This paper compares the incidence of the diagnosis of Autistic Spectrum Disorders (ASD) among White and Asian children with reference to data obtained from thirteen local education authorities (LEAs) in England. It begins by outlining some of the theoretical debates associated with the definition, diagnosis and prevalence of ASD. The empirical component underpinning this work uses logistic modelling to ascertain whether the proportion of children with a statement of special educational need (SEN) for ASD is different for Asian (...) and for White children and whether the proportion of children with a statement of SEN for ASD varies between LEAs. The discussion speculates as to possible reasons for the differences found and identifies areas for further research. (shrink)

Autism spectrum disorders (ASDs) are an issue of growing public health significance. This set of neurodevelopmental disorders, which includes autistic disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS), is characterized by abnormalities in one or more of the following domains: language use, reciprocal social interactions, and/or a pattern of restricted interests or stereotyped behaviors. Prevalence estimates for ASDs have been increasing over the past few decades, with estimates at ~5/10,000 in the 1960s, and (...) current estimates as high as 1/88 (Newschaffer et al. 2007; CDC 2012).1 While ASDs encompass a wide range of phenotypes and degrees of severity, the disorders .. (shrink)

The Autism Spectrum Disorder (ASD) represents a set of life-long disorders. In particular, subjects with ASD can display momentary behaviors of acute agitation and aggressiveness called crisis behaviors. These events are problematic for the subject and care providers but little is known about their occurrence, namely, possible relations among intensity, frequency, and duration. A group of ASD subjects (n=33) has been observed for 12 months reporting data on each crisis ( n = 1137 crises). Statistical analysis did (...) not find significant results, while the relation between crisis duration and frequency showed a good fit to a “power law” curve, suggesting the application of Self-Organized Criticality (SOC) model. The SOC is used to describe natural phenomena as earthquakes, bank failures of rivers, mass extinctions, and other systems where a type of “catastrophic events” is necessary to maintain a critical equilibrium. In a sense, subjects at risk of crisis behavior seem to fit the same model as seismic zones at risk of earthquakes. The employment of the same strategies, as those successfully developed for known SOC systems, could lead to important insights for ASD management. Moreover, the SOC model offers possible interpretations of crisis behavior dynamics suggesting that they are unpredictable and, in a sense, necessary. (shrink)

Autism spectrum disorder (ASD) is a psychopathological condition characterized by persistent deficits in social interaction and communication, and restricted, repetitive patterns of behavior and interests. To build an ecological-enactive account of autism, I propose we should endorse the affordance-based approach of the skilled intentionality framework (SIF). In SIF, embodied cognition is understood as skilled engagement with affordances in the sociomaterial environment of the ecological niche by which an individual tends toward the optimal grip. The human econiche offers (...) a whole landscape of affordances, and situated individuals respond to a field of relevant affordances. An important part of SIF is an ecological-enactive interpretation of the free energy principle and predictive processing. Predictive processing accounts indicate that in ASD too much precision is assigned to prediction errors. Autistic persons depend heavily on current sensory information and less on prior beliefs and cannot attune to stable regularities. To reduce uncertainty, they over-rely on routines, strict habits, and a familiar environment—a predictable ecological niche they construct. I argue that skilled intentionality gives us the framework from which to analyze the autistic field of affordances. Autistic patterns of affordance-related bodily states of action readiness are only sensitive to very specific solicitations in the environment and achieve optimal grip in well-known situations. Autism is to be understood as a disorder of bodily normativity. Taking this approach helps us figure out what neurotypical people can do to attune their environment in order to scaffold the needs of autistic individuals by redesigning the landscape of affordances. (shrink)

This article has two aims. The first is to introduce some novel data that highlight rather surprising pragmatic abilities in autism spectrum disorder (ASD). The second is to consider a possible implication of these data for an emerging empirical methodology in philosophy of language and mind. In pursuing the first aim, we expect our main audience to be clinicians and linguists interested in pragmatics. It is when we turn to methodological issues that we hope to pique the interest (...) of philosophers. Still, the methodological issue becomes pressing precisely because of the empirical finding—thus the first part is important for the philosophical readers as well. The game plan is as follows. Given our intended dual audience, we begin with background on autism and pragmatics. Some of this material will be familiar to some of our readership, but few will know all of it. (Those who do are invited to skip these sections.) We then present some results from our pilot study on a corpus of speech by people with ASD. The heart of our finding is that certain speakers with ASD, who have severe trouble with familiar pragmatic phenomena such as metaphor and conversational implicature, exhibit surprising abilities with respect to what is often called “pragmatic determinants of what is said.” We turn next to a possible implication of this finding: It seems to suggest that hitherto seemingly promising evidence from ASD about the semantics/pragmatics boundary is.. (shrink)

One feature of autism spectrum disorder (ASD) is a deficit in verbal reference production; i.e., providing an appropriate amount of verbal information for the listener to refer to things, people, and events. However, very few studies have manipulated whether individuals with ASD can take a speaker’s perspective in order to interpret verbal reference. A critical limitation of all interpretation studies is that comprehension of another’s verbal reference required the participant to represent only the other’s visual perspective. Yet, many (...) everyday interpretations of verbal reference require knowledge of social perspective (i.e., a consideration of which experiences one has shared with which interlocutor). We investigated whether 22 5;0- to 7;11-year-old children with ASD and 22 well-matched typically developing (TD) children used social perspective to comprehend (Study 1) and produce (Study 2) verbal reference. Social perspective-taking was manipulated by having children collaboratively complete activities with one of two interlocutors such that for a given activity, one interlocutor was Knowledgeable and one was Naïve. Study 1 found no between-group differences for the interpretation of ambiguous references based on social perspective. In Study 2, when producing referring terms, the ASD group made modifications based on listener needs, but this effect was significantly stronger in the TD group. Overall, the findings suggest that high-functioning children with ASD know with which interlocutor they have previously shared a given experience and can take this information into account to steer verbal reference. Nonetheless, they show clear performance limitations in this regard relative to well-matched controls. (shrink)

Although emerging evidence has implicated structural/functional abnormalities of patients with Autism Spectrum Disorder, definitive neuroimaging markers remain obscured due to inconsistent or incompatible findings, especially for structural imaging. Furthermore, brain differences defined by statistical analysis are difficult to implement individual prediction. The present study has employed the machine learning techniques under the unified framework in neuroimaging to identify the neuroimaging markers of patients with ASD and distinguish them from typically developing controls. To enhance the interpretability of the machine (...) learning model, the study has processed three levels of assessments including model-level assessment, feature-level assessment, and biology-level assessment. According to these three levels assessment, the study has identified neuroimaging markers of ASD including the opercular part of bilateral inferior frontal gyrus, the orbital part of right inferior frontal gyrus, right rolandic operculum, right olfactory cortex, right gyrus rectus, right insula, left inferior parietal gyrus, bilateral supramarginal gyrus, bilateral angular gyrus, bilateral superior temporal gyrus, bilateral middle temporal gyrus, and left inferior temporal gyrus. In addition, negative correlations between the communication skill score in the Autism Diagnostic Observation Schedule and regional gray matter volume in the gyrus rectus, left middle temporal gyrus, and inferior temporal gyrus have been detected. A significant negative correlation has been found between the communication skill score in ADOS_G and the orbital part of the left inferior frontal gyrus. A negative correlation between verbal skill score and right angular gyrus and a significant negative correlation between non-verbal communication skill and right angular gyrus have been found. These findings in the study have suggested the GM alteration of ASD and correlated with the clinical severity of ASD disease symptoms. The interpretable machine learning framework gives sight to the pathophysiological mechanism of ASD but can also be extended to other diseases. (shrink)

In this paper, I present a challenge for Michael McKenna’s conversational theory of moral responsibility. On his view, to be a responsible agent is to be able to engage in a type of moral conversation. I argue that individuals with autism spectrum disorder present a considerable problem for the conversational theory because empirical evidence on the disorder seems to suggest that there are individuals in the world who meet all of the conditions for responsible agency that the theory (...) lays out but who are nevertheless not responsible agents. Attending to the moral psychology of such individuals will, I think, help shed light on an important gap in the conversational theory. (shrink)

This study investigated the understanding of underinformative sentences like “Some elephants have trunks” by children with autism spectrum disorder (ASD). The scalar term ‘some’ can be interpreted pragmatically, ‘Not all elephants have trunks’, or logically, ‘Some and possibly all elephants have trunks’. Literature indicates that adults with ASD show no real difficulty in interpreting scalar implicatures, i.e., they often interpret them pragmatically, as controls do. This contrasts with the traditional claim of difficulties of people with ASD in other (...) pragmatic domains, and is more in line with the idea that pragmatic problems are not universal. The aim of this study was to: a) gain insight in the ability of children with ASD to derive scalar implicatures, and b) do this by assessing not only sensitivity to underinformativeness, but also different degrees of tolerance to violations of informativeness. We employed a classic statement-evaluation task, presenting optimal, logical false, and underinformative utterances. In Experiment 1, children had to express their judgment on a binary option ‘I agree’ vs ‘I disagree’. In Experiment 2, a ternary middle answer option ‘I agree a bit’ was also available. Sixty-six Flemish-speaking 10-year-old children were tested: 22 children with ASD, an IQ-matched group, and an age-matched group. In the binary judgment task, the ASD-group gave more pragmatic answers than the other groups, which was significant in the mixed effects logistic regression analysis, although not in the non-parametric analysis. In the ternary judgment task, the children with ASD showed a dichotomized attitude towards the speaker’s meaning, by tending to either fully agree or fully disagree with underinformative statements, in contrast with TD children, who preferred the middle option. Remarkably, the IQ-matched group exhibited the same pattern of results as the ASD group. Thanks to a fine-grained measure such as the ternary judgment task, this study highlighted a neglected aspect of the pragmatic profile of ASD, whose struggle with social communication seems to affect also the domain of informativeness. We discuss the implications of the dichotomized reaction towards violations of informativeness of these two groups in terms of the potential role of ASD and of cognitive and verbal abilities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodAnonymous One, Anonymous Two, Lorri Centineo, Anonymous Three, Virginia Clapp, Catherine Cornell, Nancy Coughlin, David McDonald, Mark Osteen, Laura Shumaker, Julie Van der Poel, Anonymous FourMy Son's Life with Autistic Spectrum DisorderAnonymous OneThis is the story of how my son, David, has tried to become independent. David is now 25–years–old. His immediate family is his (...) dad, a brother (age 22) and myself (his mother). He was diagnosed with an autism spectrum disorder (ASD) when he was 13. We looked up all the information and decided not to make a big deal of it. Looking back, he displayed all the classic signs of a high functioning autistic disorder. Would he have been diagnosed with the new DSM 5 guidelines? He probably would have. His life would be much, much different if he had been diagnosed at an early age.I'll start with David at age 13 when he was able to harness his big interest in computer science into a career for himself. He was expelled from middle school for threatening some kid that had been picking on him all year. He had a meltdown and wasn't able to communicate his side of the story and that was it.During the summer of that year he took classes in computer engineering (Microsoft) and became an engineer when he was 13. At that time it was quite an accomplishment because he was the youngest person in the United States to do so at such a young age. (By the way, the administration of the school that expelled him sent him a congratulatory card when he was written up in the paper).His father and uncle are in business running a computer company so David had a ready–made job waiting for him when he graduated from high school and was able to keep it during difficult times. David finished high school (mainstreamed special education as emotionally disturbed) and he also received another engineering certification (Cisco).I have to mention here that I truly did not understand what it was like for my son until one day when he was in high school, as I was lecturing him again for some stupid reason, he said, "You don't know how hard it is for me to not sit in a corner and rock every day." Think about that. ASD individuals get up and keep going every day when they know they are going to be misunderstood and picked on. They all deserve a medal for bravery.David became really upset that he had never had a date and that girls were not even interested in talking to him. He started cutting himself and shaving his head. That got him some attention from the stoner group. He had someone to sit with at lunch anyhow. Parents, I think it's better to have no friends than the wrong friends. They introduced him to drugs.We did not mention any trouble David was having to any relatives. We had lived 800 miles from our families in a very unspoiled part of northern America. In hindsight this was not good either. [End Page 151]Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough.During David's senior year he started work release so he could start earning money to buy a car and move out as soon as he turned 18. Things were made easy for David since the company was owned by his father and his uncle and I worked there also. David enjoyed the work but had the occasional meltdown and had difficulties fitting in with other employees. He wasn't able to communicate... (shrink)

Autism spectrum disorder is characterised by differences in unimodal and multimodal sensory and proprioceptive processing, with complex biases towards local over global processing. Many of these elements are implicated in versions of the rubber hand illusion, which were therefore studied in high-functioning individuals with ASD and a typically developing control group. Both groups experienced the illusion. A number of differences were found, related to proprioception and sensorimotor processes. The ASD group showed reduced sensitivity to visuotactile-proprioceptive discrepancy but more (...) accurate proprioception. This group also differed on acceleration in subsequent reach trials. Results are discussed in terms of weak top-down integration and precision-accuracy trade-offs. The RHI appears to be a useful tool for investigating multisensory processing in ASD. (shrink)

Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ >70) with ASD. A conceptual distinction is commonly made between “cold” and “hot” executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed (...) to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18-66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d =.54-1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognise emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs. (shrink)

In a 2007 paper, we argued that speakers with Autism Spectrum Disorders exhibit pragmatic abilities which are surprising given the usual understanding of communication in that group. That is, it is commonly reported that people diagnosed with an ASD have trouble with metaphor, irony, conversational implicature and other non-literal language. This is not a matter of trouble with knowledge and application of rules of grammar. The difficulties lie, rather, in successful communicative interaction. Though we did find pragmatic (...) errors within literal talk, the transcribed conversations we studied showed many, many successes. A second paper reinforced our finding of a general level of success. It considered differences within the class of pragmatically-inflected yet literal speech acts. The present paper carries our project forward. It overcomes some of the methodological limitations of the second paper, by increasing sample size, and looking at frequency of use rather than just seeming errors. It also includes a control sample. The emerging results are two-fold. On the one hand, there was a slight, statistically significant difference in frequency of use between our participants and the controls in four sub-categories: indexicals, possessives, polysemy and degree on a scale. In all four, the participants diagnosed with ASDs had fewer occurrences overall, relative to controls. On the other hand, there was no significant difference in error rates between ASDs and controls — not in any of the eight categories of pragmatic determinants of literal content that we coded for. The upshot is that, though there were less-preferred forms for participants with ASDs, they do very well indeed with pragmatic determinants of literal content. (shrink)

We present results from a single case study based on semi-structured interviews with a student (a boy in school year 3) diagnosed with autism spectrum disorder and his school staff after participating in a short and small-scale intervention carried out in a socio-economically disadvantaged Swedish elementary school in 2019. The student participated in a seven week long intervention with a total of 12 philosophical dialogues (ranging from 45 to 60 minutes). Two facilitators, both with years of facilitation experience (...) and teacher degree and at least BA in philosophy, facilitated the majority of the dialogues and mainly followed a ”routine” procedure. The student was interviewed in direct connection to the end of the intervention about his experiences from the dialogues and his perceptions about whether and how the dialogues had influenced him. The student’s two teachers, who had participated in the dialogues as participants, were interviewed as a pair, also in direct connection to the end of the intervention, while the school principal was interviewed two years after the study. These staff interviews concerned the staff’s experiences of the influence of the dialogues on the students within the intervention as well as transfer effects to other contexts in school. The data from the study include detailed elaborations from a student perspective of different effects on the student’s communicative and cognitive development, which are in several respects supported also by staff reports. The results show that the student was able, interested, and willing to participate in philosophical dialogues, and our data point to several positive outcomes for the student in the communicative and cognitive domains. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:IntroductionParenting Children with Autism Spectrum Disorders During the Transition to AdulthoodKelly Dineen and Margaret Bultas, Symposium EditorsThis issue of Narrative Inquiry in Bioethics is devoted to the personal stories of parents or guardians whose children with ASDs are transitioning or have transitioned to adulthood. The same parents who navigated the educational and health systems with little support twenty years ago once again find themselves as pioneers (...) in somewhat unchartered territory. Transition to adulthood, again, presents new terrain without well–defined parameters or reliable expectations for individuals with ASD and the parents who support them. At current, very little has been studied or written about the unique perspectives of parents during transition. What does exist suggests that parents of individuals with autism perceive their experiences as novel, even as compared with parents of children with other kinds of disabilities (Woodgate, Ateach, & Secco, 2008).One in 88 children is estimated to have an autism spectrum disorder (ASD) in 2012, a 78% increase since 2007 (Centers for Disease Control and Prevention, 2012). Although a variety of factors are certainly involved, the rate of diagnosis of individuals with ASDs has increased dramatically over the last twenty years and by all accounts the level and quality of support in health and social systems have lagged behind.While support and interventions have progressed significantly over time, attention on older populations has played a secondary role to early interventions. The proliferation of young people with ASD has outpaced supportive efforts at all levels. ASDs are usually diagnosed in childhood and funding for and access to research and interventions for children have resulted from, in no small part, the zealous efforts of parents. As this growing population of individuals with ASDs transitions to adulthood, finding appropriate supports and interventions have proven more elusive and more complicated. The hallmark symptoms of ASDs include social skill deficits and communication and behavioral difficulties—all traits that especially strain typical teenage and young adult relationships. Recent research backs up these difficulties and indicates that individuals with ASDs fare relatively poorly in traditional measures of independence such as employment, education and social relationships. Parents like the authors in this symposium continue to work to help their teenage and adult children navigate the demands, challenges and rewards of adulthood and independence with all its uncertainties and surprises.The editors of this issue of Narrative Inquiry in Bioethics solicited the personal stories of the parents who have navigated this transition. The call for stories was distributed to autism awareness groups, autism list–serves, bloggers, and social media outlets. Personal appeals to thought leaders and advocacy groups to distribute the call for stories also produced a number of responses. The [End Page 147] people and organizations that passed along our request and responded are too numerous to list here but our gratitude is sincere: their help made this issue possible.We hope the stories will give readers a sense of what parents find rewarding as well as especially challenging during this time and what actions and supports make a difference for the better. Stories about any aspect of the transition were welcome, ranging from navigating the health system to issues surrounding romantic relationships. We welcomed parents’ thoughts on any topic, including gender, level of function, provider behavior, stigma, friendship, services (existing or needed), decision making, independent living, co–morbidities, expectations, work, school or relationships.These topics and more emerged. Stories primarily came from mothers; however one father and one uncle also contributed. Consistent with diagnostic trends, most tell stories of parenting young men. The 12 stories that were selected for this edition represent just a fraction of the diverse set of issues, needs and commonalities of this growing population of adults. We received more stories than we could put in print. Twelve were selected to represent a range of experiences. Many other stories were so powerful that they will appear on–line in the Project MUSE edition of the journal.Commentators also represent a diverse group of professionals whose work includes direct care and support of individuals with ASD and their families, education, research, scholarship and advocacy. Some of our commentators also have a child or a loved one with ASD.Patricia Bashe... (shrink)

The Theory Theory (TT) versus Simulation Theory (ST) debate is primarily concerned with how we understand others’ mental states. Theory theorists claim we do this using rules that are akin to theoretical laws, whereas simulation theorists claim we use our own minds to imagine ourselves in another’s position. Theorists from both camps suggest a consideration of individuals with autism spectrum disorders (ASD) can help resolve the TT/ST debate (e.g., Baron-Cohen 1995; Carruthers 1996a; Goldman 2006). We present a (...) three-part argument that such research has so far been inconclusive and that the prospects for studies of ASD to resolve the debate in the near future remain uncertain. First, we discuss evidence indicating that some individuals with ASD can perform effectively on tests of mental state understanding, which questions what ASD can tell us regarding theorising or simulation. Second, we claim that there is compelling evidence that domain-general mechanisms are implicated in mental state reasoning, which undermines how ASD might inform the TT/ST debate given that both theories appeal to domain-specific mindreading mechanisms. Third, we suggest that neuroscientific evidence for an assumed role of the mirror neuron system in autism also fails to arbitrate between TT and ST. We suggest that while the study of ASD may eventually provide a resolution to the TT/ST debate, it is also vital for researchers to examine the issues through other avenues, for example, by examining people’s everyday counterfactual reasoning with mental state scenarios. (shrink)

Research on autistic spectrum disorder commonly describes autistic individuals as displaying: i) a preoccupation with the world of objects and ii) a withdrawal or detachment from the world of subjects. In her insightful and persuasive article, Sofie Boldsen argues that we should not fall into the trap of viewing the world of objects and the world of subjects in isolation from one another. Drawing from her qualitative and phenomenological study on social interaction in ASD, Boldsen urges us to recognize (...) how interacting with material objects can scaffold, facilitate, and regulate different forms of social connectedness in ASD. In doing so, the distinction between the “social” and “non-social” dimensions of ASD... (shrink)

The current investigation assessed linguistic and narrative abilities in a cohort of children with Autism Spectrum Disorder (ASD). The linguistic assessment was performed with both traditional tests and a multilevel procedure for discourse analysis. The results showed difficulties at different stages of message planning, organization, and microlinguistic processing (i.e., lexical selection and grammatical processing). Their macrolinguistic impairments were likely related to more general difficulties in the prelinguistic conceptual phase of message planning and mental model generation. Such weaknesses included (...) a difficulty in the non-verbal conceptualization of the story and the generation of an internal representation of the addressee’s mental model. (shrink)

Autism spectrum disorder is an inherited long-living and neurological disorder that starts in the early age of childhood with complicated causes. Autism spectrum disorder can lead to mental disorders such as anxiety, miscommunication, and limited repetitive interest. If the autism spectrum disorder is detected in the early childhood, it will be very beneficial for children to enhance their mental health level. In this study, different machine and deep learning algorithms were applied to classify (...) the severity of autism spectrum disorder. Moreover, different optimization techniques were employed to enhance the performance. The deep neural network performed better when compared with other approaches. (shrink)

This paper addresses how impairments in prediction in young adults with autism spectrum disorder relate to their behavior during a collaboration. To assess it, we developed a task where participants play in collaboration with a synthetic agent to maximize their score. The agent’s behavior changes during the different phases of the game, requiring participants to model their sensorimotor contingencies to play collaboratively. Our results (n = 30) show differences between autistic and neurotypical individuals in their behavioral adaptation to (...) the other partner. Contrarily, there are no differences in the self-reports of that collaboration. (shrink)

Social interactions typically involve movements of the body that become synchronized over time and both intentional and spontaneous interactional synchrony have been found to be an essential part of successful human interaction. However, our understanding of the importance of temporal dimensions of social motor synchrony in social dysfunction is limited. Here, we used a pendulum coordination paradigm to assess dynamic, process-oriented measures of social motor synchrony in adolescents with and without autism spectrum disorder (ASD). Our data indicate that (...) adolescents with ASD demonstrate less synchronization in both spontaneous and intentional interpersonal coordination. Coupled oscillator modeling suggests that ASD participants assembled a synchronization dynamic with a weaker coupling strength, which corresponds to a lower sensitivity and decreased attention to the movements of the other person, but do not demonstrate evidence of a delay in information transmission. The implication of these findings for isolating an ASD-specific social synchronization deficit that could serve as an objective, bio-behavioral marker is discussed. (shrink)

It has become something of a truism that people with Autism Spectrum Disorders (ASD) have difficulties with pragmatics. Granting this, however, it is important to keep in mind that there are numerous kinds of pragmatic ability. One very important divide lies between those pragmatic competences which pertain to non-literal contents – as in, for instance, metaphor, irony and Gricean conversational implicatures – and those which pertain to the literal contents of speech acts. It is against this backdrop (...) that our question arises: Are certain pragmatic tasks more difficult than others for people with ASD? (shrink)

Individuals with an autism spectrum disorder (ASD) are generally thought to lack empathy. However, according to recent empirical and self-advocacy studies, individuals with ASD identify with others with ASD. Based on mutual understanding, individuals with ASD respond empathically to others with these disorders. Results have shown that typically developing (TD) adults identify with typically developing fictional characters, and that such identification plays a critical role in social cognition. TD individuals retrieve episodes involving TD individuals faster than they (...) retrieve episodes involving ASD individuals. Individuals with ASD also show a “similarity effect” whereby they retrieve stories involving ASD individuals more effectively when the stories have consistent outcomes than when they have inconsistent outcomes. In this context, I hypothesized that similarities between a perceiver and a target facilitate cognitive processing. This hypothesis was named the “similarity hypothesis”. Perceivers empathize with targets similar to themselves, which facilitates subsequent cognitive processing. Behavioral and neuroimaging studies are reviewed based on the similarity hypothesis. (shrink)

Many studies have shown that using robot platforms can be effective for teaching children with autism spectrum disorder (ASD). The aim of this study was to compare performance on an imitation task, as well as focus attention levels and the presence of social behaviours of children with ASD and typically developing (TD) children during an imitation task under two different conditions, with robots and human demonstrators. The results suggested that TD children did not imitate more than children with (...) ASD. Children with ASD did not imitate the robot more than they imitated a person, but they showed more focused attention to robots and expressed more social behaviours in interaction with the robots. Behaviours that were significantly more present in ASD children than in TD children included touching the robot in the robot demonstrator condition and focusing on the robot in the person demonstrator condition. This implies a possible preference of children with ASD towards robots rather than towards people. (shrink)

On the basis of relative strengths that have been attributed to the autistic cognitive profile, it has been suggested by a number of theorists that people with autism spectrum disorders (ASD) excel at spatial navigational tasks. However, many of these claims have been made in the absence of a close inspection of extant data in the scientific literature, let alone anecdotal reports of daily navigational experiences. The present review gathers together published studies that have attempted to explicitly (...) address functional components of navigation in ASD populations, including assays of wayfinding, large-scale search, and path integration. This inspection reveals a pattern of apparent strengths and weaknesses in navigational abilities, thus illustrating the necessity for a more measured and comprehensive approach to the understanding of spatial behavior in ASD. (shrink)

Pragmatic deficits of persons with autism spectrum disorders [ASDs] are often traced back to a dysfunction in Theory of Mind. However, the exact nature of the link between pragmatics and mindreading in autism is unclear. Pragmatic deficits in ASDs are not homogenous: in particular, while inter-subjective dimensions are affected, some other pragmatic capacities seem to be relatively preserved. Moreover, failure on classical false-belief tasks stems from executive problems that go beyond belief attribution; false-belief tasks require taking (...) an alternative perspective on the reality. While this capacity is functional in typically developing young children, it is impaired in ASDs. Typically developing children are capable of taking their interlocutor's perspective into account when communicating, whereas poor cognitive flexibility makes it difficult for persons with ASDs to grasp the inter-subjective character of communicative stimuli. This analysis predicts that those pragmatic processes that amount to merely taking into account salient contextual facts during utterance interpretation, without necessarily adopting the interlocutor's perspective, may be preserved in ASDs. (shrink)

A growing body of research suggests that children with autism spectrum disorder are at risk of reading and learning difficulties. However, there is mixed evidence on their weaknesses in different reading components, and little is known about how reading skills characterize in ASD. Thereby, the current study aimed to systematically review the research investigating this function in children with ASD. To this purpose, we reviewed 24 studies that compared children with ASD and children with typical development in word (...) and nonword reading performance, children with ASD and normative data of word and nonword reading tests, and the results obtained by children with ASD in word and nonword reading tests. Most of the comparisons contrasting the reading performance of children with ASD and children with TD did not find significant differences between groups in both word and nonword reading. However, all the comparisons that reported standardized results showed that children with ASD had scores that fell within population norms. Regarding the third comparison of interest, about 54% of the studies presented data for both word and nonword reading, but only one study tested the difference between them and showed that children with ASD had higher levels of word than of nonword reading. Despite these results, the heterogeneous and small samples do not allow to draw sound conclusions regarding the strategies that children with ASD use to read words. As consequence, the nature of reading difficulties presented by children with ASD are still unknown, requiring future research conducted with larger and well-characterized samples of ASD and TD, using homogeneous specific tasks designed to assess word reading strategies. (shrink)

Eye movements during false-belief tasks can reveal an individual's capacity to implicitly monitor others' mental states (theory of mind - ToM). It has been suggested, based on the results of a single-trial-experiment, that this ability is impaired in those with a high-functioning autism spectrum disorder (ASD), despite neurotypical-like performance on explicit ToM measures. However, given there are known attention differences and visual hypersensitivities in ASD it is important to establish whether such impairments are evident over time. In addition, (...) investigating implicit ToM using a repeated trial approach allows an assessment of whether learning processes can reduce the ASD impairment in this ability, as is the case with explicit ToM. Here we investigated the temporal profile of implicit ToM in individuals with ASD and a control group. Despite similar performance on explicit ToM measures, ASD-diagnosed individuals showed no evidence of implicit false-belief tracking even over a one-hour period and many trials, whereas control participants did. These findings demonstrate that the systems involved in implicit and explicit ToM are distinct and hint that impaired implicit false-belief tracking may play an important role in ASD. Further, they indicate that learning processes do not alleviate this impairment across the presentation of multiple trials. (shrink)

Autism spectrum disorders (ASD) are heterogeneous neurodevelopmental disorders that are reportedly characterized by aberrant neural networks. Recently developed multiscale entropy analysis (MSE) can characterize the complexity inherent in EEG dynamics over multiple temporal scales in the dynamics of neural networks. We encountered an 18-year-old man with ASD whose refractory catatonic obsessive–compulsive symptoms were improved dramatically after electroconvulsive therapy (ECT). In this clinical case study, we strove to clarify the neurophysiological mechanism of ECT in ASD by assessing (...) EEG complexity using MSE. Along with ECT, the frontocentral region showed decreased EEG complexity at higher temporal scales, whereas the occipital region expressed an increase at lower temporal scales. Furthermore, these changes were associated with clinical improvement associated with the elevation of brain-derived neurotrophic factor, which is a molecular hypothesis of ECT, playing key roles in ASD pathogenesis. Changes in EEG complexity in a region-specific and temporal scale-specific manner we found might reflect atypical EEG dynamics in ASD. Although MSE is not a direct approach to measuring neural connectivity and the results are from only a single case, they might reflect specific aberrant neural network activity and the therapeutic neurophysiological mechanism of ECT in ASD. (shrink)

Background: Individuals with Autism Spectrum Disorder (ASD) have pronounced difficulties in attending to relevant visual information during social interactions. Method: We designed and evaluated the feasibility of a novel method to train this ability, by exposing participants to virtual human characters displayed on a screen which was entirely blurred, except for a gaze-contingent viewing window that followed participants’ eyes direction. The goal was to incite participants to direct their gaze towards the facial expressions of the virtual characters. Twenty-one (...) adolescents with ASD who attended ordinary school were randomized to either an experimental group, who was trained during a month and a half, or to a control group. Social communicative abilities were assessed during pre, post and follow-up tests. Results: After training, the experimental group showed significantly more interest in facial expressions on a test which involved understanding a dialogue. Significant differences were not found for the other tests used. Conclusions: This outcome suggests that the training method fostered participants’ awareness of the relevance of facial expressions. (shrink)

Objectives“Attachment difficulties” is an umbrella term often used to describe various forms of non-secure attachment. Differentiating “attachment difficulties” from autism spectrum disorder and attention deficit hyperactivity disorder has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals.DesignQualitative study.MethodsWe conducted in-depth semi-structured interviews with healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using (...) a thematic approach.ResultsWe identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization.ConclusionOur results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD. (shrink)

This study analyzed the relation between mental time travel (MTT) and the ability to produce a storytelling focusing on global coherence, which is one of the most notable characteristics of narrative discourse. As global coherence is strictly tied to the temporal sequence of the events narrated in a story, we hypothesized that the construction of coherent narratives would rely on the ability to mentally navigate in time. To test such a hypothesis, we investigated the relation between one component of MTT—namely, (...) episodic future thinking (EFT)—and narrative production skills by comparing the narratives uttered by 66 children with high-functioning autism spectrum disorder (ASD) with those produced by 66 children with typical development. EFT was assessed by administering a task with minimal narrative demands, whereas storytelling production skills were assessed by administering two narrative production tasks that required children to generate future or past episodes with respect to the target stimuli. The results showed that EFT skills were impaired only in a subgroup of children with ASD and that such subgroup performed significantly worse on the narrative production task than ASD participants with high EFT skills and participants with typical development. The practical and theoretical implications of these findings are discussed. (shrink)

Deficits in gestures act as early signs of impairment in social interaction and communication in children with autism spectrum disorder. However, the pieces of literature on atypical gesture patterns in ASD children are contradictory. This investigation aimed to explore the atypical gesture pattern of ASD children from the dimensions of quantity, communicative function, and integration ability; and its relationship with social ability and adaptive behavior. We used a semi-structured interactive play to evaluate gestures of 33 ASD children and (...) 24 typically developing children. And we evaluated the social ability, adaptive behavior, and productive language of ASD and TD children by using the Adaptive Behavior Assessment System version II and Chinese Communication Development Inventory. No matter the total score of CCDI was corrected or not, the relative frequency of total gestures, behavior regulation gestures, SI gestures, and joint attention gestures of ASD children were lower than that of TD children, as well as the proportion of JA gestures. However, there was no significant group difference in the proportion of BR and SI gestures. Before adjusting for the total score of CCDI, the relative frequency of gestures without vocalization/verbalization integration and vocalization/verbalization-integrated gestures in ASD children was lower than that in TD children. However, after matching the total score of CCDI, only the relative frequency of gestures without vocalization/verbalization integration was lower. Regardless of the fact that the total score of CCDI was corrected or not, the relative frequency and the proportion of eye-gaze-integrated gestures in ASD children were lower than that in TD children. And the proportion of gestures without eye-gaze integration in ASD children was higher than that in TD children. For ASD children, the social skills score in ABAS-II was positively correlated with the relative frequency of SI gesture and eye-gaze-integrated gestures; the total score of ABAS-II was positively correlated with the relative frequency of total gestures and eye-gaze-integrated gestures. In conclusion, ASD children produce fewer gestures and have deficits in JA gestures. The deficiency of integrating eye gaze and gesture is the core deficit of ASD children’s gesture communication. Relatively, ASD children might be capable of integrating vocalization/verbalization into gestures. SI gestures and the ability to integrate gesture and eye gaze are related to social ability. The quantity of gestures and the ability to integrate gesture with eye gaze are related to adaptive behavior.Clinical Trial Registration:www.ClinicalTrials.gov, identifier ChiCTR1800019679. (shrink)

This study evaluates the comprehension of generalized conversational implicatures (GCI) in children with and without autism spectrum disorder (ASD), using a GCI test constructed based on the Levinson model, which distinguishes between three types of implicatures: type Q (or scalar: “what is not referred to does not occur”); type I (“by default, it is not necessary to say what can be assumed”); and type M (“if someone is expressing something in a not very simple or marked way, it (...) is because s/he is describing a situation that is not very typical, frequent, or prototypical”). In addition to the ASD group ( n = 22), two comparison groups were utilized: a group matched on chronological age with the ASD group, but with a higher linguistic age (TCD group, n = 22), and a group matched on linguistic age with the ASD group, but with a lower chronological age (TLD group, n = 22). In all cases, linguistic age was assessed with the Peabody test. The performance of the three groups on the GCI test was compared (overall and on each type of implicature), and performance on the three types of implicature was compared within each group. The ASD group obtained worse performance than the other two groups, both overall and for each implicature type, without also obtaining differences in performance on the three implicature types. The TCD group obtained better performance than the TLD group on overall performance, but not on each implicature type, and both groups obtained lower performance on the type M heuristics than on the type I. Based on these results, the children with ASD in our study presented limitations in the comprehension of the three types of GCI, but it was not possible to obtain evidence for an inferential continuum of the three types of GCI. However, in the two typical development groups, this evidence was obtained, leading us to propose an inferential continuum model based on the different levels of dependence on the context of each of the three types of implicatures, with type M implicatures being more contextually dependent. (shrink)

In contrast to mainstream accounts which explain the aesthetic experience of people with autism spectrum disorder (ASD) in terms of cognitive abilities, this paper suggests as an alternative explanation the “emotional abilities approach”. We present an example of a person with ASD who is able to exercise a variety of emotional abilities in aesthetic contexts but who has difficulties exhibiting their equivalents in interpersonal relations. Using an autobiographical account, we demonstrate first that there is at least one precedent (...) where a person with ASD can exercise a series of emotional abilities when engaging with art works. Second, we offer also an explanation about why aesthetic contexts might enable this person to exercise emotional abilities which in interpersonal contexts seem to be blocked. (shrink)

Introduction: There is significant overlap in the type of structural language impairments exhibited by children with autism spectrum disorder and children with attention deficit hyperactivity disorder. This similarity suggests that the cognitive impairment contributing to the structural language deficits in ASD and ADHD may be shared. Previous studies have speculated that procedural memory deficits may be the shared cognitive impairment. The procedural deficit hypothesis argues that language deficits can be explained by differences in the neural structures underlying the (...) procedural memory network. This hypothesis is based on the premise that the neural structures comprising the procedural network support language learning. In this study, we aimed to test the PDH in children with ASD, ADHD, and typical development.Methods: One hundred and sixty-three participants : 91 with ASD, 26 with ADHD, and 46 with TD, completed standardized measures of cognitive and language ability as well as structural magnetic resonance imaging. We compared the structural language abilities, the neural structures underlying the procedural memory network, and the relationship between structural language and neural structure across diagnostic groups.Results: Our analyses revealed that while the structural language abilities differed across ASD, ADHD, and TD groups, the thickness, area, and volume of the structures supporting the procedural memory network were not significantly different between diagnostic groups. Also, several neural structures were associated with structural language abilities across diagnostic groups. Only two of these structures, the inferior frontal gyrus, and the left superior parietal gyrus, are known to be linked to the procedural memory network.Conclusions: The inferior frontal gyrus and the left superior parietal gyrus, have well-established roles in language learning independent of their role as part of the procedural memory system. Other structures such as the caudate and cerebellum, with critical roles in the procedural memory network, were not associated with structural language abilities across diagnostic groups. It is unclear whether the procedural memory network plays a fundamental role in language learning in ASD, ADHD, and TD. (shrink)

Clinical reports suggest that children with autism spectrum disorder (ASD) struggle with time perception, but few studies have investigated this. This is the first study to examine these children’s understanding of before and after. These temporal conjunctions have been argued to require additional cognitive effort when conjoining two events in a clause order that is incongruent with their order in time. Given the suggested time perception impairment and well-established cognitive deficits of children with ASD, we expected them to (...) have difficulties interpreting temporal conjunctions, especially in an incongruent order. To investigate this, the interpretation of before and after in congruent and incongruent orders was examined in 48 children with ASD and 43 typically developing (TD) children (age 6–12). Additional tasks were administered to measure Theory of Mind (ToM), working memory (WM), cognitive inhibition, cognitive flexibility, IQ, and verbal ability. We found that children with ASD were less accurate in their interpretation of temporal conjunctions than their TD peers. Contrary to our expectations, they did not have particular difficulties in an incongruent order. Furthermore, older children showed better overall performance than younger children. The difference between children with ASD and TD children was explained by WM, ToM, IQ, and verbal ability, but not by cognitive inhibition and flexibility. These cognitive functions are more likely to be impaired in children with ASD than in TD children, which could account for their poorer performance. Thus, the cognitive factors found to affect the interpretation of temporal language in children with ASD are likely to apply in typical development as well. Sufficient WM capacity and verbal ability may help children to process complex sentences conjoined by a temporal conjunction. Additionally, ToM understanding was found to be related to children’s interpretation of temporal conjunctions in an incongruent order, indicating that perspective taking is required when events are presented out of order. We conclude from this that perspective-taking abilities are needed for the interpretation of temporal conjunctions, either to shift one’s own perspective as a hearer to another point in time, or to shift to the perspective of the speaker to consider the speaker’s linguistic choices. (shrink)

This study explores the emergence and productivity of word order usage in Mandarin-speaking typically-developing children and children with autism spectrum disorder, and examines how this emergence relates to frequency of use in caregiver input. Forty-two caregiver-child dyads participated in video-recorded 30-min semi-structured play sessions. Eleven children with ASD were matched with 10 20-month-old TD children and another 11 children with ASD were matched with 10 26-month-old TD children, on expressive language. We report four major findings: Preschool Mandarin-speaking children (...) with ASD produced word order structures with pervasive ellipsis at similar rates to language-matched TD children, but also displayed differences from TD children in their usage of SVt and VtO frames; Grammatical productivity was observed in both TD children and children with ASD; moreover, children with ASD with higher expressive language produced less stereotyped language; Both TD children and children with ASD heard a range of word orders in their caregivers’ input, with TD children’s input greater in amount and complexity; however, caregivers of both groups also showed no age/language-related changes in word order usage; Few word-order-specific correlations emerged between caregivers and their children; however, strong correlations were observed for mean length of utterances for both groups: Caregivers who produced longer/more complex utterances had children who did the same. Taken together, it seems that despite their pragmatic deficits, the early grammatical knowledge of word order in Mandarin-exposed children with ASD is well preserved and in general follows the typical developmental pattern. Moreover, caregiver input is broadly rather than finely tuned to the linguistic development of TD children and children with ASD, and plays a more important role in children’s general syntactic development than in specific word order acquisition. Thus, early word order usage in preschool Mandarin-speaking TD children and children with ASD may be influenced by both caregiver input and child abilities. (shrink)

Unregulated patient treatments and approved clinical trials have been conducted with haematopoietic stem cells and mesenchymal stem cells for children with autism spectrum disorder. While the former direct-to-consumer practice is usually considered rogue and should be legally constrained, regulated clinical trials could also be ethically questionable. Here, we outline principal objections against these trials as they are currently conducted. Notably, these often lack a clear rationale for how transplanted cells may confer a therapeutic benefit in ASD, and thus, (...) have ill-defined therapeutic outcomes. We posit that ambiguous and unsubstantiated descriptions of outcome from such clinical trials may nonetheless appeal to the lay public as being based on authentic scientific findings. These may further fuel caregivers of patients with ASD to pursue unregulated direct-to-consumer treatments, thus exposing them to unnecessary risks. There is, therefore, a moral obligation on the part of those regulating and conducting clinical trials of stem cell-based therapeutic for ASD minors to incorporate clear therapeutic targets, scientific rigour and reporting accuracy in their work. Any further stem cell-based trials for ASD unsupported by significant preclinical advances and particularly sound scientific hypothesis and aims would be ethically indefensible. (shrink)

The purpose of this study is to assess the intention of typically developing peers towards learning in the classroom with students with Autism Spectrum Disorder. In developing countries, such as Ghana, the body of literature on the relationship between students with disabilities and typically developing peers has been sparsely studied. Using Ajzen's theory of planned behaviour as a theoretical framework for this study, 516 typically developing students completed four scales representing belief constructs, attitudes, subjective norms, and perceived behavioural (...) controls, hypothesised to predict behavioural intention. The data were subjected to a t-test, analysis of variance, and structural equation modelling. The modelling confirmed the combining ability of attitude, subjective norms, and perceived behavioural controls to predict intention. We conclude by revealing the need for policymakers to consider designing programmes aimed towards promoting social relationships between students with ASD and typically developing peers. (shrink)

Arousal is one of the dimensions of core affect and frequently used to describe experienced or observed emotional states. While arousal ratings of facial expressions are collected in many studies it is not well understood how arousal is displayed in or interpreted from facial expressions. In the context of socioemotional disorders such as Autism Spectrum Disorder, this poses the question of a differential use of facial information for arousal perception. In this study, we demonstrate how automated face-tracking (...) tools can be used to extract predictors of arousal judgments. We find moderate to strong correlations among all measures of static information on one hand and all measures of dynamic information on the other. Based on these results, we tested two measures, average distance to the neutral face and average facial movement speed, within and between neurotypical individuals and individuals with autism. Distance to the neutral face was predictive of arousal in both groups. Lower mean arousal ratings were found for the autistic group, but no difference in correlation of the measures and arousal ratings could be found between groups. Results were replicated in an high autistic traits group. The findings suggest a qualitatively similar perception of arousal for individuals with and without autism. No correlations between valence ratings and any of the measures could be found, emphasizing the specificity of our tested measures. Distance and speed predictors share variability and thus speed should not be discarded as a predictor of arousal ratings. (shrink)

Recent research has pointed to the importance of the prenatal environment in the etiology of autism spectrum disorder (ASD) but the biological mechanisms which mitigate these environmental factors are not clear. Mitochondrial metabolism abnormalities, inflammation and oxidative stress as common physiological disturbances associated with ASD. Network analysis of the scientific literature identified several leading prenatal environmental factors associated with ASD, particularly air pollution, pesticides, the microbiome and epigenetics. These leading prenatal environmental factors were found to be most associated (...) with inflammation, followed by oxidative stress and mitochondrial dysfunction. Other prenatal factors associated with ASD not identified by the network analysis were also found to be significantly associated with these common physiological disturbances. A better understanding of the biological mechanism which mediate the effect of prenatal environmental factors can lead to insights of how ASD develops and the development of targeted therapeutics to prevent ASD from occuring. (shrink)

BackgroundThere is much overlap among the symptomology of autistic spectrum disorders, obsessive compulsive disorders, and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health.AimThis study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging.MethodologyThe data involved electrocardiogram heart rate variability and questionnaire data. In total, 1,089 participant's data of ECG recordings (...) of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale ; Toronto Alexithymia Scale 20 ; Acceptance and Action Questionnaire ; Depression, Anxiety, and Stress Scale 21 ; Multi-dimensional Assessment of Interoceptive Awareness Scale ; and the Self-as-Context Scale.ResultsHeart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception.ConclusionThe results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model. Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame. (shrink)

Students with autism spectrum disorder are accessing college in increasing numbers. Within this cohort are students who are twice exceptional—those who are both academically talented and diagnosed with ASD. Little is known about factors and experiences that impact their successful transition to college. Parents play a critical role in the secondary transition process, but currently, there is a paucity of research that examines their perceptions of this experience. This study presents the results of semi-structured interviews with the parents (...) of 10 college students with ASD who were enrolled in postsecondary institutions in the United States. The parents provided perceptions of their student’s best and most challenging aspects of high school, as well as of the transition preparation the student received. Suggestions were offered in regard to how transition services can be improved for this group of students. Implications for planning and practice are presented. (shrink)