Autism (Edexcel A-Level Psychology): Revision Notes
Autism
What is autism?
Autism is a developmental disorder that persists throughout an individual's lifetime. It fundamentally affects how people interact with others and interpret the world around them. Autism is understood as a spectrum condition, meaning each person with autism is affected differently and to varying degrees. The prevalence of autism is approximately one in 100 people in the population. Boys are five times more likely than girls to be diagnosed with autism, though this may reflect under-diagnosis in girls rather than a true difference in occurrence rates.
The higher diagnosis rate in boys (5:1 ratio) may not reflect the true prevalence of autism across genders. Research suggests that girls with autism may present differently, leading to under-diagnosis and missed opportunities for support.
The triad of impairment
Autism is typically detected through difficulties in three key domains, collectively known as the triad of impairment:
Communication difficulties
Individuals with autism may experience challenges in how they communicate with others. This can include:
- Limited speech or absence of verbal communication
- Difficulty understanding the reciprocal nature of conversation (two-way communication)
- Challenges in understanding non-verbal cues such as facial expressions and body language
- Rigid or literal interpretation of language
- Difficulty understanding sarcasm or abstract concepts
Social interaction problems
People with autism often struggle with social relationships and interactions. They may:
- Have difficulty interpreting the intentions or emotions of others
- Struggle to form and maintain friendships
- Find it challenging to understand social rules and expectations
- Have difficulty reading facial expressions or understanding others' perspectives
Imagination and behaviour
As a consequence of autism, individuals may:
- Have difficulty interpreting the intentions or facial expressions of others
- Display somewhat rigid interests
- Misunderstand sarcasm or non-literal language
- Struggle with pretend play
- Focus intensely on details rather than seeing the overall picture
The triad of impairment represents the core diagnostic features of autism. All three domains must show impairment for an autism diagnosis, though the severity and specific manifestation can vary significantly between individuals.
Characteristics and symptoms
Symptoms of autism typically become apparent in children at approximately four years of age. Common behaviours include:
- Strong preference for routine and predictability
- Sensory sensitivity, such as dislike of certain clothing labels, distress from bright lights, or discomfort with excessive noise
- Development of specific, intense interests that may emerge from a young age
- These interests may eventually develop into hobbies or career paths in adulthood
A learning disability may also be present, ranging in severity. A learning disability refers to reduced intellectual ability and difficulty with everyday activities that affects someone throughout their life.
Asperger's syndrome
Asperger's syndrome is a form of autism. Individuals with Asperger's syndrome typically have average or above-average intelligence, and their speech tends to be less problematic compared to other forms of autism on the spectrum.
While "Asperger's syndrome" was historically used as a separate diagnosis, modern diagnostic criteria (DSM-5) now classify it within the broader autism spectrum disorder (ASD) category, reflecting the understanding of autism as a spectrum condition.
Causes of autism
The exact cause of autism remains under investigation. Current understanding suggests that multiple factors, rather than a single cause, contribute to its development. Common explanations include genetic links, neurological factors, cognitive reasons, or environmental influences. Since the precise cause of autism is yet to be clarified, these are considered 'risk factors' thought to increase the potential for developing autism.
Genetics
Bailey et al. (1995) conducted twin studies examining autism concordance rates:
- Monozygotic (MZ) twins: 60% concordance for autism
- Dizygotic (DZ) twins: 0% concordance for autism
The substantially higher concordance in MZ twins suggests genetic inheritance plays a predominant causative role. When examining the broader spectrum of related cognitive or social abnormalities (including communication and social disorders), concordance increased from 60% to 92% in MZ twins and from 0% to 10% in DZ pairs. This indicates that interactions between multiple genes cause autism, with environmental modifiers potentially contributing to variable expression of autism-related traits. The specific genes involved and their exact number remain unknown.
Hallmayer et al. (2011) found similar concordance patterns when examining both female and male twins:
| Twin type | Male concordance (strict autism) | Female concordance (strict autism) | Male concordance (autism symptoms) | Female concordance (autism symptoms) |
|---|---|---|---|---|
| MZ twins (40 pairs) | 58% | N/A | 77% for 45 MZ pairs | 50% for 9 MZ pairs |
| DZ twins (31 pairs) | 21% | N/A | 31% for 45 DZ pairs | 36% for 13 DZ pairs |
| Monozygotic pairs (7 female) | N/A | 60% | N/A | N/A |
| Dizygotic pairs (10 female) | N/A | 27% | N/A | N/A |
The lower number of female pairs reflects the smaller number of females diagnosed with autism. A substantial proportion of the variance in liability can be explained by shared environmental factors alongside moderate genetic heritability.
Despite evidence suggesting a genetic basis for autism (demonstrated by the relationship between autism and MZ twins), no specific 'autism genes' have been identified to date. The prevalence of autism in MZ twins where one has autism is not 100%, suggesting that factors beyond genetics contribute to autism development.
Theory of mind
Theory of mind is the cognitive ability to understand other people's mental states and perceive the world from another person's perspective. When a child develops theory of mind, they recognise that each person they encounter has their own set of beliefs, emotions, likes, and dislikes that may differ from their own.
Development of theory of mind
Theory of mind development begins early in life. At approximately five months of age, typical children can recognise different facial expressions, though understanding their meaning occurs somewhat later. Once young children can reliably interpret facial expressions of others, they begin using this non-verbal information to guide their behaviour.
Osterling and Dawson (1994) studied videotapes of first birthday parties of typical children and children who later received an autism diagnosis. They discovered that the best predictor of future diagnosis was lack of attention to the faces of others.
Theory of mind and autism
Children with autism do not tend to use the gaze of others to guide their behaviour, as they fail to consider the mental states of others. Most children without autism develop full understanding of theory of mind by approximately age four. This explains why autism diagnosis typically occurs after this age, allowing sufficient time for the child to develop this skill.
Children with autism develop limited or no understanding of theory of mind, resulting in difficulty relating to others. This can be a cause of their difficulties with social interaction and particularly with engaging in pretend play. It may also explain the tendency to become focused on details rather than seeing the bigger picture.
The Sally-Anne Test for theory of mind
Baron-Cohen et al. (1985) conducted a study to assess theory of mind in autistic children.
Worked Example: The Sally-Anne Test
Participants: A group of autistic children, children with Down's syndrome, and children with no identifiable developmental disability (the 'normal' group).
Aim: To assess whether participants had theory of mind by testing them individually.
Procedure: On a desk opposite the experimenter were two dolls, Sally and Anne. Sally had a basket in front of her, and Anne had a box. The dolls were introduced to the children, and the child's ability to name them was tested (the 'Naming Question').
Sally then takes a marble and hides it in her basket. She then leaves the room and 'goes for a walk'. Whilst she is away and therefore unknown to her, Anne takes the marble out of Sally's basket and puts it in her own box. Sally returns and the child is asked the key question: 'Where will Sally look for her marble?' (the 'Belief Question').
The correct response is to point to or name Sally's basket—indicating that the child knows Sally believes the marble to be somewhere it is not. The incorrect response is to point to Anne's box.
Two control questions were also asked: 'Where is the marble really?' ('Reality Question'), and 'Where was the marble in the beginning?' ('Memory Question'). Every child was tested twice, with a new location (the experimenter's pocket) for the marble introduced during the second trial.
Findings: To succeed in this task, children must attribute a belief to Sally—appreciating that Sally believes something about the world that differs from their own beliefs, and which in this case is not true.
The 'naming', 'reality', and 'memory' questions were answered correctly by all children. However, whilst at least 85% of the 'normal' children and children with Down's syndrome gave the correct response to the belief question, only 20% (4 from 20) of the autistic children did so.
The autistic children who gave the wrong response on both trials pointed to where the marble really was rather than where Sally must believe it to be.
Evaluation:
This study demonstrates that children with autism have underdeveloped theory of mind, which contributes to their social and communicative difficulties.
However, this explanation cannot account for all difficulties experienced by those with autism. It fails to explain why lack of theory of mind may contribute to difficulties in verbalising words and in communication attempts with others. This skill does not rely on interpreting others' intentions, as the reciprocal element of communication does, and therefore cannot easily be explained by the theory of mind explanation.
Research on theory of mind has typically focused on preschool children, as this is when rapid development of mental state understanding occurs. Less is known about theory of mind in older children, though it is acknowledged that this area continues to develop as children mature.
Theory of mind as symptom or cause?
Theory of mind is presented as a factor contributing to autism development; lack of theory of mind limits interactions with others. However, the absence of theory of mind may be a symptom of autism rather than a cause. It could be that due to autism, children do not develop theory of mind and the ability to understand others. The complexity of autism and its root causes makes this an ongoing puzzle.
Alternative explanations
Beyond the explanations above, other theories for autism include:
1. Weak central coherence
An imbalance in integrating information at different levels. Typically, when processing information, a child can draw information together to construct higher-level meaning (central coherence). For example, if told a story, a child may be able to recall all of it, but they will understand the overall meaning. Children with autism do not have this ability, which can explain the strong attention to detail in many with autism and their inability to recognise global meanings.
Weak central coherence theory suggests that while individuals with autism excel at processing details, they struggle to integrate these details into a coherent whole. This explains both the enhanced attention to detail and the difficulty in understanding context or "the big picture."
2. Environmental factors
The theory suggests that a person is born with a vulnerability to autism, but the condition develops only if that person is exposed to a specific environmental trigger. Such triggers include premature birth, exposure to caesarean birth, or exposure to medication sodium valproate during pregnancy. There is a lack of conclusive evidence linking pollution or maternal infections in pregnancy with increased risk of autism.
3. Neurological factors
It has been suggested that the connections between the cerebral cortex, limbic system, and amygdala within the brain are connected in such a manner that allows for overstimulation or 'over connection'. This can contribute to the experiences of extreme emotions or hypersensitivity often observed among children with autism.
Therapies
It is not possible to 'treat' autism, as it is a pervasive disorder present throughout the lifetime of the individual. Therapies for children with autism focus on supporting their needs and minimising the difficulties they present with. This can include enhancing social skills or supporting them to manage periods of change without becoming distressed.
Applied Behaviour Analysis (ABA)
Applied Behaviour Analysis (ABA) is a systematic method of observing someone's social communication, identifying desirable changes in that behaviour, and then using the most appropriate methods to make those changes.
ABA can be used to improve communication and social skills among children and adults with autism. It works by demonstrating effective ways to interact with others and rewarding improved behaviour when displayed. This can be achieved by providing opportunities (both planned and naturally occurring) to acquire and practise skills in structured and unstructured situations.
Behaviours that are harmful or not indicative of positive behaviour are ignored and not reinforced. The therapist continually analyses the effectiveness of the approach and makes changes where necessary to improve the child's behaviour next time. This makes ABA a reflective, evaluative, and therefore dynamic therapy style.
Operant conditioning principles
ABA uses the principles of positive reinforcement (operant conditioning) to support the learning of positive behaviour. It uses rewards for desirable behaviour to make it more likely the child will repeat the behaviour.
Therapists develop a tailored programme for each child, customising the intervention to their skills or needs. For these reasons, an ABA programme for one child will look different from a programme for another child, reflecting the diversity of presentation among children with autism.
Evaluation of ABA
Strengths:
- The individualised nature of ABA programmes ensures that each child receives support tailored to their specific needs
- Uses evidence-based principles from learning theory (operant conditioning)
- Can be implemented in various settings (structured and unstructured)
- Provides a systematic, evaluative approach that can be adapted over time
Weaknesses:
- Many different interventions, programmes, and techniques use ABA principles to help children with autism, making evaluation of ABA's effectiveness complex
- Longer-term effects of ABA interventions are needed, as existing studies involve only relatively short follow-up periods (though results are promising)
- Consistency and routine are essential for ABA effectiveness. Operant conditioning is effective when all positive behaviour is consistently rewarded. If this is not adhered to, the effectiveness of reinforcement can be compromised
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) can be useful for children who experience anxiety as a symptom of their autism. This technique works on the basis of exploring the child's thoughts and feelings about the source of their anxiety. It provides them with skills to manage their anxiety so that stressful situations or experiences become less distressing.
Adapting CBT for autism
CBT, when undertaken with children with autism, needs to be adapted from its typical structure. Children with autism can distinguish thoughts, feelings, and behaviours, and can work on altering their thoughts (which are all skills required within CBT). However, children with autism often have difficulty recognising emotions and working with hypothetical or abstract thoughts.
To address this, CBT for those with autism places greater emphasis on repetition and visual cues. One example might be using a picture of a thermometer to encourage a child to rate their anxiety levels, rather than using a ten-guide rating system. This makes the content of the session more relatable to them, thereby improving efficacy.
Visual supports and concrete examples are crucial adaptations when using CBT with children with autism. These modifications make abstract concepts more accessible and help bridge the gap between therapeutic techniques and the child's learning style.
Research evidence
Sofronoff et al. (2005) found that, following a brief CBT intervention, children experienced less anxiety (based on parental self-report) and an increase in the child's ability to identify positive strategies to deal with stressful situations that would previously have been problematic. They also noted that if parents were involved in the treatment, this had a further positive effect on the effectiveness of the intervention.
Wood et al. (2009) found improvement in 78.5% of young children with autism who undertook 16 sessions of CBT for their anxiety, compared to an improvement in only 8.7% of those children in a control group waiting to undertake treatment. The improvements made by the children were upheld when reassessed three months after completing the intervention.
Evaluation of CBT
Strengths:
- CBT has shown positive impact on behaviour and psychological well-being
- Adaptation to meet the specific requirements of children with autism demonstrates flexibility and appropriateness
- Research evidence supports its effectiveness (Sofronoff et al., 2005; Wood et al., 2009)
- Parental involvement enhances effectiveness
Weaknesses:
- CBT requires children to talk to the therapist to explain their thoughts or respond to visual cues given
- Not all children with autism are verbal or have a wide understanding of language
- Therefore, this treatment is less accessible to non-verbal children
- Biomedical interventions (restrictive diets, supplements, hormone interventions, drugs) are alternatives, though there is limited scientific evidence demonstrating their efficacy in supporting people to directly 'manage' their autism rather than treat other conditions
- Medication can be used to support symptoms such as anxiety associated with autism, though it does not treat the autism directly
Both ABA and CBT are support therapies, not cures. They aim to help individuals with autism develop skills and manage specific challenges, but autism remains a lifelong condition. The effectiveness of any therapy depends on individualisation, consistency, and appropriate adaptation to the person's needs and abilities.
Remember!
Key Points to Remember:
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Autism is a lifelong developmental disorder affecting approximately 1 in 100 people, with boys five times more likely to be diagnosed than girls.
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The triad of impairment includes difficulties with communication, social interaction, and imagination—these are the core diagnostic features.
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Genetics play a role: Twin studies show 60% concordance in MZ twins (Bailey, 1995) and 58% in male MZ twins (Hallmayer, 2011), but no specific 'autism genes' have been identified.
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Theory of mind deficits are central to autism—the Sally-Anne Test (Baron-Cohen et al., 1985) showed only 20% of autistic children passed, compared to 85% of typical children.
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Therapies focus on support, not cure: ABA uses operant conditioning principles to reinforce positive behaviours, whilst CBT (adapted with visual cues and repetition) helps manage anxiety in verbal children with autism.