficits inorienting (e.g., Townsend, Harris, & Courchesne, in press), shifting (e.g.,Courchesne, Akshoomoff, & Ciesielski, 1990; Courchesne et al., 1994,1994b; Wainright-Sharp & Bryson, 1993), and sustaining (e.g., Garretson,Fein, & Waterhouse; 1990) attention. For example, Courchesne et al.(1994a) reported that adults with autism detected fewer visual and auditorytargets when required to shift attention rapidly between these two sensorymodalities. Similarly, Wainwright-Sharp and Bryson (1993) found that autis-tic individuals had difficulties shifting attention within the visual modalityduring Posner's (1978) visual orienting task. During this task, participantswere required to detect a target on a computer screen which had beeneither correctly or incorrectly cued. Specifically, autistic subjects failed toshow the normal reaction time advantage for correctly cued targets. Finally,attentional abnormalities have also been documented during social inter-actions. Individuals with autism are typically deficient in "joint attention,"briefly defined as coordinating attention between interactive social partnersand environmental stimuli (Lewy & Dawson, 1992; Loveland & Landry,1986; Mundy et al., 1990). This ability to shift attention to various elementsin social situations is achieved by normal children at 12-15 months of age(Bakeman & Adamson, 1984) and is thought to be a critical element ofsocial development.

Another behavioral phenomenon indicative of attentional deficitsfound in this population is termed "stimulus overselectivity" whereby chil-dren with autism respond to only an overly restricted range of environ-mental stimulation (e.g., Lovaas, Schreibman, Koegel, & Rehm, 1971). Toillustrate this phenomenon, consider the following example: A therapist isteaching a child with autism to distinguish a picture of a house from other

266 Pierce, Glad, and Schreibman

pictures. The child is shown a series of three pictures, a car, house, and adoll and given reinforcement for pointing only to the house (i.e., the correctanswer). Later this child is shown a series of three pictures again, but thistime each of the individual constituents of the house are represented (e.g.,a door, window) on separate cards, as well as the complete house. Childrenwith autism may now fail to respond to the complete house and point toonly one element of the house (e.g., the door) as the correct answer. Thatis, they were "overselective" for only one stimulus dimension of the housewhen they learned to point to the house originally and failed to integrateall of the elements of the house (e.g., the windows, door, chimney, walls).This behavioral pattern has been found across various stimulus types andsensory domains, including multiple sensory stimuli, such as a tone, light,and a tactile stimuli (e.g., Kolo, Anderson, & Campbell, 1980; Lovaas etal., 1971), complex visual stimuli, such as line drawings (e.g., Koegel &Rincover, 1976; Koegel & Wilhelm, 1973), and social stimuli, such as verbalinstructions (i.e., J. C. Burke & Cerniglia, 1990) or doll attributes (Schreib-man & Lovaas, 1973). In addition, the concept of a narrow, or overly se-lective "spotlight" of attention for many in this population is supported byrecent electrophysiological research (Townsend & Courchesne, 1994).

Existing behavioral studies provide evidence that overselective atten-tional responding may affect the behavior of autistic children in naturalisticsettings (e.g., in the home environment), in that as the number of environ-mental cues presented to children with autism increases, responsivity tothose cues decreases. For example, J. C. Burke and Cerniglia (1990) foundthat children with autism performed best across different multicomponenttasks (i.e., language assessments and responses to multicomponent direc-tions) when only one cue or component was present and worst when mul-tiple cues were present. The present study was designed to further explorethis attentional deficit and how it might affect social perception, by pre-senting children with a social task containing one to four social cues. Itwas hypothesized that children with autism would perform better on thesingle cue condition than the multiple cue conditions because (a) it is con-sistent with the findings of extant literature (e.g., J. C. Burke & Cerniglia,1990) and (b) a single cue condition places minimal requirements on theautistic child to shift or integrate their attention to multiple cues.

Studies in the area of social cognition, the processing of social infor-mation, has increased substantially in recent years. Some researchers sug-gest that important features of autistic symptomology may be the result ofdeficits in this area. Research has shown that children with autism havedifficulties attributing mental states to others (e.g., Baron-Cohen, 1989a,1989b; Leslie & Frith, 1988); comprehending facial, vocal, or bodily expres-sions of affect (e.g., Braverman, Fein, Lucci, & Waterhouse, 1989; Hobson

Social Perception and Attention in Autism 267

& Lee, 1989; Ozonoff, Pennington, & Rogers, 1991), interpreting faces(Tantam, Monaghan, Nicholson, & Stirling, 1989), expressing emotions(Macdonald et al., 1989), and coordinating faces and voices (Hobson, Ous-ton, & Lee, 1988).

Proponents of the "theory of mind" account of autism suggest thatthe communication, socialization, and imagination handicaps of autistic in-dividuals are the result of an inability to represent and attribute mentalstates (e.g., Baron-Cohen, 1989b). The majority of this class of studies util-ized line drawings and/or required subjects to interpret a verbal narrativeof others' behavior. For example, in a study conducted by Happe (1994),autistic, normal, and mentally handicapped children were read a series ofstories and then asked questions about the story participants. Results in-dicated that the children with autism were impaired at providing appropri-ate mental state explanations of story characters' utterances compared toboth comparison groups. It is unclear, however, whether these findings aredue to deficits in attributing mental states to others, or whether they aredue to multiple attentional requirements, and even imagination require-ments, for processing information in this task. That is, individuals withautism may be able to perform accurately on social tasks when attentionalrequirements are minimal. To test this hypothesis, the present study utilizeda social task that varied in attentional requirements. Specifically, subjectswere shown vignettes with one through four social cues with the one-cuetask hypothesized to place minimal attentional demands on subjects andthe multiple-cue condition placing maximal attentional requirements.

An additional feature of much of the research assessing the social per-ception of children with autism is the use of somewhat nonnaturalistic stim-uli (e.g. line drawings and/or toys, with verbal narratives) which may notreflect autistic children's abilities in actual social situations. Although re-searchers in the area of emotion perception (e.g., Ozonoff, Pennington, &Rogers, 1990) have utilized somewhat naturalistic stimuli in the form ofphotographs, no previous research has utilized actual social interactions ofpeer models to assess social perception skills. The present study utilizedvideotaped vignettes of children interacting in naturalistic social environ-ments. For example, the interactants in the videotape were engaged in vari-ous natural activities including playing with blocks, talking, smiling, andplaying ball. Although the use of videotaped stimuli is not completely natu-ral, it likely represents a closer approximation of children's social environ-ment than stimuli utilized in past experiments.

The primary hypothesis of the current study is that attentional deficitsunderlie many areas of functioning, including social perception. The spe-cific aims of the proposed research were (a) to compare the social percep-tion skills of autistic (AD) and mentally handicapped (MH) subjects via a

Pierce, Glad, and Schreibman268

Social Perception and Attention in Autism

naturalistic (i.e., videotaped vignettes of social interactions) social percep-tion task; (b) to determine the extent to which attentional requirements inthe form of number (i.e., 1-4) of cues affect the social perception skills ofchildren with autism; and (c) to provide information which may be usefulfor the treatment of the social deficits found in this population.

METHOD

Participants and Experimental Setting

Forty-two children (14 AD, 14 MH, and 14 normal) matched on verbalmental age as assessed by the Peabody Picture Vocabulary Test (PPVT;Dunn & Dunn, 1981), participated (Table I). Normal participants were re-cruited from a research subject pool list, which contains names from thegreater San Diego area. Normal subjects represented varying ethnic back-grounds including Caucasian, Hispanic, African American, and Asian. Itwas assumed that the normal participants' language age was somewhatcomparable to their chronological age and they were thus not given thePPVT. Mentally handicapped participants were recruited from nearby SanDiego schools with all having a diagnosis of mental retardation, most withetiology unknown. None of the MH subjects were children with Down syn-drome. Because of the heavy reliance on verbal skills for the experimentaltask, children were matched on verbal mental age as assessed by the PPVTBecause children with autism typically perform better on nonverbal tasks,as opposed to verbal tasks, the autistic children in this sample tended tohave high nonverbal IQs (NVIQs). Consequently 13 of 14 of the childrenwith autism in this study had NVIQs that were in the nonretarded range(i.e., NVIQ > 75) and thus differences in performance were probably notdue to deficits in general intelligence. Comparison groups using both MHsubjects and normal children were included because although mentally re-tarded children may have socialization experiences similar to autistic chil-dren, normal comparisons provide a picture of typical social functioning.Using primarily nonretarded autistic subjects with IQs significantly higher

269

Table I. Subject Characteristicsa

Group

ADMHNormal

n

141414

Age

M

11412063

SD

20231?

PPVT

Range

81-14083-15151-86

M

6363

SD

1213

Range

48-8048-85

M

8653

NVIQ

SD

2318

Range

64-14033-105

aValues for age and PPVT represented in months.

than MH subjects minimized the likelihood that group differences reflectedonly cognitive difficulty with the task and thus provided for a more con-servative comparison group. All of the children with autism were diagnosedas autistic by the third author using the DSM III-R (American PsychiatricAssociation, 1987) criteria. In addition, autistic subjects received a seconddiagnosis of autism from agencies not afflicted with this research.

Autistic subjects did not differ significantly from mentally handicappedsubjects on chronological age, t(l, 22) = 0.40, p > .25. See Table I for adescription of subject characteristics. There were no significant group dif-ferences on receptive language age as assessed by the PPVT, F(2, 39) =1.95, p > .05. Autistic subjects had significantly higher nonverbal IQ scoresthan the mentally handicapped comparison group as assessed by the LeiterInternational Performance Scale (Leiter, 1979), t(l, 22) = 4.28, p < .001.One of the MH children tested with a NVIQ score of 105. The teacherwas alerted to his test score and the possibility of improper placement wasdiscussed. Excluding this child's NVIQ score, the range for the MH stu-dents was 33 to 65.

All testing occurred in either the child's home, a clinic setting, or aquiet classroom at the child's school.

Procedures

Autistic and MH comparison subjects participated in approximatelythree 60-minute sessions, approximately 1 week apart. In the first and sec-ond sessions, the PPVT and the Leiter were administered to determinethe appropriateness of the child for the study. Children with autism andmental retardation were considered appropriate if they had a PPVT ageequivalent score of 4 years of greater. This criterion was utilized becauseit was determined during pilot testing that normally functioning childrenunder age 4 had difficulty answering some of the questions accurately. Dur-ing the third session, the experimental procedure (i.e., the social perceptiontask) was administered. Normal comparison subjects received only the ex-perimental procedure during one 60-minute session.

Social Perception Task. During this task, the child was seated directlyin front of a 19-inch television monitor and shown a series of 16 videotapedvignettes of child-child interactions (adapted from Price & Brew, 1990).Five vignettes contained single cues, 5 contained two cues, 4 containedthree cues, and 2 contained four cues. The cue "object" was not presentedalone in the single cue condition because it would not be a social cue ifit was not combined with a nonverbal action. Each vignette representedeither a positive or negative social interaction in which an observable actionor set of actions occurred, such as one child giving a gift to another child.


Each vignette contained one to four social cues which served to alert theobserver of the vignette to (a) the extent to which the provocateur (i.e.,the child who initiates action) is engaging in positive or negative socialbehavior and; (b) the affective disposition and/or interpretation of thoseactions by the recipient of action. The four types of cues presented in thevignettes were as follows (a) verbal content (e.g., saying "I like your toy");(b) tone (e.g., saying "I like your toy" in an animated voice); (c) nonverbalwithout object (e.g., smiling at an approaching person); (d) nonverbal withobject (e.g., giving a present to another child). See Table II for descriptionof vignettes. Each vignette was approximately 7 seconds in length (range:4-12) with no systematic difference in length of vignette across cues. Afterthe presentation of each vignette, participants were asked a series of sixquestions to assess the extent to which they were attending to, and couldinterpret the cues presented. The first two questions were asked after thechildren had seen the vignette once and the video was paused after thefinal frame (i.e., no picture was present on monitor): (1) How many peoplewere there? (2) Were they boys or girls? These questions were asked toassess attention to cues not primarily related to social interaction and toensure that the children were in fact attending to the vignettes. Followingthis, the vignette was shown again (to minimize the extent to which memorywas needed to remember actions in the vignette) and paused on the finalframe (i.e., final picture was present). As the experimenter pointed to theappropriate child on the television monitor, participants were asked thefollowing questions relating to the provocateur: (3) Was that a good wayto make friends? (4) Was that child mean or nice? Next, the experimenterpointed to the recipient of action and asked: (5) How does that child feel?(6) Why does he feel that way (relating to the answer to Question 5). Ifthe child did not answer Question 6, or gave an ambiguous response (e.g.,"because of what he did") the child was further asked what happened. Thisquerying system was employed to ensure that all children had the oppor-tunity to relay the greatest amount of information. Questions were repeateda maximum of three times. Subject responses were transcribed in vivo andlater scored for accuracy of responding. Breaks were given as needed andfood given on an intermittent schedule for on-task behavior (e.g., sittingin seat).

Scoring. Performance for Questions 1 through 5 were scored as eithercorrect or incorrect, with participants receiving 1 point for correct answersand 0 points for incorrect answers. Points were awarded for Question 5(How does that person feel?) if the participant answered correctly in eitherthe positive or negative direction. For example, saying the child feels"good" or "happy" was scored as correct, as this study was not designedto investigate understanding of specific emotions, rather, perception of so-


Table II. Description of Vignettes

Vignette

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

No. ofcue(s)

1

4

3

2

2

2

1

2

1

3

1

1

3

2

3

4

Type ofcuea

C

T, C, NV, O

T, C, NV

NV, O

NV, O

NV, T

T

C, NV

NV

T, C, NV

NV

NV

T, NV, O

T, 0

T, NV, O

T, C, NV, O

Brief description

Two girls are sitting at a picnic table. Girl 3 approachesand says in a neutral tone "that looks like fun."Two boys are standing outside. Boy 1 is holding a ball.Boy 1 places ball in Boy 2's face and says "you'd bettersay you're sorry!" in an angry tone of voice.Two boys are sitting at a table with blocks. Boy 1 leanshis body forward as he yells "you'd better fix mybuilding!"Two girls are sitting at a table with blocks. Girl 3 enters.Girls 1 and 2 move away from Girl 3 and move theirblocks to the opposite side of the table.Two boys are sitting on a picnic bench outside. Boy 1 isholding a brown lunch bag. Boy 3 approaches andsnatches bag from 1 as he says in a neutral tone "what'sin your bag?"Two boys are sitting at a table. Boy 1 puts down his headinto his arms and makes a whining sound.Two girls are sitting at a picnic table outside. Girl 3approaches and says in a happy tone "I went rollerskating yesterday."Two girls are sitting in a living room next to a television.Girl 1 says in a neutral tone "turn it on or else I'll hityou" as she extends her fist into the face of Girl 2.Two girls are sitting at a table. Girl 3 approaches. Girls1 and 2 smile.Two boys are sitting on chairs. Boy 1 is reading a book.Boy 2 says in an angry tone "I'm not gonna let you readany more books!" as he extends his fist in Boy 1's face.Two boys are playing catch. Boy 3 approaches. Boys 1and 2 move away from boy 3.Two girls are sitting at a table. Girl 3 approaches. Girls1 and 2 smile.Two girls are sitting at a table with clay. Girl 1 says toGirl 2 in an angry tone as she leans over and smashesGirl 2's clay "you copied me."Two girls are sitting at a table with paint. Girl 3 isstanding and says "I'm gonna use those colors to paint"in an angry tone as she grabs the paint.Two boys sitting on chairs. Boy 1 is holding a book. Boy2 knocks book out of Boy 1's hands. Boy 1 puts his headdown and makes a whining sound.Two boys sitting at picnic table outside. Boy 3 enters andsays in an angry tone "you're doing it wrong" as he leansforward and quickly grabs bag from Boy 1.

aC = content; T = tone; NV = nonverbal; O = object.

272 Pierce, Glad, and Schreibman

rial cues in general. Since Question 6 (Why does he/she feel that way?)had many possible interpretations, responses from 30 normal children wereused to establish normative responses for this question. Participants re-sponses were scored on a 3-point scale, with 0 points given if the child

commented on an irrelevant cue (e.g., "He is sad because his leg was mov-ing"), 1 point if the child answered correctly but failed to report the specificcues involved (e.g., "He is sad because the other kid was mean"), and 2points for a correct answer identifying the relevant cues involved (e.g., "Heis sad because the other kid hit him"). Again, children who responded in-completely (i.e., 1-point responses) were queried three times to ensure thatthey had an adequate opportunity to respond. Responses to this questionwere analyzed separately from Questions 1 through 5. To form the depend-ent variable for subsequent analyses, the number of points were summedand divided by the number of possible points for each question separately.

Interrater Reliability. One third of all participant responses were tran-scribed by a second rater naiver to the purpose of this study. A response wascoded as an agreement if both raters transcribed exactly the same contentfor the response (e.g., both raters transcribed the word "sad" in response tothe question "how does that person feel?"). A response was coded as a dis-agreement if rater transcribed different utterances. Overall interrater reliabil-ity was 97%. In addition, interrater reliability was also obtained for numberof cues present in each vignette. An undergraduate research assistant naiveto the purpose of this study rated each of the 16 vignettes for number andtype of cues. An agreement was coded when both raters agreed on both thenumber (i.e., tone, content, nonverbal, nonverbal with object) of cues presentin each vignette and a disagreement was coded if raters did not on bothnumber and type of cues. Overall reliability was 94%.

RESULTS

Results from Questions 1-5 (forced choice questions) were analyzedseparately from Question 6 (free response question) because of the differ-ences in the format of the questions. Questions 1-5 were collapsed to formtwo stimulus categories, nonsocial (Questions 1-2) and social (Questions3-5). To determine the relationship between the diagnosis of the child, thetype of stimulus and the number of cues in each stimulus, a Group (i.e.,AD, MH, normal) x Type of Stimulus (i.e., social, nonsocial) x Number ofCues (i.e., 1-4) ANOVA was conducted on Questions 1-5 yielding a sig-nificant three-way interaction, F(6, 117) = 4.13, p < .05. A significant two-way interaction between Group x Type of Stimulus, F(2, 39) = 31.06, p <.05, Group x Number of Cues, F(6, 117) = 4.05, p < .05, and main effectsof Group, F(2, 39) = 2433, p < .05, Type of Stimulus, F(l, 39) = 73.19,p < .05, and Number of Cues, F(3, 117) = 2.61, p < .05, were also found.

Two Group x Number of Cues ANOVAs were conducted, one for eachstimulus condition (social and nonsocial). For the nonsocial stimuli, analyses


Pierce, Glad, and Schreibman

revealed a significant main effect of group, F(2, 39) = 4.35, p < .05. Tofollow up this main effect, a series of pairwise comparisons were then con-ducted between each of the groups, using Bonferroni's correction in orderto reduce the probability of a Type I error when conducting numerous tests(a = .017). After this correction, none of the groups were found to besignificantly different from one another; AD children were not differentfrom MH children, t(l, 40) = 2.55, p > .017, nor were they significantlydifferent from normal comparisons, t(1, 40) = 2.31, p > .017, and MHchildren were not significantly different from normal comparisons, t(l, 40)= 0.42, p > .0166.

For the social stimuli, analyses revealed a significant Group x Numberof Cues interaction, F(6, 117) = 6.16, p < .05, and a significant main effectof Group, F(2, 39) = 34.06, p < .05. Results appeared to indicate that ADsubjects, in general, performed worse than the two comparison groups, butthat this was much more apparent when the number of cues increased. Tofollow up this interaction, the effect of group was then examined at eachcue level. Again a Bonferroni correction was applied (a = .006). In theone cue condition, groups did not differ significantly, F(2, 39) = 2.52, p >.013; however, groups were significantly different in the two cue, F(2, 39)= 29.27, p < .013, three cue, F(2, 39) = 31.52, p < .013, and four cue,F(2, 39) = 17.3, p < .013, conditions. A series of pairwise comparisonswere then conducted between groups in these conditions, respectively,again using the Bonferroni correction (a = .006). Comparisons revealedthat children with autism performed significantly worse than MH childrenin each of the two cue, t(1, 40) = 6.5, p < .006, three cue, t(l, 40) = 6.32,p < .006, and four cue, t(l, 40) = 4.57, p < .006, conditions. Children withautism also performed significantly more poorly than normal comparisonsin each of the two cue, t(l, 40) = 4.76, p < .006, three cue, t(l, 40) =5.28, p < .006, and four cue, t(l, 40) = 3.92, p < .006, conditions. Mentallyhandicapped and normal comparison children did not differ in any of thetwo cue, t(l, 40) = 2.71, p > .006, three cue, t(l, 40) = 1.71, p < .006,or four cue, t(1, 40) = 1.59, p > .006, conditions. See Table III for meanscores on Questions 3-5 and Figure 1 for graph of overall performance onsocial perception questions by cue.

274

Table III. Scores for Performance on Questions 3-5 (Maximum = 1.00)

AD

No. ofcues

1234

M

.68

.45

.47

.56

SD

.16

.29

.31

.35

Range

.40-.87

.00-.93

.11-1.00

.11-1.00

M

.80

.961.00.98

MH

SD

.18

.050

.04

Range

.40-1.00

.87-1.001.00-1.00.89-1.00

M

.82

.86

.94

.94

Normal

SD

.18

.14

.10

.12

Range

.6-1.00.67-1.00.67-1.00.40-1.00


Table IV. Scores for Performance on Questions 6 (Maximum = 2.00)

AD

No. ofcues

1234

M

.37

.47

.55

.38

SD

.5.52.70.49

Range

.0-1.4

.0-1.80-20-1.33

M

1.261.461.641.64

MH

SD

.4

.36.4.46

Range

.8-2.001.00-2.00.67-2.00.67-2.00

M

1.391.561.811.57

Normal

SD

.4

.42

.22

.22

Range

.4-2.00.8-2.00

1.33-2.001.33-2.00

For Question 6, a Group (AD, MH, normal) x Number of Cues (1-4)ANOVA was conducted in order to understand the relationship betweenthese variables. This analysis yielded a significant main effect of Group,F(3, 117) = 41.40, p < .05, and Number of Cues, F(2, 39) = 8.33, p <.05. To better understand main effect of group, a series of pairwise com-parisons of groups was conducted, again using a Bonferroni correction (cor-rected error a = .017). Results indicated children with AD performedsignificant more poorly than MH children, t(1, 40) = 6.87, p < .017, andsignificantly worse than normal comparisons, t(l, 40) = 7.44, p < .017;however, MH children did not perform significantly differently than normalcomparisons, t(l, 40) = 0.83, p > .017 on Question 6. Following up on themain effect of numbers of cues, a series of pairwise comparisons was alsoconducted, again using a Bonferroni correction (corrected a = .008).Analyses revealed that across groups children performed significantly worseon the one than the three cue condition, t(1, 40) = 4.48, p < .008, andsignificantly worse on the two cue than the three cue condition, t(l, 40) =3.03, p < .008. See Table IV for mean scores.

Results also showed that many autistic individuals reported nonsocialcues as relevant during social interactions. Table V represents a sample ofresponses made by four autistic (AD), mentally handicapped (MH), and

Fig. 1. Overall percentage correct responding to social perception Questions 3-5 for vignettescontaining one, two, three, or four cues for autistic, mentally handicapped, and normal sub-jects.

Table V. Sample Responses to Vignette 10, Question 6

Vignette: Two children are sitting on chairs. Child 1 is reading a book and Child 2 says angrily,"I'm not gonna let you read any books!" while putting his fist in Child 1's face.

Social cues: Tone-angry; Content-mean/bullying; Nonverbal-body language indicating hostil-ity (i.e., extending fist in face of other child). Total cues = 3.

Question: Why does he/she feel that way? (Relating to answer from Question 5)

Responses by group

AD MH Normal

"Because his leg was "What he did. He put his "Because he's threatening tomoving" fist up and said, I won't let punch him."

you read any books."

"Because he kicked the "Because the one in the "Because he said somethingchair" red is fixin to punch him." mean to him.""Sitting on the chair" "He'll get hit." "Because he is not letting him

read.""Because he likes to sit down""Because the other boy "Because that boy yelled at

is being mean to him." him."

normally functioning children to Question 6. As indicated in Table V, chil-dren with autism reported insignificant cues (e.g., leg movement, sitting ina chair) as relevant to social behavior, whereas no children from eithercomparison group reported nonsocial cues as relevant.

Overall, autistic participants performed at an accuracy level below thatof the MH and normal comparison groups on questions regarding socialinteractions. These differences, however, depended on number of cues pre-sent in that autistic participants performed equally well as comparisons onquestions relating to single cue vignettes for Questions 3-5, but significantlyworse than comparisons on Questions 3-5 relating to multiple cue vignettes.Autistic participants, however, performed significantly more poorly thancomparisons regarding Question 6, regardless of number of cues.

DISCUSSION

Findings from this study did replicate those of other researchers: Autis-tic participants were deficient in their interpretation of social situationsoverall, however, this deficit was dependent on number of social cues pre-sent. That is, children with autism performed equally well as both MH andnormal comparison groups at interpreting social situations when only onesocial cue was present, but performed significantly worse than comparisongroups when multiple cues were present.


It is important to note autistic subjects performed almost as well asboth comparison groups on general attentional questions (i.e., How manypeople were there? Were they boys or girls?) and there were no statisticallysignificant differences between groups. This suggests that they were in factattending to the videotape and poor performance on questions of socialperception was not due to a lack of overall attention to the stimuli. Thisalso implies that general environmental information (e.g., gender of indi-viduals) is interpretable by autistic subjects when this information is presentover extended periods of time and attentional requirements are minimal.

If children with autism have a pervasive social deficit, then it wouldbe expected that they would be most successful at interpreting their socialenvironment when multiple cues are present, because the additional andredundant information should make the task easier to perform. If childrenwith autism have a pervasive attentional deficit, then it would be expectedthat they would be most successful at interpreting their social environmentunder task conditions of minimal attentional strain (e.g., minimal require-ments of shifting and integrating). Equal performances in all three groupsduring task conditions of low attentional strain (i.e., the single cue condi-tion) but highly unequal performances between three groups during thehigh attentional strain conditions (i.e., the multiple-cue conditions) suggeststhat the complexity of the environment may play a role in social interpre-tation for autistic individuals.

Findings from a wide array of research provide support for this hy-pothesis. For example, Courchesne et al. (1994a) found that when autisticsubjects were given a short amount of time to integrate two environmentalcues (e.g., a sound and a light) they performed worse than when they weregiven an increased amount of time to perform the task, suggesting thatthey had difficulty shifting attention during this task. Similarly, children withautism in J. C. Burke and Cerniglia's (1990) study were more successfulon responding to single stimulus components than in a multiple componentcondition. These studies are consistent with earlier studies on stimulusoverselectivity (see Schreibman, 1988, for a discussion of this work). Com-bined with results from the present study, the data suggest that when at-tentional requirements are great, individuals with autism are likely to havedifficulties responding to environmental cues.

A related possibility is that children with autism have difficulties inarousal modulation which, in turn, directly influences their capacity to at-tend to social information (Dawson & Lewy, 1989). That is, when stimulusconditions become too complex (e.g., during social situations), the autisticindividual becomes overaroused and attempts to modulate this arousal byfailing to maintain attention to the stimulus, or by attending to an irrelevantstimulus. It is easy to imagine how a social interaction replete with sounds,


gestures, and actions may serve to overstimulate a child with autism. Inthe single cue condition, however, overarousal may not occur: the cue'sinterpretation is predictable (e.g., a smile typically denotes positive affect)and it is presented alone without interference from other cues. Sample re-sponses from autistic subjects suggest that some sort of overarousal mayin fact be occurring. That is, when asked the question "why does he/shefeel that way?," autistic subjects reported answers based on simple, irrele-vant stimuli (e.g., the presence of a chair), rather than the relevant, socialstimuli. For example, when autistic subjects were asked to describe why aparticular child might be sad, they answered: "because he likes to sit down";"because he kicked the chair"; "sitting in chair" (see Table III). It is inter-esting to note that the majority of autistic subjects chose to give an answerto this question which focused on aspects of the chair.

An alternate hypothesis might be that the one-cue condition providedmore salient, and concrete cues and this is why children with autism per-formed best with only a single cue. However, since both the normal and MHparticipants performed the worst in this condition, this suggests that the cuesin the one cue condition were not necessarily more concrete or salient.

The use of naturalistic stimuli in the form of videotaped interactions isan important factor for social perception researchers to consider. Childrenwith autism in the present study may have performed well, in part, due tothe naturalistic assessment used. It is possible that the social perception skillsof children with autism are underestimated as interpreted by traditional as-sessment methods (e.g., interpreting doll actions). Future research may at-tempt to go even further and conduct research in vivo when possible.

It is also interesting to note that MH subjects had the exact oppositeprofile from the AD subjects in that they performed with greatest accuracyduring the multiple cue conditions but with the least accuracy during thesingle cue situation. This pattern of responding presents the possibility thatthe additional cues assisted in their interpretation of the social interactions.Again, the low levels of performance of the children with autism duringthe multiple cue conditions suggests that the additional cues were impedingperformance. Normal subjects performed with equals levels of accuracy,regardless of number of cues present. Also of note is the fact that MHindividuals did better than normal comparison subjects on the task overall.On average, MH subjects were 8 years old, whereas normal subjects werean average of 5 years old. The older age of MH children implies increasedlevels of social experience over time and thus this group might be expectedto perform better than a younger group.

Proponents of theory of mind as the primary deficit of autism suggestthat the majority of autistic subjects are impaired on tasks requiring meta-representation (e.g., Baron-Cohen, 1989a). For the present social percep-


tion task, this theory would predict that autistic subjects would have diffi-culties on Questions 5 and 6 which assessed the mental states of one ofthe actors in the vignettes. Findings from the present study, however, sug-gest that the autistic subjects were able to answer metarepresentation ques-tions (i.e., Question 5) if the attentional requirements were minimal (i.e.,in the single-cue condition). Hence, it may be that autistic individuals failon traditional theory of mind tasks because attentional requirements aretoo great. It is reasonable to suggest that attentional requirements are greatin a situation where one has to imagine a social interaction via a verbalnarrative and simultaneously examine a line drawing or doll figures in orderto interpret the situation. For example, in Baron-Cohen's study (1989b)subjects were required to listen to multiple (e.g., six) sentence stories andsimultaneously attend to doll actions occurring in a toy village in order toobtain enough information to answer the test questions. In contrast withthese tasks requiring high levels of attention and imagination, the presentstudy utilized brief presentation of stimuli (i.e., 4-12 seconds) in which theminimal requirement condition for successful performance on test ques-tions utilizes a single cue (e.g., a whine).

Autistic subjects' successful performances on Questions 3-5 in the sin-gle cue condition also has implications for the emotion perception litera-ture. Although the literature suggests that autistic subjects would be unableto infer the emotion of others upon visual presentation, the current studyfound that autistic subjects were not impaired on this task in the single-cuecondition. This suggests that the stimuli used (i.e., naturalistic vignettes vs.photographs) may provide a more ecologically relevant test of emotion per-ception in this population.

A limitation of this study is that only five vignettes containing singlecues were presented to the subjects, and replications are needed to deter-mine reliability of findings. Additionally, vignettes were counterbalancedaccording to type of cue (e.g., nonverbal) appeared both alone in the singlecue conditions and with other cues during the multiple cue conditions. Thecomplete counterbalancing of cues, with every possible permutation, wasnot possible because the social perception task was edited from a preex-isting videotape (i.e., Price & Brew, 1990). Also, the exact cues (e.g., asmile) used in the single cue vignettes were not necessarily represented inthe multiple cue conditions, allowing for the possibility that the cue itself,rather than the complexity of the social situation, may have been respon-sible for the results. Although it seems unlikely, this is nonetheless pre-sented as an alternate interpretation of the results. Finally, it is importantto mention that only 5 of the vignettes represented positive social interac-tions, whereas 11 represented negative interactions. This imbalance, again,was due to restrictions of the original videotape used (i.e., Price & Brew,


1990) and although slight, of course limits generalizability of the findingsprimarily to negative social interactions.

It is important to consider why autistic subjects performed poorly onQuestion 6 (i.e., "why does he/she feel that way?") regardless of numberof cues. First, it is possible that autistic subjects did not understand the"why" component of the question. Although subjects were matched on re-ceptive language ability, it is possible that the expression language require-ments of this open-ended question were too great for the children withautism. Future research should either test for the ability to answer "why"questions a priori, or utilize alternate methods of questioning.

Research identifying attentional patterns of responding during natu-ralistic situations with children with autism have enormous treatment im-plications in that once this pivotal behavior (i.e., attention) is "normalized,"this normalization could affect many areas of functioning including socialawareness. For example, after remediation of overselectivity, children withautism demonstrated more positive and frequent social interaction and jointattention engagement (J. C. Burke & Cerniglia, 1990).

Findings from the present investigation are consistent with other litera-ture suggesting that the social deficits found in this population may reflectan underlying attentional deficit. Attentional deficits, however, could work incollaboration with other deficits, such as affective, to form a primary constel-lation of deficits. This view of a multicomponent primary deficit model isconsistent with the theories of others (e.g., Ozonoff et al., 1991; Sigman,1994). Further research is needed to replicate these findings as well as ma-nipulate stimulus parameters (e.g., verbal vs. nonverbal cues) to examinemore clearly the relationship between social perception and attention.

REFERENCES

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders(3rd ed, rev.).

Bakeman, R., & Adamson, L. B. (1984). Coordinating attention to people and objects inmother-infant and peer-infant interaction. Child Development, 55, 1278-1289.

Baron-Cohen, S. (1989a). Are autistic children "behaviorists"? Journal of Autism and Devel-opmental Disorders, 19, 579-600.

Baron-Cohen, S. (1989b). The autistic child's 'theory of mind': A case of specific develop-mental delay. Journal of Child Psychology and Psychiatry, 30, 285-297.

Braverman, M., Fein, D., Lucci, D., & Waterhouse, L. (1989). Affect comprehension in chil-dren with PDD. Journal of Autism and Developmental Disorders, 19, 301-316.

Burke, C. B. (1991). Some developmental implications of a disturbance in responding to com-plex environmental stimuli. American Journal on Mental Retardation, 96, 37-52.

Burke, J. C, & Cerniglia, L. (1990). Stimulus complexity and autistic children's responsivity:Assessing and training a pivotal behavior. Journal of Autism and Developmental Disorders,20, 233-253.


Courchesne, E., Akshoomoff, N. A., & Ciesielski, K. T. (1990). Shifting attention abnormalitiesin autism: ERP and performance evidence. Poster presented at the meeting of the Inter-national Neuropsychology Society, Orlando, FL.

Courchesne, E., Townsend, J., Akshoomoff, N., Saitoh, O., Yeung-Courchesne, R., Lincoln,A., James, H., Haas, R., Schreibman, L., & Lau, L. (1994a). Impairment in shifting at-tention in autistic and cerebellar patients. Behavioral Neumscience, 108,1-17.

Courchesne, E., Townsend, J. P., Akshoomoff, N. A., Yeung-Courchesne, R., Press, G. A.,Murakami, J. W., Lincoln, A. J., James, H. E., Saitoh, O., Egaas, B., Haas, R. H., &Schreibman, L. (1994b). A new finding: Impairment in shifting attention in autistic andcerebellar patients. In S. H. Broman & J. Grafman (Eds.), Atypical deficits in develop-mental disorders: Implications for brain functions (pp. 101-137). Hillsdale, NJ: Erlbaum.

Dawson, G., & Lewy, A. (1989). Arousal, attention, and the socioemotional impairments ofindividuals with autism. In G. Dawson (Ed.), Autism: Nature, diagnosis and treatment (pp.49-74) New York: Guilford.

Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabulary Test Revised: Manual. CirclePines, MN: American Guidance Services.

Garretson, H., Fein, D., and Waterhouse, L. (1990). Sustained attention in autistic children.Journal of Autism and Developmental Disabilities, 20, 101-114.

Happe, F G. E. (1994). An advanced test of theory of mind: Understanding of story characters'thoughts and feelings by able autistic, mentally handicapped and normal children andadults. Journal of Autism and Developmental Disabilities, 24, 129-154.

Hobson, R. P., & Lee, A. (1989). Emotion-related and abstract concepts in autistic people:Evidence from the British Picture Vocabulary Scale. Journal of Autism and DevelopmentalDisorders, 19, 601-623.

Hobson, R. P., Ouston, J., & Lee, A. (1988). Emotion recognition in autism: Coordinatingfaces and voices. Psychological Medicine, 18, 911-923.

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 3, 217-250.Kinsbourne, M. (1987). Cerebral-brainstem relations in infantile autism. In E. Schopler & G.

Mesibov (Eds.), Neurobiological issues in autism (pp. 107-125). New York: Plenum Press.Koegel, R. L., & Rincover, A. (1976). Some detrimental effects of using extra stimuli to guide

responding in autistic and normal children. Journal of Abnormal Child Psychology, 5, 59-71.Koegel, R. L., & Wilhelm, H. (1973). Selective responding to the components of multiple

visual cues by autistic children. Journal of Experimental Child Psychology, 15, 442-453.Kolo, D. J., Anderson, L., & Campbell, M. (1980). Sensory preference and overselective re-

sponding in autistic children. Journal of Autism and Developmental Disorders, 10, 259-271.Leiter, R. G. (1979). Leiter International Performance Scale: Instruction manual. Chicago:

Stoelting.Leslie, A., & Frith, U. (1988). Autistic children's understanding of seeing, knowing and be-

lieving. British Journal of Developmental Psychology, 6, 315-324.Lewy, A. L., & Dawson, G. (1992). Social stimulation and joint attention in young autistic

children. Journal of Abnormal Child Psychology, 20, 555-567.Lovaas, O. I., Schreibman, L., Koegel, R. L., & Rehm, R. (1971). Selective responding by

autistic children to multiple sensory output. Journal of Abnormal Psychology, 77, 211-222.Lovaas, O. L, Koegel, R. L., & Schreibman, L. (1979). Stimulus overselectivity in autism: A

review of research. Psychological Bulletin, 86, 1236-1254.Loveland, K., & Landry, S. (1986). Joint attention and language in autism and developmental

language delay. Journal of Autism and Developmental Disorders, 16, 335-348.Macdonald, H., Rutter, M., Howlin, P., Rios, P., Le Conteur, A., Evered, C., & Folstein, S.

(1989). Recognition and expression of emotional cues by autistic and normal adults. Jour-nal of Child Psychology and Psychiatry, 30, 865-877.

Mundy, P., Sigman, M., & Kasari, C. (1990). A longitudinal study of joint attention and lan-guage development in autistic children. Journal of Autism and Developmental Disorders,20, 115-12S.

Ozonoff, S., Pennington, B., & Rogers, S. (1990). Are there emotion perception deficits inyoung autistic children? Journal of Child Psychology and Psychiatry, 31, 343-361.


Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychol-ogy and Psychiatry, 32, 1081-1105.

Pierce, K., Glad, K., & Schreibman, L. (1995, March). Social perception skills in children withautism: Inability to integrate multiple cues? Paper presented at the biannual conference ofthe Society for Research in Child Development.

Posner, M. I. (1978). Chronometric explorations of the mind. Hillsdale, NJ: Erlbaum.Price, J., & Brew, V (1990). The role of social cogniton in the development of aggressive behavior

in children. Annual meeting of the Society for Research in Child Development, New Or-leans.

Schreibman, L. (1988). Autism. Newbury Park, CA: Sage.Schreibman, L., & Lovaas, I. O. (1973). Overselective responding to social stimuli by autistic

children. Journal of Abnormal Child Psychology, 1, 152-168.Sigman, M. (1994). What are the core deficits in autism? In S. H. Broman & J. Grafman

(Eds.), Atypical cognitive deficits in developmental disorders: Implications for brain junction(pp. 139-157). Hillsdale, NJ: Erlbaum.

Tantam, D., Monaghan, L., Nicholson, & Stirling, J. (1989). Autistic children's ability to in-terpret faces: A research note. Journal of Child Psychology and Psychiatry, 30, 623-630.

Townsend, J., Harris, N. S., & Courchesne, E. (in press). Visual attention abnormalities inautism: Delayed orienting to location. Journal of the International Neuropsychological So-ciety.

Townsend, J., & Courchesne, E. (1994). Parietal damage and narrow "spotlight" spatial at-tention. Journal of Cognitive Neuroscience, 6, 220-232.

Wainwright-Sharp, J. A., & Bryson, S. E. (1993). Visual orienting deficits in high-functioningpeople with autism. Journal of Autism and Developmental Disorders, 23, 1-13.


Social Perception in Children with Autism: An Attentional Deficit?

Documents

Transcript of Social Perception in Children with Autism: An Attentional Deficit?