critical thinking and autism

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Recommended Autism Resources for Developing Critical Thinking Skills

Autism Resources and Success Stories

June 28, 2009, Updated Feb. 27, 2024, by The Critical Thinking Co. Staff

The neurobiological disorder known as autism is part of a group of disorders known as autism spectrum disorders (ASD). Treatment and educational needs are often very similar for these conditions, even though there are subtle differences and degrees of severity among the disorders. Autism affects a person's ability to communicate and relate to others. It is also associated with rigid routines and repetitive behaviors, such as obsessively arranging objects or following very specific routines. Symptoms can range from very mild to quite severe.

The general term “autism” is often used either specifically to refer to Autistic Disorder (AD) or more generally to refer to ASD. Another term that is often used synonymously with ASD is Pervasive Developmental Disorders (PDD). This term is simply the diagnostic category heading under which five specific diagnoses are listed. The different diagnostic terms that fall under the broad meaning of PDD / ASD, include:

• Autistic Disorder (AD) • Asperger’s Disorder • Rett’s Disorder • Childhood Disintegrative Disorder • Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS)

Autism disorders can usually be diagnosed by age 3; parents are usually the first to notice unusual behaviors in their child or a failure to reach appropriate developmental milestones.

If a child is diagnosed with autism, early intervention is critical. Although parents may have concerns about labeling a toddler “autistic,” the earlier the diagnosis is made, the earlier interventions can begin. There are no effective means to prevent autism, no completely effective treatments, and no known cure. Research indicates that early intervention, in an appropriate educational setting, for at least two years of preschool, can result in significant improvements for many young children with autism disorders. Effective programs focus on developing communication, social, and cognitive skills.

While products from The Critical Thinking Co.™ weren’t initially developed with autistic children in mind, over our 50-year history producing award-winning books and software, we’ve discovered (thanks to our customers) there are several titles parents with autistic children and teachers of autistic students find to be essential resources.

Many of our books and software programs can help children and adults living with autism. The Mind Benders® series presents challenging deductive reasoning activities for autistic children and adults. Building Thinking Skills® provides a comprehensive mix of visual-spatial and verbal skill development, highly recommended for teaching children and adults with autism. Math and Reading Detective® books and software can help children in grades 3 through 8, fine-tune reading comprehension and critical thinking skills in the content areas. Memory Challenge® software is an excellent tool for developing and testing visual memory skills.--> Visual Perceptual Skill Building® develops recognition of letters, words, numbers, and similar/dissimilar objects. It also improves sequencing and visual memory skills. Hands-On Thinking Skills uses manipulatives and helps non-verbal children increase their skills.

Here's what some of our customers have said regarding the use of our products with autistic children.

Carrie, a proud parent from Pennsylvania, said, "My son (10) is on the autism spectrum. He has a brilliant mind for facts and figures, but always struggled with his thought process.  Mind Benders® and  Building Thinking Skills® have given him solid direction in organizing his thoughts and following logical patterns. The progress my son has made in barely one year is incredible. No therapy or modification has come close to having such an impact in the 6 years since his diagnosis. There are no words to express how thankful we are for The Critical Thinking Co.™ ."

"My daughter, age 14, has PDD/Autism. Also, she has an accompanying non-verbal learning disorder (this doesn't mean she doesn't talk; it means that she has trouble interpreting body language and other non-verbal information). Something she has always struggled with has been visual problem solving. We have been using The Critical Thinking Co.™ materials since she was small, as they were the only materials that broke down tasks into small enough chunks for her. As she has grown older, we have also been using the software, most recently the Building Thinking Skills® software. The  Mind Benders® software also presented many challenging visual-puzzle activities, and we have used all of the  Math and Reading Detective® software to help her fine-tune her critical thinking skills in the content areas. When she was 12, I purchased [other] software… but The Critical Thinking Co.™ activities were more varied to hold her interest, and much more reasonably priced. The materials haven't 'cured' my daughter, of course, but they have helped her stick with practicing her skills even when it is difficult. She 'asks' to play the second Building Thinking Skills® software nearly every day. Thank you!" said parent Sandy from Maryland.

Polly Brophy from the LA Unified School District said, “I’m a special education teacher. I was surprised when my supervisor recommended I use The Critical Thinking Co.™ products for children below grade level. She said your books aren’t just for the gifted, and she was so right. Reading Detective® is wonderful for building verbal reasoning skills. One of my autistic students said the other day after finishing a lesson in Reading Detective® , ‘I can’t believe I can do this. I’m so proud!’ At first it wasn’t easy for them. Then they learned how to eliminate the wrong answers. Now some of them have gone up two whole grade levels. I wouldn’t have believed it was possible.”

“I am a very experienced teacher and cognitive trainer. One of my students was in the Special Education program for years; after working with the   Building Thinking Skills® books he returned to grade level in seven months,” said Claudette Anderson, of Prescription for Success Learning Center in Parker, Colorado. “I have worked with various brands of thinking skills materials, but The Critical Thinking Co.™ has the best on the market."

“ The Critical Thinking Co.™ … is a breath of fresh air in a special needs market that too often finds publishers focused on isolated skills rather developing students’ flexible thinking ability,” said John Alexander, executive director of Chartwell School for language learning disabilities, Seaside, California.

Whether your child with autism is 18 months old, or 18 years old, he or she will still benefit from therapy. Early intervention is always helpful, but you're not too late to make a difference in life of your child.

As with all students, but especially autistic children, we highly recommend finding out what the student’s strengths and interests are and emphasize them in your lessons to increase engagement and retention. This simple approach approach builds confidence and nurtures a love of learning.

Helpful Resources:

• Autism Society of America
• Top Ten Facts About Autism
• Symptoms of Autism
• Before You Let an Autism Diagnosis Drive You Crazy
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Embracing Neurodiversity, Empowering Lives

• Oct 11, 2022

Cultivating Critical Thinking Skills in Children with Autism

Does your child face rigidity in thought and routines, or difficulties with managing emotions and social situations? Your child might lack adequate critical thinking skills, an essential aspect of children’s development. Critical thinking is the ability to make sense of our environment and our experiences, allowing us to cope with diverse situations and to problem-solve.

Building critical thinking skills in children with autism helps them to increase flexibility of thought and improve self-regulation. Children with strong thinking skills can approach novel situations with an open mind, ask thoughtful questions, and understand that there might be more than one answer or method to do things.

It may be more difficult to develop critical thinking skills in children with autism as they often think in concrete terms, and may not naturally draw upon past experiences or make novel connections independently. Hence, they may benefit from more explicit teaching and guidance during moments of decision making and when internalising new information. Given that critical thinking skills are crucial, how do we cultivate these skills in children with autism? Here are three strategies to help you build critical thinking skills in your child!

1. Relate stories to your child’s knowledge and experiences

When reading stories or observing situations, draw similarities between the situation and your child’s knowledge and experiences. Relating others’ experiences to your child’s own past experiences helps him realise why the characters acted and thought the way they did. This teaches your child to recognise and adopt others’ perspectives, aiding them in developing critical thinking in similar situations.

To kick off this activity, you can choose a story where the main character goes through a situation familiar to your child, e.g. going to a dentist, or visiting a new place. While reading the book with your child, ask him about his own experiences and compare it to the character’s experience, e.g. “How did you feel when you visited the dentist for the first time? How was Bobby (character) feeling in this story? Why did you feel differently from Bobby?”

2. Vocalise your thought process

Research has shown that we make about 35,000 choices a day (Krockow, 2018). That amounts to thousands of thoughts that we filter through to come to those decisions. Critical thinking and problem-solving processes often come naturally to us, but your child may struggle with organising his thoughts and choosing a line of reasoning. By verbalising your thoughts in real time instead of contemplating silently in your mind, you will model your thought process for your child. Your child can observe how you arrived at certain decisions, and what considerations you reviewed in making those decisions.

For instance, you can vocalise your thoughts on choosing what to eat for dinner, or how to fix a broken chair. Use thinking-out-loud comments, which start with words like “I’m wondering about…” or “I’m thinking that…”. After sharing your thoughts, encourage your child to try talking through a decision he can make in that moment. Your thought processes will provide your child with many examples to learn from when making his own decisions.

3. Keep asking your child questions

It is important to develop a habit of questioning your child about their thoughts and opinions on everything that they experience. Some children with autism may have fleeting thoughts and fail to stay with a strain of thought for long; others may not view a situation from all angles and become easily fixated on a narrow perspective. Your repeated questions will remind your child to think more deeply and holistically, and will help him to learn what questions should be asked about each situation.

You can ask your child why something happened, and have him provide explanations and justifications. You can also ask for more information, or clarify something he shared that you may have questions about. Additionally, you can request for examples or counter-examples, or for the conditions necessary for certain situations to occur. When engaging your child, just remember to keep asking!

Relating stories to your child’s experiences, vocalising your thought processes, and asking questions are good starting points for you to build your child’s critical thinking skills. Grasp informal “in-the-moment” teaching opportunities throughout your child’s day to engage him in critical thinking. View your child as a little intellectual who can surprise you with his depth and complexity of thought. Although critical thinking skills may not come as naturally to some children with autism, your child has the potential to develop strong thinking skills if he is provided with the right stimulation and a rich learning environment!

Written by Hazel.

Greenberg, J. & Weitzman, E. (2014). I'm Ready! How to Prepare Your Child for Reading Success . Hanen Early Language Program.

Krockow, E. M. (2018, September 27). How many decisions do we make each day? Psychology Today. https://www.psychologytoday.com/sg/blog/stretching-theory/201809/how-many-decisions-do-we-make-each-day .

Marlowe, W. B. (2000). An intervention for children with disorders of executive functions. Developmental Neuropsychology , 18 (3), 445-454.

Photo Credits: https://www.pexels.com/photo/clear-light-bulb-on-black-surface-356043/

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Home » Autism Parenting Advice » Teaching Autistic Children Critical Thinking Skills

Teaching Autistic Children Critical Thinking Skills

By   Donnesa McPherson, AAS

October 21, 2022

What is so important about teaching autistic children critical thinking skills? These skills are important to everyday decisions and obstacles an individual may face, there are many neurotypical and neurodivergent individuals that have a hard time with these skills.

This article is going to outline abstract and conceptual thinking skills development, practice, and use in the school setting and at home. I plan on including ways that both parents and teachers will best be able to encourage and build these skills in children with autism spectrum disorder (ASD).

It may take some creativity and thinking outside the box when interacting and teaching these skills. It is important to remember and take note of the differences and potential difficulties that your child may have when taking these ideas into consideration.

As always, these are merely the tip of the iceberg and may not work for everybody. That is why the ability of parents and educators to think outside the box and use their own critical thinking skills when figuring out what will work best for the child.

Neurodivergence, autism, and critical thinking skills

It has been thought that neurodivergent children, particularly autistic children, have a harder time with an abstract idea. In the article, Associations Between Conceptual Reasoning, Problem Solving, and Adaptive Ability in High-functioning Autism, they state that this thought is not entirely correct and cannot cover the spectrum that autism covers.

For instance, the article states that there are children that have learned some conceptual reasoning skills, along with abstract thinking in a therapy or school setting and do well. Then when they go about their everyday lives they tend to forget or have a hard time applying these skills to everyday occurrences.

There are also autistic children who have no need to further their problem solving and conceptual skills. As I stated, with the spectrum that autism falls under, it can be challenging to address all the differing areas of development in these areas.

Ways to promote and enhance abstract and conceptual thinking skills

In this section I will mainly focus on ways of developing these skills in the classroom environment. Also, what alterations and support can be put in place to help the individuals develop these skills.

Problem solving and critical thinking development in the classroom

The presentation, Understanding Autism Professional Development Curriculum: Strategies for Classroom Success and Effective Use of Teacher Supports, starts with explaining what autism is and moves into what affects the autistic students and ways to help and support these students.

What can affect the student with autism?

• Unpredictability this can be daunting and even a little scary for a student that may rely on knowing what they should expect next when school events, like an unexpected pep rally in the loud gym, can be met with extreme difficulty and be more of a stressful event than something fun
• Transitions knowing what is coming up next and have the time to prepare for these transitions can be key with some students keeping transitions and how they are handled in mind can help decrease difficult behaviors before they begin by making it easier for the student to transition smoothly
• Environmental changes these changes can be anything from seating changes to adding a new plant to the classroom and can stimulate certain sensory sensitive individuals or be an unwelcome surprise they were not ready for
• Sensory overload if a student is exhibiting unusual or difficult behaviors, it can occur from all the sounds in the hallway to the buzzing from the lights and can affect the individual that may have a sensitive sensory response
• Sensory seeking these students need some type of sensory stimulating activity, or could be the individuals that need to move around during discussion because that is how their brain best functions
• Navigation it can be confusing, especially if the student has any of the various communication difficulties and may lack the social skills needed to ask when navigating from classroom to classroom or learning center to learning center and can be further irritated by loud and unexpected sounds of voices and chairs scraping the floor
• Expectations not knowing what is expected of them, if the student is still developing social skills they may not do what is asked because they are unsure of what the expectations were before the activity and/or task and are unaware of how to ask appropriately
• Decision making if given too many possibilities for decisions, the student may become confused and irritated because they don’t know what to do and there are too many choices that have been presented to them

Ways to help and support these students

• Provide structure and consistency organizational skills are so important when it comes to this step because it can require a posted classroom schedule and one that the students also have in their notebooks that they can refer to, if needed try to stay clear of visual clutter, as that can cause more confusion
• Make information and supplies readily accessible label where items, homework, lessons, etc. go for the day don’t forget to verbally explain and show the students where they can find these areas and labels, if they haven’t been introduced
• Predictability this is where having a schedule and following it helps and is a nice starting point also having different tools and visual supports that are easily accessible to the student makes it easier for them to use and understand
• Consider potential distractions try to remember that open windows, fluorescent lighting, strong smells, and loud noises can be extremely distracting and are a few of the things that can affect a sensory sensitive student keeping these distractions down or altering them in a friendlier way can help the individual with paying attention to the task at hand
• Provide plenty of visual supports visual supports are your friend and ones that are interactive, more so for younger students but can benefit older students who like the sensory stimulation when the student physically removes a piece to the complete side or has a visual schedule in front of them and knows to expect gym class after recess

What are five ways that teachers can support critical thinking in the classroom?

Whether the student is in a general education classroom or special education program, there are five ways that teachers and teaching aids can help support students:

• Expose and prepare this a way that the teacher or aid could show and talk about the assignment before the assignment is taught and helps expose the student to the material and prepare them for what is going to be expected of them and what the assignment will entail
• Provide and plan for necessary adaptations for the student if the student already has an Individualized Education Plan (IEP) there could be modifications and adaptations already outlined
• Visual supports these could be token charts that allow the student to interact and add tokens when they have accomplished something all the way to an interactive visual board that the student carries around, to a visual schedule that changes as the tasks change throughout the say letting the students know what to expect next
• Reinforcement the reinforcement discussed here is a way of rewarding the child for following school rules, finishing assignments, interacting with other students, or whatever they are working on for the moment
• Offer a safe space this is an area where the student can decompress and can either be a place where they go by themselves when they become overwhelmed

Free your mind

As a parent, it can be difficult changing around your thought patterns and expectations when it comes to different aspects of your child and what is being expected of them. It is an important thing to remember, though, that as your child is learning all kinds of things like new ways to interact in a more socially acceptable way to keep all your interactions as light and fun as possible.

As a parent you can look at things in a creative way. This can be fun and add a sense of adventure to how you and your child continue to learn and respond, especially when it comes to critical thinking, abstract skills, conceptual skills, and problem solving skills.

For instance, if you know your child doesn’t like doing their school work at the table, you can ask them where they would like to do their school work, be careful and avoid verbal overload by talking too long. It is best to keep to shorter sentences and questions and offer two to three potential answers.

If they say they would prefer to practice spelling on the couch, just make sure to minimize distractions and voila they have a new place to do work and where able to practice some abstract concepts to where homework can be done.

In her article, 3 Simple Habits to Improve Your Critical Thinking, Helen Lee Bouygues states three ways of improving critical thinking, and they are things parents can do at home to practice with their children!

What are the three things that parents can do at home to help these skills?

• Ask questions this can seem super simple, but the act of asking and answering repetitive verbal questions can help build problem solving skills because the child has to use their thinking skills and reason with the question to come up with potential answers
• Be logical if your child is very logical, this exercise could help them expand beyond their logic, although they would start with logic, and expand as you both come up with more questions and concepts to talk about
• See things differently you and your child have had a discussion about homework and they have figured out that they can do spelling practice on the couch, maybe come up with what other subjects may be done on the couch? Or where else could be a good place to practice spelling words and find out that they love spelling while swinging on their sensory swing.

Key takeaways

There are many ways that teachers and parents can both support and help develop critical thinking and other skills that will help the student in their future. Some of these ideas include ways that the classroom can help or hinder development and education.

Also, challenging parents to think outside the box when helping develop thinking skills and those needed for problem and organizational solving on a daily basis. Although there are children that may be able to express these skills during some times and forget about them during daily tasks, practice can help further the skill set.

As with anything else in life, practice can make perfect. Or, it can at least help by making steps toward the ultimate goals of using these skills as a student and beyond.

Bouygues, H. (2019). 3 Simple Habits to Improve Your Critical Thinking. https://hbr.org/2019/05/3-simple-habits-to-improve-your-critical-thinking

Goldstein, G., Mazefsky, C., Minshew, N., Walker, J., Williams, D. (2018). Associations Between Conceptual Reasoning, Problem Solving, and Adaptive Ability in High-functioning Autism. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067678/

The Center on Secondary Education for Students with Autism Spectrum Disorders & Organization for Autism Research. Understanding Autism Professional Development Curriculum: Strategies for Classroom Success and Effective Use of Teacher Supports. https://csesa.fpg.unc.edu/sites/csesa.fpg.unc.edu/files/imce/other/Presentation%202%20(Strategies%20for%20Classroom%20Success%20and%20Effective%20Use%20of%20Teacher%20Supports)(2).pdf

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October 13, 2016

People with Autism Make More Logical Decisions

Experiments show lower emotional awareness lead to more rational choices

By Punit Shah & The Conversation

For illustration purposes only.

MARTIN BARRAUD Getty Images

The following essay is reprinted with permission from  The Conversation , an online publication covering the latest research.

Decisions are based on the way choices are framed. This is because people use emotion when making decisions, leading to some options feeling more desirable than others. For example, when given £50, we are  more likely to gamble the money  if we stand to lose £30 than if we are going to keep £20.

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Although both options are mathematically equivalent, the thought of losing money evokes a powerful emotional response and we are more likely to gamble to try to avoid losing money. This cognitive bias, first described by the psychologist Daniel Kahneman in the 1980s, is known as the  “framing effect” . Despite this phenomenon being well documented, scientists are still trying to understand why our emotions have such a powerful influence on decision making.

My colleagues and I at King’s College London  investigated  how the perception of internal bodily sensations is related to emotion and how this may, in turn, be linked to how we make decisions. First, we gave a group of typical adults a  gambling task  to measure their susceptibility to the framing effect. They were later asked to close their eyes and count their heartbeats to measure how well they monitored internal sensations. Their emotional awareness was also measured using a questionnaire. We discovered that people who were good at monitoring their heartbeat—people who “followed their heart”—were most guided by emotion and particularly susceptible to the framing effect.

But what about people with poor emotional awareness and difficulties monitoring their heartbeat? Research has shown that these things are  impaired in people with alexithymia , otherwise known as “emotional blindness”. As  emotional blindness is more common in people with autism , we tested a group of adults diagnosed with this condition. Replicating  previous research , people with autism showed a smaller framing effect. It was found that people with autism were able to monitor their heartbeat just as well as people without autism, but there was no relationship between how well they did this, or emotional awareness, and their susceptibility to the framing effect.

Ignore your heart

This indicates that people with autism use a different strategy when making decisions. Instead of using intuition and emotion like people without autism, they were not following their heart and don’t use emotional information to guide their decisions. Instead, they viewed differently framed, but numerically equivalent, options more rationally than typical people. So they gambled just as much as non-autistic people, but did so using the numerical information instead of making decisions based on how those numbers made them feel.

This demonstrates that “following your heart” is related to complex decision-making, which builds on recent work showing that heartbeat perception is linked to  survival in the financial markets . However, it also suggests that listening to your heart and being in touch with your emotions—usually seen as positive things—may lead to decisions that are not so rational.

Our findings add to evidence showing that people with autism think differently to typical people. Although this is related to the difficulties they experience in social situations, this different way of thinking may sometimes be advantageous in situations where it is it better to follow your head and not your heart.

This article was originally published on  The Conversation . Read the original article .

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A Guide to Identifying and Understanding Scientific Research About Autism

Whether you are an individual with autism or a parent to a loved one with an autism spectrum disorder, you may want to stay informed about scientific research related to ASD. You can find information on the internet and other media channels, but how accurate is that information? Knowing how to understand scientific research studies can help you find reliable and relevant information. 

This article is a tool to help you assess information about autism based on scientific principles. As you put these recommendations into practice, remember to use critical thinking and common sense when assessing any claim about autism. Combining an understanding of scientific research studies with your own powers of reasoning can help you: 

• Make evidence-based decisions
• Understand recommendations from your care team and discuss them knowledgeably
• Minimize overwhelm
• Advocate for yourself or your family member with autism. 

Good autism research – like all medical research – meets three criteria: It is based on scientific principles and procedures, it has been peer-reviewed, and the study is able to be replicated. We’ll explore each of these criteria in more detail below.

Special thanks to Anissa Ryland and the staff of The Johnson Center for Child Health and Development for helping to develop some of the guidelines and information included in this article. 

What is a peer-reviewed study?

Peer-review is a process that academic journals use to understand if the studies they publish are based on good research. Before including a study in their publication, the journal sends the research out to other experts in the field. 

Experts who were not involved in the original study check that the study design applies scientific principles and procedures. They also use their own knowledge of the subject to determine whether the results and conclusions make sense based on available data. The editor of the journal takes their recommendations into account when deciding whether to publish the study. 

Some scientific journals have been in print longer than others or are more respected in their field. Readers can use a metric called an impact factor to decide if the journal that printed a particular study is a reliable source of information. The Impact factor is the total number of times articles from that journal were cited, divided by the total number of citable articles in that journal during that span of time. 

The impact factors of various journals are calculated and printed yearly in Journal Citation Reports . You can find the current impact factor of most journals with a quick web search. Keep in mind that a journal must exist for at least two years before its impact factor can be calculated. 

Where to find research

Many groups, organizations, and individuals write about autism. Whenever you come across a new treatment or new information about autism, you can check the validity by seeking out original sources. 

Places to find original sources: 

• Google Scholar
• University websites
• Journal websites

Some of these research aggregation services are free, others cost money. For paid services, check with your local library to see if they can connect you with a free account. You can also ask your clinician to provide you with research related to specific treatments, comorbidities, and symptoms

Types of studies

You may come across several different types of studies as you read and learn about autism. Each study type can be used to investigate topics related to autism, but some have a wider application than others. Get to know the different study types so you can think critically about how the research applies to you or your child with autism. 

• Animal and Cell Studies – Observe and test animals or cell cultures. These types of studies provide initial insight, but the application to humans may not be clear. 
• Case Reports – A written record on a single subject. Each case study represents an individual experience. This can be a starting point for research. It does not prove that what worked for one individual will work for others. 
• Case Series – A group of case reports that track multiple subjects. Remember that correlation is not causation. That means that two things can happen around the same time, but that doesn’t prove one caused the other. 
• Case-Control Studies – Look at the experiences of two groups of subjects, one group with autism and one without. The investigation is retrospective, meaning it looks at experiences in the past and attempts to draw conclusions. Causation is hard to prove with this type of study.
• Cohort Studies – Track two groups, ex. One group of people with autism and one group without or one group that receives treatment and one that does not. It notes differences in outcomes for the two groups.
• Randomized Controlled Trials – Randomly assigns subjects to either a test group or a control group. The test group receives the treatment while the control group receives a placebo. This type of study can be blind (study subjects don’t know which group they’re in) or double-blind (experimenters also don’t know which group the subjects are in).
• Systematic Review – Compares and contrasts the results of several randomized controlled trials and draws conclusions based on the quality of the study and on their results. 

Assessing information about autism and autism treatments

The following questions will help you use what you’ve learned to assess information about autism and autism treatments. Remember that critical thinking skills are your most valuable tools in assessing any claim about autism spectrum disorder. 

What is the source of this information? Blog posts, books, pamphlets, social media posts, websites, news stories, or other non-journal sources can bring information to your attention, but it’s up to you to check their sources. Is the information based on studies and research or is it the opinion of the author?

Who performed this research? What people, groups, universities, or businesses were involved in this study? Do they have a track record of producing reliable autism research? 

Who funded this research? Does the researcher or institution have any conflicts of interest that I should be aware of? What businesses, funding sources, products, or services, might benefit from the results of this study?

Has the research been peer-reviewed? Does it appear in a peer-reviewed journal? What is the impact factor of that journal? 

Has it been replicated? Have other scientists used the same method to achieve the same results? If not, why not? Be cautious about accepting any claim that has not been tested by other researchers or studies.

What other works are cited in the study? Are the researchers basing their work on good science? Have they cited earlier studies published in peer-reviewed journals?

Reading and assessing biomedical research studies takes practice. Navigating autism research can be overwhelming at first, but critical thinking and common sense, along with the knowledge you’ve gained in this article, can help you assess information. Stop and think whenever you read a new statement about autism treatments, possible causes, or potential outcomes. Before acting on any new information go to the source to check the validity of the claim. 

For more on understanding autism research, watch this webinar from The Johnson Center.

Scientific Research Glossary

Autism and Sleep – Research Updates

autismAdmin 2024-04-17T17:37:25-05:00 April 16th, 2024 | Autism Spectrum Disorders , Sleep Issues , Ways to Help , Webinar |

Learn research updates on co-occurring sleep disturbances and autism. To participate in the study mentioned in the presentation, see: Participate in our Research - Sleep, Cognition and Neuropsychiatry (SCAN)

Animal study reveals clues that developmental vitamin D deficiency may be associated with gut alterations in autism

Melanie Glock 2023-09-25T12:21:18-05:00 September 25th, 2023 | News |

Vitamin D deficiency is strongly implicated as a risk factor for autism spectrum disorders (ASD), and researchers in Australia report evidence that vitamin D deficiency during early development may increase the

New multi-national study adds to evidence linking alterations of the gut microbiome to autism

Melanie Glock 2023-08-29T16:27:41-05:00 August 29th, 2023 | News |

Strong new evidence linking alterations of the gut microbiome to autism spectrum disorders (ASD) comes from a new multi-national study by James Morton and colleagues. In the study, researchers in North

Editorial: Revisiting Two Lesser-Known Teaching Strategies to Enhance Speech Production in Autism

Melanie Glock 2023-12-05T13:20:21-05:00 August 29th, 2023 | News |

In this editorial, I would like to shed light on two methods for improving the speech production of individuals on the autism spectrum, discuss potential neurological factors that may underlie their effectiveness,

Sleep problems in infancy associated with ASD, autism traits, and social attention alterations

Melanie Glock 2023-07-20T18:49:05-05:00 July 20th, 2023 | News |

A new study from the United Kingdom indicates that sleep problems in infancy may help to predict later social skills deficits, autism traits, and autism diagnoses in children. Jannath Begum-Ali and

Constipation in infancy associated with higher likelihood of autism diagnosis

Melanie Glock 2023-06-26T16:29:40-05:00 June 26th, 2023 | News |

More evidence linking autism spectrum disorders (ASD) to gastrointestinal problems comes from a study by researchers in Taiwan and the United States, who report that ASD occurs at an elevated rate

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How Does Autism Affect Thinking?

One of the most common symptoms of autism is difficulty with thinking and processing information. In this article, we'll explore how autism affects thinking and what that means for people with autism.

Autism and Logical Thinking

Autism can affect thinking in a variety of ways, from executive functioning to sensory processing to theory of mind.

However, it's important to remember that everyone with autism is unique and may experience these difficulties to different degrees.

By understanding how autism affects thinking, we can better support and accommodate people with autism in their daily lives.

Executive Functioning

One of the key ways that autism affects thinking is through executive functioning. Executive functioning is a set of mental processes that help us to plan, organize, and complete tasks. People with autism often struggle with executive functioning, which can make it difficult for them to complete tasks and stay organized.

For example, people with autism may have trouble with:

• Planning and organizing their day
• Starting and finishing tasks
• Managing their time effectively
• Keeping track of multiple things at once

Sensory Processing

Another way that autism affects thinking is through sensory processing. Sensory processing refers to the way that our brains interpret and respond to sensory information from our environment. People with autism often have sensory processing difficulties, which can affect the way they think and behave.

For example, people with autism may:

• Be hypersensitive to certain sensory inputs, such as loud noises or bright lights
• Be hyposensitive to certain sensory inputs, such as touch or smell
• Have difficulty filtering out irrelevant sensory information
• Have difficulty processing multiple sensory inputs at once

Theory of Mind

Theory of mind is the ability to understand that other people have thoughts, feelings, and beliefs that may be different from our own. People with autism often struggle with theory of mind, which can affect their ability to understand and interact with others.

For example, people with autism may have difficulty with:

• Understanding sarcasm or jokes
• Recognizing when someone is upset or angry
• Understanding social cues, such as body language or facial expressions
• Taking another person's perspective

In addition to the challenges with executive functioning, sensory processing, and theory of mind, people with autism often have unique strengths in logical thinking . Logical thinking is the ability to reason, analyze information, and solve problems using a systematic approach.

People with autism may have exceptional logical thinking skills that allow them to excel in areas such as mathematics, science, or programming.

They may be able to identify patterns and connections that others might miss and have an excellent memory for details.

However, this strength can also present challenges when it comes to flexible thinking. People with autism may struggle with changing their routine or adapting to new situations because they rely heavily on logic and structure. This can make it difficult for them to think outside the box or come up with creative solutions.

Overall, while autism can present challenges in many areas of thinking, it's important to recognize that people with autism also have unique strengths and abilities that should be celebrated and supported.

Do people with autism think differently?

Many people wonder if those with autism think differently from those who do not have the disorder. The answer is yes and no. People with autism process information differently, but this does not mean that they think differently in all aspects of their lives.

For example, some individuals with autism may struggle with verbal communication but excel in visual thinking. They might be able to visualize complex concepts in ways that others cannot, allowing them to solve problems more quickly and efficiently.

This type of thinking is sometimes referred to as "thinking in pictures."

On the other hand, people with autism may struggle with abstract reasoning or understanding metaphors because they have difficulty interpreting non-literal language. This can make it difficult for them to understand idioms or jokes that rely on figurative language.

Overall, while people with autism may approach thinking differently than neurotypical individuals, it's important to recognize that everyone has their unique strengths and challenges when it comes to cognitive processing. By understanding these differences and celebrating diversity, we can create a more inclusive world for all individuals.

Do people with autism have critical thinking skills?

Critical thinking is the ability to analyze information, evaluate evidence, and make informed decisions. People with autism may have unique strengths in critical thinking due to their exceptional logical thinking skills. They may be able to identify patterns and connections that others might miss and have an excellent memory for details.

However, it's important to note that critical thinking skills can be affected by other areas of difficulty associated with autism, such as executive functioning and theory of mind.

For example, people with autism may struggle with decision-making or problem-solving if they have trouble planning or organizing their thoughts.

Overall, while people with autism may have strengths in critical thinking, it's important to recognize that everyone has their unique challenges when it comes to cognitive processing. By understanding these differences and providing support where needed, we can help individuals with autism reach their full potential.

How does autism affect cognitive skills?

Autism can affect many cognitive skills, including attention, memory, and processing speed. People with autism may have difficulty focusing their attention on specific tasks or information, which can make it challenging to complete complex tasks that require sustained attention.

They may also struggle with working memory, which is the ability to hold and manipulate information in our minds over short periods.

Processing speed refers to the rate at which we can take in and respond to information.

Some people with autism may have slower processing speeds than their peers, which can make it difficult for them to keep up with conversations or respond quickly to social cues.

It's important to note that while autism can affect cognitive skills, this does not mean that individuals with autism are not intelligent or capable of learning.

In fact, many people with autism have exceptional talents and abilities in areas such as music, art, or science. By understanding and supporting their unique strengths and challenges, we can help individuals with autism reach their full potential.

Does autism make you think slower?

Autism can affect cognitive processing speed, which refers to the rate at which we can take in and respond to information.

Some people with autism may have slower processing speeds than their peers, making it difficult for them to keep up with conversations or respond quickly to social cues.

However, it's important to note that this is not always the case and that individuals with autism can have a wide range of processing speeds.

Additionally, while some tasks may take longer for people with autism to complete due to their processing speed, they may be able to compensate by using their exceptional logical thinking skills and attention to detail.

Overall, it's important not to assume that all people with autism think slower and instead recognize the unique strengths and challenges each individual brings.

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Why You Should Strengthen Your Autistic Kid’s Thinking Skills

Thinking skills are necessary for independence, communication, and navigating social situations.

By Jenny Burke, September 1, 2020

You might feel overwhelmed at the idea of taking a fresh look at your autistic child’s programming. But strengthening your child’s thinking skills  should be a goal to be worked on both in and out of school. Yes parents, I mean you can work on this, too!

I speak from experience: helping our autistic child to build his thinking skills made a huge difference in so many ways, and I believe it would for your child as well.

Now, you might be thinking that I am making a big leap here from my child to yours, especially since no two kids with autism are the same. While that’s certainly true, take a look at this snapshot of my child to see if you can connect with anything. When he was younger, he did things like this:

• Screamed bloody murder over hot french fries or a missed shot on goal during pee wee soccer.
• Walked back and forth incessantly along walls; one stim (repetitive behavior) on a long list of many.
• Sang loudly during class and believed that other kids really actually did like his loud, non-stop singing because if they didn’t like it, they would for sure tell him.
• Often was not paying attention when others were talking because he didn’t understand them or was thinking about something way more interesting like the numbers cycling on a gas pump
• Insisted that I drive the exact same route to and from school, and when I took a different route, he’d get extremely upset.
• Absolutely would not under any circumstances eat off the plate with the yellow flower pattern.

It’s pretty clear that in addition to all his wonderful strengths—such a fantastic sense of humor, musical talent, and a really good nature—my child had significant challenges when it came to communication/language; flexibility; coping; managing intense sensory needs/aversions; and knowing what to say and do in social situations.

If you can relate to any of the above, this blog post is for you.

The infamous yellow plate. I recently busted my now 20-year-old son scraping pizza off this plate onto a plain brown one so he wouldn’t have to eat off of it.

Fast forward to today, Danny is an awesome young man who has made amazing progress. His expressive communication is pretty darn good, and he’s made great progress with receptive language . His social, coping, and problem-solving skills have improved so much. I was so proud when he told me recently he had on his own figured out a solution to a big challenge: keeping up with what a music tech instructor was saying in class (he decided to try a recording app on his phone). Further, his stimming behaviors are subtle and more “mainstream.”

I’m also happy to report that he is way more flexible. That said, to this day he’ll avoid that dang yellow flower plate like the plague!

Sure, he has ongoing challenges. I’m not going to paint a picture of perfection here because that would be untrue and unfair to other autism parents. He is a work-in-progress. But aren’t we all? I know I sure am .

Our autistic kiddo made amazing progress because we took an all hands on deck, multi-faceted approach to helping him with the challenges. This has included professional support; LOTS of effective intervention and structured programming both in and out of school; and, tons of parent involvement , (advocacy, homework help, and yes, even therapy and teaching).

Speech, occupational, sensory-based, and behavioral interventions along with social skills programming all were critical to Danny making so much progress. But as important were our efforts to build his active thinking skills, both through therapy and at home.

Building Danny’s thinking skills relied mainly on two methods. One was cognitive-behavioral -type visual work, thanks to an an extremely talented clinical psychologist with the Cleveland Clinic, Dr. Beth Anne Martin who did cognitive-behavioral and other types of  therapeutic work with Danny during one-on-one sessions.  If you choose to try cognitive-behavioral therapy for your child, you need to find a therapist who has good experience working with kids with autism, and that the therapy involves a lot of visual teaching. This is because autistic kids are often very concrete , “black and white” thinkers and visuals will greatly help with the process.

The second method was tons of at-home, informal, “in-the-moment” teaching by Tim (Danny’s dad and my husband) and me.  It was Ellen Doller, a Ritchie McFarland Occupational Therapist (OT), and Danny’s amazing integrated preschool “Dream Team” who taught us the value of low-key, even fun in-the-moment teaching that takes place during unstructured time or daily routines as a means for helping a child make progress.

I cannot say enough about the difference at-home in-the-moment teaching has made for my autistic child. If you do the math, autistic kids are not in school or outside programming a lot of hours each week. All that time spent getting dressed, eating meals, driving somewhere, playing, etc., really add up when it comes to quick, informal teaching, reinforcement , and generalization opportunities for communication, social, and coping skills. As the OT, Ellen Doller said to me one time as she was working with my young child, “I am only with Danny twice a week for 45 minutes each time. You are the one who needs to interact with your child just like what I’m doing right now, and you need to be doing this all the time .” Parents, I’m not telling you to become a Ph.D., but I am urging you to take advantage of your child’s unstructured, at-home time!

As I go through the reasons why strengthening thinking skills matter so much, I’ll use examples to illustrate the two above approaches in action.

Here are the reasons why strengthening thinking skills helps a child make progress.

1. thinking skills help with coping and problem-solving.

Dr. Martin and Danny drew this visual together to work on coping. She used thinking bubbles and talking balloons in her masterful work. Dr. Martin would be the first to agree that an adult need not have excellent drawing skills ☺.

Take Danny’s behavior of dealing with disappointment by screaming. Dr. Martin used the above visual as a tool to process with Danny his thoughts and feelings and to provide him with a schema or visual framework for how to handle these types of situations. She would emphasize it’s absolutely OK to feel disappointed, but that Danny could choose to react in a different way than screaming. In other words, Danny had to think about how he was feeling in a situation, and then think about how he would react, or, course correct ; i.e., change his initial angry outburst to a more moderated one.

Dr. Martin’s and Danny’s visuals would come home so we could refer to them as needed. Also, we used Dr. Martin’s visuals as a model for new visuals that we would create to address other incidents of screaming or other melt-down-type behavior. Just like Dr. Martin, we’d engage Danny in the process of creating the visual.  The use of visuals made a huge difference.

As a result, I am such a huge fan of using with autistic kids comic-book style visuals (with talking balloons and thinking bubbles) as a tool to work on all kinds of social and coping skills (they are great for receptive and expressive language work as well). (Check out Tips & Topics’, “After-the-Moment Teaching” for examples of this.) Be sure to check out Carol Gray’s Social Story model.   Carol Gray has developed an autism-friendly, very specific process-based, visual tool for  social learning.

Other visuals that can be helpful are: a visual that identifies the “triggers” for your child (e.g., thunder and lightening, large crowds) and a cartoon of your child engaging in a self-calming strategy.

Our in-the-moment teaching for increasing thinking skills to improve coping took many forms. We did a lot of describing of the triggers; i.e., what had caused Danny to become upset. For example, I might say, “Danny, this thunderstorm is very loud. You feel very scared.” Describing in real time to a child their thoughts and feelings is often a good first step in helping them understand better their thoughts and feelings and to be more self aware. (Describing is also a great in-the-moment teaching tool for building receptive language.)

Additional in-the-moment teaching by us involved prompting  and reinforcing. Prompting was often in the form of what I call an indirect “thinking prompt.” If I could get away with it when Danny was upset, I would say things like, “What do you think you need right now?” or “You are having a strong feeling about the thunderstorm. What did Dr. Martin say you can do when you have a strong feeling?” Reinforcing essentially meant “catching,” or making a big deal, whenever he engaged in a positive coping behavior, like this: “Wow, I am so proud of you! I can tell you are feeling very disappointed you can’t go to the Science Center today, but you are coping with your disappointment! High-five!”

In-the-moment teaching also came in the form of holding off on giving help or even sneaky “sabotage” to force our kiddo to grapple with a problem. This piece nicely explains sabotage to promote communication and has great ideas. Here is a resource from our Tips & Topics content on using waiting as a strategy to encourage coping, communication, problem-solving, and independence.

Remember, coping with a problem, change, disappointment, a sensory challenge, or any strong feeling involves: self-awareness, choice-making, problem-solving, and communication. All of which require a person TO THINK! 

Please note: for some children, a lack of functional coping behaviors stems from serious anxiety, depression, and/or another mental health challenge. Parents, if your child’s behaviors when upset are extreme and/or have somehow changed or worsened, please talk to your child’s pediatrician or a mental health provider, ideally one who specializes in children with autism. For more on this, check out this very helpful resource.

2. Thinking skills helps with interpreting and navigating social situations

I believe we do kids a huge disservice if we only teach social skills as discrete, separate behaviors. Of course we need to teach kids how to take turns, shake hands, or say “thank you” (we spent a lot of time working on such behaviors). But we also need to teach autistic kids to think about about what other people think and feel , especially in response to their words and actions.

A lack of understanding that others can can think or feel differently can get a lot of people with autism in trouble socially, and this was certainly true for Danny. Consider him singing loudly in class, which was super disruptive. My child was not intentionally trying to bug the teacher and the other kids, he simply had no idea of how they felt about his singing. So, I made a visual to help him understand. This visual explanation of the others’ thoughts and feelings coupled with some great work by his school Speech Language Pathologist (SLP) made a huge difference in Danny keeping quiet during classtime.

Visuals like these really helped Danny grasp how others felt about his words and actions.

In addition to visual teaching, in-the-moment teaching was a big help in getting Danny to think about what others were thinking and feeling, and to adjust his own behaviors as a result. Consider Danny’s love of saying a joke over and over and over, to the great annoyance of others, usually his sister. I would say things like, “Danny, you think the joke is really funny. But Molly is feeling mad that you won’t stop telling it,” or “Molly, tell Danny how you are feeling right now that he won’t stop telling the joke.”

Pointing out in social situations the difference between what Danny and someone else was thinking or feeling was a very useful in-the-moment teaching technique that I learned from the “Dream Team.” Let’s say Danny and a preschool classmate wanted to play with the same toy, the Dream Teamers would say in the moment, “Danny is thinking about the bucket. Zach is thinking about the bucket, too! What can Danny say to Zach to get turn with the bucket?”

I am not suggesting here you skip social skills programming, especially when it is group-based. But the more you can build your child’s thinking skills, the better they will do in social situations.

3. Thinking skills help communication skills

When my autistic child was young, I had a saying: “Language is the key to the kingdom.” (If your child has minimal or no verbal abilities, swap out “language” and replace it with “communication.”) I felt that so much of his ability to make progress hinged on our maximizing his receptive language and expressive communication skills.

I love THINK-SAY. Parents, try this visual to help your kiddos build their coping, social, and communication skills.

Helping Danny improve his active thinking skills truly was a critical piece of him building communication. This visual here is exactly what we used to encourage expressive communication for  a “need” or “want.” (By the way, there’s so much overlap, between the different skill areas. Asking for help is communication-based coping, and asking for a turn is a communication-based social skill.) Getting Danny to think first about what he needed or wanted really helped so much in getting him to then communicate that need or want.

And again, good old in-the-moment teaching during everyday life was huge for encouraging Danny to think in order to express himself, and then to reinforce him when he did. Let’s say my kiddo was not using language to ask for a drink, but instead was crying. I’d hold off on giving Danny the drink and say something like, “Danny, I do not know what you are thinking right now because you are not telling me.” While there were times where I might use a more direct verbal prompt such as “Say, ‘Drink, please,'” as Danny got older, I grew to favor more indirect “thinking prompts” (as I mentioned above) because they forced my child to, you guessed it, think ! (In my resource about prompting , I discuss thinking prompts and give examples.)

A LOT of time and effort goes into helping a child, like mine, build communication skills. If your child has receptive and/or expressive challenges, talk to your child’s SLP about incorporating thinking skills into a plan to build communication.

4. Thinking skills help with the ability to pay attention

When a teacher or other adult says to a child with autism, “Pay attention!” that kiddo might not have the slightest idea what the teacher wants them to do. This was certainly the case for Danny. Therefore, time and effort was dedicated to helping him to learn what paying attention actually means. Here is a visual where Dr. Martin did an awesome job breaking down with Danny the concept. Notice how thinking (“Brain on, thinking about math”) is an important element of paying attention.

Helping an autistic child to improve their focus and attending capabilities often requires a comprehensive approach that includes sensory-based interventions, therapy, and for some kids, possibly even medication. Additionally, kids who really struggle with this absolutely need supports to ensure they learn and make progress in school. Regardless, strengthening thinking skills should be part of the game plan.

5. Thinking skills help manage sensory input, boredom, or stress, which can help with stimming behaviors

“Stimming,” or self-stimulatory behavior, is a complicated, in-depth topic that deserves its own blog. Until I share my thoughts on raising an extremely stimmy kid, I think this article from Autism Parenting Magazine has clear information and solid advice.

While I can’t prove a causal connection between thinking skills and stimming, what I can say is that as we saw an increase in Danny’s skills and abilities (including thinking ones), we saw a decrease in certain stimming behaviors. So when Danny learned to cope by asking for help, say, with a zipper, he was less likely to get really upset and start wiggling his fingers. Or, when his receptive language skills improved such that he could follow simple dinner table conversation, he was less likely to tune out during a meal with a “wiper blade” arm swing. Or, when his social skills progressed to the point that it became easier and more enjoyable to play with another kid, he’d find playing chase preferable to walking alone back and forth along a wall.

Today, as a young man, all the stims from his younger years have been replaced with more “socially acceptable” activities like computer games. Making progress in all domains (e.g., communication, coping, social) have helped a ton with stimming. And, as I’ve said before, the reason Danny made such progress was definitely thanks in part to building his thinking skills.

What is the right approach for helping your child build their thinking skills?

The answer to this is that it totally depends on your own child’s needs and challenges. Maybe they would benefit from outside-of-school therapy that includes visually-based cognitive-behavioral work by a professional like Dr. Martin. Or, perhaps they are a great candidate for Michelle Garcia Winner’s Social Thinking Curriculum . Maybe your child’s school SLP and OT would be willing to incorporate strengthening thinking skills as a component of their work with your child. Your child might even be lucky enough to have teachers who already value metacognition —thinking about thinking—as a tool for learning. No matter what happens with your child in their therapies or at school, there’s still the opportunity to use in-the-moment teaching at home to practice critical thinking skills.

Regardless of your approach, take an active role, as you are the person who spends more time with your child than anyone else.

I LOVE this creation by Danny where he used a thinking bubble and talking balloons, but all these years later, I truly have no idea what it says!

I’d like to help, too! Find here affordable, visual tools for helping kids get better at being thinkers and expressing their thoughts, needs, and feelings. They use photos of real kids, have fun activities, and are great for building communication and social skills. And find here free resources for parents.

What about you? Have you had success with helping a child build their thinking skills?

Would your child eat off of that yellow plate? Please share!

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Children With Autism Improve Key Thinking Skills Over Time

Research suggests their cognitive deficits aren't set in stone.

Children with Autism Improve Thinking Skills

Children with autism think differently, and that thinking changes over time—for the better. That first statement might not seem like news: Of course their brains are different, they have autism! But children with autism do improve their thinking skills over time, according to new research. That's encouraging, particularly because most research has focused on whether communication skills and behavior can change, rather than on cognitive skills.

HealthiNation

Thinking problems typical of autism include difficulties predicting other people's behavior based on their thoughts and feelings (known as theory of mind), and in problem-solving and planning (executive function). Children with autism also are often better than children without autism at focusing on tiny details, like a pattern in a carpet, or small parts of Legos. Previous research hasn't found much change in these cognitive skills, even though children with autism spectrum disorders (ASDs) can show big improvements in behavior, especially with intensive behavioral therapies.

But according to Elizabeth Pellicano, senior lecturer in autism education at the Institute of Education in London, the cognitive deficits in children with autism aren't set in stone.

She tested 37 children with ASDs and 31 non-autistic children when they were 5 or 6 years old, and tested them again three years later. While cognitive skills varied from child to child, most of the children with autism improved their abilities in theory of mind and executive function; when older, the children could better appreciate the thoughts and feelings of others and they were better able to plan and regulate their feelings than they were three years earlier, Pellicano reported in the October issue of Child Development. However, the children with autism didn't improve their detail-spotting over time, which was tested by asking them to search for shapes hidden in pictures, and to make patterns with wooden blocks. The non-autistic kids improved in those tasks over time.

Parents of children with autism can use this intriguing information to think differently about their child's cognitive potential, according to Pellicano. "These findings are immensely encouraging for parents," she said in an E-mail. "They suggest that critical improvements in their child's cognitive skills can take place within a reasonably short period of time."

But it's too early to say what therapies might help those thinking skills along, Pellicano adds. "It is important that parents are aware of this and that they don't get misled by the promises that the advocates of some treatments make," she says. "There is clearly a huge need for future research on promoting children's cognitive skills, since it will ensure that children with autism get the very best start in life."

[ 4 Promising Autism Treatments, From Vitamin B12 to Alzheimer's Drug Namenda ]

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Critical Thinking Skills for Children with Autism

Critical thinking is an important skill our children need to learn. It enables a child to generate the ability for a higher level of conceptual thinking and appropriately solve problems in their everyday life.

Children with Autism may lack the ability to appropriately communicate their feelings or sometimes tend to engage in repetitive ways of rigid thinking and repetitive behaviors. When they are faced with challenges, moments of frustration occur when no clear expectations are provided to our children regarding their daily schedule, and the activities they are required to engage in throughout the day.

It is important to understand our children while equipping them with the skills needed to think critically (i.e., Executive Functioning and Problem-Solving Skills ) by teaching them:

● Be more open-minded, less rigid, and more flexible in adapting to their environment.

● Give them opportunities to learn creative mind thinking through play and leisure time.

● Identify problems and proper solutions, based on the intensity of the given problem.

● Understand their emotions and the likes/dislikes of others.

● Provide them with visual support to clarify expectations such as schedules and decrease verbal interactions during challenging times.

Applied Behavior Analysis is “the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior ”- 1968 Baer, Wolf, & Risley.

It is okay for our children to make errors, however, as caregivers and parents, we should create learning opportunities for our children, give them the emotional support they need and model proper responses.

For more information on how to manage aggressive behavior and proper communication, connect with us by sending your messages and questions to [email protected] or contact us directly at www.azinstitute4autism.com/contactus.

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Reasoning on the Autism Spectrum: A Dual Process Theory Account

Mark brosnan.

Department of Psychology, University of Bath, Bath, BA2 7AY UK

Marcus Lewton

Chris ashwin.

Dual process theory proposes two distinct reasoning processes in humans, an intuitive style that is rapid and automatic and a deliberative style that is more effortful. However, no study to date has specifically examined these reasoning styles in relation to the autism spectrum. The present studies investigated deliberative and intuitive reasoning profiles in: (1) a non-clinical sample from the general population with varying degrees of autism traits ( n  = 95), and (2) males diagnosed with ASD ( n  = 17) versus comparisons ( n  = 18). Taken together, the results suggest reasoning on the autism spectrum is compatible with the processes proposed by Dual Process Theory and that higher autism traits and ASD are characterised by a consistent bias towards deliberative reasoning (and potentially away from intuition).

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder of unknown underlying etiology characterised by persistent deficits in social communication and social interaction combined with restricted, repetitive patterns of behaviour, interests, or activities (APA 2013 ) with prevalence estimates up to one in 68 children (CDC 2015 ). A continuum of autism traits extend throughout the general population until they become clinically significant under ASD diagnostic criteria to form part of an ‘autism spectrum’ of autistic presentation (Constantino and Todd 2003 ; Plomin et al. 2009 ; Posserud et al. 2006 ; Wing 1988 ; see Ruzich et al. 2015 , for systematic review). Ruzich et al. report that, within the general population, males have significantly higher levels of autism traits than females, and those with ASD have significantly higher autism traits than males from the general population (with no sex differences in autism traits within the ASD population).

Reasoning and decision making are core human capabilities that enable effective participation within society, yet have received relatively little attention within the autism spectrum literature. Reasoning in a manner which is normatively logical and subsequent rational decision making are specialised higher cognitive functions attributed to common processing mechanisms (see Evans and Stanovich 2013 ). Luke et al. ( 2012 ) identified three core features of reasoning and decision making that were particularly problematic for people with ASD using a self-report methodology. Decisions were difficult to make for people with ASD if they involved talking to others; involved a change in routine; or if the decision has to be made quickly. Whilst difficulties talking with others and changes in routine reflect the core diagnostic features of ASD (respectively), the difficulty with rapid decision making for those with ASD does not, and may provide added insight into reasoning on the autism spectrum.

A more deliberative approach to reasoning has been proposed to characterise people with ASD compared to the general population. For example, De Martino et al. ( 2008 ) report that people with ASD reason in a more logically consistent manner than matched controls. People with ASD also request more information prior to making a decision upon a probabilistic reasoning task compared to controls, a style of reasoning that has been termed a ‘circumspect reasoning bias’ (Brosnan et al. 2014a ). Similarly, those from the general population who self-reported being higher in autism traits also require more information prior to making decisions when compared to those lower in autism traits (Brosnan et al. 2013 ). This behavioural data is consistent with self-reports from people with ASD about their difficulties with rapid decision-making and reasoning and a preference for more deliberation (Luke et al. 2012 ). Contrasting rapid decision-making/reasoning processes with deliberative decision-making/reasoning processes forms the basis of Dual Process Theory. When considering human reasoning, Dual Process Theory has been a dominant model within cognitive psychology for almost 50 years (Evans and Frankish 2009 ). The dual processes are referred to as Type 1 and Type 2 and will be referred to as intuition and deliberation (respectively) for convenience. Intuition involves rapid, effortless, parallel, non-conscious processing that is independent of working memory and cognitive ability. Deliberation, on the other hand, involves slower, effortful, sequential, conscious processing and is heavily dependent on working memory and related to individual differences in cognitive ability (see Evans 2011 ; Evans and Stanovich 2013 ; Kahneman 2011 ; Stanovich and West 2000 , 2008 ; for reviews; see Keren and Schul 2009 for critique; see Kruglanski and Gigerenzer 2011 for an alternative view).

Within Dual Process Theory, rapid autonomous processes (‘intuitive reasoning’) are assumed to yield default responses unless intervened upon by distinctive higher order reasoning processes (‘deliberative reasoning’). Intuitive reasoning preceding deliberative reasoning is known as the default-interventionist position (see Evans and Stanovich 2013 ; Kahneman 2011 ). One of the most widely used behavioural assessments of intuition and deliberation is the Cognitive Reflections Test (CRT: Frederick 2005 ). The CRT comprises of three reasoning questions that have both an intuitive (incorrect) and deliberative (correct) response. A majority of intuitive responses are typically provided for the CRT questions (Frederick 2005 ), which is theorised to reflect the output from initial intuitive reasoning which has not been over-ridden by deliberative reasoning. The over-riding of initial intuitive reasoning by subsequent deliberative reasoning is demonstrated by achieving the correct answer. In support of this, experimental manipulations designed to encourage participants to engage in deliberative reasoning reduces intuitive responses (Evans and Curtis-Holmes 2005 ).

Intuitive reasoning is also argued to be evidenced by ‘the framing effect’ (Tversky and Kahneman 1974 ) in which logical decision making is influenced by the context of the reasoning task. De Martino et al. ( 2008 : 10746) report a decreased susceptibility to the framing effect in people with ASD, who demonstrate an ‘unusual enhancement in logical consistency’. Within the context of Dual Process Theory, De Martino et al. ( 2008 ) hypothesise that individuals with ASD have an increased tendency towards deliberation, attributable to impairment within intuitive reasoning systems. This is consistent with Klin and Volkmar ( 1997 : 102) observations of people with Asperger’s Syndrome as having ‘a deficient intuition and lack of spontaneous adaptation’ (see Allman et al. 2005 ). Klin et al. ( 2003 ) propose an embodied cognition ‘Enactive Mind’ approach for understanding social adaptation, which is argued to have important temporal constraints. Social adaptation is reasoned to require the processing of salient stimuli based upon split-second environmental demands with moment-by-moment disregard of stimuli perceived as irrelevant. Under this approach, people with ASD do not reflect the typical processing bias towards socially relevant stimuli.

In addition to the CRT behavioural measure, the propensity to engage in intuitive and deliberative reasoning can be assessed through self-report. The Rational-Experiential Inventory (REI) is a widely used measure of intuition and deliberation (Epstein et al. 1996 ). The Rational component is based upon a ‘need for cognition’ (Cacioppo and Petty 1982 ) which measures engagement in, and enjoyment of, cognitive activities. The Experiential component was developed to measure engagement and confidence in one’s intuitive abilities and is termed ‘faith in intuition’ (Epstein et al. 1996 ; Pacini and Epstein 1999 ). Epstein et al. argue that these two information processing styles are independent of one another, such that one can be high or low in either or both dimension.

Deliberative responses on the CRT have been found to positively correlate with REI self-reported deliberation and negatively with REI self-reported intuition. Additionally, intuitive responses on the CRT have been found to positively correlate with REI self-reported intuition and negatively with REI self-reported deliberation (Pennycook et al. 2015 ). However, other studies have only reported the positive relationship between deliberation on the CRT and REI (Liberali et al. 2012 ; Thoma et al. 2015 ). Thus, the variability between self-reported preference for intuition and behavioural intuition needs to be borne in mind. Freeman et al. ( 2012 ) found that combinations of high and low intuition with high and low deliberation, as measured by the REI, best predicted clinically relevant traits (schizotypy) in a general non-clinical population. The literature above would suggest that autism traits in a general population would best be predicted by a combination of high deliberative and low intuitive reasoning styles.

The aim of the present research was to investigate intuitive and deliberative reasoning across two studies that focus on the autism spectrum; one involving a non-clinical sample, and the other involving a clinical sample. As a continuum of autism traits is proposed to extend throughout the (general and ASD) population, the relationship with reasoning was examined in relation to relatively higher and lower levels of autism traits. In the non-clinical sample it was predicted that higher levels of autism traits would relate to a profile characterised by greater deliberative and reduced intuitive reasoning. Study 2 compared self-report and behavioural measures of intuitive and deliberative reasoning between people with and without ASD, and it was predicted that the ASD group would show a more deliberative and less intuitive profile than the comparison group.

Participants

Participants were 95 undergraduate students from a range of disciplines (43 male, 52 female) aged 18–31 years old (mean = 21.0, SD = 4.01, see Table  1 ) recruited at the University of Bath. All participants were native English speakers, and no participant reported a diagnosis of a mental health condition. Participants were rewarded with either course credit for their participation or received £5.00. The research was approved by the Psychology Departmental Research Ethics Committee at the University of Bath, which implements the ethical guidelines of the British Psychological Society.

Table 1

Mean scores for age, autism traits (AQ) and reasoning ( n  = 95)

Autism traits were assessed using the AQ (Baron-Cohen et al. 2001a , b ), which is a self-report measurement that is used to identify autism traits in clinical and non-clinical adult populations. Participants rated their level of agreement with 50 items (e.g. “I enjoy doing things spontaneously”) on a 4-point Likert scale ranging from 0 (‘definitely disagree’) to 4 (definitely agree). A response in the direction of autism characteristics is scored as 1, while a response in the opposite direction is scored as 0. This results in scores ranging from 0 to 50. The AQ in the present study had a high level of internal consistency, with a Cronbach’s alpha of .88.

Reasoning processes were assessed using the Rational Experiential Inventory (REI; Pacini and Epstein 1999 ). The REI measures a participant’s preference for both intuitive (experiential) and deliberative (rational) reasoning. The REI is a 40 item questionnaire, containing 20 items that assess intuitive reasoning and 20 items that assess deliberative reasoning. Examples from the intuitive scale include, “I trust my initial feelings about people” and “I often go on my instincts when deciding on a course of action”. Examples of items from the rational scale include, “I have a logical mind” and “I enjoy solving problems that require hard thinking”. Respondents score each item on a 5-point scale, from 1 = completely false to 5 = completely true. Mean scores for each subscale can therefore range from 1 to 5 for each reasoning style. In the present study the Cronbach’s alpha for the experiential-intuitive scale was .91, and for the rational-deliberative scale it was .88.

The total scores for AQ, intuition and deliberation are displayed in Table  1 . There were no significant sex differences for self-reported autism traits, intuition or deliberation (all p  > .05). Following Freeman et al. ( 2012 ), a median-spilt method was used across both intuitive and deliberative scores to divide the participants into one of four groups: namely (1) high intuition/high deliberation; (2) low intuition/low deliberation; (3) high intuition/low deliberation; or (4) low intuition/high deliberation. (Freeman et al. 2012 ). The numbers of males and females in each group were: (1) 9:11; (2) 9:14; (3) 13:14; and (4) 12:13; which did not differ significantly (chi = .516, p  ≥ .05).

A one-way ANOVA revealed that the high deliberation/low intuition group had a significantly higher AQ total than the low deliberation/high intuition group ( F (3, 91) = 19.87, p  < .01; all other comparisons p  > .05; see Fig.  1 ).

Mean Autism traits by the interaction of intuitive and deliberative reasoning process. ** p  < .01

Discussion of Study 1

Study 1 examined the extent to which autism traits in a non-clinical population were associated with self-reported preferences for more deliberative over intuitive reasoning. Results found higher autism traits in those with a profile consisting of low intuitive and high deliberative reasoning, compared to those with a high intuitive and low deliberative profile of reasoning. Those with comparable levels of self-reported intuitive and deliberative reasoning, whether the levels were both high or low, did not differ from each other in their levels of autism traits. Consistent with the hypothesis, higher autism traits were associated with a combination of greater deliberative and less intuitive reasoning styles. This is consistent with the clinical literature, where ASD is associated with a more logical and circumspect reasoning bias (Brosnan et al. 2014a ; De Martino et al. 2008 ).

Interestingly, the present findings are the opposite results to that reported by Freeman et al. ( 2012 ) for schizotypy traits in the general population, where higher levels of schizotypy traits were associated with high levels of intuition combined with low levels of deliberation. This opposing reasoning profile is consistent with the diametrical model of Crespi and Badcock ( 2008 ), who propose that ASD and schizotypy represent opposing poles of a cognitive continuum. Thus a bias towards deliberative reasoning and away from intuitive reasoning may characterise reasoning associated with higher autism traits (with the opposite pattern characteristic of higher schizotypy traits). Whilst this analysis is useful for comparative purposes, it is not intended to reify these groupings. Figure  1 highlights that the two reasoning style combinations containing high intuition were associated with the lower levels of autism traits and the two reasoning style combinations containing low intuition were associated with higher levels of autism traits. Study 1 therefore provided initial support for autism traits within the general population being relevant to Dual Process Theory. However, the REI provides a self-reported reasoning preference rather than an assessment of reasoning behaviour, although previous research has suggested a correlation between the two (Liberali et al. 2012 ; Pennycook et al. 2015 ; Thoma et al. 2015 ). Study Two extended the investigation to a clinical population with Autism Spectrum Disorder and included a behavioural measure of intuition and deliberation, the CRT (Frederick 2005 ).

Participants were 17 males with ASD and 18 typically developing (TD) males without ASD who served as the comparison group. The ASD group had a mean age of 18.4 years (range 17–21; SD = 1.3) and the TD group had a mean age of 19.5 years (range 16–21; SD = 1.9; the difference in age between groups did not reach statistical significance ( t (31) = 1.94, ns; see Table  2 ). The research was approved by the Psychology Departmental Research Ethics Committee at the University of Bath which implements the ethical guidelines of the British Psychological Society.

Table 2

Means (and SD) for ASD and TD groups for demographics and dual process self-report and behavioural measures

Cohen’s d effect size, with 95 % Confidence Intervals

*  p  < .05, **  p  < .01, ***  p  < .001. 6 participants with ASD did not complete the REI

The ASD Group comprised of participants attending a University Summer School for students on the autism spectrum focussed on providing an insight into university life. On application to the summer school, students provided evidence of clinic diagnosis of ASD using international criteria (DSM-IV, APA 1994 ; ICD-10, WHO 1992 ) by a qualified professional. ASD diagnosis was then confirmed using the Social Communication Questionnaire (SCQ-Lifetime; Rutter et al. 2003 ), a 40 item parent report measure. The SCQ is a dimensional measure of ASD symptomatology, with a sensitivity of .92 and specificity of .62 (Witwer and LeCavalier 2008 ). In addition, the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-r; Ritvo et al. 2011 ) was also utilised, which is an 80 item self-report measure assessing four symptom areas: language, social relatedness, sensory-motor, circumscribed interests. The RAADS-r has a sensitivity of .97 and specificity of 1 (Ritvo et al. 2011 ). Scores on both measures were significantly above the clinical cut-offs (Mean SCQ score = 19.75, SD = 5.07, range 11–27; t (15) = 3.75, p  = .002; and mean RAADS-R score = 113, SD = 21.77, range 65–140; t (16) = 9.09, p  < .001). The TD group was an opportunity sample of male students commencing their first year at the same university. TD participants completed the AQ10, which is a ten item version of the AQ which can be used for screening purposes. A cut off of 6 or greater indicates a referral to diagnostic services may be appropriate (Allison et al. 2012 ). Scores ranged from 0 to 4, with a mean of 2.1 (SD = 1.1) indicating the TD group did not have a screening score warranting investigation for an ASD.

The Rational-Experiential Inventory-Short (REI-S: Epstein et al. 1996 ) was developed as a short version of the questionnaire used in Study One which contains 10 items, equally divided between intuitive and deliberative subscales. The short version was used as time was limited at the Autism Summer School, however 6 members of the ASD group still did not complete the REI-S.

The Cognitive Reflection Task (CRT: Frederick 2005 ) is a widely used 3-item performance measure of intuition and deliberation. Each question has a potentially intuitive and deliberative answer, as well as the potential for wrong answers. Scores can therefore range from 0 to 3 for each subscale. (Note, the intuitive response is a wrong answer). An example item is: ‘A bat and ball cost £1.10 in total. The bat costs £1 more than the ball. How much does the ball cost?’ The intuitive answer is 10 pence (cents in USA version) and the deliberative answer (which is correct) is 5 pence. All other responses are considered wrong. Planned t tests compared between group differences on the REI and CRT, in addition to one-sample t tests comparing the CRT to expected means.

The means for each group are highlighted in Table  2 . Independent-samples t tests showed that the ASD group provided more deliberative and less intuitive responses than the TD group on the behavioural CRT measure (see Fig.  2 ). Cohen’s d analysis indicated medium to large e effect sizes. Since a mean of 1.5 represents the middle neutral point of responding between intuitive and deliberative responses on the CRT, one-sample t tests were carried out for the CRT scores of each group to see if they were significantly responding towards one style or the other. Results highlighted that the TD group means did not significantly differ from the middle neutral value (both p  > .05). For the ASD group, both the number of intuitive ( t (16) = 3.56, p  < .01) and deliberative responses ( t (16) = 2.38, p  < .05) differed from the middle value 1.5; see Fig.  2 ). 8 incorrect responses were provided by the TD group and 5 by the ASD group which were not analysed (this number did not significantly differ between groups ( t (32) = .93, ns).

Mean group differences between intuitive and deliberative reasoning responses on the CRT by Group. Note Dotted line represents mid-point of potential scores. Significant difference from this represented by ** p  < .01, * p  < .05

Further t tests also showed the ASD group self-reported significantly lower levels of intuition than the TD group using the REI ( t (27) = 3.67, p  < .001). There was also a trend for the ASD group to self-report higher levels of deliberation than the TD group ( t (27) = 1.7, p  < .1), see Fig.  3 .

Intuitive and deliberative responses to the REI by Group

Discussion of Study 2

Study 2 demonstrated, for the first time, that young male adults with ASD responded on the CRT in a less intuitive and more deliberative manner. The task is not purely ipsative as it is also possible to make errors. However, providing an intuitive answer does necessitate that a deliberative answer is not provided. The REI (short) is not ipsative (in that one could self-report being high in both), and again lower intuition was evidenced in the ASD group along with a trend towards higher deliberation. Taken together, the data are consistent with a Dual Process Theory account of ASD as a bias away from intuitive reasoning and towards deliberative reasoning (Brosnan et al. 2014a ; De Martino et al. 2008 ). The term ‘bias’ is appropriate as those with ASD tended to respond intuitively half as often as TD participants and respond deliberatively twice as often as TD participants. This is clearly different to only responding in a deliberative manner. It may suggest intuitive processes can be employed by those with ASD, though just not as frequently or easily as TD participants. Dual Process Theory proposes that intuitive processes represent default responses unless intervened upon by deliberative processes (Evans and Stanovich 2013 ). De Martino et al. ( 2008 ) hypothesise that a logical reasoning bias in ASD is attributable to impairment within the intuitive reasoning mechanisms and the evidence of limited intuitive responding by those with ASD in the present study is consistent with this.

General Discussion

Two studies explored the relationship between Dual Process Theory of human cognition and reasoning on the autism spectrum. People with high autism traits and those diagnosed with ASD showed a pattern of having a combination of lower intuitive and greater deliberative reasoning styles. Both those with high autism traits and those with a diagnosis of ASD consistently responded less intuitively and more deliberatively, when compared to those with low autism traits and without a diagnosis of ASD, on behavioural and self-report assessments of reasoning. Taken together, the results suggest that Dual Process Theory provides a useful framework for considering the strengths and weaknesses in reasoning on the autism spectrum. De Martino et al. hypothesised that those with ASD may have compromised intuitive reasoning, based upon those with ASD demonstrating enhanced logical consistency. Consistent with this, this is the first study to demonstrate enhanced deliberative responding explicitly in those with ASD and those with high autism traits, which is consistent with enhanced logical consistency or a circumspect reasoning bias (Brosnan et al. 2014a ; De Martino et al. 2008 ).

Within the default-interventionist perspective of dual process theory (see Evans and Stanovich 2013 ; Kahneman 2011 ), intuitive processes are assumed to yield default responses unless intervened upon by distinctive higher order reasoning processes (deliberative). There are at least three potential explanations for the present findings: (1) those with ASD have impaired intuitive mechanisms and consequently deliberative reasoning is dominant; (2) intuitive mechanisms are intact but dominated by deliberative reasoning; or (3) Intuitive mechanisms are intact in different contexts but this context triggers deliberative reasoning in those with higher levels of autistic traits. Under this Dual Process model, a slower, effortful, sequential, deliberative reasoning style would be dominant in ASD as a consequence of impairment in rapid, effortless, parallel intuitive mechanism (De Martino et al. 2008 ), though the possibility remains that this may be due to dominant deliberative reasoning (possibly within the context of the task). Either way, higher autism traits would be associated with a propensity to engage in deliberative reasoning rather than being associated with deliberative reasoning abilities per se (e.g. a greater preference for deliberative reasoning within an individual does not necessarily entail greater deliberative skills within that individual). This is consistent with Luke et al. ( 2012 ) who found that those with ASD did not self-report a greater reliance upon a rational/deliberative reasoning style. However, people with ASD self-reported that they have difficulties making decisions quickly, which is consistent with the idea of an impairment in the rapid reasoning that characterises intuition.

It should be noted that the intuitive response is actually a wrong choice, despite being the dominant response in highly educated American college students (Frederick 2005 ). A propensity to engage in deliberative reasoning within a context that typically triggers erroneous intuitive reasoning can be seen as an advantage associated with ASD (and potentially higher autism traits). Toplak et al. ( 2011 , 2014 ) provide an extensive analysis of the correlates of the CRT with other reasoning tasks, however there are no tasks which assess intuition independently of deliberation. Within the CRT, intuitive reasoning results in erroneous responses and could therefore be regarded as a deficit within this context that people with ASD do not demonstrate to the same degree as the general population. 1 Toplak et al. ( 2011 , 2014 ) argue that the CRT is a unique predictor of susceptibility to biases. As biases occur through the application of heuristics rather than engaging in further analytic processing, Toplak et al. describe the CRT as a particularly potent measure of ‘miserly’ cognitive processing (or ‘lazy thinking’, Kahneman 2011 : 48). Defaulting to the reduced processing demands of being a cognitive miser has been argued to be typical in many contexts (cf. Fiske and Taylor 1991 ). From this perspective, ASD is associated with not being cognitively miserly (or lazy thinking), and the proposed reasoning bias is best characterised as being unbiased (within the context of the CRT at least).

Thus, in the present study, the ASD group obtained more correct answers than the TD group which is consistent with the literature identifying a diminished framing effect in ASD (De Martino et al. 2008 ). The deliberative score on the CRT relates to a wide range of rational reasoning tasks (Lesage et al. 2013 ; Sirota et al. 2014 ; Toplak et al. 2011 , 2014 ). However, whilst self-reported intuition can negatively correlate with rational reasoning (Shiloh et al. 2002 ), apart from the intuitive subscale of the REI, assessments of intuition are rare (see Pennycook et al. 2015 ). The proposed advantages in a greater propensity towards deliberative reasoning in ASD may have an associated cost on intuitive reasoning. However, this was not independently evidenced in this study as we did not have a behavioural measure of intuition independent of deliberation. Recall also, the variation in findings regarding the relationship between behavioural and self-reported intuition in the general population identified in the literature, which may indicate that the intuitive subscale of the REI is not a reliable index of intuitive behaviour.

Despite issues with assessment, potential biases away from intuitive reasoning in other contexts, such as social contexts, may be pertinent to ASD as they may be associated with deficits in empathy (e.g. Baron-Cohen and Wheelwright 2004 ). The social world often requires rapid processing of social cues occurring in an uncertain context rather than an overt ‘rule-based’ system. Within their Enactive Mind approach, Klin et al. ( 2003 ) characterise the social world as an ‘open domain task’ requiring an understanding of the relative significance of a multitude of elements, the importance of which are dependent upon the context of the situation. Future research can develop the extent to which a propensity towards deliberative processing within naturalistic social settings is too slow and effortful to allow for effective participation. As Darius ( 2002 : 25; cited in Davidson 2008 ) recounts: ‘There is no such thing as adequate delayed social reactions. One is either quick enough to keep up, or one is weird and socially disabled’. Rapidly and automatically extracting emotional information from social environments is argued to be an intuitive process that feeds ‘downstream’ empathy processes and related social–emotional functioning (Clark et al. 2008 ; Kahneman 2011 ; see also Rump et al. 2009 ; Tracy et al. 2011 ). Thus, the unbiased use of deliberation identified in the present research may relate to the social-emotional weaknesses which form part of the diagnostic criteria for ASD. Consistent with this, the measures on intuition used in the present study have been found to correlate with measures of empathy in a general population (Brosnan et al. 2014b ). Dual Process Theory may therefore extend beyond reasoning to provide a fuller account of the social cognition that characterises ASD (see Evans 2008 ; Sherman et al. 2014 ).

Thus a bias towards deliberative reasoning within Dual Process Theory may provide an account of the strengths associated with ASD. Dual Process Theory therefore might usefully bring to bear additional cognitive research from non-clinical groups pertaining to how combinations of intuition and deliberation may relate to ASD. For example, the default-interventionist position could characterise the application of deliberative reasoning in ASD to typically intuitive tasks such as emotion recognition (‘corners of mouth turned down, lowered eyebrows = sad’: Rutherford and McIntosh 2007 ; Walsh et al. 2014 ; see also Brosnan et al. 2015b ; Golan and Baron-Cohen 2006 ; Golan et al. 2010 ). Within Dual Process Theory, intuitive tasks such as rapid emotion recognition, would be expected to be independent of working memory and cognitive abilities in a general population, but not in an ASD group who were utilising deliberative reasoning (see Harms et al. 2010 , for review of the evidence for this). Physically slowing stimuli would also be predicted to enhance the performance of those utilising deliberative reasoning strategies (see Gepner et al. 2001 ; Tardif et al. 2007 ; Gepner and Féron 2009 ). Typically, intuitive and deliberative reasoning can be applied as appropriate to the perceived demands of the reasoning context. The present study is consistent with the idea that those with ASD do not have the balance of reasoning styles but have a bias towards deliberative reasoning and away from intuitive reasoning across contexts. There may be contexts where this is beneficial (e.g. mathematics) and contexts where this is detrimental (e.g. social).

Interestingly, Freeman et al. ( 2012 ) also propose an imbalance in reasoning styles is related to schizotypy traits in a non-clinical population sample. Freeman et al. found that higher intuitive reasoning combined with lower deliberative reasoning was related to the degrees of schizotypy traits, which is the opposite pattern to that associated with autism traits in the present study. Those with high levels of schizotypy have also been found to bias towards making decisions rapidly (‘jumping to conclusions’; Freeman 2007 ; Freeman et al. 2008 ; Garety et al. 2005 , 2007 ) again reflecting the opposing pattern to higher autism traits and ASD identified in the present study. Schizotypy was not assessed in the present study, but it is interesting to speculate that variation in the relative biases towards intuition and deliberation within Dual Process Theory may represent a framework within which similarities and differences between these clinical conditions and associated traits across the general population can be further explored (see Crespi and Badcock 2008 ; see also Brosnan et al. 2010 ; Chisholm et al. 2015 for review). Within the non-clinical population, the extent to which individuals engage in intuitive or deliberative reasoning has been found to be susceptible to manipulation. For example, being told to ‘think carefully’ or to write down details of how you came to a decision have been found to elicit more deliberative responses, where as being instructed to go with a ‘gut-feeling’ has been found to elicit more intuitive responses (e.g. Dijkstra et al. 2012 ; Usher et al. 2011 ). However, if reasoning in ASD is characterised by diminished intuitive mechanisms, whether such manipulations would affect those with ASD is an open question future research. Further, there is also the intriguing possibility that even if people with ASD were shown not to employ rapid, effortless, parallel, non-conscious processing (‘intuition’) in social contexts they may default to them in other contexts (e.g. there are alternative ‘open domain tasks’; Klin et al. 2003 ).

There were limitations to the present research. All of the participants were at university or intending to go to university and were therefore not reflective of either the ASD or non-clinical populations as a whole. This may relate to the lack of sex differences in Study One. The sample was also not specified in terms of further demographics, such as social economic status, which limits generalisability. The participants in Study 2 were all considering attending university, and the degree of ASD symptomology was likely mild and the findings may not extend to the whole autism spectrum. Study 2 only compared male participants which is another limitation of the study, especially given the relatively little understanding of female populations with ASD (Halladay et al. 2015 ). In addition, only 11 participants with ASD completed the REI in Study 2, and the potential for a Type 1 error needs to be borne in mind. Whilst the CRT is a widely used measure of intuitive and deliberative responding, it should be noted that the intuitive response is wrong. Other wrong responses are not considered intuitive and are not typically analysed (hence the task is not purely ipsative). Analysing errors may provide useful insights into whether they emerge from intuitive or deliberative reasoning (Brosnan et al. 2015a ). In addition, the terms intuition and deliberation have been used for stylistic convenience, but it should be noted that they refer to two clusters of concepts (Type 1 and Type 2 respectively, see Evans 2008 for a review; see Keren and Schul 2009 for critique; Kruglanski and Gigerenzer 2011 for an alternative view) that share similarities, but also have differences, within each cluster. Finally, an independent assessment of IQ was not undertaken, which is a major limitation of the study. Whist intuitive reasoning is argued to be independent of cognitive abilities, deliberative reasoning is not. The participants were studying at the same educational level (A-levels, examinations typically taken at 18 years of age for University entry) though may not attain the same grades. Future research can address the assessment of cognitive ability. Although college students do not necessarily have higher levels of autism traits than random control groups, those studying sciences (including mathematics) have been shown to have higher levels of autism traits than those studying humanities and social sciences (Baron-Cohen et al. 2001a , b ), which can also be explored in future research.

Acknowledgments

The second author led on Study One as part of his doctoral studies.

Author Contributions

All authors contributed to the design analysis and writing of the paper. The second author led on Study One as part of his doctoral studies.

Compliance with Ethical Standards

Conflicts of interest.

1 We thank an anonymous reviewer for highlighting this point.

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• Dr. Engelbrecht ND RP
• Main contact
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Thinking styles in autistic people

• 1.1 Visual thinkers
• 1.2 Verbal/logic thinkers
• 1.3 Music and math (‘pattern’) thinkers
• 2.1 Bottom-up thinking
• 2.2 Associative thinkers
• 2.3 Analytical thinkers
• 2.4 Lateral thinkers
• 3 References
• 5 Disclaimer

Temple Grandin:

I have observed that there are three different specialized autistic/Asperger cognitive types. They are: (1) Visual thinkers such as I, who are often poor at algebra. (2) Verbal specialists who are good at talking and writing but they lack visual skills. (3) Pattern thinkers such as Daniel Tammet , who excel in math and music but may have problems with reading or writing composition.

Visual, verbal, and pattern thinkers

Visual thinkers.

My mind is similar to an Internet search engine that searches for photographs. I use language to narrate the photo-realistic pictures that pop up in my imagination. When I design equipment for the cattle industry, I can test-run it in my imagination, similar to a virtual reality computer program. All my thinking is associative and not linear. To form concepts, I sort pictures into categories similar to computer files. To form the concept of orange, I see many different orange objects, such as oranges, pumpkins, orange juice, and marmalade. When I design livestock facilities, I can test run the equipment in my imagination similar to a virtual reality computer program.

My mind is associative and does not think in a linear manner. If you say the word ‘butterfly’, the first picture I see is butterflies in my childhood backyard. The next image is metal decorative butterflies that people decorate the outside of their houses with and the third image is some butterflies I painted on a piece of plywood when I was in graduate school. Then my mind gets off the subject and I see a butterfly cut of chicken that was served at a fancy restaurant approximately three days ago. The memories that come up first tend to be either early childhood or something that happened within the last week.

A teacher working with an autistic child may not understand the connection when the child suddenly switches from talking about butterflies to talking about chicken. If the teacher thinks about it visually, a butterfly cut of chicken looks like a butterfly.

Verbal/logic thinkers

Verbal/logic thinkers tend to be good at learning languages, and have an affinity for words, literature, and speech. They love to make lists, and will often memorize (mundane) things such as train timetables & routes, stories in alphabetical order, and software product codes.

Verbal/logic thinkers tend to have a huge memory for verbal facts on all kinds of things, such as film stars, sporting events, publications, or historical events. Areas of interest often include history, geography, weather, and sports statistics. Parents and teachers can use these interests and talents as a motivation for learning less interesting parts of academics.

Some verbal/logic thinkers are exceptionally adept at learning many different foreign languages, but they tend to be poor at drawing and other visual thinking skills.

Music and math (‘pattern’) thinkers

The same is true in visual arts. Vincent van Gogh ’s later paintings had all sorts of swirling, churning patterns in the sky—clouds and stars that he painted as if they were whirlpools of air and light. And, it turns out, that’s what they were! In 2006, physicists compared van Gogh’s patterns of turbulence with the mathematical formula for turbulence in liquids. The paintings date to the 1880s. The mathematical formula dates to the 1930s. Yet van Gogh’s turbulence in the sky provided an almost identical match for turbulence in liquid. [7] How an Entirely New, Autistic Way of Thinking Powers Silicon Valley (2013) | Wired jQuery('#footnote_plugin_tooltip_784_1_7').tooltip({ tip: '#footnote_plugin_tooltip_text_784_1_7', tipClass: 'footnote_tooltip', effect: 'fade', predelay: 0, fadeInSpeed: 200, delay: 200, fadeOutSpeed: 300, position: 'top right', relative: true, offset: [10, 10], });

What if we recognized these categories consciously and tried to make the various pairings work to our advantage? What if each of us was able to say, Oh, here’s my strength, and here’s my weakness—what can I do for you, and what can you do for me? If people can consciously recognize the strengths and weaknesses in their ways of thinking, they can then seek out the right kinds of minds for the right reasons. And if they do that, then they’re going to recognize that sometimes the right mind can belong only to an autistic brain.

Bottom-up, analytical, lateral, and associative thinkers

Bottom-up thinking.

I’m good at trawling through the Internet through vast amounts of journal articles and then pick out what are the really important things. I then synthesize all of this resource down into one short paragraph… That’s something that I’m good at doing… I’m a bottom-up thinker—I take the details and put them together.

Autistic people are “details-before-the-concept” thinkers, while non-autistic people are “concept-before-the-details” thinkers. What this means is that the autistic mind approaches its environment—a bottom-up approach—while the non-autistic mind utilizes top-down thinking—drawing on prior learning and memories. As such, all thoughts and actions are contextualized based upon prior knowledge—and thus, are also constrained by this.

A top-down thinker sees a set of symptoms and fits it into a prior box. The autistic mind is not similarly constrained, and is thus more prone to generating novel ideas, and finding innovative solutions. Additionally, the autistic mind is bombarded with sensory information through multiple stimuli, thus processing a greater extent of information that can be utilized for innovative thinking.

Associative thinkers

My mind is associative and does not think in a linear manner. If you say the word ‘butterfly’, the first picture I see is butterflies in my childhood backyard. The next image is metal decorative butterflies that people decorate the outside of their houses with and the third image is some butterflies I painted on a piece of plywood when I was in graduate school. Then my mind gets off the subject and I see a butterfly cut of chicken that was served at a fancy restaurant approximately 3 days ago. The memories that come up first tend to be either early childhood or something that happened within the last week.

Analytical thinkers

Framing effects are particularly prone to emerge during uncertainty, and research suggests it may be the co-occurrence of alexithymia and autism that lies behind the use of logic. Alexithymia is the inability to recognize one’s own or another’s feelings—leaving only logic as a way to decipher the world. The research indicates that although framing effects are associated with interoception and alexithymia in the neurotypical population, emotional and interoceptive signals have less impact on the decision-making process in autistic people.

Lateral thinkers

My mind is similar to an Internet search engine that searches for photographs. I use language to narrate the photo-realistic pictures that pop up in my imagination. When I design equipment for the cattle industry, I can test run it in my imagination similar to a virtual reality computer program. All my thinking is associative and not linear. To form concepts, I sort pictures into categories similar to computer files. To form the concept of orange, I see many different orange objects, such as oranges, pumpkins, orange juice and marmalade.

  [ + ]

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Martin Silvertant is a co-founder of Embrace Autism, and lives up to his surname as a silver award-winning graphic designer. Besides running Embrace Autism and researching autism, he loves typography and practicing type design. He was diagnosed with autism at 25 .

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Encyclopedia of Autism Spectrum Disorders pp 1–9 Cite as

Critical Autism Studies

• Richard Woods 2 &
• Krysia Emily Waldock 3  
• Living reference work entry
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• First Online: 22 June 2020

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Critical autism studies ; Emancipatory autism studies ; Transformative autism studies (Woods et al. 2018)

Introduction

Critical Autism Studies (CAS) is the only autistic-led community of practice, within autism studies, and it has a few proposed definitions. A recent entry by notable autistic CAS scholars reviewed the main definitions and its ontology to propose a more inclusive approach between autistic and non-autistic academics; the preferred definition put forward is:

The ‘criticality’ comes from investigating power dynamics that operate in discourses around autism, questioning deficit-based definitions of autism, and being willing to consider the ways in which biology and culture intersect to produce ‘disability’. (Waltz 2014 , p. 1337)

For a discussion on the other primary CAS definitions, see Woods et al. ( 2018 ). This essay outlines key concepts from disability studies and the nature of the neurodiversity movement before explaining how CAS is relevant to...

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Woods, R., Waldock, K.E. (2020). Critical Autism Studies. In: Volkmar, F. (eds) Encyclopedia of Autism Spectrum Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6435-8_102297-2

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Accelerating Science to Improve Early Autism Screening

April 23, 2024 • Feature Story • 75th Anniversary

At a Glance

• Autism is a neurodevelopmental disorder that affects how people interact, communicate, and learn.
• Making early autism screening part of routine health care helps connect families to support and services as early as possible.
• Despite American Academy of Pediatrics guidelines, only a small fraction of pediatricians reported screening for autism at well-child visits.
• NIMH-supported efforts to close the gap between science and practice have yielded key insights into effective strategies for expanding early autism screening.
• Researchers are identifying new tools for detection, new models for delivering services, and new strategies for embedding early autism screening and rapid referral into routine health care.

As many parents of young children know all too well, visits to the pediatrician typically involve answering a series of questions. Health care providers may ask about the child’s eating and sleeping habits or about their progress toward walking, talking, and many other developmental milestones. Increasingly, they’re also asking questions that could help identify early signs of autism.

Autism is a neurodevelopmental disorder that affects how people interact, communicate, behave, and learn. It is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.

Today, thanks to research focused on embedding routine screening in well-baby checkups, the early signs of autism can be identified in children as young as 12–14 months. These efforts, many supported by the National Institute of Mental Health (NIMH), show that making early autism screening part of routine health care can have a significant impact on children and families, helping connect them to support and services as early as possible.

“This progress wasn’t inevitable or linear,” explains Lisa Gilotty, Ph.D., Chief of the Research Program on Autism Spectrum Disorders in the Division of Translational Research at NIMH. “Rather, it’s part of an evolving story that reflects the persistent, collective efforts of researchers and clinicians working to translate science into practice.”

Identifying the disconnect

The modern concept of autism as a neurodevelopmental disorder first emerged in the 1940s and coalesced into a diagnostic label by the 1980s. Diagnostic criteria evolved over time and, by the early 2000s, clinicians had evidence-based tools they could use to identify children with autism as early as 36 months. At the same time, evidence suggested that parents may notice signs even earlier, in the child’s second year of life.

“Reducing this gap—between observable signs and later identification and diagnosis—became an urgent target for researchers in the field,” said Dr. Gilotty. “The research clearly showed that kids who were identified early also had earlier access to supports and services, leading to better health and well-being over the long term.”

Researcher Diana Robins, Ph.D.   , then a doctoral student, wondered whether an evidence-based early screening tool might help close the gap. With support from NIMH  , Robins and colleagues developed the Modified Autism Checklist for Toddlers (M-CHAT)   , which they introduced in 2001. They aimed to provide pediatricians with a simple screening measure that could identify children showing signs of autism as early as 24 months.

The science behind early screening continued to build and gain momentum over the next few years. By the mid-2000s, researchers were exploring the possibility of using various developmental screening tools—such as the Communication and Symbolic Behavior Scales, First Year Inventory, and Ages & Stages Questionnaires—to identify early signs of autism.

The growing body of evidence did not go unnoticed. In 2006, the American Academy of Pediatrics (AAP) issued evidence-based guidelines recommending autism-specific screening   for all children at the 18-month visit. In a later update, they recommended adding another autism-specific screening at the 24-month visit, recognizing that some children may start showing signs a bit later in development.

To the research community, these new guidelines signified a huge step forward for science-based practice. But this sense of progress was soon dashed by reality.

When researchers actually surveyed health care providers, they found that very few knew about or followed the AAP guidelines. For example, in a 2006 study   , 82% of pediatricians reported screening for general developmental delays, but only 8% reported screening for autism. Most of the pediatricians said they weren’t familiar with autism-specific screening tools, and many also cited a lack of time as a significant barrier to screening.

The disconnect between science and practice prompted concern in the research community. A series of conversations in scientific meetings and workshops led to a crystallizing moment for the staff at NIMH.

“There was a period of several years in which researchers would go off and do unfunded work and then bring it back to these meetings and say, ‘This is what I've been working on,’” said Dr. Gilotty. “It was an impetus for those of us at NIMH to say, ‘We’re going to do something about this.’”

Bridging the gap

Gilotty worked with colleagues Beverly Pringle, Ph.D., and Denise Juliano-Bult, M.S.W., who were part of NIMH’s Division of Services and Intervention Research (DSIR) at the time, to synthesize several file drawers’ worth of different measures, meeting notes, and research papers and distill them into an NIMH funding announcement.

The announcement, issued in 2013, focused on funding for autism services research in three critical age groups: toddlers  , transition-age youth  , and adults  . NIMH ultimately funded five 5-year research projects that specifically examined screening and services in toddlers. The projects focused on interventions that emphasized early screening and connected children to further evaluation and services within the first two years of life.

In 2014, Denise Pintello, Ph.D., M.S.W., assumed the role of Chief of the Child and Adolescent Research Program in DSIR. She directed the research portfolio that included these projects, which sparked an idea:

“It was such an exciting opportunity to connect these researchers because the projects were all funded together as a cluster,” she said. “I thought, ‘Let’s encourage these exceptional researchers to work closely together.’”

At NIMH’s invitation, the researchers on the projects united to form the ASD Pediatric, Early Detection, Engagement, and Services (ASD PEDS) Research Network. Although the ASD PEDS researchers were using different research approaches in a range of settings, coming together as a network allowed them to share knowledge and resources, analyze data across research sites, and publish their findings together   . The researchers also worked together to identify ways that their data could help address noticeable gaps in the evidence base.

Building on the evidence

Together, the ASD PEDS studies have screened more than 109,000 children, yielding critical insights into the most effective strategies for expanding early autism screening.

For example, an ASD PEDS study   led by Karen Pierce, Ph.D.   , showed the effectiveness of integrating screening, evaluation, and treatment (SET) in an approach called the Get SET Early model.

Working with 203 pediatricians in San Diego County, California, Pierce and colleagues devised a standardized process that the providers could use to screen toddlers for autism at their 12-, 18-, and 24-month well-child visits. The researchers also developed a digital screening platform that scored the results automatically and gave clear guidelines for deciding when to refer a child for further evaluation.

These improvements boosted the rate at which providers referred children for additional evaluation and sped up the transition from screening to evaluation and services. The study also showed that autism can be identified in children as young as 12–14 months old, several years earlier than the nationwide average of 4 years.

This and other studies showed that incorporating universal early screening for autism into regular health care visits was not only feasible but effective. Working closely with health care providers allowed researchers to build trust with the providers and address their concerns.

“There is this sense that if you sit down and really talk with pediatricians, you can bring them into the fold,” said Dr. Gilotty. “Once you get some key people, you get a few more and a few more, and then it becomes something that ‘everybody’ is doing.”

Meeting the need

At the same time, the ASD PEDS studies have also explored ways to reach families with young children outside of primary care settings. Numerous studies have shown that some families are much less likely to have access to early screening and evaluation, including non-English-speaking families, families with low household incomes, and families from certain racial and ethnic minority groups.

“Screening is most effective when everyone who needs it has access to it,” said Dr. Pintello. “Addressing these disparities is a critical issue in the field and NIMH’s efforts have prioritized focusing on underserved families.”

One way to accomplish this is to integrate standardized universal screening into systems that are already serving these families. For example, in one study , ASD PEDS investigators Alice Carter, Ph.D.   , and Radley Christopher Sheldrick, Ph.D.   , worked with the Massachusetts Department of Public Health to implement an evidence-based screening procedure at three federally funded early intervention sites.

The researchers developed a multi-part screening and diagnosis process that included both clinicians and caregivers as key decision-makers. They hypothesized that this standardized process would minimize procedural variations across the early intervention sites and help to reduce existing disparities in ASD screening and diagnosis.

The results suggested their hunch was correct. All three study sites showed an increase in the rate of autism diagnosis with the new procedure in place, compared with other intervention sites that served similar communities. Importantly, the standardized procedure seemed to address existing disparities in screening and diagnosis. The increased rate of diagnosis observed among Spanish-speaking families was more than double the increase observed among non-Spanish-speaking families.

Looking to the future

Researchers are continuing to explore the best ways to put existing evidence-based screening methods into practice. At the same time, NIMH is also focused on research that seeks to develop new and improved screening tools. Evidence from neuroimaging and eye tracking studies suggests that, although the age at which observable features of autism emerge does vary, subtle signs can be detected in the first year of life. NIMH is supporting a suite of projects that aim to validate screening tools that can be used to identify signs of autism before a child’s first birthday.

“In other words, are there measures we can use to identify signs even before parents and clinicians begin to notice them?” explained Dr. Gilotty. “This is the critical question because the earlier kids are identified, the earlier they can be connected with support.”

These projects leverage sophisticated digital tools to detect subtle patterns in infant behavior. For example, researchers are using technology to identify patterns in what infants look at, the vocalizations they make, and how they move. They’re using technology to examine synchrony in infant–caregiver interactions. And they’re developing digital screening tools that can be administered via telehealth platforms.

The hope is that new tools identified and validated in this first stage will go on to be tested in large-scale, real-world contexts, reflecting a continuous pipeline of research that goes from science to practice.

“As a result of targeted research funded by NIMH over the last 10 years, we are seeing new tools for detection, new models for delivering services, and new strategies for embedding early screening and rapid referral into routine health care,” said Dr. Pintello.

“I feel like it’s just the beginning of the story—we are just now seeing the impact of bringing science-based tools and practices into the hands of health care providers. Over the next few years, we hope that ongoing efforts to bridge science and practice will help us meet the unique needs of children at the exact time that they need services.”

Publications

Broder Fingert, S., Carter, A., Pierce, K., Stone, W. L., Wetherby, A., Scheldrick, C., Smith, C., Bacon, E., James, S. N., Ibañez, L., & Feinberg, E. (2019). Implementing systems-based innovations to improve access to early screening, diagnosis, and treatment services for children with autism spectrum disorder: An Autism Spectrum Disorder Pediatric, Early Detection, Engagement, and Services network study. Autism , 23 (3), 653–664. https://doi.org/10.1177/1362361318766238  

DosReis, S., Weiner, C., Johnson, L., & Newschaffer, C. (2006). Autism spectrum disorder screening and management practices among general pediatric providers. Journal of Developmental and Behavioral Pediatrics , 27 (2), S88–S94. https://doi.org/10.1097/00004703-200604002-00006  

Eisenhower, A., Martinez Pedraza, F., Sheldrick, R. C., Frenette, E., Hoch, N., Brunt, S., & Carter, A. S. (2021). Multi-stage screening in early intervention: A critical strategy for improving ASD identification and addressing disparities. Journal of Autism and Developmental Disorders, 51 , 868–883. https://doi.org/10.1007/s10803-020-04429-z  

Feinberg, E., Augustyn, M., Broder-Fingert, S., Bennett, A., Weitzman, C., Kuhn, J., Hickey, E., Chu, A., Levinson, J., Sandler Eilenberg, J., Silverstein, M., Cabral, H. J., Patts, G., Diaz-Linhart, Y., Fernandez-Pastrana, I., Rosenberg, J., Miller, J. S., Guevara, J. P., Fenick, A. M., & Blum, N. J. (2021). Effect of family navigation on diagnostic ascertainment among children at risk for autism: A randomized clinical trial from DBPNet. JAMA Pediatrics , 175 (3), 243–250. https://doi.org/10.1001/jamapediatrics.2020.5218  

Pierce, K., Gazestani, V., Bacon, E., Courchesne, E., Cheng, A., Barnes, C. C., Nalabolu, S., Cha, D., Arias, S., Lopez, L., Pham, C., Gaines, K., Gyurjyan, G., Cook-Clark, T., & Karins, K. (2021). Get SET Early to identify and treatment refer autism spectrum disorder at 1 year and discover factors that influence early diagnosis. The Journal of Pediatrics, 236 , 179–188. https://doi.org/10.1016/j.jpeds.2021.04.041  

Robins, D. L., Fein, D., Barton, M. L., & Green, J. A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders , 31 , 131–144. https://doi.org/10.1023/A:1010738829569  

Sheldrick, R. C., Carter, A. S., Eisenhower, A., Mackie, T. I., Cole, M. B., Hoch, N., Brunt, S., & Pedraza, F. M. (2022). Effectiveness of screening in early intervention settings to improve diagnosis of autism and reduce health disparities.  JAMA Pediatrics , 176 (3) ,  262–269. https://doi.org/10.1001/jamapediatrics.2021.5380  

• NIMH Health Information Page: Autism Spectrum Disorder
• NIMH Brochure: Autism Spectrum Disorder
• NIMH Statistics Information: Autism Spectrum Disorder (ASD)
• NLM MedlinePlus: Autism Spectrum Disorder 
• HHS Interagency Autism Coordinating Committee 

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Brain organoids and assembloids are new models for elucidating, treating neurodevelopmental disorders

Stanford Medicine research on Timothy syndrome — which predisposes newborns to autism and epilepsy — may extend well beyond the rare genetic disorder to schizophrenia and other conditions.

April 24, 2024 - By Bruce Goldman, Erin Digitale

In this 2019 photo, Timothy syndrome patient Holden Hulet, left, rides in a side-by-side ATV driven by his dad, Kelby Hulet, at sand dunes near their home in southern Utah.  Courtesy of the Hulet family

For a long time, no one understood that Holden Hulet was having seizures.

“He would just say ‘I feel tingly, and my vision kind of goes blurry,’” said Holden’s mom, JJ Hulet. “But he couldn’t communicate exactly what was going on.”

JJ and Kelby Hulet could see their son was having short spells of incoherent speech, rapid back-and-forth eye movements and odd physical changes. “He’d kind of go — I don’t want to say ‘limp’ because he would stand just fine — but his body would just be in zombie mode,” JJ said. The episodes lasted less than a minute.

The parents were puzzled and worried, as they had been many times since Holden was born in 2008 and they learned that their newborn had an extremely rare genetic disease. “I was thinking it was his heart,” Kelby Hulet, Holden’s dad, said.

Holden’s condition, Timothy syndrome, causes long, irregular gaps in heart rhythm. He spent his first six months hospitalized in a neonatal intensive care unit in his family’s home state of Utah while he grew big enough to receive an implantable cardioverter defibrillator. The device sends an electrical signal to restart his heart when it pauses for too long.

As a small child, Holden would sometimes pass out before the defibrillator shocked his heart back into action. When Holden started telling his parents about the blurry-vision episodes at age 6, Kelby initially believed it was a new version of the same problem, and he kept a time stamp on his phone for each episode. But the records from Holden’s defibrillator showed that these times did not line up with any heart-rhythm problems.

The family’s pediatrician was confused, too. Perhaps Holden was having periods of low blood sugar, another possible Timothy syndrome complication, he suggested. Initial testing at the local medical center did not turn up clear answers.

But Kelby, who was training to become an operating room nurse, realized Holden’s episodes reminded him of what he was learning about warning signs for stroke. JJ called Holden’s cardiologist in Utah and asked for a detailed neurologic evaluation, which enabled the mysterious episodes to be diagnosed as seizures. Holden began taking anti-seizure medication, which helped, to his parents’ great relief.

Researching a rare disease

A few months after Holden was born, Sergiu Pasca , MD, arrived at Stanford Medicine to pursue a postdoctoral fellowship in the lab of Ricardo Dolmetsch, PhD, then an assistant professor of neurobiology, who was redirecting his research to autism spectrum disorder. At the time, Pasca did not know the Hulet family. But his work soon became focused on the disorder that has shaped Holden’s life.

Caused by a defective gene on the 12th chromosome, Timothy syndrome is vanishingly rare, with no more than 70 diagnosed cases. Children with this disorder rarely survive to late adolescence. It is caused by a mutation in the gene coding for a type of calcium channel — a protein containing a pore that selectively opens or closes, respectively permitting or blocking the flow of calcium across cells’ membranes. While a prominent feature — severe heart malfunction — can be tackled with a pacemaker, most children with Timothy syndrome will end up with lifelong brain disorders including autism, epilepsy and schizophrenia.

By mid-2009, Pasca had succeeded in generating nerve cells from induced pluripotent stem cells (which can be induced to form virtually any of the body’s numerous cell types). These included cells derived from the skin of two patients with Timothy syndrome. Later that year he observed defects in how the patient-derived neurons were handling calcium. This advance — the creation of one of the initial in-a-dish models of brain disease, built from neurons with defects that precisely mirrored those of a patient’s brain — was published in Nature Medicine in 2011.

Pasca and colleagues continued to monitor these Timothy-syndrome neurons in standard two-dimensional culture — growing as single layers in petri dishes — over the next few years. While this two-dimensional culture method was limited in its ability to sustain viable neurons, it was soon superseded by a genuine scientific breakthrough.

Pioneering the first assembloids

The constraints of two-dimensional culture, including the inability to keep these neurons for long periods of time so that they could reach key stages of neural development, prompted Pasca in 2011 to start developing an unprecedented three-dimensional method. The novel technology produced what came to be known as brain organoids. These constructs recapitulated some of the architecture and physiology of the human cerebral cortex. The organoids can survive for several years in culture, enabling neuroscientists to view, non-invasively, the developing human brain up close and in real time. The scientists wrote a seminal Nature Methods paper , published in 2015, that described their discovery.

Pasca’s group subsequently showed that culturing brain organoids in different ways could generate organoids representing different brain regions (in this case, the cerebral cortex and a fetal structure called the subpallium). In a breakthrough set of experiments, Pasca’s team found ways to bring these organoids into contact so that they fuse and forge complex neuronal connections mimicking those that arise during natural fetal and neonatal development. Pasca named such constructs assembloids.

In their paper on the research, which was published in Nature in 2017, Pasca’s team showed that after fusion, a class of inhibitory neurons originating in the subpallium migrates to the cortex, proceeding in discrete, stuttering jumps. (See animation .) These migrating neurons, called interneurons, upon reaching their destinations — excitatory neurons of the cortex — form complex circuits with those cortical neurons.

But in assembloids derived from Timothy syndrome patients, the motion of interneurons as they migrate from the subpallium is impaired — they jump forward more often, but each jump is considerably shorter, so they fail to integrate into the appropriate circuitry in the cortex. This wreaks havoc with signaling in cortical circuits. Pasca’s team tied this aberrant neuronal behavior on the part of Timothy syndrome neurons to the key molecular consequence of the genetic defect responsible for the condition: namely, malfunction of the critical channels through which calcium must pass to cross neurons’ outer membranes.

A family’s struggles

While Pasca was developing assembloids, the Hulet family was progressing through their own journey of discovery with Holden. They faced painful uncertainty at every stage, starting when Holden was discharged from the NICU in the summer of 2009, after several months of hospitalization and multiple heart surgeries.

“Even when we brought him home, [his doctors] said ‘Don’t get your hopes up. We don’t usually see them make it past age 2,” JJ recalled. Many children with Timothy syndrome die from cardiac failure in early life.

“It’s really hard to be positive in that kind of situation, and for a long time I did let it get to me,” JJ said. “I finally got to a point where I said, ‘I have to live my life and we just keep fighting.’”

JJ runs a child care center and has years of experience working with special-needs kids, which motivated her to push for an autism evaluation when she saw signs of autism in Holden. He’s much more verbal than many children with autism, which paradoxically made it more difficult to get an official diagnosis.

“That was frustrating,” JJ said. Although the family’s pediatric cardiologist in Salt Lake City was familiar with the vagaries of Timothy syndrome, their local caregivers in the small town where they live in southern Utah were not. “They kept saying ‘Oh, no, it’s just developmental delays because he was so premature,’” she said. She wonders whether it would have been easier to have Holden’s autism diagnosed had more been known about Timothy syndrome at the time.

“I think research is important so that parents and children have the support they need,” she said, noting how lonely and painful it can be to advocate for a child when his condition is poorly understood — and when, as a parent, you may be doubted by medical professionals. “It’s a really hard thing to deal with.”

Her voice breaks briefly. She continues, “I think research brings validity to that.”

Sergiu Pasca

Implanting organoids

In 2022, Pasca published a  study in  Nature describing the transplantation of human cortical organoids into neonatal rats’ brains, which resulted in the integration of human neurons along with supporting brain cells into the brain tissue of rats to form hybridized working circuits. The implanted human organoids survived, thrived and grew. Individual neurons from the human organoids integrated into young rats’ brains were at least six times as big as those — generated the same way, at the same time — that remained in a dish. The transplanted neurons also exhibited much more sophisticated branching patterns. Pasca and his colleagues observed marked differences in the electrical activity of, on one hand, human neurons generated from a Timothy syndrome patient, cultured as organoids and transplanted into one side of a rat’s brain, and, on the other hand, those generated from a healthy individual and transplanted, as an organoid, into the corresponding spot on the other side of the same rat’s brain. The Timothy syndrome neurons were also much smaller and were deficient in sprouting branching, brush-like extensions called dendrites, which act as antennae for input from nearby neurons.

“We’ve learned a lot about Timothy syndrome by studying organoids and assembloids kept in a dish,” Pasca said. “But only with transplantation were we able to convincingly see these neuronal-activity-related differences.”

That same year, the FDA Modernization Act 2.0 was signed into law, exempting certain categories of new drug-development protocols from previously mandated animal testing. The act was predicated on the understanding that recent advancements in science offer increasingly viable alternatives to animal testing, so the findings based on the organoid- and assembloid-culture technologies may be adequate to justify clinical trials in some neurodevelopmental conditions.

Most recently, in a Nature paper published April 24, Pasca and his colleagues demonstrated, in principle, the ability of antisense oligonucleotides (ASOs) to correct the fundamental defects that lead to Timothy syndrome by nudging calcium-channel production toward another form of the gene that does not carry the disease-causing mutation. Using ASOs to guide production of the functional rather than defective form of this channel reversed the defect’s detrimental downstream effects: Interneuronal migration proceeded similarly to that procedure in healthy brains, and the altered electrical properties of the calcium channel reverted to normalcy. This therapeutic correction was demonstrated in a lab dish — and, critically, in rat-transplantation experiments, suggesting that this therapeutic approach can work in a living organism.

Pasca is now actively searching the globe for carriers of the genetic defect, in preparation for the pursuit of a clinical trial at Stanford Medicine to test the safety and therapeutic potential of ASOs in mitigating the pathological features of Timothy syndrome.

“We are also actively engaged in conversations with other scientists, clinicians in the field and ethicists about the best way to move forward and safely bring this therapeutic approach into the clinic,” he said.

Pasca added that the calcium channel that is mutated in Timothy syndrome is, in fact, “the hub” of several neuropsychiatric diseases including schizophrenia and bipolar disorder. So it may be that the lessons learned — and the therapies derived — from his 15-year focus on a rare disease may have broad application in a number of widespread and troubling psychiatric conditions.

‘Amazing’ teenager

Today, in defiance of his doctors’ warning that he might not live past age 2, Holden Hulet is 15 years old and doing well.

“I think a lot of times, autism is perceived as ‘They’re not neurotypical and they’re not capable of certain things.’ But he is brilliant,” JJ said. “He’s amazing with techie stuff or Legos. He’s funny and super honest and very self-aware.”

Kelby often takes Holden to visit the farm where he grew up. Holden loves to ride the farm equipment and enjoys hanging out with the animals, especially the farm dogs and calves. Like a lot of kids, he keeps an eye out for good rocks, Kelby said with a chuckle.

“He’s always either throwing them or collecting them,” JJ said. “That’s something I really like about him: He’s always got a pocket full of something.”

Although navigating a rare disease is one of the most challenging things they have faced, the Hulets see light in their situation, and would offer encouragement to any family facing a new Timothy syndrome diagnosis.

“There is hope,” JJ said. “There are people out there who care, people out there who fight for you who don’t even know you. I think that’s what is so important about research — that you’re fighting a battle for people you don’t even know.”

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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