"being autistic does not always make someone bad at seeing the world from another's viewpoint"

The quote titling today's post - "being autistic does not always make someone bad at seeing the world from another's viewpoint" - comes from the findings reported by Shisei Tei and colleagues [1].

Their research paper observing that "more careful attention should be paid to the idea of egocentricity in individuals with ASCs [autism spectrum conditions]" is part of a research mash-up post today that also includes the findings reported by Hidetsugu Komeda and colleagues [2]. Both papers help to put a 'real-life perspective' on to sweeping generalisations that everyone on the autism spectrum is completely egocentric and lack the capacity to help others.

The Tei study was initially based on the idea that: "Individuals with autism spectrum conditions (ASCs) often experience difficulty and confusion in acknowledging others' perspectives and arguably exhibit egocentricity." Egocentrism can mean a few things, but all have in common that self is the be-all-and-end-all, and the interests, beliefs and attitudes of others are of secondary regard. It's a concept that we all engage in to some degree at certain times of development and maturation, and from an evolutionary perspective, probably served (and continues to serve) as an important survival mechanism. But: "whether this egocentricity necessarily results in selfish behavior during social situations remains a matter of debate." Tei et al examined the possibility of a link between egocentricity and selfish behaviour in the context of autism...

I'm not totally au fait with all the ins-and-outs of the Tei study techniques - "derived from cognitive psychology and behavioral economics" - but it looks like it was quite a bit to do with response times to a "computerized visuospatial perspective-taking task (VPT)" and the use of a task to measure altruism ("disinterested and selfless concern for the well-being of others"). Compared with a non-autistic control group, they observed some differences among their tested groups but, and it is an important 'but', "having ASCs does not always exhibit selfish behavior during interpersonal communication."

Then we have the findings reported by Komeda et al. The starting point was a sweeping one: "Individuals with Autism Spectrum Disorder (ASD) often lack cognitive empathy, so they experience difficulty in empathizing with others." Their study was perhaps less complicated than the Tei study as a group of adults with autism and control non-autistic adults were asked to read a number of stories - "(12 stories featured protagonists with characteristics of ASD and the other 12 featured TD protagonists)" - and answer questions about said stories. Questioning included "How did the protagonist feel?" and "Would you help if the protagonist were in trouble?"

Results again were interesting. So: "individuals with ASD empathize with other people who have ASD and are motivated to help other people with ASD." Based also on examination of autism spectrum quotient (AQ) scores and when "controlling for alexithymia" (marked dysfunction in emotional awareness, social attachment, and interpersonal relating), authors concluded that: "the reason why individuals with ASD are considered to have limited cognitive empathy and helping behaviors could be related to alexithymia and the lack of social skills and attention to detail, which are related to atypical perception."

OK, both the Tei and Komeda findings have to be put into some perspective. They don't for example, completely exonerate the social cognition or perspective-taking issues that are seen in autism. They can't do so either, because issues with social interaction for example, are a core facet of a diagnosis of autism. In effect, they define autism. I should also add that the reliance on participants who were very much cognitively able in both the Tei and Komeda studies means that one has to be quite careful of generalising such findings to all quarters of the autism spectrum, particularly the under-studied and under-represented (see here) parts.

But as I mentioned earlier in this post, the combined findings do help to put a 'real-life perspective' on things; specifically that such core issues that have defined autism for many, many years - empathy and perspective-taking - don't always manifest in a uniform fashion across people or situations. They also suggest that various other variables also might serve to promote issues with empathy and perspective-taking in relation to autism, as per mention of alexithymia; something that has been noted before by other independent study (see here).

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[1] Tei S. et al. Egocentric biases and atypical generosity in autistic individuals. Autism Res. 2019 May 17.

[2] Komeda H. et al. Do individuals with autism spectrum disorders help other people with autism spectrum disorders?: An investigation of empathy and helping behaviors in adults with ASD. Front. Psychiatry. 2019. May 13.

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Big data does... the extreme male brain theory of autism and the Empathizing–Systemizing theory

"Two long-standing psychological theories – the empathising-systemising theory of sex differences and the extreme male brain theory of autism – have been confirmed by our new study, the largest of its kind to date."

That was the opening sentence to a write-up (see here) of a recent research paper published by David Greenberg and colleagues [1] which sought to "test 10 predictions from the Empathizing–Systemizing (E-S) theory of sex differences and the Extreme Male Brain (EMB) theory of autism." The 'big data' words included in the title of this post refer to the collection of data from hundreds of thousands of people as part of a TV documentary that aired here in Blighty called 'Are you autistic?' whose data were included for study. This follows a similar format from some of the co-authors on the Greenberg paper on previous research occasions (see here).

Minus any charges of plagiarism, a few descriptors might be useful. First: "The first theory, known as the empathising-systemising theory of typical sex differences, posits that, on average, females will score higher on tests of empathy than males, and that, on average, males will score higher on tests of systemising than females." Second: "The second theory, known as the extreme male brain theory of autism, extends the empathising-systemising theory. It posits that autistic people will, on average, show a shift towards “masculinised” scores on measures of empathy and systemising." Researchers also talked about something called a 'd score': "the difference between each person’s score on the systemising and empathy tests" in their research, alongside mention of the words 'brain type'.

As part of the interactivity of that TV documentary, some 670,000 people "who indicated they were males or females" completed various measures: "the Autism Spectrum Quotient-10 (AQ-10)... the Empathy Quotient (EQ)..., Systemizing Quotient-Revised (SQ-R)..., and the Sensory Perception Quotient (SPQ)" via an on-line questionnaire portal. About 36,000 people who took part "indicated that they had been diagnosed with an “Autism Spectrum Condition”." Data from responses to the questionnaires were crunched pertinent to those 10 predictions from both theories (said predictions concerned sex differences based on responses to the questionnaires, those various 'brain types' and how responses might look with reference to the presentation of autistic traits). For good measure, researchers also describe carrying out an 'independent replication' of their findings on a separate cohort of adults ("14,354 participants (226 autistic individuals, and 14,119 controls)"). Although there were some minor differences from the larger main trial, to all intents and purposes the same procedures were employed "for calculating brain types and performing statistical analysis."

Results: well "all 10 predictions from the E-S and EMB theories" were confirmed. So for example, men taking part in the study "had a shift towards a high d score" suggestive of being more likely to be systemisers than empathisers, whilst "typical females had a shift towards a low d score" (i.e. more likely to empathetic than systemiser). The previous STEM (science, technology, engineering, and mathematics) findings [2] were also supported, in that: "STEM professionals on average scored significantly higher on the AQ" suggesting a link between the choice of STEM career and autistic traits. And for those reporting a diagnosis of autism or autism spectrum disorder (ASD): "autistic people, regardless of their sex, had a shift towards an even higher d score than typical males" (systemisers) but "were not more likely to work in STEM occupations, compared with controls."

There is a lot to take in from the Greenberg research and related commentary. The study has a number of things going for it insofar as the huge participant size and the use of an independent replication set to confirm findings. These factors should not be underestimated. The limitations? Well, self-report is still one of them, and the fact that at least one of the questionnaires used is probably picking up a lot more than just 'autistic traits' (see here). I'm also inclined to point out once again that the *correlation* between autistic traits and STEM career choice did not seemingly extend to those with autism being "more likely to work in STEM occupations, compared with controls." Going back to that 'what is being tested' issue, the AQ for example, might also be picking up something linked to "loneliness, social anxiety, depression, and anxiety" [3] or even something approaching the schizophrenia spectrum (see here) or personality disorder (see here). Indeed, one might have to entertain the idea that the definition 'autistic traits' may not tell the whole story in this study.

I have to admit to being still a little sceptical of big psychological theories such as the EMB or the E-S theory of sex differences. The reason? Whilst attractive in their compartmentalising nature, real life is often far from being so clear-cut and linear. The fact also that an important part of the evidence behind such theories remains a little 'fluffy' (see here for example) cannot be readily brushed under the scientific carpet. As for the use of the term 'brain types', well, I can see what the authors were getting at, but I'm not convinced such terminology is particularly useful. 'Brain types' kinda sits in the same category as 'neurotypical' (see here). I was also drawn to the fact that the authors have to explicitly say that their results don't mean that "autistic people lack empathy" and that "autistic people are not hyper-male in general." It kinda tells you how some of the history behind these theories shows that they have not exactly been received with open arms by many.

But even with all that, the Greenberg results cannot be just discounted, and more research on this topic is indicated.

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[1] Greenberg DM. et al. Testing the Empathizing-Systemizing theory of sex differences and the Extreme Male Brain theory of autism in half a million people. Proc Natl Acad Sci U S A. 2018 Nov 12. pii: 201811032.

[2] Ruzich E. et al. Sex and STEM Occupation Predict Autism-Spectrum Quotient (AQ) Scores in Half a Million People. PLoS One. 2015 Oct 21;10(10):e0141229.

[3] Reed P. et al. Loneliness and Social Anxiety Mediate the Relationship between Autism Quotient and Quality of Life in University Students. Journal of Developmental and Physical Disabilities. 2016; 28: 723-733.

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"ASD characteristics in adulthood are differently perceived across age, sex, and informants"

The research tag-team that is Anne Lever and Hilde Geurts have provided peer-reviewed fodder for this blog before (see here and see here). Without wishing to cajole their research interests into a specific box, quite a bit of their time seems to be taken up by looking at autism in the context of ageing, alongside how the label of autism does not seem to have a monopoly on the presentation of certain autistic traits.

A recent paper published by this team [1] provides yet more blogging material, specifically focused on testing "the association between age and ASD [autism spectrum disorder] characteristics, including empathy and sensory sensitivity, in adults aged 19–79 years." A scientific hat-tip is offered to other research in this area [2] that previously observed that: "older age was associated with higher ratings of ASD traits and better cognitive performance."

Drawing on data derived from a participant group numbering above 400 (N=237 with autism and N=198 without autism) spanning the age ranges, a variety of self-report and informant-report (family members, friends, other significant others) were utilised. I should point out that the autism participant group seemed to be represented by the 'more able' part of the autism spectrum (I don't use the term 'functioning') insofar as most either being diagnosed with Asperger syndrome or PDD-NOS (pervasive developmental disorder - not otherwise specified), being predominantly independent or living with a partner or housemate in residential status terms and also with that reliance on self-report used throughout the study kept in mind. This is worth knowing given other discussions on under-represented groups when it comes to scientific study (see here) and how representative autism research may or may not be to the entire spectrum.

Among the measures included for analysis we have an old favourite - the Autism-Spectrum Quotient (AQ) - as well as the Interpersonal Reactivity Index (IRI) (measuring various aspects of empathy) and the Sensory Sensitivity Questionnaire (SSQ) (examining sensory hyper- or hyposensitivity). Obtained results were collated and subjected to quite a few statistical analyses.

Results: noted as a 'group difference' findings were reported observing that: "Adults with ASD reported higher scores on the SSQ and on all subscales of the AQ than adults without ASD." This is pretty much what would be expected, despite any qualms I might have about what the AQ actually measures (see here for more of them). Sensory issues being reported as being greater in those with a diagnosis of autism also ties in well with their inclusion in the DSM-5 schedule for diagnosing autism or ASD (see here).

Then: "Within the ASD group, age-related differences were observed in self-reported ASD traits and sensory sensitivity, with a peak among middle-aged adults." Alongside that previously 'hat-tipped' study, the authors conclude that "ASD characteristics are more heavily experienced in middle adulthood than in younger or older adults." This is interesting from quite a few perspectives; bearing in mind that such findings say nothing about the expression of autism in childhood and early adulthood. Appreciating that the self-report of autism or sensory traits may not be the same as everyday autism expression, such findings *might* have some relevance to various issues such as the rise and rise of adult autism diagnoses being given and indeed, how a diagnosis of autism for some (a few?) might not be a 'lifelong' issue (see here). I know that last point raises blood pressure in some quarters as words like 'masking' are banded around (with the need for far greater study), but there is good reason to think that like many other conditions/labels, autistic behaviours and/or traits ebb and flow according to environment and perhaps other factors, such as the presentation of comorbidity for example (as per the author's other work [3] already mentioned). In short, the presentation of autism is probably dynamic and fluidic, rather than just a static thing.

Onward: "we replicated earlier findings that females with ASD had more sensory issues and reported more ASD characteristics than males... whereas females without ASD manifested fewer ASD traits than non-ASD males.". Females with ASD (74 females vs. 163 males) 'reported more ASD characteristics than males'? Intriguing - "ASD females reported higher scores than ASD males on the AQ total score" - to say the least in light of other [childhood] findings [4] but not without cautions. I go back once again the question of what the AQ is actually measuring and whether for example, the typically higher rate of mood disorders generally noted in females could be a potential confounder when it comes to AQ scores in the context of that previous reference [3] from the authors. This area requires further investigation.

Finally: "Overall, the current results show poor to fair agreement between self- and other-reports of well-known proxies, even though the agreement of the overall group was similar to those previously reported for social responsiveness." Again, some potentially important lessons to be learned here insofar as the 'meaning of autism' to a person and those around them. Indeed I note the authors' offer one explanation: "the self may be more accurate about traits that describe unobservable thoughts and feelings due to privileged access (e.g. feelings of empathy and sensory sensitivity), whereas an informant would be more accurate about observable behavior (e.g., ASD traits)." Again, jumping back into 'hot potato' territory, such a finding may have implications for the whole 'self-diagnosed vs. formal diagnosis' debate that still continues at a pace (see here).

There is quite a bit more to take in from this latest paper from Lever & Geurts and definitely some food for thought. I'll leave you however with one final quote from the authors that is perhaps one of the more important take-away points from their study: "it is important to repeatedly assess self-reported ASD characteristics during adulthood." Who would argue with that in terms of getting wants, wishes, needs and requirements accurate and up-to-date?

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[1] Lever AG. & Geurts HM. Is Older Age Associated with Higher Self- and Other-Rated ASD Characteristics? Journal of Autism & Developmental Disorders. 2018. Jan 18.

[2] Happé FG. et al. Demographic and Cognitive Profile of Individuals Seeking a Diagnosis of Autism Spectrum Disorder in Adulthood. J Autism Dev Disord. 2016 Nov;46(11):3469-3480.

[3] Geurts HM. et al. Autism Characteristics in Older Adults with Depressive Disorders. The American Journal of Geriatric Psychiatry. 2016; 24: 164-169.

[4] Øien RA. et al. Sex-Differences in Children Referred for Assessment: An Exploratory Analysis of the Autism Mental Status Exam (AMSE). J Autism Dev Disord. 2018. Feb 8.

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"Theory of mind is not theory of emotion"

A rather interesting paper by Beth Oakley and colleagues [1] (open-access might be available here) appeared recently providing a "cautionary note on the Reading the Mind in the Eyes Test" [2], one of the premier assessments thought to offer a performance-based measure "involving mental state attribution and complex facial emotion recognition from photographs where only the eye region of the face is available."

Most people with some knowledge about autism research history will have heard about the proposal that Theory of Mind (ToM) - a term often used to cover that "mental state attribution" - might be affected in cases of autism (see here) and indeed, how careers and reputations have been made on such a generalisation. These days ToM is less and less being talked about as the heterogeneity of the autism spectrum becomes better understood and how specificity in particular, has proved to be an Achilles' heel for the concept (see here).

One of the emerging ideas to account for some of the results obtained using the Reading the Mind in the Eyes test (RMET) in cases of autism is that alexithymia - a construct characterised by an inability to describe or understand emotions - might actually be the more important issue than autism per se. The idea being that alexithymia can co-occur alongside some autism and that for those presenting with that combination, ToM and assessments like RMET might be problematic.

So Oakley et al delved a little deeper into some of the hows and whys of some of the RMET results obtained with autism in mind and whether "the RMET indexes emotion recognition, associated with alexithymia, or ToM, associated with ASD [autism spectrum disorder]." They did it on the basis of examining a small group of participants diagnosed with an ASD (n=19) alongside 24 participants without autism. Alexithymia was assessed using "the 20-item Toronto Alexithymia Scale (TAS–20)." Autism symptoms severity was measured using the Autism Spectrum Quotient (50) (oh dear..) and "current functioning" in the autism group was assessed using the gold-standard that is the Autism Diagnostic Observation Schedule (ADOS) (more like it).

Results: well bearing in mind the small participant numbers and the need for further independent replication of the findings, "Reading the Mind in the Eyes Test (RMET) performance was unaffected by autism spectrum disorder... but was negatively impacted by alexithymia." Indeed, we are told that: "Six ASD and eight control participants met the criterion for severe alexithymia, with a score of 61 or above on the 20-item Toronto Alexithymia Scale (TAS–20)." Further: "in individuals with ASD and comorbid alexithymia, it is alexithymia, rather than ASD per se, that impairs emotion recognition performance."

I probably don't need to say too much more about this line of research and its important implications outside of perhaps the requirement to screen for alexithymia as and when autism is diagnosed. Insofar as the idea of an "alexithymia hypothesis of emotion-related deficits in ASD", this does sound like a tantalising option but again, I'd be slightly reluctant to go all-in with yet another grand theory for autism given the trials and tribulations that psychological theories in particular have faced over the years with autism in mind. As to other potential impacts from work such as this, well, assertions that a lack of empathy might the root of all evil (see here) also made by proponents of ToM might do well to take on board a role for alexithymia in any future judgements...

Minus any charges of plagiarism, I leave you with the general summary from Oakley and colleagues:

"This study suggests that a highly popular test of the ability to detect what someone else is thinking—the Reading the Mind in the Eyes Test—is instead a test of the ability to recognize another person’s emotional expression. This is important because it suggests that patients who perform badly on this test may still be able to understand another person’s mental state and that, conversely, patients who perform well on this test may still have difficulties in mental state understanding."

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[1] Oakley BF. et al. Theory of mind is not theory of emotion: A cautionary note on the Reading the Mind in the Eyes Test. J Abnorm Psychol. 2016 Aug;125(6):818-23.

[2] Baron-Cohen S. et al. The “Reading the Mind in the Eyes” Test: Complete Absence of Typical Sex Difference in ~400 Men and Women with Autism. PLoS ONE. 2015; 10(8).

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Oakley BF, Brewer R, Bird G, & Catmur C (2016). Theory of mind is not theory of emotion: A cautionary note on the Reading the Mind in the Eyes Test. Journal of abnormal psychology, 125 (6), 818-23 PMID: 27505409

Is empathising rather than systemising linked to maths achievement?

"Contrary to our hypothesis, we found no relationship between systemizing and math achievement after controlling for domain general abilities and no relationship between the systemizing brain type (greater discrepancy between systemizing and empathizing) and math achievement."

That quote taken from the study published by Emily Escovar and colleagues [1] (open-access available here) provides some blogging fodder today. Based on some ideas proposed in autism research circles that "mathematics is purported to be an example of an ability requiring systemizing" and some rather sweeping claims about facets of autism being explained "as a high tendency to systemize" researchers set about testing the idea that being a good systemiser might make for good maths ability. I might add that previous research has demonstrated that a diagnosis of autism (and comorbidities) does not necessarily equal 'maths genius' (see here).

Drawing on data from a cohort of 112 "typically developing children" (authors words not mine) aged between 7 and 12 years old, researchers set about assessing various functions. "Intelligence was assessed using the full-scale intelligence quotient (FSIQ) of the Wechsler Abbreviated Scale of Intelligence (WASI)." Various facets of maths ability were also included for study as a function of the use of "the Woodcock Johnson III, Form A" and specifically "the Calculation, Math Fluency, and Applied Problems subtests as measures of math achievement." Researchers also sensibly included a measure of maths anxiety - the Scale for Early Mathematics Anxiety - as part of their protocol. Alongside the use of the Social Responsiveness Scale (SRS) to provide some background on presented autistic-like traits, the main event was the that: "The primary guardian of each child completed the Combined Empathy Quotient-Child (EQ-C) and Systemizing Quotient-Child (SQ-C)."

Results: from the point of view of proponents of the whole systemising-empathising thing with gender in mind, there was some good news: "There was a marginally significant gender difference on SQ-C, with boys scoring higher than girls. In contrast, boys and girls differed significantly on EQ-C with girls scoring higher than boys." This follows other work in this area (see here). But it was not all one-way traffic as per the opening statement to this post and the conclusion that "SQ-C is not an independent predictor of math achievement in children."

One particularly interesting detail did emerge from the study findings: "results demonstrate that empathizing is a previously unknown predictor of math skills in TD [typically developing] children." This was specifically based on the results of the Calculation skills subtest but was independent of gender (as an effect) and neither was explained by maths anxiety scores. Some further analysis taking into account SRS scores was undertaken and the idea that "children with higher social abilities tended to have lower math skills" emerged. Finally, just in case you might think that 'autistic behaviours' might be the driving force between empathising and maths ability, the authors have something to say about this too: "the link between empathizing and math achievement may be related to social awareness and cognition rather than autistic behaviors."

I am cautious that the Escovar findings do require replication and further investigation before any grand claims are made about autism, empathising/systemising and maths ability; not least because of the cohort used and, although a decent sized number, the requirement for even greater participant numbers. That other categories of behaviour can seemingly affect maths performance should also not be forgotten [2]. That being said, I'd like to think that there could be some really important issues to come from such work if the relationships proposed holds out. Not least is the idea that reinforcing empathising skills *might* have a knock-on effect for something like maths ability and perhaps equally important, the possibility of a downside to being a classroom 'social butterfly' from a maths perspective...

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[1] Escovar E. et al. The Empathizing-Systemizing Theory, Social Abilities, and Mathematical Achievement in Children. Sci Rep. 2016 Mar 14;6:23011.

[2] May T. et al. The role of attention in the academic attainment of children with autism spectrum disorder. J Autism Dev Disord. 2013 Sep;43(9):2147-58.

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Escovar E, Rosenberg-Lee M, Uddin LQ, & Menon V (2016). The Empathizing-Systemizing Theory, Social Abilities, and Mathematical Achievement in Children. Scientific reports, 6 PMID: 26972835

Autistic traits in adults with epilepsy

"Increased autistic characteristics found in adults with epilepsy without an ASD [autism spectrum disorder] diagnosis suggest that epilepsy syndromes may incorporate behavioral aspects of autism in the absence of some of its core cognitive features."

Contrariwise, if you think we're alive you ought to speak to us.

That was the intriguing finding reported by Sally Ann Wakeford and colleagues [1] who examined test performance on the Autism Spectrum Quotient (AQ) and "systemizing and empathizing abilities" in a small-ish sample of adults with epilepsy compared with those without epilepsy. They found that: "Significantly more autistic behavioral traits, as measured by the AQ, were related to having epilepsy" but those systemising (UK spelling) and empathising abilities did not differ between the groups. The AQ, as I've indicated in previous posts, is a self-report measure and not necessarily autism-specific in terms of the features being described, so one has to be slightly cautious from this angle. But please don't let that detract from the interesting suggestion being reported...

Autism and epilepsy is an association which goes back quite a few years. Not only is epilepsy one of the more frequently reported comorbidities suggested to follow at least some diagnoses of autism (see here), epilepsy and autism co-occurring in certain situations, also provides some of the strongest evidence yet that the plural autisms might be a better definition than the catch-all categorisation that we currently use (see here). Dare I even direct you also to the preliminary research talking about joint intervention for autism and epilepsy too?

Insofar as the connection between autism and epilepsy, the Wakeford results might also imply that the genetics and biology of autism (some autism) and epilepsy (some epilepsy) might also show some kind of interplay with one and another. From me, this could imply that the research by Ong and colleagues [2] talking about a heightened risk of epilepsy in those with autoimmune disorders (see here for my take), might also extend into autism as per quite the increasing body of peer-reviewed literature talking about autoimmunity and [some] autism.

I'm also minded to suggest that despite the lack of a relationship between epilepsy and the core cognitive features of autism, I wouldn't yet rule out more subtle presentation as uniting the two diagnostic concepts [3].

Music then... Pharrell Williams - Gust of Wind.

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[1] Wakeford S. et al. Autistic characteristics in adults with epilepsy. Epilepsy Behav. 2014 Oct 30;41C:203-207.

[2] Ong MS. et al. Population-level evidence for an autoimmune etiology of epilepsy. JAMA Neurol. 2014 May;71(5):569-74.

[3] Kavanaugh BC. et al. Parent-rated emotional–behavioral and executive functioning in childhood epilepsy. Epilepsy & Behavior. 2015; 42: 22-28.

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Wakeford S, Hinvest N, Ring H, & Brosnan M (2014). Autistic characteristics in adults with epilepsy. Epilepsy & behavior : E&B, 41C, 203-207 PMID: 25461216

Signs of autism in eating disorders?

To mention 'food and autism' in the same sentence can conjure up images of quite a few associations made in the peer-reviewed research literature over the years. You have for example, the growing body of work talking about how certain dietary interventions might be useful for some people on the autism spectrum (see here) and all the accompanying science on potentially why which seems to follow (see here).

Your differential analyser or mine? @ Wikipedia 

In another vein, issues with food and feeding behaviours, present in quite a few cases of autism, represent a far more practical issue to contend with; something which I've talked about before on this blog (see here).

Outside of the various sensitivities to things like taste, texture and smell which can affect a person's relationship with food (see here for a great overview* with autism in mind), questions are being asked about whether there may be more pathological issues to contend with as a result (see here**). I refer readers to the question asked by Prof. Gillberg 30 years ago on whether autism and familial anorexia might be linked (see here).

With this in mind, and slightly reversing the nature of any relationship, I want to discuss the paper by Baron-Cohen and colleagues*** (open-access) which suggested that females diagnosed with anorexia nervosa (AN) might being more likely to present with a cognitive style reminiscent of that seen in autism. Quite a nice overview of the study and its findings can be found here and due credit should be given to the article by Clare Allely which recently appeared in The Psychologist.

In essence (no, not that ESSENCE) we are talking about a group of adolescent females diagnosed with AN (n=66) compared with a control group of similarly aged young women without AN (n=1609). Based on the previous work looking at empathising and systemising (see here) styles in autism, participants completed questionnaires (EQ --- SQ-R --- AQ) to report on these attributes.

The results: "As predicted, the patients with anorexia has a higher AQ and SQ". In other words, the distribution of AN cases scoring higher on the AQ (see here for some more chatter about this instrument) was greater than that seen in the non-AN controls (see Figure 1 of the paper here). Ergo, more autistic traits in the AN group as per earlier research****. That also the AN group seemed to be better systemisers was another finding.

Whilst I have had my doubts about some of the earlier manifestations of the whole empathising-systemising theory (think the sweeping generalisations of Theory of Mind and autism) I have to say I am really interested in these recent results. I note also that another review study looking at the presence of autism in eating disorder populations***** likewise suggests that this might be a relationship which requires much further investigation.

If I had to throw a few spanners into the works outside of the study limitations already talked about by the authors, it would have to be that we should be cautious of making too many over-generalisations from this work. The recent 'mixed' findings by Courty and colleagues****** need to be considered. Although I am not an expert on eating disorders, it's still possible that we might also consider some shared comorbidity outside of autism as potentially accounting for some of the results at least in a sub-group. So for example, are features such as anxiety or obsessionality potential links between AN and the autism spectrum disorders particularly when talking about being better systemisers? The paper by Morsanyi and colleagues******* might be relevant here: [the systemising quotient] "was correlated with statistics-related attitudes, self-efficacy, and anxiety". I tip my hat also to the findings reported by Coombs and colleagues********. I'd also like to see more data on whether the described relationship between eating disorders and autistic traits holds for other kinds of eating disorders such as bulimia too?

Without also wishing to cause any offence, I do wonder about these results potentially being extended following in the tracks of the Gillberg letter. Take for example the paper by Grove and colleagues********* who talked about the empathising-systemising results being extended to other family members where autism is present. Does this therefore imply that we should be thinking about eating disorders potentially being more prevalent in other family members where autism is present? Indeed should we consider the possibility that the presence of a maternal (or paternal) eating disorder could be [another] subsequent risk factor for offspring autism?

To close, an Elvis track for you... His Latest Flame. I'd also like to mark the passing of David Barker (see here for his obituary) and his insightful contribution to science discussed in an earlier post (see here) which in an odd sort of way might also be relevant to today's discussions.

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* Cermak SA. et al. Food selectivity and sensory sensitivity in children with autism spectrum disorders. J Am Diet Assoc. 2010 February; 110(2): 238–246.

** Råstam M. et al. Eating Problems and Overlap with ADHD and Autism Spectrum Disorders in a Nationwide Twin Study of 9- and 12-Year-Old Children. Scientific World Journal. 2013; 2013: 315429.

*** Baron-Cohen S. et al. Do girls with anorexia nervosa have elevated autistic traits? Mol Autism. 2013; 4: 24.

**** Hambrook D. et al. Empathy, systemizing, and autistic traits in anorexia nervosa: a pilot study. Br J Clin Psychol. 2008 Sep;47(Pt 3):335-9. doi: 10.1348/014466507X272475.

***** Huke V. et al. Autism spectrum disorders in eating disorder populations: a systematic review. Eur Eat Disord Rev. 2013 Sep;21(5):345-51.

****** Courty A. et al. Levels of autistic traits in anorexia nervosa: a comparative psychometric study. BMC Psychiatry. 2013 Sep 10;13(1):222.

******* Morsanyi K. et al. Are systemizing and autistic traits related to talent and interest in mathematics and engineering? Testing some of the central claims of the empathizing-systemizing theory. Br J Psychol. 2012 Nov;103(4):472-96.

******** Coombs E. et al. An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample. Br J Clin Psychol. 2011 Sep;50(3):326-38.

********* Grove R. et al. Empathizing, systemizing, and autistic traits: latent structure in individuals with autism, their parents, and general population controls. J Abnorm Psychol. 2013 May;122(2):600-9.

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Baron-Cohen S, Jaffa T, Davies S, Auyeung B, Allison C, & Wheelwright S (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular autism, 4 (1) PMID: 23915495

Cord blood testosterone and autistic-like traits: no link?

Prof. Andrew Whitehouse has featured quite a bit on this blog. The most recent occasion (aside from this post) was a piece of research on maternal vitamin D status and early adult offspring scores on the Autism Spectrum Quotient (AQ) which concluded no overall link despite some interesting details. Indeed quite a bit of his work derived from the Raine study focuses on recording factors during pregnancy and the very earliest days in the big, wide world and seeing how they might relate to results like those derived from the AQ some years later. Not wholly dissimilar from the ethos behind looking at archive dried blood spots it has to be said.

Cord clamping @ Wikipedia  

In a similar vein, I want to talk about another of his papers* (open-access), this time on perinatal testosterone exposure and once again, early adult offspring AQ scores. And in particular a lack of association between the two variables and some potentially important implications for one of the more widely cited theories of how autism might come about.

I've kinda covered testosterone and autism before on this blog with reference to the finger length ratio (2D:4D), apparently quite an interesting correlate of how much testosterone we might have been swimming around in in-utero, and also more speculatively on a post on PCOS.

Most people thinking testosterone and autism are brought back to the theory posited by Prof. Simon Baron-Cohen - see one of the papers here** - extending the so-called extreme male brain (EMB) theory of autism*** itself extending the systemising/empathising sex differences**** again extending good old Theory of Mind (ToM). It's quite a logical train of thought I must admit, and probably why so many people truly do believe testosterone may show some primary connection to cases.

That being said, regular readers perhaps know that I'm not really one for sweeping generalisations when it comes to autism (see pages 949-951), no matter how much the science of psychology loves to try and compartmentalise conditions like autism. And take my word for it, psychology has been pretty fanatical about compartmentalising autism, its core cognitive features, down the years, almost it seems searching for some kind of scientific closure.

Anyhow, the paper in question is open-access but here are a few bullet points:

• The study is part of the Raine initiative again, whereby out of 861 children where BioT (free testosterone & albumin-bound testosterone) taken from umbilical cord blood at delivery was available, 707 provided diagnostic data at any of the specified follow-up points through infancy and early adulthood.
• Testosterone analysis was made by mass spectrometry, so one can't really fault accuracy, and DNA analysis from a small sample of the cohort ensured that cord blood samples were not contaminated by maternal blood so as to rule out reading maternal testosterone levels over offspring.
• Five of those 707 offspring were eventually diagnosed with an autism spectrum disorder (ASD).
• Results: "no significant correlations between TT levels and scores on any AQ scale among males (rho range: -.01 to .06) or females (rho value range: -.07 to .01)". TT = total testosterone.
• Indeed, "no significant association between BioT or TT concentrations and AQ scores among males (rho value range: -.07 to .08) or females (rho value range: -.06 to .12)".
• When looking at those 5 who were diagnosed with ASD, four "had TT and BioT levels lower than the sex-specific BioT means of the broader cohort, and all cases were within one standard deviation of these means".
• Not surprisingly the authors conclude that "testosterone concentrations from umbilical cord blood are unrelated to autistic-like traits in the general population".

There have been a few murmurs about this study in cyberspace, its results and implications for the EMB theory; partly genuine scientific interest, partly prejudice it has to be said. I'm going to try and remain objective. Assuming there was no significant sample degradation given that cord samples were taken at parturition and then thawed out apparently some years later for analysis, there are a few other factors to take into account which might have more general implications of the EMB-autism work.

Fair-do to Prof. Whitehouse for not totally poo-pooing the other research literature built up on testosterone and autism based on his findings. Indeed an even more recent study again by Bonnie Auyeung and colleagues***** (including Prof. Baron-Cohen) looking at amniotic fluid foetal testosterone and Q-CHAT results in 18-24 months old found a more positive relationship; bearing in mind a much smaller sample size and the focus on infancy not adulthood.

Back to the Whitehouse study: he for example talks about concentrations of cord testosterone not necessarily being the sole factor of any relationship but rather "individual differences in biological sensitivity to testosterone". That and the fact that the AQ is not a comprehensive autism assessment but rather a screen, and quite a subjective screen by all accounts. Other authors have talked about testosterone within a wider context of other biological markers as per this study by Geier and Geier****** who bring in words like glutathione, cysteine and homocysteine. I think you can see where I'm going with this; similar to the increasingly distant prospect of an autism gene, so an individual biomarker for autism is also looking less and less likely. Then there's heterogeneity (autisms not autism), comorbidity, etc. Indeed comorbidity is something that really needs a lot more study with testosterone-autism in mind.

Finally, I was interested to see that poverty might have been an influence on the AQ scores reported in the recent trial, to quote: "Total AQ scores were significantly higher for those adults whose mother was 
living below the poverty line during pregnancy". Assuming that you share the same enthusiasm for epigenetics and things like the Barker hypothesis as I do, you can perhaps see that this might be an area ripe for some further investigation.

To finish, a bad moon rising... oh yeah, I see it now.

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* Whitehouse AJ. et al. Perinatal testosterone exposure and autistic-like traits in the general population: a longitudinal pregnancy-cohort study. J Neurodev Disord. 2012; 4: 25.

** Auyeung B. et al. Fetal testosterone and autistic traits. Br J Psychol. 2009; 100: 1-22.

*** Baron-Cohen S. The extreme male brain theory of autism. Trends Cogn Sci. 2002; 6: 248-254.

**** Baron-Cohen S. et al.  Is there a link between engineering and autism? Autism. 1997; 1: 101-109.

***** Auyeung B. et al. Prenatal versus postnatal sex steroid hormone effects on autistic traits in children at 18 to 24 months of age. Molecular Autism. 2012; 3: 17.

****** Geier DA. & Geier MR. A clinical and laboratory evaluation of methionine cycle-transsulfuration and androgen pathway markers in children with autistic disorders. Horm Res. 2006; 66: 182-188.

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Whitehouse AJ, Mattes E, Maybery MT, Dissanayake C, Sawyer M, Jones RM, Pennell CE, Keelan JA, & Hickey M (2012). Perinatal testosterone exposure and autistic-like traits in the general population: a longitudinal pregnancy-cohort study. Journal of neurodevelopmental disorders, 4 (1) PMID: 23110806

Don't give me evils..

Another quick post (honestly!). The title of the post will be recognised by most of the UK audience as taken from Little Britain and everyones favourite 'chav' Vicky Pollard.
Anyway, I stumbled across an article in today's Independent online titled: Why a lack of empathy is the root of all evil.
The article discusses a new book from Prof. Simon Baron-Cohen called 'Zero degrees of empathy: a new theory of human cruelty'. Most people connected to autism will have heard about Prof. Baron-Cohen's theories on empathy and autism. The article has attracted some interesting comments.
That's all.