Recent Advances and New Directions in Measuring Theory of Mind in Autistic Adults

Livingston, Lucy Anne; Carr, Bethany; Shah, Punit

doi:10.1007/s10803-018-3823-3

Cited by 59 publications

(69 citation statements)

References 54 publications

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“…It is also debated whether ‘cognitive empathy’ and ‘theory of mind’ are synonymous because it remains unclear whether experimental tasks of these abilities are measuring the same construct (Happé et al 2017; Warrier and Baron-Cohen 2018). We therefore suggest that, following refinement of the theoretical overlap, terminology, and measures of these social cognitive processes (Happé et al 2017), it may be necessary to conduct a follow-up of the present study that includes refined measures of cognitive empathy and theory of mind (see Livingston et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Trait Autism is a Better Predictor of Empathy than Alexithymia

Shah

Livingston

Callan

et al. 2019

J Autism Dev Disord

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It has been proposed that atypical empathy in autism spectrum disorder (ASD) is due to co-occurring alexithymia. However, difficulties measuring empathy and statistical issues in previous research raise questions about the role of alexithymia in empathic processing in ASD. Addressing these issues, we compared the associations of trait alexithymia and autism with empathy in large samples from the general population. Multiple regression analyses showed that both trait autism and alexithymia were uniquely associated with atypical empathy, but dominance analysis found that trait autism, compared to alexithymia, was a more important predictor of atypical cognitive, affective, and overall empathy. Together, these findings indicate that atypical empathy in ASD is not simply due to co-occurring alexithymia.Electronic supplementary materialThe online version of this article (10.1007/s10803-019-04080-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Trait Autism is a Better Predictor of Empathy than Alexithymia

Shah

Livingston

Callan

et al. 2019

J Autism Dev Disord

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“…Accordingly, a handful of studies [2,3,13] have quantified social compensatory ability in ASD as the discrepancy between observerrated social skills and performance on social-cognitive tasks (e.g. measuring theory of the mind-the ability to understand other minds [14]). This approach is advantageous in that it captures the overall output of compensation, both in conscious and unconscious forms, in a fairly objective manner.…”

Section: Approaches To Studying Compensation In Autismmentioning

confidence: 99%

Quantifying compensatory strategies in adults with and without diagnosed autism

et al. 2020

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Background: There is growing recognition that some autistic people engage in 'compensation', showing few behavioural symptoms (e.g. neurotypical social skills), despite continuing to experience autism-related cognitive difficulties (e.g. difficulties in social cognition). One way this might be achieved is by individuals consciously employing 'compensatory strategies' during everyday social interaction. However, very little is currently known about the broad range of these strategies, their mechanisms and consequences for clinical presentation and diagnosis. Methods:We aimed to measure compensatory strategies in autism for the first time. Using a novel checklist, we quantified self-reported social compensatory strategies in 117 adults (58 with autism, 59 without autism) and explored the relationships between compensation scores and autism diagnostic status, autistic traits, education level, sex and age at diagnosis.Results: Higher compensation scores-representing a greater repertoire of compensatory strategies-were associated with having an autism diagnosis, more autistic traits and a higher education level. The link between autism diagnostic status and compensation scores was, however, explained by autistic traits and education level. Compensation scores were unrelated to sex or age at diagnosis. Limitations: Our sample was self-selected and predominantly comprised of intellectually able females; therefore, our findings may not generalise to the wider autistic population.Conclusions: Together, our findings suggest that many intellectually able adults, with and without a clinical diagnosis of autism, report using compensatory strategies to modify their social behaviour. We discuss the clinical utility of measuring self-reported compensation (e.g., using our checklist), with important implications for the accurate diagnosis and management of autism and related conditions.

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“…Developmental trajectories in autism spectrum disorder are heterogeneous, 2 but there is insufficient understanding of this phenomenon. In particular, it is unclear why some autistic people appear neurotypical in their behavioural presentation, despite having autism-related cognitive difficulties or differences (eg, in Theory of Mind [ToM]) 3 . One explanation is that individuals compensate for their cognitive difficulties by using alternative cognitive routes to achieve neurotypical behaviour 4 .…”

Section: Introductionmentioning

confidence: 99%

Compensatory strategies below the behavioural surface in autism: a qualitative study

Livingston

Shah

Happé

2019

The Lancet Psychiatry

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Summary Background Little is known about the compensatory profile in autism; that is, people with autism spectrum disorder who show few symptoms in their behavioural presentation, despite continuing to report autism-related cognitive difficulties or differences. Even less is known about the specific compensatory strategies that these individuals use to disguise autism at the behavioural surface, both in the clinic and everyday life. It is also currently unclear whether individuals without a formal autism diagnosis, but experiencing autistic-like difficulties, use similar compensatory strategies, potentially enabling them to sit below the diagnostic threshold. This study aimed to investigate social compensatory strategies, and their effect on diagnosis and clinical outcome, in adults with and without autism. Methods In this study, individuals aged 18 years or older who responded to a study advert that was distributed worldwide via social media and the UK National Autistic Society formed a convenience sample. Participants self-reported their use and experiences of compensatory strategies using an online platform. Novel analyses, including a qualitative thematic approach, were used to interpret their responses and gain insight into compensatory strategies in autism. Findings Between Oct 19, 2017, and Jan 2, 2018, 136 adults (58 had a clinical diagnosis of autism, 19 self-identified but were not formally diagnosed as autistic, and 59 were not diagnosed or self-identified, but nevertheless reported social difficulties) completed the online study questions. The findings suggested that there are multiple compensatory strategies with distinct characteristics, individual and environmental factors that modulate compensatory strategy use and success, positive (social relationships, independence, employment) and negative (poor mental health, late diagnosis) outcomes associated with compensatory strategy use, and that individuals without a diagnosis use compensatory strategies that are qualitatively similar to individuals with a diagnosis. Interpretation Increased awareness and measurement of compensatory strategy use in autism should guide future diagnostic guidelines, towards improved diagnostic accuracy and support for people with autism spectrum disorder whose cognitive difficulties are not immediately evident in observable behaviour. Funding UK Medical Research Council and UK National Institute for Health Research.

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Recent Advances and New Directions in Measuring Theory of Mind in Autistic Adults

Cited by 59 publications

References 54 publications

Trait Autism is a Better Predictor of Empathy than Alexithymia

Trait Autism is a Better Predictor of Empathy than Alexithymia

Quantifying compensatory strategies in adults with and without diagnosed autism

Compensatory strategies below the behavioural surface in autism: a qualitative study

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