"children with both ASD and subclinical autistic traits have lower neuropsychological performance"

The quote heading this post - "children with both ASD [autism spectrum disorder] and subclinical autistic traits have lower neuropsychological performance" - comes from the findings reported by Fjola Hyseni and colleagues [1].

Researchers report results from a study "embedded in the Generation R Study" (an initiative that has appeared before on this blog) examining whether neuropsychological performance as measured by "using subtests of the NEPSY-II-NL" showed any connection to autistic signs and symptoms. The sorts of things looked at via the NEPSY-II included "attention and executive functioning, memory and learning, sensorimotor, language, and the visuospatial domain."

Actually, the Hyseni study was a multi-factorial study in that their analysis "involved an ASD case versus control analysis comparing children with a diagnosis of ASD to children without an ASD diagnosis" and also "to test for a linear relationship between autistic traits and NEPSY-II performance in the entire sample." Finally, they "excluded both children with a diagnosis of ASD and children with high autistic symptoms" but still looked at scores on the Social Responsiveness Scale (SRS) as a function of NEPSY-II test performance.

Results: based on the inclusion of data from over 1000 children, there were some important details attached to the authors observation that autistic traits were negatively correlated with neuropsychological performance. So, as well as higher levels of autistic traits or a diagnosis of autism being associated with lower neuropsychological performance across various domains and taking into account various other potential confounding variables - covariates - (gender, age, ethnicity, child attention problems, etc), so those analyses of SRS scores of participants without a diagnosis of autism or high autistic traits yielded important findings. For the 960 children who this covered, authors reported that "the significant relationship between SRS scores and neuropsychological performance remained", at least when it came to memory and learning, sensorimotor functioning, and language domains following adjustment for those covariates. The authors conclude that: "Our results provide support for a relationship along the continuum between autistic symptoms and neuropsychological performance in school-age children who encompass children with subclinical autistic traits." Further investigations are implied in this area on the basis for example, that: "the measurements of autistic traits, neuropsychological functioning, and IQ were not performed at the same time; thus, there was a short time difference between the two measurements."

There are some important implications from such results. Not least, as the authors point out: "children with both ASD and subclinical autistic traits have lower neuropsychological performance" and also that they: "may provide an understanding of why some children without an ASD diagnosis may require some additional assistance within academic settings." I hasten to add that neuropsychological performance is not necessarily the same as academic performance, and so one has to be quite careful of where such discussions could lead. I also think back to those ideas that have perpetuated autism down the ages suggesting that a diagnosis of autism confers some sort of 'savant' advantage to the masses. I've talked before about how sweeping a generalisation such thinking is (see here) and indeed, the Hyseni findings kinda add further cold water to such universal sentiments. People diagnosed as on the autism spectrum are gifted in many ways, but not necessarily because of any diagnostic label they have received and not necessarily consistently so [2]...

And on the topic of autistic traits potentially 'influencing' performance, the findings reported by Crehan and colleagues [3], including one John Constantino - "the authors of the SRS" - are also pertinent. To quote: "Splitting the SRS scores into three severity classes revealed that impaired social responsiveness is significantly related to competency." One also has to wonder in the longer term, whether the sentiments expressed by Skylark & Baron-Cohen [4] on how certain autistic traits (particularly socially implicated traits) might "influence a person’s financial circumstances" could also 'interact' with the findings being discussed.

Much food for thought.

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[1] Hyseni F. et al. Autistic traits and neuropsychological performance in 6- to-10-year-old children: a population-based study. Child Neuropsychol. 2018 Apr 23:1-18.

[2] Lindor E. et al. Superior Visual Search and Crowding Abilities Are Not Characteristic of All Individuals on the Autism Spectrum. J Autism Dev Disord. 2018. May 22.

[3] Crehan ET. et al. Tracking the Influence of Autistic Traits on Competencies Among School Aged Children with Subthreshold Autistic Traits: A Longitudinal Study. Child Psychiatry Hum Dev. 2018 May 11.

[4] Skylark WJ. & Baron-Cohen S. Initial evidence that non-clinical autistic traits are associated with lower income. Mol Autism. 2017 Nov 13;8:61.

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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

Maths problem solving ability and autism: as varied as the label itself

I'm bringing the paper by Tasha Oswald and colleagues [1] to the blogging table today and a reiteration of the important idea that within the vast heterogeneity that surrounds the presentation of autism (or even the autisms) so too there is quite a lot of variability in the presentation of strengths and weaknesses; indeed, not so dissimilar to life in general.

Mathematics problem-solving was the specific area that Oswald et al have zoomed in on, with the aim of assessing: "the relative proportions of youth with ASD who demonstrate giftedness versus disability on applied math problems."

Researchers reported that of the 27 "high-functioning adolescents with ASD [autism spectrum disorder]" (their words not mine), just over a fifth of participants (22%) "evidenced a mathematics learning disability" whilst only 4% presenting with "mathematical giftedness." These results, by the way, were based on "standardized measures of math problem solving, perceptual reasoning, verbal ability, and test anxiety." When it came to predicting which factors might be relevant to maths problem solving ability, the authors reported a sliding scale: "perceptual reasoning, followed by verbal ability and test anxiety, then diagnosis of ASD" taking into account results from age and cognitively matched controls (n=27) also.

Outside of the idea that not everyone diagnosed with an ASD is Rainman (indeed that whilst autism is over-represented in savant skills, this does not mean that autism = savant [2]), there are some interesting lessons to be potentially learned from the quite preliminary Oswald findings. Not least is the suggestion that results "highlight possible targets of intervention for students with ASD struggling with mathematics" based on those proposed predictors of maths ability and where further educational focus might be directed. Indeed, the specific idea that 'test anxiety' might for example be a factor, ties in well with other peer-reviewed evidence hinting at how the effects of different types of anxiety may be far-reaching when it comes to autism (see here).

I might also forward the idea that whilst autism was the focus on the Oswald data, one should perhaps be mindful of how other comorbidity can similarly affect academic attainment. May and colleagues [3] talked about how aspects of attention could very well affect skills such as mathematics performance with autism in mind and specifically how: "attentional switching difficulties are linked with poorer mathematics outcomes in ASD." Without hopefully confusing attentional switching with something like a diagnosis of attention-deficit hyperactivity disorder (ADHD) (although there is overlap), I will bring in the important data hinting that ADHD difficulties may indeed be over-represented when it comes to autism (see here) and what impact this might have on maths abilities in at least some cases of autism. Further, the question of whether 'tackling' said ADHD might have some interesting effects on areas like maths ability with autism in mind, bearing in mind pharmacotherapy might not be the only suggested avenue?

I'm gonna close with reference to the paper by De Marco and colleagues [4] detailing just how impressive the human mind can be...

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[1] Oswald TM. et al. Clinical and Cognitive Characteristics Associated with Mathematics Problem Solving in Adolescents with Autism Spectrum Disorder. Autism Res. 2015 Sep 29.

[2] Treffert DA. & Rebedew DL. The Savant Syndrome Registry: A Preliminary Report. WMJ. 2015 Aug;114(4):158-62.

[3] 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.

[4] De Marco M. et al. Brief Report: Two Day-Date Processing Methods in an Autistic Savant Calendar Calculator.  J Autism Dev Disord. 2015. Oct 17.

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Oswald TM, Beck JS, Iosif AM, McCauley JB, Gilhooly LJ, Matter JC, & Solomon M (2015). Clinical and Cognitive Characteristics Associated with Mathematics Problem Solving in Adolescents with Autism Spectrum Disorder. Autism research : official journal of the International Society for Autism Research PMID: 26418313