In Chapter One it was concluded that in normally developing children, the quality of awareness of other people develops from a primitive and apparently non-reflective form, that allows for spontaneous social reactions (primary intersubjectivity), to a more reflective, co-ordinated form as evidenced, for example, in their capacity for joint attention, social referencing, and more advanced forms of imitation and social
role-taking (secondary intersubjectivity). These capacities are important for young children's awareness of others and of themselves. In this section, consideration will be restricted to those empirical studies that have specifically examined these four important facets of social behaviour in young people with autism. A review of those studies that have explicitly focused on the capacity in young people with autism for self-recognition and self-understanding will then follow.
Both Mead (1934) and Vygotsky (1979) emphasised the importance of the ability to take the perspective of another person for social development. Joint attention interactions that focus the child's and caretaker's attention on the same object, and social referencing interactions that alert the child to the caregiver's attitudes to a shared world, are each important expressions of the child's psychological linking to and differentiation from other people. They both represent early manifestations of the kinds of social relations that are essential to self- and other-awareness, for the reason that such 'linkage' is essential for the development of awareness that 'self and 'other' are in many respects comparable (especially, as centres of consciousness), and such differentiation is essential to awareness that 'self is separate and distinguishable from others. In the following review a small number of studies in this area will be considered, because together these studies are perhaps the most revealing for the abnormalities observed in young people with autism.
Joint attention
Joint attention interactions demonstrate the capacity to not only respond appropriately to the simple gestures of another person, but to deliberately use such gestures with eye contact to co-ordinate attention with another person in order to share the experience of an interesting object or event.
Loveland and Landry (1986) considered joint attention skills and language development in 11 young
people with autism, who ranged from 4% to 11% years of age, and who as a group had a mean mental
age of 5% years (SD 26 months). All of the participants had a minimum mean length of utterance of 1.0. They were group matched with 11 children with developmental language delay for chronological age, mental age and mean length of utterance. Four tasks were administered during a play session: the
language task examined the comprehension and production of the pronouns T / 'you', 'my' / 'your', and
'mine' / 'yours' (e.g., 'What do I have?' and 'Whose got the the gesture task examined the child's
comprehension of attention-directing gestures (e.g., the Shifting Gaze Task: After establishing eye
contact with the child the experimenter shifted gaze to the side of the child to see whether the child turned around to search for the object of the experimenter's attention); the third task examined the comprehension of combined attention-directing words and their appropriate gestures (e.g., the
experimenter shifted gaze and said to the child: 'Look at the and the final task was designed to
elicit attention-directing behaviour from the child (e.g., the experimenter sat in front of and ate food liked by the child to examine whether the child would indicate her/his desire for the food or not).
The young people with autism responded correctly to only 40 percent of the language tasks (compared with 61 percent for the language delayed group), 81 percent of the gesture tasks (compared with 92 percent for the control group), and 71 percent of the language plus gesture tasks (compared with 91 percent for the control group). The between-group comparisons were all statistically significant. Regarding the within-group patterning of response, the investigators observed that the language only tasks were difficult for both groups, the gesture only tasks were easier for both groups, while the language-plus-gesture tasks were more difficult for the young people with autism but not for those with language delay. The investigators did not provide statistics to support the specificity of these within- group observations. They comment:
Apparently, as long as only a gesture is present, the developmental language delay (DLD) child and the autistic child with language can probably interpret the stimulus. When language is added, the DLD child can still interpret the stimulus, but the autistic child is less able to do so, perhaps because o f an inability to focus on the gesture in the presence o f language that may not be understood (p. 346).
Though, generally, the performance of the two groups was similar in terms of the number of spontaneous and elicited language and gesture joint attention responses, the language delay group used significantly more developmentally advanced gestures (i.e., pointing and showing as opposed to touching and taking) when compared to the autistic group. While touching and taking are often difficult to classify in terms of their communicative intent, pointing and showing are always used in a communicative manner. Thus, the developmental language delay children's gestures were more communicative and developmentally advanced than that of the young people with autism.
Loveland and Landry examined the response to, and use of gestures in relatively able young people with autism. Attwood, Frith and Hermelin (1988) examined young people with autism of different mental ability levels for their proficiency in understanding and expressing interpersonal gestures. There were two experiments. In the first, the young people with autism were grouped based on their intellectual
ability: in the higher-fimctioning sub-group the nine participants ranged from 10 to 18^2 years of age,
and in full-scale IQ from 60 to 94 points; in the moderate-functioning sub-group the six participants ranged fi'om 11 to 17% years of age, and in full-scale IQ from 42 to 50 points; and in the lower- functioning sub-group the seven participants ranged from 10 to 19% years of age, and all had full-scale IQ scores below 40 points. The moderate- and lower-functioning sub-groups were group matched for chronological age and full-scale IQ with young people with Down syndrome. All participants were assessed for their ability to respond to each of eight simple instrumental gestures (e.g., pointing to direct the participants' attention, and finger to lips to direct the participants to be quiet). In addition, all participants were assessed for their ability to express eight simple instrumental gestures on verbal request. The experimenter, for example, moved quickly toward the participant from across a large room
as if to bump into her/him, saying. With your hands tell me to stop.'
The investigators found that all three autistic sub-groups responded appropriately to about seven of the eight simple instrumental gestures. This performance was similar to that of the respective clinical control sub-groups. In response to a verbal request to elicit a gesture, however, sub-group differences were found. The higher-functioning young people with autism produced an average of six out of eight appropriate gestures, the moderate-functioning sub-group an average of four, and the lower-functioning an average of three such gestures. The moderate- and lower-functioning clinical sub-groups performed significantly better than the young people with autism producing an average of seven and six instrumental gestures respectively.
In the second experiment Attwood, Frith and Hermelin examined the spontaneous use of gestures in young people with autism in two social situations: while in the playground and while eating their diner.
with 13 of the original control group for spontaneous social interactions as defined by the occurrence of gestures, speech, and facial gestures directed at another person.
The degree of mental retardation made no difference to the frequency of interaction for the young people with autism, thus the investigators combined the data from the three autistic sub-groups. Only 11 of the 18 young people with autism engaged in peer interaction, compared with all of the young people with Down syndrome. This difference was highly significant, and was reflected in the production of fewer gestures, fewer facial glances, and less speech than the control group. Finally, considering those participants who showed at least one social interaction, the average number of gestures between groups were compared. Though the autistic group interacted significantly less than the Down syndrome group in both social situations, the mean number of gestures per interaction was similar. In considering the class of gesture, there was no group difference in the mean number of deictic gestures (e.g., pointing) nor instrumental gestures (e.g., waving someone out of the way) used by the two groups. The young people with autism were not observed using expressive gestures (e.g., hugs, kisses, hands covering face in embarrassment), while 10 of the 15 control group used at least one such gesture. This difference in group performance was statistically significant.
Although the moderate- and lower-functioning young people with autism showed difîiculty when asked to initiate gestures on verbal request, the results of the second experiment suggested that this difficulty was perhaps more an indication of a failure to understand the instructions rather than a failure to understand the meaning of the gestures. Spontaneous gestures were observed in the most severely retarded young people with autism.
... instrumental gestures do not depend on having a concept o f mental states ... (and through them) ... one directly influences somebody else's behavior, in the same way as one would manipulate an object in order to obtain a simple physical effect. Autistic children are clearly able to do th is... Expressive gestures, in contrast, do presuppose a concept o f mental states. They are not primarily aimed at influencing somebody else's behaviour. Instead they are a means o f deliberately showing one's own feelings (p. 254).
More recently, Mundy, Sigman and Kasari (1994) examined the specificity of joint attention in 30 young people with autism. They too designed their study to consider the effect of developmental level on the
expression of non-verbal communication, but unlike Attwood, Frith and Hermelin, they worked with much younger children. The 'low mental age' group comprised 13 children with a mean chronological age of 3 years (SD 7 months) and a mean mental age of 18 months (SD 2 months). The remaining 17 children comprised the 'high mental age' group, and had a mean chronological age of 4 years (SD 13 months) and a mean mental age of 30 months (SD 12 months). These two sub-groups of young people with autism were matched with young people with mental retardation for chronological age and mental age, and a normally developing children for mental age only. Over the course of approximately 20 minutes, various toys were systematically presented to each child. Between each of these presentations, other situations designed to elicit non-verbal responses were set up: the experimenter clapped, sang a short song and tickled the child three times; pointed to the left, the right and behind the child while saying the child's name; and provided each child with the opportunity to roll a ball back and forth, a car back and forth, and to take turns using a comb, hat or pair of glasses in a functionally appropriate way. In the coding schedule. How level joint attention behaviour', which included incidents of either eye contact while holding a toy, or alternating eye gaze between the experimenter's face and the toy, was
distinguished from 'high level Joint attention behaviour', which included either pointing to toys within
reach, or showing or extending toys towards the experimenter's face.
The investigators found that only 19 percent of the young people with autism in the low mental age sub group followed the experimenter's pointing. This was significantly lower compared with the two matched control sub-groups: 65 percent of the mentally retarded group, and 61 percent of the normally developing group responded. Among the high level mental age groups there were no significant differences between the three groups: 70 percent of the young people with autism, 84 percent of the
children with mentally retardation, and 86 percent of the normally developing children responded
appropriately to the experimenter's pointing gesture.
Mundy, Sigman and Kasari also found that the young people with autism exhibited significantly less 'low level' and 'high level' joint attention behaviour as compared with that of the two control groups, both of whom performed similarly. Furthermore, the higher mental age sub-groups displayed significantly more 'low level' and 'liigh level' joint attention behaviour than did the lower mental age
sub-groups. No interaction efifects were found. Pair-wise group contrasts revealed that among the low mental age sub-groups, the young people with autism exhibited significantly less 'low level' joint attention behaviour as compared with the two control groups, and significantly less 'high level' Joint attention behaviour compared with the normally developing group only. Among the high mental age sub-samples, no significant difference emerged in the frequency of 'low level' joint attention behaviour between the three groups, and for 'high level' joint attention behaviour the autistic group exhibited significantly less high level joint attention behaviour than the developmentally delayed group, but the difference between the autistic and normally developing groups did not reach significance.
The investigators examined the effects of intellectual functioning on non-verbal communication skills by re-grouping the two clinical samples. Thirteen young people with autism fell into a higher-functioning
sub-group (mean full-scale IQ = 68 points), and 17 into a lower-functioning sub-group (mean full-scale
IQ = 41 points). In responding to joint attention gestures, the investigators reported a marginal effect of intellectual functioning, with the two higher-functioning sub-groups more likely to respond by looking in the correct direction during pointing trials than the two lower-functioning sub-groups. The young people with autism in the lower-functioning sub-group displayed a more pronounced deficit on low level joint attention behaviour than did those in the higher-fimctioning sub-group. The two mentally retarded sub-groups performed similarly in this respect. For high level joint attention behaviour, the young people with autism in the lower-functioning sub-group displayed a more pronounced deficit relative to the those in the higher-functioning sub-group. A pattern repeated for the mentally retarded sub-groups.
To summarise at this point, in general the comprehension of joint attention skills in young people with autism appears to depend upon their chronological age and their mental ability. These same factors determine the likelihood of production of gestures, though even the most able young people with autism display difficulties with the more advanced joint attention skills. The nature of the gestures themselves are revealing.
The less advanced gestures referred to above are examples of protoimperatives. In general these tipes of gesture are used by normally developing children to make a request of another person. For example, the
young child may point to an object to request that another person give them a toy or food. The use of such gestures do not require an understanding of the other person's mental state. The more advanced forms of gesture are examples of protodeclaratives, and are used by normally developing children to indicate to another person. For example, the child may point in order to comment or remark on the world to another person. These gestures are used when the child wishes to influence the mental state of the other person (e.g., to make another person recognise, attend to or understand what she/he is thinking or feeling).
Baron-Cohen (1989a) considered these two different classes of pointing gesture. In the first experiment,
the investigator examined the comprehension of pointing in 20 young people with autism who ranged
from 6 to 16!6 years of age, in non-verbal mental age from 5Va to 15% years, and in verbal mental age
from 2% to VA years. The performance of this group was compared with that of 14 young people with
Down syndrome who were matched for chronological age, but who had significantly lower non-verbal and verbal mental functioning. Twenty-seven normally developing children whose chronological ages were similar to the verbal mental ages of the autistic group were also included in the study. The first
condition examined for the comprehension of protoimperative pointing. The experimenter said, '/ am
going to use my finger to say something. What am I saying?', and pointed to one of four toys in front of the young person. A non-verbal or verbal acknowledgement that the experimenter required the young person to hand the toy to him was rated as a pass. The second condition examined for protodeclarative
pointing. The experimenter said, 'Now I am going to use my finger to say something else. What am I
saying?', and pointed to four objects that the young person could not see. A non-verbal or verbal response indicating that the young person understood that the experimenter wanted her/him to look at what was being pointed to was rated as a pass.
Fourteen of the 20 young people with autism, 11 of the 14 young people with Down syndrome, and 25 of the 27 normally developing children demonstrated an ability to comprehend protoimperative pointing.
In contrast to this, only 2 of the 20 young people with autism, compared with 12 of the 14 yoimg people
comprehend protodeclarative pointing. The difference between the autistic and two control groups was highly significant.
In the second experiment, Baron-Cohen examined the production of pointing in 10 young people with autism who ranged from IVi to 5 years of age, in non-verbal mental age from VA to 5/2 years, and in verbal mental age from l‘/2 to 3 years. The performance of this group was compared with that of 10 young people with mental retardation who were matched for chronological age and verbal mental age. Ten normally developing children whose chronological ages were similar to the verbal mental ages of the autistic group were also included. The groups of young people were videotaped for 45 minutes in free play, and incidents of protoimperative and protodeclarative pointing were recorded.
Four of the young people with autism produced a protoimperative pointing gesture, compared with eight of the mentally retarded group and seven of the normally developing group. This group difference did not reach statistical significance. Not a single young person with autism displayed a protodeclarative pointing gesture. This performance was significantly less than the two control groups: seven young