Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-19T21:58:42.185Z Has data issue: false hasContentIssue false

Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism

Published online by Cambridge University Press:  19 June 2018

Vikram K. Jaswal
Affiliation:
Department of Psychology, University of Virginia, Charlottesville, VA 22904-4400. jaswal@virginia.eduhttp://www.jaswallab.org
Nameera Akhtar
Affiliation:
Psychology Department, University of California, Santa Cruz, Santa Cruz, CA 95064. nakhtar@ucsc.eduhttp://people.ucsc.edu/~nakhtar/
Get access
Rights & Permissions [Opens in a new window]

Abstract

Progress in psychological science can be limited by a number of factors, not least of which are the starting assumptions of scientists themselves. We believe that some influential accounts of autism rest on a questionable assumption that many of its behavioral characteristics indicate a lack of social interest – an assumption that is flatly contradicted by the testimony of many autistic people themselves. In this article, we challenge this assumption by describing alternative explanations for four such behaviors: (a) low levels of eye contact, (b) infrequent pointing, (c) motor stereotypies, and (d) echolalia. The assumption that autistic people's unusual behaviors indicate diminished social motivation has had profound and often negative effects on the ways they are studied and treated. We argue that understanding and supporting autistic individuals will require interrogating this assumption, taking autistic testimony seriously, considering alternative explanations for unusual behaviors, and investigating unconventional – even idiosyncratic – ways in which autistic individuals may express their social interest. These steps are crucial, we believe, for creating a more accurate, humane, and useful science of autism.

Type
Target Article
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

The way people see autistic folks is that they don't want to be around other people. That's wrong. The truth about autistic people is that we want what everyone else wants, but we are sometimes misguided and don't know how to connect with other people.

Owen Suskind (quoted in R. Suskind Reference Suskind2014, p. 366)

1. Introduction

AutisticFootnote 1 people behave in unusual ways. Sometimes they do things that non-autistic people do not regularly do, like flick their fingers in front of their eyes (Goldman et al. Reference Goldman, Wang, Salgadd, Greene, Kim and Rapin2009) or repeatedly recite dialogue from movies or television shows (Gernsbacher et al. Reference Gernsbacher, Morson and Grace2016). Sometimes they fail to do things that non-autistic people regularly do, like engage in sustained eye contact (Senju & Johnson Reference Senju and Johnson2009a) or point with their index finger to draw attention to an object or event (Baron-Cohen Reference Baron-Cohen1989).

One way to interpret many of the behavioral differences between autistic and non-autistic people is that autistic people are not interested in other people: If you expect socially interested people to behave in certain ways (e.g., to engage in eye contact), you might infer that someone who does not do so (or who does so infrequently) is aloof and uninterested. This inference is evident in some lay characterizations of autistic people as “perfectly happy within themselves” and “confined in their own world” (Huws & Jones Reference Huws and Jones2010, p. 339). It is also evident in some scientific accounts of autism, where autistic behavior has been seen as signaling a “powerful desire for aloneness” (Kanner Reference Kanner1943, p. 249), “little or no social interest” (Grelotti et al. Reference Grelotti, Gauthier and Schultz2002, p. 214), and “an aversion to social stimuli” (Helt et al. Reference Helt, Kelley, Kinsbourne, Pandey, Boorstein, Herbert and Fein2008, p. 353). Some scientists have argued that autism “can be construed as an extreme case of diminished social motivation” (Chevallier et al. Reference Jones, Quigney and Huws2012b, p. 231).

Indeed, the belief that many of autistic people's unusual behaviors reflect diminished social interest is central to social motivation accounts of autism (e.g., Abrams et al. Reference Abrams, Lynch, Chen, Phillips, Supekar, Ryali, Uddin and Menon2013; Chevallier et al. Reference Jones, Quigney and Huws2012b; Dawson Reference Dawson2008; Klin et al. Reference Klin, Jones, Schultz and Volkmar2003; Kohls et al. Reference Kohls, Chevallier, Troiani and Schultz2012; Mundy Reference Mundy2016). On these accounts, because of differences in the reward circuitry of the brain, autistic people do not find social stimuli to be as rewarding as non-autistic people do (Kohls et al. Reference Kohls, Chevallier, Troiani and Schultz2012). As a result, they are less likely to behave in socially interested ways: They are less likely to (a) orient toward, (b) seek out and enjoy, or (c) attempt to maintain relations with other people (Chevallier et al. Reference Jones, Quigney and Huws2012b). These behavioral differences can alter the interactions autistic children and adults have with other people. Altered interactions may deprive autistic children of the kinds of experiences thought to be necessary for typical language and social development, and they may deprive autistic children and adults of opportunities to develop strong social relationships, which have important mental and physical health benefits (e.g., Baumeister & Leary Reference Baumeister and Leary1995; Holt-Lunstad et al. Reference Holt-Lunstad, Smith and Layton2010).

There is no doubt that many autistic people do not seem by conventional standards to be as interested in the social world as many non-autistic people seem to be.Footnote 2 Indeed, atypical social behavior constitutes part of the diagnostic criteria for autism (American Psychiatric Association 2013). There is also evidence that autistic people may process rewards differently from non-autistic people (see sect. 6; for reviews, see Bottini Reference Bottini2018; Clements et al. Reference Clements, Zoltowski, Yankowitz, Yerys, Schultz and Herrington2018) and that they may have fewer and lower quality friendships (e.g., Billstedt et al. Reference Billstedt, Gillberg and Gillberg2011; Kasari et al. Reference Kasari, Locke, Gulsrud and Rotheram-Fuller2011; but see Petrina et al. Reference Petrina, Carter, Stephenson and Sweller2017). But the fundamental assumption underlying social motivation accounts of autism – that some of autistic people's unusual behaviors reflect diminished social motivation or interest (we use the two terms interchangeably) – is problematic for at least three reasons.

First, it is contradicted by the testimony of a number of autistic people themselves (see the appendix). As the quotation from Owen Suskind that opens this article makes clear, someone can appear uninterested in the social world but long to be a part of it. Second, it ignores the fact that explanations unrelated to social motivation are possible for many of autistic people's unusual behaviors. Third, it misconstrues social motivation as residing within an individual when it is more appropriately understood as arising from a dynamic interaction between the individual and how others perceive and react to that individual. I may perceive another person's behavior – say, sidelong glances toward me or use of my hand to open a door – as indicating social interest, and you may not. Who is right? Is that person socially motivated?

Assuming that people are not socially motivated when in fact they are can have devastating consequences. If you misinterpret the behavior of autistic persons as indicating that they are not interested in interacting with you, it can affect the way in which (and even whether) you interact with them. This, in turn, may undermine their motivation to engage with you, which will confirm your beliefs about their lack of interest, thus resulting in a self-fulfilling prophecy. Furthermore, being socially motivated is considered by some to be an essential part of being human (Baumeister & Leary Reference Baumeister and Leary1995; Tomasello Reference Tomasello2014); proposing that deficits in social motivation “ought to appear in all or nearly all individuals with ASD [autism spectrum disorder]” (Chevallier et al. Reference Jones, Quigney and Huws2012b, p. 236) effectively dehumanizes autistic individuals (Gernsbacher Reference Gernsbacher2007a).

In this article, we challenge the assumption that some common behavioral differences between autistic and non-autistic people necessarily reflect a deficit in social motivation. We begin by presenting alternative explanations unrelated to social motivation for four of these differences. We next describe some of the unintended, negative effects the social motivation perspective has had on research and intervention efforts in autism. Finally, we consider the possibility that autistic people may show their desire to engage with other people in unconventional ways.

In making our case, we draw on both quantitative and qualitative sources. Like a number of others, we believe that autistic people represent an essential, but surprisingly underused, source of insight into autism (e.g., Friedner & Block Reference Friedner and Block2018; Gernsbacher Reference Gernsbacher2007b; Nicolaidis et al. Reference Nicolaidis, Raymaker, McDonald, Dern, Ashkenazy, Boisclair, Robertson and Baggs2011; Pellicano & Stears Reference Pellicano and Stears2011). The perspectives of autistic people are rarely included in scientific accounts that make claims about their social interest or motivation even though they are the ones most affected by this research. We recognize that there are limits on introspection (e.g., Wilson Reference Wilson2002), and some scientists have cautioned against taking “at face value” autistic (and non-autistic) self-reports (Frith & Happé Reference Frith and Happé1999, p. 18; Happé Reference Happé and Frith1991; O'Neill & Jones Reference O'Neill and Jones1997). However, if an autistic person expresses a desire to connect with other people – as many autistic people so clearly do (see the appendix) – it seems perverse not to take that testimony seriously, a courtesy we certainly extend to non-autistic people who express the same sentiment. This, in turn, compels us to search for alternatives for why they behave in ways that are sometimes interpreted to mean they are not socially interested. Autistic people's self-reports provide a valuable data point in this endeavor and, at the least, a starting point for additional research. We provide further discussion of our use of autistic testimony in section 3.

Before beginning, it is important to note that social motivation accounts represent just one class of several theories of autism; not all theories make the assumption that autistic individuals have inherent deficits in social motivation (e.g., Baron-Cohen Reference Baron-Cohen1995; Happé & Frith Reference Happé and Frith2006; Hill Reference Hill2004; Mottron et al. Reference Mottron, Dawson, Soulières, Hubert and Burack2006; Pellicano & Burr Reference Pellicano and Burr2012). However, many early intervention programs do make this assumption. For example, the Early Start Denver Model is designed to “make social relationships more rewarding for the child, thereby improving the child's social motivation” (Webb et al. Reference Webb, Jones, Kelly and Dawson2014, p. 39). According to the authors of another popular intervention called Pivotal Response Training (PRT), “at its core, PRT aims to improve social motivation” (Bradshaw et al. Reference Bradshaw, Koegel and Koegel2017, p. 2444). The primary way in which most early intervention programs attempt to improve social motivation is by trying to increase the frequency of behaviors that are conventionally interpreted as indicating social motivation (Mottron Reference Mottron2017). Additionally, a recent study designed to inform interventions to improve social functioning in autistic adults “highlight[ed] the importance of targeting social motivation in treatment” (Pallathra et al. Reference Pallathra, Calkins, Parish-Morris, Maddox, Perez, Miller, Gur, Mandell, Schultz and Brodkin2018, p. 10). Thus, the influence of the social motivation perspective on the treatment of autistic people has been and continues to be profound even as its core assumption is questionable. To be clear, we are not offering a new theory of autism in this article; rather, we are interrogating an influential approach to studying and intervening in autism.

2. Alternative explanations for behaviors commonly interpreted as indicating diminished social motivation in autism

Behavior is only an imperfect index of what someone is thinking or feeling (for a review, see Gilbert & Malone Reference Gilbert and Malone1995). Although observers tend to assume a one-to-one correspondence between the two – a smile indicating happiness, for example, and a frown indicating sadness – there is no necessary relation between them. People regularly behave in ways that we later learn were not consistent with how they were thinking or feeling. They may do so deliberately, as when they smile despite feeling sad, or they may do so for reasons that are beyond their control. For example, people with Parkinson's disease may speak slowly and repeat themselves (e.g., Benke et al. Reference Benke, Hohenstein, Poewe and Butterworth2000). Members of Western, middle-class cultures expect adult conversational partners to respond promptly and to make their contributions to conversations unambiguous and relevant (Grice Reference Grice, Cole and Morgan1975). An uninformed interlocutor therefore might infer that someone with Parkinson's who regularly violates these (and perhaps other) conventions is socially aloof and/or uninterested in conversation. But that inference would be based entirely on interpretations of behaviors over which the individual has no control.

Autism is a neurological condition with widespread effects, including in attentional, perceptual, and sensorimotor systems (e.g., Burack et al. Reference Burack, Russo, Kovshoff, Palma Fernandes, Ringo, Landry and Iarocci2016; Leekam et al. Reference Leekam, Nieto, Libby, Wing and Gould2007; Mottron et al. Reference Mottron, Dawson, Soulières, Hubert and Burack2006). As we will show in this section, some behaviors that social motivation accounts of autism interpret as indicating a lack of social interest can occur because of factors unrelated to social motivation (see also Donnellan et al. Reference Donnellan, Hill and Leary2013). Some may occur deliberately, as when autistic people choose not to engage in eye contact so as to avoid the anxiety it produces, and some may occur involuntarily, as when they cannot control their repetitive hand movements. There may be different causes for the same unusual behavior across autistic individuals and even within the same individual at different points in time. But in any case and as we will describe, these unusual behaviors do not have any necessary relation to social motivation, and some may constitute adaptive responses to the unique circumstances of being autistic.

We focus on four behavioral differences between autistic and non-autistic individuals: reduced levels of both eye contact and pointing as well as increased levels of both motor stereotypies and echolalic speech. We chose these four differences because they are well established in the literature and because they map onto the three categories of behavioral manifestations of social motivation proposed by Chevallier et al. (Reference Jones, Quigney and Huws2012b): Socially motivated people are expected to (a) orient toward others by engaging in behaviors like sustained eye contact; (b) seek out opportunities to share experiences with others by, for example, pointing to interesting objects or events; and (c) maintain and enhance relationships with others by, for example, refraining from behaviors that could be stigmatizing (e.g., motor stereotypies and echolalia).

2.1. Low levels of eye contact

People look each other in the eye for a variety of social reasons – to acknowledge each other, communicate emotion, and coordinate visual attention.Footnote 3 Autistic people tend to engage in eye contact much less frequently than non-autistic people. Indeed, in infancy, reduced eye contact is one of the features that distinguishes infants who are later diagnosed with autism from those who are not (Elsabbagh & Johnson Reference Elsabbagh and Johnson2010; Oner et al. Reference Oner, Oner and Munir2014; Zwaigenbaum et al. Reference Zwaigenbaum, Bryson, Rogers, Roberts, Brian and Szatmari2005). One explanation for why autistic children and adults infrequently engage in eye contact is that they are not motivated to do so. For example, Chevallier et al. (Reference Jones, Quigney and Huws2012b) describe “a spontaneous disinterest in mutual gaze” (p. 235) as part of a suite of behaviors that indicate “diminished social orienting” (p. 231), which is in turn taken to indicate diminished social motivation. But there are alternatives to this social explanation.

Although sustained eye contact is often assumed to be a universal behavior among non-autistic people, there are striking cultural differences in the extent to which individuals engage in it (LeVine et al. Reference LeVine, Dixon, LeVine, Richman, Leiderman, Keefer and Brazelton1994). For example, among the Gusii of Kenya, “conventions of adult conversation involve much less mutual gaze” than among Westerners (Richman et al. Reference Richman, Miller and LeVine1992, p. 617). Among the Navajo, “looking someone in the eye while they are speaking is a form of rudeness and causes the Navajo speaker considerable discomfort” (Connors & Donnellan Reference Connors and Donellan1993, p. 273). Similarly, in China, direct eye contact was historically not common because it was considered “rude and arrogant” (Zhang et al. Reference Zhang, Wheeler and Richey2006, p. 112). Despite the fact that eye contact is less common in some other cultures, no one would propose that members of those cultures have diminished social motivation.

There are also cultural differences in the amount of eye contact between non-autistic mothers and infants. For example, Richman et al. (Reference Richman, Miller and LeVine1992) compared naturally occurring social interactions between Gusii mothers and their infants with those between suburban American mothers and their infants. For the American mothers, the most common category of social behavior directed toward their 10-month-old infants was “looking.” In contrast, the most common category of social behavior for the Gusii mothers was “touching”; “looking” was fourth of the five categories coded. We doubt that Gusii mothers are less interested in connecting with their infants than American mothers. Rather, as LeVine (Reference LeVine, Gielen and Roopnarine2004) has suggested, other behaviors, like touching and holding, may be “functionally equivalent to the verbal and visual engagement of Americans” (p. 161). This is a crucial point that is frequently acknowledged in cross-cultural comparisons but rarely in the autism literature: There are multiple ways to communicate social engagement (see sect. 5); gaze aversion may be a useful diagnostic marker for autism in Western cultures (Norbury & Sparks Reference Norbury and Sparks2013), but it does not necessarily indicate social aversion (Akhtar & Gernsbacher Reference Akhtar and Gernsbacher2008; Gernsbacher et al. Reference Gernsbacher, Stevenson, Khandakar and Goldsmith2008b).

In fact, looking away from another person's eyes has been shown to have several adaptive functions in non-autistic individuals. In early infant-caregiver interactions, for example, when infants become overstimulated, they often look away, which leads to lowered heart rates (Field Reference Field1981). In some cultures, caregivers avert their gaze when their infants are upset as a means of calming them (Dixon et al. Reference Dixon, Tronick, Keefer, Brazelton, Field, Sostek, Vietze and Leiderman1981). Doherty-Sneddon and Phelps (Reference Doherty-Sneddon and Phelps2005) argue that, because maintaining mutual gaze consumes processing resources, gaze aversion can help manage cognitive load: Non-autistic adults avert gaze when solving difficult problems (Glenberg et al. Reference Glenberg, Schroeder and Robertson1998), and training young children to avert gaze can improve their performance on cognitively demanding tasks (Phelps et al. Reference Phelps, Doherty-Sneddon and Warnock2006).

For autistic individuals too, both experimental evidence and first-person accounts suggest that gaze aversion can confer adaptive benefits. For example, in a classic study, Klin et al. (Reference Klin, Jones, Schultz, Volkmar and Cohen2002) showed autistic adolescents clips from the film Who's Afraid of Virginia Woolf and measured what they looked at and for how long. There was no relation between the amount of time they spent looking at the actors’ eyes and measures of social competence; however, the more time they spent looking at the actors’ mouths, the better was their social competence. Klin et al. argued that social information conveyed through speech may be easier for some autistic individuals to interpret than social information conveyed through the eyes. Concentrating visual attention on the channel that produces the social information they find most interpretable (i.e., the mouth) may help them gain a better understanding of the social world (see also Rice et al. Reference Rice, Moriuchi, Jones and Klin2012).

In fact, some autistic people say that they avoid looking at a speaker's face altogether to concentrate on what they are saying. For example, one autistic informant in Robledo et al. (Reference Robledo, Donnellan and Strand-Conroy2012) explained, “I can hear a person better if I don't look at their face … So, when I'm making an effort to listen, I'm not making an effort to look, so sometimes when I'm listening to somebody I might look away from them, but I might turn my ear toward them” (p. 5). This is consistent with the autistic self-advocate Kedar's (Reference Kedar2012) explanation for why he does not commonly engage in eye contact: “I can listen better if I don't look at the person” (p. 49).

Another reason many autistic individuals avoid eye contact is because they find it uncomfortable. It “feels a bit creepy, so I tend to avoid it” (Higashida Reference Higashida2013, p. 25); “I can look but it's not pleasant” (Kedar Reference Kedar2012, p. 49); doing so feels “strange and uncomfortable” (Tammet Reference Tammet2006, p. 75); and “It is painful for me to look people in the eye” (Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012, p. 5) (for several additional first-person accounts, see McGlensey Reference McGlensey2016). Rather than indicating a lack of social interest, gaze aversion may be a strategy that some autistic people use to focus or to reduce or avoid stress.

There may be circumstances where learning to engage in eye contact more frequently can be beneficial (see sect. 4.2). But for now, the important point is that relatively low levels of eye contact do not necessarily signal a lack of social interest; in fact, gaze aversion is used adaptively by both autistic and non-autistic individuals to manage affective and cognitive resources.

2.2. Infrequent declarative pointing

Autistic children point less often than non-autistic children (e.g., Mundy et al. Reference Mundy, Sigman, Ungerer and Sherman1986), a behavioral difference that is sometimes interpreted as indicating that autistic toddlers lack the motivation to share experiences with others. In this section, we describe weaknesses with this social motivation interpretation of reduced pointing in autism and discuss alternative explanations.

Non-autistic children begin pointing with their index finger around 12 months of age (e.g., Bates et al. Reference Bates, Camaioni and Volterra1975; Camaioni Reference Camaioni1997; Carpenter et al. Reference Carpenter, Nagell and Tomasello1998; Liszkowski et al. Reference Liszkowski, Brown, Callaghan, Takada and de Vos2012). Researchers have traditionally suggested that infants are motivated to point for two primary reasons: to obtain things (“proto-imperatives”) and to share experiences with someone (“proto-declaratives”). For example, an infant may point to a desirable toy because she wants it; in this case, obtaining the toy is the goal and the adult is merely the means to that goal. Or an infant may point to a helicopter overhead to direct the adult's attention to that interesting event; in this case, sharing the experience with the adult is the goal and the helicopter is the means to that goal (Bates et al. Reference Bates, Camaioni and Volterra1975; Brinck Reference Brinck2004).

Declarative points are generally considered to be more socially, cognitively, and communicatively sophisticated than imperative points are. Someone who points to share an experience is assumed to be (1) motivated to inform the addressee of something interesting and (2) sensitive to whether the addressee has registered the intended message. For example, typically developing 12-month-old infants in one study pointed more at an interesting event (e.g., a puppet popping out of a display) if the experimenter expressed positive emotion toward the infant but did not actually look at what the infants were pointing to than if she expressed positive emotion and looked (Liszkowski et al. Reference Liszkowski, Carpenter, Henning, Striano and Tomasello2004). These kinds of findings suggest that infants who engage in declarative pointing do so because they want to affect their addressee's attentional state – specifically, they want them to notice something the infant finds interesting or noteworthy (e.g., Baron-Cohen Reference Baron-Cohen1989; Bates Reference Bates1976; Camaioni Reference Camaioni1997).

Imperative points, in contrast to declarative points, are viewed as purely instrumental (e.g., Baron-Cohen Reference Baron-Cohen1989; Camaioni Reference Camaioni1997). To produce imperative points, some understanding of others as causal agents – as individuals who can be directed to carry out desired actions – may be necessary. But the assumption is that imperative gestures can be produced for no purpose other than obtaining a desired object; affecting the mental state of the addressee is not the primary goal (but see Grosse et al. Reference Grosse, Behne, Carpenter and Tomasello2010; Shwe & Markman Reference Shwe and Markman1997).

It is commonly asserted that autistic children point to obtain things, but not to share experiences. For example, DeMarchena and Eigsti (Reference DeMarchena and Eigsti2014) write that “protodeclarative pointing is reduced in young children with ASD, while protoimperative pointing is not” (p. 375). Camaioni (Reference Camaioni1997) writes, “children with autism have severe difficulties in producing … declarative, but not imperative, pointing” (p. 222). And Whalen and Schreibman (Reference Whalen and Schreibman2003) have suggested that autistic children are “profoundly impaired” on declarative pointing, but not on imperative pointing (p. 456). If autistic children do point imperatively but not declaratively, it would be consistent with the assumption that they lack the motivation to share experiences with other people (Chevallier et al. Reference Jones, Quigney and Huws2012b; Liszkowski Reference Liszkowski2005). The logic is as follows: Because they point imperatively (and, perhaps, to direct their own attention; Goodhart & Baron-Cohen Reference Goodhart and Baron-Cohen1993), they are capable of producing the pointing gesture when they are motivated to do so; their failure to point declaratively must therefore be due to reduced motivation to share experiences with others.

But there are both empirical and theoretical problems with this line of reasoning. As noted earlier, there is no doubt that as a group, autistic children point less frequently than non-autistic children (e.g., Mundy et al. Reference Mundy, Sigman, Ungerer and Sherman1986). But the data on the dissociation between imperative and declarative pointing are not nearly as conclusive as they are sometimes made out to be. Specifically, an autistic child who does not point declaratively also tends not to point imperatively. For example, in one highly cited study (Baron-Cohen Reference Baron-Cohen1989, Experiment 3), 4 of the 10 autistic preschool-aged children observed during a 45-minute play session pointed imperatively but not declaratively, which is consistent with the notion that autistic children are uniquely impaired on declarative pointing. But the remaining 6 autistic children did not point at all, suggesting that pointing simply may not be a part of the behavioral repertoire for many or most young autistic children.

Similarly, in Baron-Cohen et al.’s (Reference Baron-Cohen, Cox, Baird, Swettenham, Nightingale, Morgan, Drew and Charman1996) report on the development of the Checklist for Autism in Toddlers (CHAT), 9 of the 10 parents of toddlers who were later diagnosed as autistic reported that their child did not engage in either type of pointing. Later work on the development of the Modified CHAT confirmed this finding (Robins et al. Reference Robins, Fein, Barton and Green2001): Parents of 82% of toddlers who later received a diagnosis of autism reported that their child did not point declaratively, and 72% reported their child did not point imperatively.Footnote 4 In short, autistic children as a group are not specifically impaired on declarative pointing, which undermines the claim that autistic children do not point declaratively because they are not interested in sharing experiences with other people.

An alternative explanation is that, as Gernsbacher and colleagues (Reference Gernsbacher, Stevenson, Khandakar and Goldsmith2008b) have argued, “it is the core act of pointing and its underlying motor demands rather than any deficit in intentionality or desire to share experience that underlies autistic children's lower frequency of [declarative] pointing” (p. 42). Indeed, autistic children and adults have well-documented and widely acknowledged difficulties with the planning, coordination, and execution of intentional movements in a variety of domains (e.g., Fournier et al. Reference Fournier, Hass, Naik, Lodha and Cauraugh2010; Glazebrook et al. Reference Glazebrook, Elliott and Szatmari2008; LeBarton & Iverson Reference LeBarton and Iverson2016; MacDonald et al. Reference MacDonald, Lord and Ulrich2014; Torres & Donnellan Reference Torres and Donnellan2015).

In firsthand accounts, too, autistic individuals describe occasionally or regularly experiencing a disconnect between a movement they would like to make and the movements they are actually able to make (e.g., Grandin Reference Grandin, Schopler and Mesibov1992; Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012; Williams Reference Williams1992). For example, an autistic 12-year-old explained his movement difficulties as follows: “I may wish to say something or do something. I can't get myself to move … It is confusing because I can initiate some things like eating or getting things in the house sometimes. I don't have an insight into this aspect of my illness. I just know it's there” (Kedar Reference Kedar2012, p. 63). At 13, the same child wrote of difficulties he had in getting his body to do what he wanted: “I am telling my hand to raise in class, or my feet to run, or my fingers to move on the piano, however they don't listen to me. Either they don't move, or they move badly. It's really rotten” (p. 101). Another autistic individual explained that, as a child, he “could not point at objects for many reasons. The most important reason is that I had very little sensation of my body” (Mukhopadhyay & Biklen Reference Mukhopadhyay, Biklen and Biklen2005, p. 133). Thus, some autistic children may have difficulty pointing because of motor and/or sensorimotor challenges, not because of a deficit in social motivation.

Furthermore, among autistic children who point, many do, in fact, point declaratively. For example, Mundy et al. (Reference Mundy, Sigman, Ungerer and Sherman1986) showed that although autistic preschoolers pointed less frequently overall in a standardized assessment than non-autistic children, the autistic children produced, on average, as many declarative as imperative points.Footnote 5 Additionally, in a study in which parents of autistic children were asked to rate the frequency of declarative pointing, more than 25% selected “a few times/week,” “a few times/day,” or “many times/day” (Allison et al. Reference Allison, Baron-Cohen, Wheelwright, Charman, Richler, Pasco and Brayne2008).Footnote 6 Given that many autistic children at least occasionally point declaratively, one cannot argue that they are not motivated to share experiences with others.

One could argue that because autistic children engage in declarative pointing less often than non-autistic children, they are less motivated to do so. But this neglects the previously mentioned motor challenges that may make pointing difficult for many autistic children. Furthermore, it is possible that autistic children are similarly motivated to share experiences, but that there are differences in the kinds of things they find interesting or worth sharing. For example, in one commonly used assessment of nonverbal communication (the Early Social Communication Scales; Mundy et al. Reference Mundy, Delgado, Block, Venezia, Hogan and Seibert2013), autistic toddlers are less likely than non-autistic toddlers to point declaratively at a moving wind-up toy or to pictures in a picture book. The behavioral difference is indisputable, but the social interpretation that is frequently offered – a lack of motivation to share experiences (e.g., Mundy Reference Mundy2016) – is disputable: It is possible that some autistic children simply do not find these toys or events as interesting as most non-autistic children do.

Some empirical support for this possibility comes from a study in which autistic children were less likely than non-autistic children both to engage in declarative communication about toys and to explore the toys themselves (O'Neill & Happé Reference O'Neill and Happé2000). This is consistent with reports from some autistic individuals, who describe focusing on and finding enjoyment in different things than non-autistic people. For example, one autistic adult wrote that “Lots of times I'm surprised by what other people said they saw and heard, because it is not what I saw and heard … I don't know why my head picks things to focus on, but I know it is usually not the same things other people pick to focus on” (Jones et al. Reference Jones, Quigney and Huws2003, p. 119; see also Rubin Reference Rubin and Biklen2005). As a 12-year-old, Kedar (Reference Kedar2012) explained, “I'm not entertained by the ordinary things that most people enjoy” (p. 45).

The production of declarative gestures, including pointing, has been linked to a number of positive language outcomes (for reviews, see Colonnesi et al. Reference Colonnesi, Stams, Koster and Noon2010; Goldin-Meadow Reference Goldin-Meadow2009). When a child points to an object, many parents in Western, middle-class families use it as an opportunity to offer the object's name (e.g., Goldin-Meadow et al. Reference Goldin-Meadow, Goodrich, Sauer and Iverson2007). Clearly, there can be benefits if a child and adult attend to the same referent when it is labeled (Tomasello & Farrar Reference Tomasello and Farrar1986). But as with eye contact, pointing is just one of several ways joint attention – a shared focus on the same object or event – can be achieved (Akhtar & Gernsbacher Reference Akhtar and Gernsbacher2007; Gernsbacher et al. Reference Gernsbacher, Stevenson, Khandakar and Goldsmith2008b), an issue we consider in more detail in section 5.

Although it is possible that the reduced frequency of declarative pointing in autistic children is somehow caused by a reduced motivation to share experiences, alternative explanations are possible, including differences in motor ability and in what they find worth sharing.

2.3. Elevated levels of motor stereotypies

Most autistic people engage in motor stereotypies: rhythmic, repetitive movements that (from a naïve observer's perspective) appear purposeless (Bodfish et al. Reference Bodfish, Symons, Parker and Lewis2000; Goldman et al. Reference Goldman, Wang, Salgadd, Greene, Kim and Rapin2009; Seltzer et al. Reference Seltzer, Krauss, Shattuck, Orsmond, Swe and Lord2003). For example, they might flap their hands or arms, rock their bodies, wiggle their fingers in front of their eyes, or spin objects.Footnote 7 Many non-autistic people also engage in motor stereotypies when anxious or bored, twirling their hair or a pencil, biting their nails, drumming their fingers, or tapping their feet. Motor stereotypies are also common early in typical development, where it is thought that they may help infants transition from uncoordinated motor activity to voluntary motor control (Thelen Reference Thelen1981). But whereas they are infrequent beyond the preschool years in most non-autistic children, they tend to persist or become more frequent among autistic children (Harrop et al. Reference Harrop, McConachie, Emsley, Leadbitter and Green2014; MacDonald et al. Reference MacDonald, Green, Mansfield, Geckeler, Gardenier, Anderson, Holcomb and Sanchez2007). In MacDonald et al. (Reference MacDonald, Green, Mansfield, Geckeler, Gardenier, Anderson, Holcomb and Sanchez2007), for example, 2- and 4-year-old non-autistic children were observed engaging in motor stereotypies, on average, for 4.8% and 2.1%, respectively, of a 10-minute sample; in autistic children, the average percentages were 6.9% and 20.2%.

When as much as one-fifth of an autistic child's time is spent engaging in behaviors that appear meaningless to many observers, questions arise about whether that time would be better spent doing other things. Repetitive behaviors in autism have been called “debilitating” (South et al. Reference South, Ozonoff and McMahon2005, p. 155), “disrupting” (Goldman et al. Reference Goldman, Wang, Salgadd, Greene, Kim and Rapin2009, p. 36), a “prominent impairment to the daily life of affected individuals” (Langen et al. Reference Langen, Durston, Kas, van Engeland and Staal2011, p. 356), and a “major barrier to learning” (Leekam et al. Reference Leekam, Prior and Uljarević2011, p. 562). Additionally, because motor stereotypies look odd (Smith & Van Houten Reference Smith and Van Houten1996), they can be a source of social stigma (Cunningham & Schreibman Reference Cunningham and Schreibman2008).Footnote 8 For these reasons, reducing or eliminating them is an explicit goal for many clinicians, teachers, and parents (e.g., Lanovaz et al. Reference Lanovaz, Robertson, Soerono and Watkins2013; Rapp & Lanovaz Reference Rapp and Lanovaz2014; Rapp & Vollmer Reference Rapp and Vollmer2005).

The cause of motor stereotypies in autism is unknown, but one proposal suggests that it may be related to a lack of social motivation in infancy. In a recent review, Leekam et al. (Reference Leekam, Prior and Uljarević2011) noted that non-human animals raised in restricted or deprived environments can develop stereotyped motor movements, such as pacing, body rocking, and compulsive grooming (e.g., Lewis et al. Reference Lewis, Tanimura, Lee and Bodfish2007). They suggested that autistic infants may also suffer from a restricted environment, specifically, a “self-imposed” restricted environment caused by their “extreme social withdrawal” (p. 577). According to Leekam et al., this restricted environment could have a number of cascading effects, including the development of motor stereotypies (see also Schultz Reference Schultz2005).

But the link between perceived social withdrawal and motor stereotypies is tenuous at best. Among autistic toddlers and young children, the level of impairment in the social domain (as measured by observation and parent report of conventionally expected social behaviors) is not correlated with the frequency of repetitive and restricted behaviors (RRBs), the umbrella category of behaviors of which motor stereotypies are a part (Harrop et al. Reference Harrop, McConachie, Emsley, Leadbitter and Green2014). A large population-based study investigating autistic-like traits reported very low correlations (0.1–0.3) between social impairments and RRBs in 7- to 9-year-old children, even when considering only those with extreme scores (Happé & Ronald Reference Happé and Ronald2008).

Furthermore, when Leekam et al. (Reference Leekam, Prior and Uljarević2011) suggest that the ultimate cause of motor stereotypies could be autistic infants’ “extreme social withdrawal” (p. 577), the implication is that these infants are not motivated to interact with people. Leekam et al. do not describe the particular behaviors they believe constitute evidence for extreme social withdrawal in infancy, but we imagine they might include things that are also routinely interpreted as indicating diminished social motivation (e.g., failing to engage in sustained eye contact, not responding when called by name, not actively seeking out adult interaction). As we have been arguing, however, explanations unrelated to social interest are possible for these kinds of behaviors. An infant may be perceived as lacking in social interest, but this does not necessarily mean that the infant actually is lacking in social interest (see sect. 5).

Lack of social motivation has also been implicit in some explanations for why motor stereotypies persist. Many scientists and clinicians believe that motor stereotypies can be brought under voluntary control (e.g., Rapp & Vollmer Reference Rapp and Vollmer2005), and individuals who do not learn to suppress them are sometimes thought to lack the motivation to do so (Miller et al. Reference Miller, Singer, Bridges and Waranch2006). The underlying assumption seems to be that individuals who want to connect with other people would not engage in apparently meaningless behaviors that can cause others to ostracize them. Although some autistic individuals have described using stereotypies because they want to be left alone (Joyce et al. Reference Joyce, Honey, Leekam, Barrett and Rodgers2017), others have reported that they simply cannot control these movements even though they would like to (e.g., Fleischmann & Fleischmann Reference Fleischmann and Fleischmann2012; Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012; Tammet Reference Tammet2006). As one autistic informant explained, “I want to stop doing anything that doesn't look normal” (Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012, p. 6).

For some autistic people, motor stereotypies can serve important self-regulatory and even communicative functions. For example, one informant explained that “one of my most interesting and prevalent repetitive behaviors (stims, ‘stereotypies’) is rubbing objects (e.g., door knobs) because of the unpleasant sensations they leave on my hands – I keep trying to ‘rub’ the touch off” (Jones et al. Reference Jones, Quigney and Huws2003, p. 118). A study of autistic young adults found that many described engaging in stereotypies as a coping response to anxiety or uncertainty (Joyce et al. Reference Joyce, Honey, Leekam, Barrett and Rodgers2017), which is consistent with data showing a link between parent reports of their child's anxiety and parent and clinician measures of stereotyped behaviors (Sukhodolsky et al. Reference Sukhodolsky, Scahill, Gadow, Arnold, Aman, McDougle, McCracken, Tierney, White, Lecavalier and Vitiello2008). In terms of communication, Julia Bascom (Reference Bascom2011), executive director of the Autistic Self Advocacy Network, has explained that she expresses emotion through hand flapping: Friends “can ‘read’ my flapping better than my face … I wish everyone could look at my hands and see I need you to slow down or this is the best thing ever or can I please touch or I am so hungry I think my brain is trying to eat itself” (italics in original).

Non-autistic individuals can engage in motor stereotypies that look very similar to those produced by autistic individuals, but when they do, their behaviors are not assumed to reflect deficits in social motivation. For example, Harris et al. (Reference Harris, Mahone and Singer2008) studied 100 non-autistic children referred to a pediatric neurology movement-disorders clinic specializing in tic disorders. These children (on average, 8 years of age) were otherwise typically developing but engaged in many of the same kinds of stereotypies as autistic children (e.g., hand flapping, rocking), often multiple times a day, and sometimes for several minutes each time. Social motivation was not mentioned as a possible cause. The way in which the very same unusual repetitive motor movements are characterized “appears to depend more on the underlying diagnosis of the patients than the movements themselves” (Edwards et al. Reference Edwards, Lang and Bhatia2012, p. 181; see also Leary & Hill Reference Leary and Hill1996).

In one study offering a particularly compelling demonstration of how laypeople interpret motor stereotypies differently depending on diagnosis (Sperry & Symons Reference Sperry and Symons2003), mothers of young autistic children watched several 10-second home-movie clips of infants between the ages of 9 and 18 months and were asked to rate how intentional the infants’ behaviors were (i.e., “On a scale of 1–6, how much do the children mean to do what they are doing”; Feldman & Reznick Reference Feldman and Reznick1996). Half of the mothers were told that all of the children in the clips had a diagnosis of autism, and half were given no diagnostic information. Unbeknownst to the mothers, in fact, all of these infants had later received a diagnosis of autism. For clips showing a child engaged in stereotyped motor movements (e.g., arm flapping, leg kicking, body rocking), there was a striking effect of condition: Mothers who had been told that the infants were autistic rated the behavior shown in those clips as less intentional than mothers who had not been given any diagnostic information.

According to autistic individuals, some motor stereotypies are involuntary behaviors and some are intentional, and the same individual may engage in stereotypies for a number of different reasons. But engaging in them does not necessarily have anything to do with one's interest in connecting with other people.

2.4. Frequent echolalia

Echolalia involves the verbatim repetition of part or all of another's utterance and can include words and phrases that do not appear to be relevant in the current context. For example, on meeting a therapist for the first time, one young autistic child repeatedly exclaimed, “Got a splinter!” (Prizant Reference Prizant2015). It has been estimated that 75% of autistic children engage in echolalia (Rutter et al. Reference Rutter, Greenfield and Lockyer1967), and in the DSM-5, it is listed alongside motor stereotypies as an example of a restricted, repetitive pattern of behavior (American Psychiatric Association 2013). To a naïve interlocutor, these violations of conversational conventions can make it appear as though the individual's utterances are not communicative and that the individual is therefore not interested in social engagement or communication.

Because echolalic speech is so common in autism and can appear to be meaningless, it (like motor stereotypies) has been a target for behavioral interventions designed to reduce or eliminate it (for a review, see Neely et al. Reference Neely, Gerow, Rispoli, Lang and Pullen2016). Indeed, some have argued that echolalia is not just meaningless but actually problematic: Some have argued, for example, that repetitions of (apparently) irrelevant words and phrases interfere with language development (Valentino et al. Reference Valentino, Shillingsburg, Conine and Powell2012) and contribute to communicative breakdowns (Neely et al. Reference Neely, Gerow, Rispoli, Lang and Pullen2016). In this section, we argue that echolalia should not be dismissed as meaningless merely because a listener is unable to immediately decipher its meaning. We describe how autistic and non-autistic children and adults use it communicatively – to connect with other people – as well as for self-regulatory purposes.

If a young non-autistic child is asked, “Is your sister bothering you?” and responds, “Bothering you,” this would likely be interpreted as an affirmative reply (“Yes, she is bothering me”). These “frozen phrases” are structurally and perhaps functionally equivalent to echolalic speech and are seen as playing an important role in language development. Typically developing children use unanalyzed chunks of spoken language to convey meaning (Bretherton et al. Reference Bretherton, McNew, Snyder and Bates1983). In the case of “bothering you,” a young child may not yet be able to separate that phrase into its constituents or know how to slot in a different pronoun, but the child is using that phrase to communicate a meaningful proposition (Bloom Reference Bloom1973; Nelson Reference Nelson1981). Indeed, the use of frozen phrases in typical development is seen as a step on the road to productive speech.

Just as frozen phrases give way to productive multiword utterances in typical development (Lieven et al. Reference Lieven, Pine and Barnes1992), echolalia can serve as a stepping stone to productive use of grammar for speaking autistic individuals (Blanc Reference Blanc2012; Gernsbacher et al. Reference Gernsbacher, Morson and Grace2016; Manning & Katz Reference Manning and Katz1989; Roberts Reference Roberts, Arciuli and Brock2014). A sentence or phrase that starts as fully echolalic can become modified over time as some elements are replaced by others. For example, one autistic child regularly repeated, “One day in Teletubbie land, all of the Teletubbies were very busy when suddenly a big rain cloud appeared.” Later, this boy (named Bud) described his father's returning home by saying, “One day in Bud's house, Mama and Bud were very busy when suddenly Daddy appeared” (Dawson et al. Reference Dawson2008, p. 766).

Non-autistic adults also repeat utterances verbatim for various communicative functions. For example, they repeat what someone else has said to express agreement (e.g., Speaker 1: “Let's go.” Speaker 2: “Let's go.”). They use repetition to express incredulity (e.g., after a child asks for ice cream for breakfast, a parent might respond, “Ice cream for breakfast?!”) and quote lines from television shows or movies to comment on the similarity between the current situation and the one depicted on film (e.g., “No soup for you!” from Seinfeld). In all these cases, the speaker's use of repetition is intended to be communicative, and a listener who shares the relevant common ground would interpret it as such.

Why is something that occurs regularly in typical development and in non-autistic adult speech often seen as aberrant and meaningless in autism? There are at least three reasons. First, autistic people use echolalia more often than non-autistic people do (van Santen et al. Reference van Santen, Sproat and Hill2013).Footnote 9 Second, autistic individuals who engage in echolalia likely also engage in other behaviors that are frequently perceived as meaningless (like motor stereotypies; sect. 2.3). Finally, it may be more difficult to decipher the meaning behind a given instance of autistic echolalia.

This last point about meaning may be the most problematic. The tension between when and whether echolalia should be considered meaningful can be seen even in Kanner's (Reference Kanner1943) original description of autism. Some of the autistic children he described engaged in “parrot-like repetitions” (p. 228) that could not always “be linked up with immediate situations” (p. 227). He considered some of these utterances to be meaningful, as when he inferred that one child “expressed agreement by repeating the question literally, echolalia-like” (p. 220; also p. 243) or that the same child was asking his mother to pull off his shoe even though he said “pull off your shoe” (p. 219). But Kanner considered other examples of echolalia (e.g., “You'll fall off the bicycle and bump your head”; p. 227) to be meaningless, writing, for example, “None of [the child's] remarks was meant to have communicative value” (p. 227).

But just because a listener is unable to decipher the meaning of an utterance in a particular context does not mean that the speaker did not have a meaning in mind (e.g., Stiegler Reference Stiegler2014). Sometimes, the intended meaning can be understood only by someone who knows the speaker well and is motivated to take the time to carefully study the contexts of use. For example, the child introduced at the beginning of this section, who repeated “Got a splinter!” when meeting a new therapist, had sometime in the past experienced a painful splinter and used that phrase to communicate her anxiety (Prizant Reference Prizant2015). One autistic boy echoed the phrase “UPS [United Parcel Service] is here” as a clever means of getting his father's attention (Light et al. Reference Light, Roberts, DiMarco and Greiner1998, p. 166). Another repeated, “Chicken Little thought the sky was falling, but the sky is not falling” when his mother was despondent over the death of a friend (Gralow Reference Gralow2008). Listeners who did not know these individuals well or know what was going on in their lives would probably mistakenly consider these phrases meaningless.Footnote 10

Anecdotal evidence suggests that when interlocutors impute meaning to echolalic speech they had previously considered meaningless, the effects can be profound. For example, Suskind (Reference Suskind2014) describes how his young autistic son, Owen, would repeatedly say “juicervose,” an apparently meaningless sequence of sounds. One day, however, Suskind and his wife recognized that “juicervose” was Owen's approximation of the phrase “just your voice,” a line that figures prominently in The Little Mermaid, one of his favorite Disney movies. In that movie, a witch offers a mermaid human legs in exchange for her voice, explaining, “It won't cost much: just your voice!” Putting these pieces together, the Suskinds concluded that Owen's use of “juicervose” was an attempt to draw attention to his own lost ability to speak.

Whether they were correct that Owen intended “juicervose” to have this or any meaning is almost beside the point. If they were correct, it was a clear instance of Owen successfully communicating with his family. If they were not correct, it was still a breakthrough: From that moment forward, Suskind (Reference Suskind2014) writes, they began actively encouraging Owen to use dialogue from Disney movies to express his thoughts and feelings (and they also communicated with him in the same way). As an adult, Owen now uses non-echolalic speech to communicate, but he continues to recite dialogue from movies to convey particular meanings and to make sense of particular situations, just as non-autistic people do. It is impossible to know for sure, but it seems likely that the Suskind family's willingness and ability to see meaning in Owen's echolalia as a child played an important role in his subsequent linguistic, cognitive, and social development.

Indeed, in the literature on typical development, the meaning parents ascribe to their child's behavior influences how they treat the child, which is thought to have important downstream consequences (e.g., Reddy & Trevarthen Reference Reddy and Trevarthen2004). Parents of typically developing infants often react to early vocalizations as if they were intended to communicate something, responding in ways that are thought to promote communicative development (Snow & Ferguson Reference Snow and Ferguson1977). For example, Gros-Louis et al. (Reference Gros-Louis, West and King2014) found that mothers in a Western culture frequently responded to the “meaningless” vocalizations made by their 8- to 14-month-old infants by expanding upon them: If the infant babbled “da-da-da,” the mother might respond with “Da-da is working. I am mama” (p. 392). Gros-Louis et al. found that these kinds of maternal responses predicted an increase in infants’ vocal production. Similarly, treating echolalia as intentional communication is likely to signal to an individual that conversational partners are interpreting their attempts to communicate as meaningful, which may reinforce the individual's desire to communicate.

Some instances of echolalia may not be intended to communicate anything to other people, but this does not necessarily mean that they are meaningless. Like motor stereotypies, some autistic people use echolalia as an adaptive, self-regulatory strategy, repeating a phrase to assure themselves that things will be okay, for example (Prizant Reference Prizant2015). This is not so different from the mantras that some non-autistic people repeat to calm themselves in stressful situations (see, e.g., Eddie Murphy's repetition of “Keep it together” in the movie Bowfinger). Some autistic individuals have also reported using echolalia as a means of keeping material in short-term memory (Higashida Reference Higashida2013), the same strategy non-autistic individuals use when trying, for example, to remember an address or phone number long enough to write it down.

Some autistic people have reported that they occasionally repeat words and phrases involuntarily (Rentenbach & Prislovsky Reference Rentenbach and Prislovsky2012; Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012). But echolalia is also clearly used by autistic (and non-autistic) people communicatively, as a creative means of connecting with other people.

2.5. Summary and key points

We have described four behavioral differences commonly associated with autism: Compared with non-autistic individuals, autistic individuals are less likely to engage in eye contact or point, and they are more likely to engage in motor stereotypies and echolalia. We have explained how each of these behavioral differences has been interpreted by some scientists as reflecting diminished social interest or motivation. Using arguments from logic, existing quantitative data, and the testimony of autistic people themselves, we have described alternative explanations for each behavioral difference. Here we synthesize two key points from the previous sections.

The first is that most of the unusual behaviors documented in autism have also been documented among non-autistic children and adults (Bishop Reference Bishop1989). When non-autistic people engage in these behaviors, they are not attributed to deficits in social motivation; to the contrary, they are often considered to be adaptive responses to a particular situation. Take reduced levels of eye contact. As noted, many autistic people do not consistently engage in eye contact. But many non-autistic people also refrain from eye contact when they are trying to concentrate or control their emotions. Similarly, many autistic people repeat words or phrases. But so do typically developing children when they are learning to communicate, and so do non-autistic adults when they are trying to emphasize a point or self-regulate. Finally, most autistic individuals engage in motor stereotypies, rhythmically moving parts of their bodies or engaging with objects in unusual ways. But stereotypies are also not unique to autism: They are ubiquitous in typical development, where they are considered essential to motor development, and common among non-autistic adults, who use them to combat anxiety and boredom.

The second key point is that many autistic people have explained that they do not intend their atypical behavior to reflect anything about social interest. For example, they report that averting gaze allows them to concentrate and regulate their emotions, just as it does for non-autistic people. They report that motor stereotypies and echolalia both serve self-regulatory and communicative functions, just as they do in non-autistic people. They describe experiencing an occasional or regular disconnect between movements they would like to produce and those they can actually produce in the moment: a disconnect that could affect their ability to engage in pointing and other behaviors that are conventionally interpreted as indicating social interest.

3. Use of autistic testimony

In section 2, the explanations we reviewed for several behavioral differences between autistic and non-autistic people were many and varied. The social motivation perspective is admittedly more parsimonious in that it proposes that these kinds of behavioral differences can be attributed to a single cause. But parsimonious accounts are favored in science only to the extent that they can explain the available evidence. One readily available source of evidence that the social motivation perspective does not explain is the testimony of many autistic people who claim to be socially motivated and who offer alternative explanations for why they sometimes behave in ways that suggest they are not. Given that the input of autistic people is not traditionally included in the scientific literature on autism (Jivraj et al. Reference Jivraj, Sacrey, Newton, Nicholas and Zwaigenbaum2014), we anticipate that there may be implicit or explicit concerns about our use of their testimony in this way.

One concern could be that we have focused on autistic individuals who report being socially motivated (e.g., those in the appendix) without considering others who report that they are not. For example, Temple Grandin has argued that “autistic people tend to be less social” (quoted in Flatow Reference Flatow2006), Sue Rubin (Reference Rubin and Biklen2005) has written, “A room full of people does not intrigue me as much as a toy or object on the other side of the room” (p. 93), and some studies have found that autistic people report experiencing less social enjoyment, on average, than non-autistic people do (Chevallier et al. Reference Chevallier, Kohls, Troiani, Brodkin and Schultz2012a). We recognize that, just like non-autistic people, autistic people vary in how socially motivated they report themselves to be (e.g., Calder et al. Reference Calder, Hill and Pellicano2013; Garman et al. Reference Garman, Spaulding, Webb, Mikami, Morris and Lerner2016). But we have focused on testimony from autistic people who profess an interest in others because we have not seen their perspective or experiences well represented in the scientific literature on autism and because they present a challenge to social motivation accounts of autism.

Furthermore, we believe that attempts to measure whether autistic people are, on average, less socially motivated than non-autistic people are unlikely to yield data that are useful in theory or practice. Like other kinds of putatively innate motivations (e.g., intrinsic motivation; Ryan & Deci Reference Ryan and Deci2000), whether people are socially motivated at any given point in time depends not just on their innate predisposition toward social stimuli and interaction, but also on a number of other factors, including the context, the attitudes and behaviors of potential social partners, other competing goals, their history of successes and failures in similar situations, and so on. We suspect that a lifetime of having their behavior (mis)interpreted as indicating they are not socially motivated may lead some autistic people to withdraw from, and experience little enjoyment in, social situations (see sect. 6).

One might also be concerned that we relied on autistic testimony when we described reasons unrelated to social motivation that autistic people sometimes behave in unusual ways. A large body of work shows that people are not very good at explaining their own behavior, sometimes ignoring factors that an experimenter knows are relevant and sometimes emphasizing others that an experimenter knows are irrelevant (e.g., Wilson Reference Wilson2002). We acknowledge that people do not always have insight into the reasons for their behavior. However, as described in section 2.5, the explanations autistic people offer for the behavioral differences we examined are consistent with objective measures and/or accepted explanations for why non-autistic people engage in the same behaviors.

A third concern might be that the explanations unrelated to social interest that some autistic adults provide for their behavioral differences may not apply to autistic children. For example, autistic adults have reported that they find eye contact to be uncomfortable, but this does not necessarily mean that young autistic children (who cannot articulate why they do not engage in eye contact) also find it uncomfortable. Indeed, some have argued that a behavioral difference that begins in childhood because of a lack of social interest might persist into adulthood for different reasons (e.g., Leekam et al. Reference Leekam, Prior and Uljarević2011; Moriuchi et al. Reference Moriuchi, Klin and Jones2017). At the very least, however, the fact that autistic adults offer explanations unrelated to social motivation for some of their unusual behaviors should lead researchers to consider and examine whether those (or other) explanations might also apply in childhood.

4. Effects of the social motivation perspective on autism research and intervention

The assumption that behavioral differences between autistic and non-autistic people that appear to indicate lack of social interest actually do indicate lack of social interest has had unfortunate consequences for how some findings in autism science are interpreted and for what the targets of intervention in autism have traditionally been.

4.1. Research

Consider, as an example, a recent study by Moriuchi et al. (Reference Moriuchi, Klin and Jones2017) designed to investigate whether autistic toddlers do not engage in eye contact as often as non-autistic toddlers because they find it aversive (see sect. 2.1) or because they do not find eyes engaging or informative. Recall that eye contact is one behavior conventionally assumed to reflect social motivation because it represents an obvious example of orienting toward another person (Chevallier et al. Reference Jones, Quigney and Huws2012b). Moriuchi et al. hypothesized that if autistic toddlers found eye contact aversive, they would look away more quickly if they happened to look at a videotaped actress's eyes than if they happened to look at her mouth or other stimuli in the scene.Footnote 11 The results did not support the gaze aversion hypothesis as it was operationalized in that study: Just like non-autistic toddlers, autistic toddlers looked away from eyes as quickly (or slowly) as they looked away from mouths or non-face stimuli.

The authors also hypothesized that whereas non-autistic toddlers would seek out the videotaped actress's eyes when she was behaving in an especially socially engaging manner, autistic toddlers who were averse to gaze would avoid the actress's eyes at those times. Results again did not support the gaze aversion hypothesis: Autistic toddlers spent less time overall than non-autistic toddlers looking at eyes, but they tended to seek them out at the same times as the non-autistic toddlers. The authors concluded that their results “contradict the hypothesis that children with ASD actively avoid looking at the eyes early in life” and instead suggest that autistic children have a “passive insensitivity to social signals in others’ eyes” (Moriuchi et al. Reference Moriuchi, Klin and Jones2017, p. 33).

We find the second part of this conclusion puzzling. That autistic toddlers in this study tended to seek out the actress's eyes at the same times as non-autistic toddlers (though less frequently) suggests a sensitivity to social signals, not an insensitivity. It suggests that, like non-autistic toddlers, autistic toddlers were motivated to look at the actress when she was most likely to be providing interesting or important social information. As the authors note, this is not consistent with the prediction one would make if they had an aversion to looking at others’ eyes. But it is also not consistent with the prediction one would make if they were passively insensitive to social signals in others’ eyes.

Thus, one negative consequence of assuming that autistic individuals are socially uninterested is that it can lead researchers to interpret autistic participants’ behavior as indicating that they are socially uninterested, even though that interpretation is not made about non-autistic participants who behave in the same ways. Additionally, researchers tend to emphasize differences between autistic and non-autistic behavior even though, as in the Moriuchi et al. (Reference Moriuchi, Klin and Jones2017) study, the similarities may be at least as interesting and important (see Jaswal et al. Reference Jaswal, Akhtar and Burack2016).

4.2. Interventions

At some level, a focus on behavioral differences is understandable; this is what allows diagnoses to be made and support provided. But when differences between two groups are obtained, members of the marginalized group are generally assumed to lack something desirable (Medin et al. Reference Medin, Bennis and Chandler2010). Even differences that could be benign or adaptive tend to be interpreted as “deficits” in need of remediation (Akhtar & Jaswal Reference Akhtar and Jaswal2013). In autism, the practical effect is that many interventions focus on making autistic people appear more like non-autistic people with little consideration of the potential negative consequences of these efforts. These efforts may sometimes have the unintended and ironic effect of undermining their interest in interacting with other people.

For example, research targeting the reduction or elimination of echolalia has recently been described as “burgeoning” (Stiegler Reference Stiegler2014, p. 750) despite the fact that, as described in section 2.4, echolalia can serve important communicative functions. The potentially adaptive functions of echolalia do not seem to be considered in these elimination efforts: An exhaustive review of published studies on echolalia interventions noted that “none of the studies reported the function of the target echolalia behavior” (Neely et al. Reference Neely, Gerow, Rispoli, Lang and Pullen2016, p. 90). Ignoring the function of echolalia is not just a questionable practice, it is a dangerous one: If someone's unconventional attempts to communicate are ignored or, worse, discouraged, their motivation to communicate is likely to be reduced (Akhtar et al. Reference Akhtar, Jaswal, Dinishak and Stephan2016; Prizant Reference Prizant2015; Sterponi et al. Reference Sterponi, de Kirby and Shankey2015).

Motor stereotypies are also a common target for intervention, presumably because they are ubiquitous, apparently purposeless, and thought to interfere with social and academic development. But reducing motor stereotypies has not been particularly effective at increasing desired behaviors (Lanovaz et al. Reference Lanovaz, Robertson, Soerono and Watkins2013) and may result in new undesirable behaviors (Epstein et al. Reference Epstein, Taubman and Lovaas1985) that parents actually report as more problematic than the original motor stereotypies (South et al. Reference South, Ozonoff and McMahon2005). We hope that some of the techniques that were employed to eliminate stereotypies in the past, including shouting at and shaking autistic children who engaged in rocking behavior (Risley Reference Risley1968), are no longer used. But parents are still routinely advised to try to eliminate these harmless movements. For example, in a recent op-ed piece in The New York Times, one mother of a young autistic child explained that she was told by therapists, “Try to cut down on his arm flapping” and “Don't let him spin objects.” She explained, “I drove myself to tears trying. At nap time I resorted to climbing into his crib to snuggle and sing because it was the only way I could get him to stop waving his hands in front of his eyes” (O'Brien Reference O'Brien2017).

Autistic individuals have described finding efforts to prevent them from engaging in harmless and adaptive motor stereotypies as both frustrating and aversive (e.g., Bascom Reference Bascom2011). It is not difficult to see how autistic people's desire to interact with someone might diminish if that person prevents them from engaging in harmless “stims” that may be soothing, enjoyable, or something over which they have no control.

Autistic children are also regularly instructed to look other people in the eye. There may be circumstances in which learning to make eye contact more frequently can be beneficial. For example, Krstovska-Guerrero and Jones (Reference Krstovska-Guerrero and Jones2016) trained autistic toddlers to shift their gaze from an object to an adult's eyes and found an increase in other conventional communicative behaviors such as initiating requests and smiling. This, in turn, may have led caregivers of these children to behave in ways that facilitated further social and communicative development. That said, insisting on eye contact may backfire. For example, Moriuchi et al. (Reference Moriuchi, Klin and Jones2017, supplemental materials, p. 20) suggest that autistic children may be conditioned to find eye contact aversive when adults’ exaggerated bids for eye contact become associated with “non-preferred activities.” Thus, attempting to increase a behavior that is conventionally interpreted as indicating social interest could paradoxically actually undermine that interest.

5. New directions for research and intervention

Social behavior is behavior that an observer perceives to be social. As we have been arguing, just because a given observer fails to see conventional signs of social interest does not mean that the person being observed lacks social interest. In this section, we describe the importance of studying how non-autistic people interpret autistic behavior, and we consider possible benefits of helping them recognize and respond to unconventional ways autistic people may show their social interest.

5.1. Who is responsible for altered social interactions?

Recall from section 2.3 that, in the context of motor stereotypies, Leekam et al. (Reference Leekam, Prior and Uljarević2011) proposed that autistic infants experience a “self-imposed constrained environment” caused by their “extreme social withdrawal” (p. 577). As noted in that section, we cannot know whether an infant who is perceived to be socially withdrawn is actually socially withdrawn. It is true, however, that an infant who is interested in people but who – because of a neurological condition affecting her perceptual, attentional, and sensorimotor systems – does not frequently smile, coo, or engage in sustained eye contact with her caregivers will not get the same kinds of social opportunities in Western cultures as one who routinely does engage in these behaviors. Crucially, however, this would not represent a “self-imposed” restricted environment; it would represent an environment that became restricted over time as a result of the way the infant was treated by adults who expected her to show her social interest in conventional ways. All social environments arise from an interaction between how a person behaves and others respond. It is simply inaccurate to describe any child's environment as “self-imposed.”

This is a crucial point because it has important implications for intervention efforts. If an infant's restricted environment is thought to be “self-imposed” because she is socially withdrawn, then interventions are likely to focus on making her appear less socially withdrawn. For example, Leekam et al. (Reference Leekam, Prior and Uljarević2011) advocate for “active and intensive intervention [on autistic infants] that acts upon that self-imposed constrained environment to enhance brain development and reduce stereotypies” (p. 577). Similarly, Dawson (Reference Dawson2008) recommends early behavioral intervention to correct the “failure on the part of the [autistic] child to actively engage in early social interaction” (p. 776).

If, however, we take seriously the possibility that an autistic infant's restricted environment comes about, at least in part, because caregivers (mis)interpret her unusual behaviors as indicating social withdrawal and so treat her as if she were socially withdrawn, then an important target for intervention should be caregivers’ perceptions of the infant's behavior. Broadening the range of behaviors seen as indicating social interest might provide alternative ways for autistic infants to gain the experience-dependent stimulation needed to support healthy social, communicative, and cognitive development (e.g., Akhtar et al. Reference Akhtar, Jaswal, Dinishak and Stephan2016; Prizant Reference Prizant2015).

An instructive analogy can be seen in the education of deaf individuals in the United States. When forced to lip-read and speak, deaf individuals have difficulty with both language development and academic achievement (Marschark Reference Marschark2006). However, when exposed to sign language – particularly early in life and from fluent signers – deaf children's developmental trajectories in those domains more closely match those of their hearing peers (for a review, see Lederberg et al. Reference Lederberg, Schick and Spencer2013). Sometimes the most effective intervention is one that broadens the range of behaviors deemed acceptable by the majority group, accommodating individuals’ unique needs and strengths rather than insisting that they behave in the conventional way (Mottron Reference Mottron2017).

5.2. A path forward

In disabilities other than autism, it is widely recognized that there are unconventional ways in which social interest can be expressed. For example, blind infants’ behavior could lead observers to assume they are not socially motivated: They do not orient toward others by engaging in eye contact; they sometimes turn away when others are talking; and they rarely use gestures like pointing, offering, or showing (Pérez-Pereira & Conti-Ramsden Reference Pérez-Pereira and Conti-Ramsden1999). But parents do not assume, on the basis of these behaviors, that their infants are uninterested in social interaction. Parents are not instructed to insist that their children engage in eye contact, pointing, or showing. Instead, parents learn “to be more patient and careful in detecting responses and signs of engagement,” to establish joint attention via touch, and to recognize “idiosyncratic movements/gestures” as bids for experience sharing (Pérez-Pereira & Conti-Ramsden Reference Pérez-Pereira and Conti-Ramsden1999, pp. 45-47; see also Bigelow Reference Bigelow2003; Fraiberg Reference Fraiberg1977).

Among typically developing children, too, there is evidence that social engagement can be shown in alternative ways. For example, although gaze following is the most commonly studied route to achieving a shared focus on an object, Yu and Smith (Reference Yu and Smith2013) found that it was not necessary. In a study of 12-month-old infants and their parents interacting with several toys, infants rarely looked at their parent's face. But because parents tended to hold and look at a toy when attempting to draw their child's attention to it, infants could (and did) successfully coordinate visual attention with their parent simply by looking at their parent's hands. In fact, there was so much redundancy between the hands and the eyes that the authors concluded that “Current approaches [to joint attention] that concentrate on looks to faces and eyes, and to teaching those looks as parts of intervention programs for individuals with various developmental delays may be making the task harder” (p. 6).

In the case of autism, Ochs and Solomon (Reference Ochs and Solomon2010) pointed out that autistic people “possess a characteristic range of possibilities for social coordination that is shaped not only by their disorder, but also by the sociocultural practices of the communities they inhabit and the interlocutors with whom they interact” (pp. 73–74). In ethnographic work observing autistic children in a variety of settings, they found that what they called “autistic sociality” was often limited by interlocutors relying on standard ways of interacting, including face-to-face body alignment and insistence on speech (see also Ochs et al. Reference Ochs, Solomon and Sterponi2005). Based on our own preliminary work, informed by autistic people and their families, we hypothesize that sociality is also limited when interlocutors fail to recognize and respond to unconventional bids for social connection, including proximity, touch (see also Escalona et al. Reference Escalona, Field, Nadel and Lundy2002), coordinated movement, repetition (see also DeThorne et al. Reference DeThorne, Hengst, Valentino and Russell2015), and rituals.

Investigating unconventional ways autistic people may show their social interest will require a multipronged approach. One important step should involve further theoretical work on the psychological construct of social motivation itself. As noted earlier, Chevallier and colleagues (Reference Jones, Quigney and Huws2012b) operationalized social motivation in terms of an individual's tendency to (a) orient toward, (b) seek out and enjoy, and (c) maintain relations with other people. This definition bears a striking resemblance to some descriptions of extraversion (e.g., Costa & McCrae Reference Costa and McCrae1980): “Extraverts have a preference for seeking, engaging in, and enjoying social interactions” (Fishman et al. Reference Fishman, Ng and Bellugi2011, p. 67). Introverts, by contrast, are described as “withdrawn, retiring, reserved, inhibited, quiet” (McAdams Reference McAdams and Kazdin2000, p. 305) – adjectives that might also be used to describe many autistic individuals. In fact, autistic people (and non-autistic people with more autistic-like traits) do score higher on measures of introversion and lower on measures of extraversion than non-autistics (Ozonoff et al. Reference Ozonoff, Garcia, Clark and Lainhart2005; Schwartzman et al. Reference Schwartzman, Wood and Kapp2016; Wakabayashi et al. Reference Wakabayashi, Baron-Cohen and Wheelwright2006). Thus, an important question is how what social motivation theorists call “diminished social motivation” relates to what personality psychologists call “introversion.”

This question is important because there is evidence that although introverts may not show their social interest in ways that have traditionally been valued or associated with social interest in Western cultures, many do seek out and enjoy social interactions; those interactions are just different from the ones pursued by extraverts (e.g., smaller groups, less small talk; see Cain Reference Cain2012). We see an interesting parallel to autism: Like introverts, perhaps autistic people show their social interest in unconventional (i.e., non-extraverted) ways. To be clear, we are not arguing that autism can be explained as an extreme form of introversion (see Grimes Reference Grimes2010); much more work would be required to make that case. But clarity and insight could be gained from a thorough examination of how social motivation is related to other psychological constructs.

Research is also urgently needed to identify and characterize the range of behaviors that can signal social interest. For example, interviews with autistic individuals and their families can identify candidate behaviors, and observations can quantify and investigate how they change over time. Experience sampling methods and experimental manipulations can shed light on both the idiosyncratic and common conditions under which those kinds of behaviors occur and what effects they have on different social partners. Cultural comparisons can investigate ways in which observers’ judgments of social interest may be mediated by cultural expectations, which could inform debates about the range of behaviors that can demonstrate social interest. Intervention studies can investigate whether caregivers can be trained to see behaviors already in an autistic child's repertoire as bids for social connection – albeit unconventional ones – and what effects this training might have on the child, the caregiver, and their relationship.

Proponents of the social motivation perspective are likely to agree that social interactions are reciprocal (e.g., Dawson Reference Dawson2008), that is, that each member of a dyad influences the other. But theoretical and empirical work in this area has focused primarily on the problems that arise when autistic individuals fail to show their social interest in conventional ways; little consideration has been given to how (mis)interpretations of autistic behavior may contribute to those problems (Dinishak & Akhtar Reference Dinishak and Akhtar2013; Gernsbacher Reference Gernsbacher2006). Investigating and capitalizing on unconventional ways that social interest may be expressed and responded to represents a domain with rich potential and should be a high priority for autism research and intervention.

6. Concluding thoughts

Many autistic people describe themselves as interested in others and motivated to engage with them. Autistic adults and adolescents express a desire for friends (Gillespie-Lynch et al. Reference Gillespie-Lynch, Kapp, Brooks, Pickens and Schwartzman2017b; Marks et al. Reference Marks, Schrader, Longaker and Levine2000), autistic children are as likely as non-autistic children to choose to play with someone else rather than alone (Cage et al. Reference Cage, Bird and Pellicano2016), and some autistic people report experiencing greater loneliness than non-autistic people (Bauminger & Kasari Reference Bauminger and Kasari2000; Bauminger et al. Reference Bauminger, Shulman and Agam2003; but see Chamberlain et al. Reference Chamberlain, Kasari and Rotheram-Fuller2007). Autistic individuals’ desire for friendship and connection may be frustrated by lack of social skills (e.g., Mendelson et al. Reference Mendelson, Gates and Lerner2016), but for many, social interest itself is not lacking. This dissociation between social interest and social skills has also been noted clinically:

[A]t least some high-functioningFootnote 12 adults with ASD have a strong – sometimes even fanatical – interest in what other people feel or think: They spend a great deal of time trying to infer what a certain behavior or utterance means. Often they describe this uncertainty about what is going on in other people's minds as the greatest stressor in their lives. These adults clearly do not suffer from a lack of motivation to share things psychologically with others, but rather from the conflict between their desire to understand others and their inability to do so adequately. (Verbeke et al. Reference Verbeke, Peeters, Kerkhof, Bijttebier, Steyaert and Wagemans2005, p. 718)

In the face of this kind of empirical evidence, testimony, and clinical observation, why is there still a stereotype among laypeople that autistic people are happiest when left alone (e.g., Huws & Jones Reference Huws and Jones2010)? Why does a popular undergraduate textbook in abnormal psychology continue to claim a central feature of autism is “lack of interest in other people” (Comer Reference Comer2013, p. 539)? Why is social motivation still considered by many scientists to be a “core deficit” in need of remediation, one that requires the autistic individual to appear more conventionally socially interested (e.g., Dawson Reference Dawson2008; Kohls et al. Reference Kohls, Chevallier, Troiani and Schultz2012; Mundy Reference Mundy2016)? We suspect there are at least four reasons.

First, autism has traditionally been considered a social disorder (e.g., Kanner Reference Kanner1943), and so attributing behavioral differences to a deficit in social motivation fits squarely within a very entrenched paradigm. Second, people tend to assume that others are as they act (Gilbert & Malone Reference Gilbert and Malone1995). Autistic people are assumed to lack an interest in others because they rarely engage in some behaviors that non-autistic people expect as indicators of social interest (e.g., eye contact and pointing), and they regularly engage in behaviors that non-autistic people believe indicate a lack of social interest (e.g., motor stereotypies and echolalia). But as we have discussed, alternative, even adaptive, explanations for these behavioral differences are possible.

Third, evidence showing diminished reward processing in autistic compared with non-autistic people has been interpreted as providing the neurobiological basis for social motivation accounts of autism. Specifically, the cortical-basal ganglia circuit – considered to be “at the heart of the reward system” (Haber & Knutson Reference Haber and Knutson2010, p. 4) – is disrupted in autism (for a review, see Bottini Reference Bottini2018).Footnote 13 For example, Scott-Van Zeeland et al. (Reference Scott-Van Zeeland, Dapretto, Ghahremani, Poldrack and Bookheimer2010) found reduced response in the ventral striatum to social rewards among autistic compared with non-autistic children. Similarly, Abrams et al. (Reference Abrams, Lynch, Chen, Phillips, Supekar, Ryali, Uddin and Menon2013) found diminished resting-state connectivity between areas of the temporal cortex where the human voice is processed and areas of the dopaminergic reward pathway in autistic compared with non-autistic children.

According to social motivation accounts, if reward networks in autistic brains do not respond to social stimuli in the same way they do in non-autistic brains, it follows that autistic people do not find social stimuli as intrinsically rewarding as non-autistic people do: “It is most likely that the lack of social-seeking tendencies in individuals with ASD is caused by an inability of the ‘wanting’ circuit to activate motivational behaviors, particularly in social contexts” (Kohls et al. Reference Kohls, Chevallier, Troiani and Schultz2012, p. 13).Footnote 14 This might explain why autistic individuals are less likely to engage in attempts to seek out, orient toward, or maintain relations with other people (Chevallier et al. Reference Jones, Quigney and Huws2012b).

The problem with this line of reasoning is that, as we have noted, many autistic people claim to be very interested in other people. Kohls et al. (Reference Kohls, Chevallier, Troiani and Schultz2012) acknowledge that some autistic individuals may show greater social interest than others, but they seem to assume that this would be done in conventional ways. For example, in the context of intervention, they write that “[autistic] children who display stronger [conventional] social approach (‘wanting’) and fewer avoidance behaviors at treatment onset are more responsive to early behavioral interventions than are passive and avoidant children” (p. 14). This does not account for the alternative ways in which social interest may be expressed – presumably because those have not yet been widely considered or studied in autism (sect. 5) – or for the alternative explanations for why autistic people may not engage in conventional approach behaviors (sect. 2).

Research is beginning to bridge the gap between neurobiological data, assumptions about autistic people's social interest (formed on the basis of interpretations of conventional behavioral indicators), and autistic people's testimony about their behaviors. For example, consistent with autistic self-reports about eye contact feeling uncomfortable (see sect. 2.1), Hadjikhani et al. (Reference Hadjikhani, Johnels, Zürcher, Lassalle, Guillon, Hippolyte, Billstedt, Ward, Lemonnier and Gillberg2017) found oversensitivity in the subcortical system when autistic participants were attending to the eye region of neutral and emotional faces. They conclude that “In everyday life, such oversensitivity may lead to attempts to decrease one's arousal levels, and firsthand reports suggest that simply avoiding to attend to the eyes of others is one common strategy among individuals with ASD” (pp. 2–3). We hope that the arguments we have outlined in this article underscore the importance of taking seriously the phenomenological experiences of those being studied.

A final reason for the belief that autistic people are not socially interested is related to the self-fulfilling prophecy we alluded to in section 1. It is possible – perhaps even likely – that for some, “both emotional poverty and an aversion to company are not symptoms of autism but consequences of autism” (Mitchell Reference Mitchell and Higashida2013, p. xv). After repeatedly being ignored or treated as not socially motivated, after repeatedly being told to act in certain ways and not others even when that is not possible, some autistic individuals report experiencing a form of learned helplessness whereby they give up trying to engage with others (e.g., Kedar Reference Kedar2012; Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012). As one autistic informant explained, “I have been endlessly criticized about how different I looked, criticized about all kinds of tiny differences in my behavior. There's a point where you say to hell with it, it's impossible to please you people” (Robledo et al. Reference Robledo, Donnellan and Strand-Conroy2012, p. 6). For this reason, we believe that in research, interventions, and daily interactions, it is far less dangerous to assume that someone is interested in other people and later learn that they were not than to assume that someone is not interested in other people and later learn that they were (see Donnellan Reference Donnellan1984).

In conclusion, we have shown that the assumption that many of the behaviors associated with autism indicate that autistic people are socially uninterested is deeply problematic. It does not reflect how many autistic people describe themselves, it does not recognize the many reasons other than lack of social interest why autistic people may behave in unusual ways, and it can have unintended negative impacts on how they are studied and treated. Understanding and supporting autistic individuals will require taking autistic testimony seriously, continuing to investigate explanations that are not related to social motivation for their unusual behaviors, and studying and capitalizing on unconventional – even idiosyncratic – ways in which they express their social interest.

Appendix

Autistic individuals describe being socially interested

Blackman (Reference Blackman and Biklen2005)

“It may be that the social deficits which are the cornerstone of an autism spectrum diagnosis tell us far more about the person who made them markers for such a diagnosis than about the child whom he observes … [T]he whole testing procedure is somehow actually constructed on whether the tester observed the person to socialise in a way the tester understood to be socialisation” (p. 149).

Burke (Reference Burke and Biklen2005)

“Teachers can help me mollify my desire for friends. You can give students a chance to know me” (p. 250).

Drew (Reference Drew2017)

“You might have been told that people with autism do not want social or romantic relationships, but this is a myth. While it is true that many of us struggle to create or maintain them, this does not mean that we do not want them. I have met some people with autism who, as a result of their experiences of repeated failure, have decided not to pursue friendships or relationships and focus on spending their lives on their own, but this is a rarity” (p. 127).

Frugone (Reference Frugone and Biklen2005)

“Nobody would have bet I could become the social person that inside me I wanted to be” (p. 195).

“Glenn” (quoted in Marks et al. Reference Marks, Schrader, Longaker and Levine2000)

“I want to be known as just someone who, uh, someone who works hard and also, someone who likes to be around others” (p. 12).

Harris (Reference Harris2015)

“Motivated as I was to find a place of belonging among my peers, I did not give up but started to talk to and hang around a group of ‘popular’ girls” (p. 41).

Higashida (Reference Higashida2013)

“I can't believe that anyone born as a human being really wants to be left all on their own, not really. The truth is, we'd love to be with other people. But because things never, ever go right, we end up getting used to being alone … Whenever I overhear someone remark how much I prefer being on my own, it makes me feel desperately lonely” (p. 27).

Kedar (Reference Kedar2012)

“[E]xperts deduce that because of my autism I am not a social person and that I like objects more than people. This is a big misconception” (pp. 99–100).

Page (Reference Page2009)

“Learning to make connections with people – much as I desperately wanted to – was a bewildering process, for they kept changing, and I felt like an alien, always about to be exposed” (p. 7).

Prince-Hughes (Reference Prince-Hughes2004)

“Many people, again lay and professional alike, believe that all people with autism are by definition incapable of communicating, that they do not experience emotions, and that they cannot care about other people or the world around them. My experience, both personally and with others like me, is that in many cases quite the opposite is true” (p. 31).

Rentenbach and Prislovsky (Reference Rentenbach and Prislovsky2012)

“Many times, autistics revert to isolation by default rather than preference. It is infinitely easier to back away and not try to be included instead of oafishly stepping in and attempting to convey your intent to be a part. Loneliness is the most predominant side effect of our unique design” (p. 39).

Sequenzia (Reference Sequenzia and Bascom2012)

“Once I meet people or when I know I will meet people who know me only through my writings, my anxiety level is so high, I can act in very strange ways. I can look very childish and silly and I am very self-conscious about this. I can also seem uninterested, but this is only a self-preservation mask. I find it hard to communicate even if I have a lot of things I want to say” (p. 114).

Suskind (Reference Suskind2014)

“The way people see autistic folks is that they don't want to be around other people. That's wrong. The truth about autistic people is that we want what everyone else wants, but we are sometimes misguided and don't know how to connect with other people” (p. 366).

Tammet (Reference Tammet2006)

“People with Asperger's syndrome do want to make friends but find it very difficult to do so. The keen sense of isolation was something I felt very deeply and was very painful for me” (p. 78).

Triplett (one of Kanner's [Reference Kanner1943] original case studies, quoted in Donvan & Zucker Reference Donvan and Zucker2010)

“I just wanted those boys to think well of me” (p. 90).

Yergeau (Reference Yergeau and Bascom2012)

“I wish you wouldn't interpret my silence as silence. My silence is, in fact, a compliment. It means that I am being my natural self. It means that I am comfortable around you, that I trust you enough to engage my way of knowing, my way of speaking and interacting” (p. 208).

Acknowledgments

We thank Maureen Callanan, Jerry Clore, Ben Converse, Jennifer Henderlong Corpus, Audun Dahl, Janette Dinishak, Morton Gernsbacher, Denny Proffitt, Bobbie Spellman, Christine Stephan, Tauna Szymanski, Dan Willingham, participants in “The Science & Lived Experience of Autism,” and the reviewers for helpful comments.

Footnotes

1. We use “autistic” to refer to those who have received a diagnosis of autism, both to respect the identity-first preference of many autistic self-advocates (e.g., Kenny et al. Reference Kenny, Hattersley, Molins, Buckley, Povey and Pellicano2016) and because use of person-first language (e.g., “person with autism”) in scholarly writing may accentuate the stigma associated with disabilities (Gernsbacher Reference Gernsbacher2017).

2. Note that some autistic individuals do engage in some behaviors that are conventionally interpreted as indicating social interest. For example, Wing and Gould (Reference Wing and Gould1979) described a subgroup of autistic children who spontaneously approached potential social partners. The resulting interactions, however, were considered unusual because these children did not adapt their behavior or conversational style to match social norms expected in such situations (hence the name given to this subgroup: “active but odd”).

3. Attention to another's gaze is also common in learning situations (e.g., Csibra & Gergely Reference Csibra and Gergely2009); for example, where a speaker is looking can indicate what that speaker is referring to. Our discussion here, however, is limited to eye contact as a means of communicating emotional connection and social engagement.

4. For comparison, only 2% of parents of toddlers who did not later receive a diagnosis of autism in the study of Robins et al. (Reference Robins, Fein, Barton and Green2001) reported that their child did not point declaratively, and just 3% indicated their child did not point imperatively.

5. Non-autistic children in Mundy et al. (Reference Mundy, Sigman, Ungerer and Sherman1986) produced more imperative than declarative points. Ironically, one could interpret this pattern of results to mean that non-autistic children are the ones who have a specific impairment in declarative pointing: They regularly used pointing to obtain objects but much less often to share attention with others.

6. Ninety-seven percent of the non-autistic sample pointed declaratively at least a few times per week (Allison et al. Reference Allison, Baron-Cohen, Wheelwright, Charman, Richler, Pasco and Brayne2008).

7. In discussions of motor stereotypies, self-injurious behaviors are sometimes included (for discussion, see Symons et al. Reference Symons, Sperry, Dropik and Bodfish2005). However, whereas the prevalence of motor stereotypies in autism is thought to be around 100% (e.g., Bodfish et al. Reference Bodfish, Symons, Parker and Lewis2000), one recent population-based study estimates the prevalence of self-injurious behavior in autism to be around 30% (Soke et al. Reference Soke, Rosenberg, Hamman, Fingerlin, Robinson, Carpenter, Giarelli, Lee, Wiggins, Durkin and DiGuiseppi2016). Thus, the two may represent different classes of behaviors. Our discussion focuses on motor stereotypies that do not involve self-injury.

8. In fact, there is evidence to suggest that motor stereotypies in and of themselves do not cause stigmatization. In Harris et al. (Reference Harris, Mahone and Singer2008), only 18% of non-autistic children referred to a pediatric neurology movement-disorders clinic because they engaged in many of the same kinds of stereotypies as autistic children (e.g., hand flapping, rocking) reported being teased or facing difficulties in group activities because of their stereotypies: “Despite the concerns of caregivers, the behaviors appear to be of little concern to the affected child, whose daily activities are rarely affected” (p. 271). At least part of the reason motor stereotypes are considered so problematic in autism may be because they are produced by autistic people.

9. Note that in one study, the rate of echolalic speech in autistic children was not different from the rate in children with specific language impairment and did not correlate with frequency of other autistic behaviors (van Santen et al. Reference van Santen, Sproat and Hill2013).

10. Kanner (Reference Kanner1946) later described uncovering the meaning behind some of the apparently meaningless echolalic utterances produced by autistic children he observed. He explained that that “whenever such tracing was possible, the utterances, though still peculiar and out of place in ordinary conversation, assume definite meaning” (p. 242).

11. We question the hypothesis of Moriuchi et al. (Reference Moriuchi, Klin and Jones2017) given the conflicting research about autistic toddlers’ ability to disengage from visual stimuli (e.g., Fischer et al. Reference Fischer, Smith, Martinez-Pedraza, Carter, Kanwisher and Kaldy2016; Landry & Bryson Reference Landry and Bryson2004) and the lack of evidence that the procedure used is actually a valid measure of aversion to eye contact. When latency to disengage is used as a dependent variable in work with non-autistic children, the question is typically how long it takes them to disengage from a central stimulus when a target is presented in the periphery (e.g., Peltola et al. Reference Peltola, Leppanen, Vogel-Farley, Hietanen and Nelson2009; for a similar procedure with autistic toddlers, see Fischer et al. Reference Fischer, Smith, Martinez-Pedraza, Carter, Kanwisher and Kaldy2016; Landry & Bryson Reference Landry and Bryson2004); the procedure in Moriuchi et al. (Reference Moriuchi, Klin and Jones2017) did not include a peripheral target. Additionally, the prediction of Moriuchi et al. was that autistic toddlers would be faster to disengage from eyes if they found them aversive. But the prediction might have been that if autistic toddlers found eyes aversive, they would be slower to disengage. In work using peripheral targets, typically developing infants are slower to disengage from stimuli that are assumed to be threatening (e.g., a fearful face), not faster (Peltola et al. Reference Peltola, Leppanen, Vogel-Farley, Hietanen and Nelson2009). Similarly, non-autistic adults who are anxious are slower to disengage from threat-related central stimuli (Fox et al. Reference Fox, Russo, Bowles and Dutton2001).

12. The distinction between “high” and “low” functioning is not clear in the autism literature, and these terms should be replaced with more precise ones (Bal et al. Reference Bal, Farmer and Thurm2017). Additionally, we consider this terminology offensive because of the negative and uninformed inferences that tend to be made about individuals referred to as “low-functioning.”

13. The jury is still out on whether autistic people respond differently to social rewards specifically or rewards more generally (Bottini Reference Bottini2018; Clements et al. Reference Clements, Zoltowski, Yankowitz, Yerys, Schultz and Herrington2018).

14. The reward system can be dissociated into “wanting” and “liking” components, which are subserved by distinct but overlapping neural substrates (Berridge & Robinson Reference Berridge and Robinson2003). Kohls et al. (Reference Kohls, Chevallier, Troiani and Schultz2012) argue that the “wanting” circuit is specifically impaired in autism, but that the data are inconclusive about whether the “liking” circuit is also disrupted.

References

Abrams, D. A., Lynch, C. J., Chen, K. M., Phillips, J., Supekar, K., Ryali, S., Uddin, L. Q. & Menon, V. (2013) Underconnectivity between voice-selective cortex and reward circuitry in children with autism. Proceedings of the National Academy of Sciences USA 110:12060–65. Available at: http://dx.doi.org/10.1073/pnas.1302982110.Google Scholar
Akhtar, N. & Gernsbacher, M. A. (2007) Joint attention and vocabulary development: A critical look. Language and Linguistic Compass 1:195207. Available at: http://dx.doi.org/10.1111/j.1749-818x.2007.00014.x.Google Scholar
Akhtar, N., & Gernsbacher, M. A. (2008) On privileging the role of gaze in infant social cognition. Child Development Perspectives 2:5965. Available at: http://dx.doi.org/10.1111/j.1750-8606.2008.00044.x.Google Scholar
Akhtar, N. & Jaswal, V. K. (2013) Deficit or difference? Interpreting diverse developmental paths: An introduction to the special section. Developmental Psychology 49:13. Available at: http://dx.doi.org/10.1037/a0029851.Google Scholar
Akhtar, N., Jaswal, V. K., Dinishak, J. & Stephan, C. (2016) On social feedback loops and cascading effects in autism: A commentary on Warlaumont, Richards, Gilkerson & Oller (2014) Psychological Science 27:1528–30. Available at: http://dx.doi.org/10.1177/0956797616647520.Google Scholar
Allison, C., Baron-Cohen, S., Wheelwright, S., Charman, T., Richler, J., Pasco, G. & Brayne, C. (2008) The Q-CHAT (quantitative checklist for autism in toddlers): A normally distributed quantitative measure of autistic traits at 18–24 months of age: Preliminary report. Journal of Autism and Developmental Disorders 38:1414–25. Available at: http://dx.doi.org/10.1007/s10803-007-0509-7.Google Scholar
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). American Psychiatric Association.Google Scholar
Bal, V. H., Farmer, C. & Thurm, A. (2017) Describing function in ASD: Using the DSM-5 and other methods to improve precision. Journal of Autism and Developmental Disorders 47:2938–41. Available at: http://dx.doi.org/10.1007/s10803-017-3204-3.Google Scholar
Baron-Cohen, S. (1989) Perceptual role taking and protodeclarative pointing in autism. British Journal of Developmental Psychology 7:113–27. Available at: http://dx.doi.org/10.1111./j.2044-835X.1989.tb00793.x.Google Scholar
Baron-Cohen, S. (1995) Mindblindness: An essay on autism and theory of mind. MIT Press.Google Scholar
Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightingale, N., Morgan, K., Drew, A. & Charman, T. (1996) Psychological markers in the detection of autism in infancy in a large population. British Journal of Psychiatry 168:158–63. Available at: http://dx.doi.org/10.1192/bjp.168.2.158.Google Scholar
Bascom, J. (2011, October 5) Quiet hands [blog post]. Available at: https://juststimming.wordpress.com/2011/10/05/Google Scholar
Bates, E. (1976) Language and context: The acquisition of pragmatics. Academic Press.Google Scholar
Bates, E., Camaioni, L. & Volterra, V. (1975) The acquisition of performatives prior to speech. Merrill-Palmer Quarterly 21:205–26.Google Scholar
Baumeister, R. F. & Leary, M. R. (1995) The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin 117:497529. Available at: http://dx.doi.org/10.1037/0033-2909.117.3.497.Google Scholar
Bauminger, N. & Kasari, C. (2000) Loneliness and friendship in high-functioning children with autism. Child Development 71(2):447–56. Available at: http://doi.org/10.1111/1467-8624.00156Google Scholar
Bauminger, N., Shulman, C. & Agam, G. (2003) Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders 33:489507. Available at: https://doi.org/10.1023/A:1025827427901.Google Scholar
Benke, T. H., Hohenstein, C., Poewe, W. & Butterworth, B. (2000) Repetitive speech phenomena in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry 69:319–25. Available at: http://dx.doi.org/10/1136/jnnp.69.3.319.Google Scholar
Berridge, K. C. & Robinson, T. E. (2003) Parsing reward. Trends in Neurosciences 26(9):507–13. Available at: https://doi.org/10.1016/S0166-2236(03)00233-9.Google Scholar
Bigelow, A. E. (2003) The development of joint attention in blind infants. Development and Psychopathology 15:259–75. Available at: http://dx.doi.org/10.1017.S0954579403000142.Google Scholar
Billstedt, E., Gillberg, I. C. & Gillberg, C. (2011) Aspects of quality of life in adults diagnosed with autism in childhood: A population-based study. Autism 15:720. Available at: https://doi.org/10.1177/1362361309346066.Google Scholar
Bishop, D. V. M. (1989) Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries? British Journal of Disorders of Communication 24:107–21. Available at: http://dx.doi.org/10.3109/13682828909011951.Google Scholar
Blackman, L. (2005) II. Reflections on language. In: Autism and the myth of the person alone, ed. Biklen, D., pp. 146–67. New York University Press.Google Scholar
Blanc, M. (2012) Natural language acquisition on the autism spectrum: The journey from echolalia to self-generated language. Communication Development Center.Google Scholar
Bloom, L. (1973) One word at a time: The use of single words before syntax. De Gruyter Mouton.Google Scholar
Bodfish, J. W., Symons, F. J., Parker, D. E. & Lewis, M. H. (2000) Varieties of repetitive behavior in autism: Comparisons to mental retardation. Journal of Autism and Developmental Disorders 30:237–43. Available at: http://dx.doi.org/10.1023/A:1005596502855.Google Scholar
Bottini, S. (2018) Social reward processing in individuals with autism spectrum disorder: A systematic review of the social motivation hypothesis. Research in Autism Spectrum Disorders 45:926. Available at: https://doi.org/10.1016/j.rasd.2017.10.001.Google Scholar
Bradshaw, J., Koegel, L. K. & Koegel, R. L. (2017) Improving functional language and social motivation with a parent-mediated intervention for toddlers with autism spectrum disorder. Journal of Autism and Developmental Disorders 47:2443–58. Available at: https://doi.org/10.1007/s10803-017-3155-8.Google Scholar
Bretherton, I., McNew, S., Snyder, L. & Bates, E. (1983) Individual differences at 20 months: Analytic and holistic strategies in language acquisition. Journal of Child Language 10:293320. Available at: http://dx.doi.org/10.1017/S0305000900007789.Google Scholar
Brinck, I. (2004) The pragmatics of imperative and declarative pointing. Cognitive Science Quarterly 3:429–46. Available at: https://lup.lub.lu.se/search/publication/810107.Google Scholar
Burack, J. A., Russo, N., Kovshoff, H., Palma Fernandes, T., Ringo, J., Landry, O. & Iarocci, G. (2016) How I attend – not how well do I attend: Rethinking developmental frameworks of attention and cognition in autism spectrum disorder and typical development. Journal of Cognition and Development 17:553–67. Available at: http://dx.doi.org/10.1080/15248372.2016.1197226.Google Scholar
Burke, J. (2005) I. The world as I'd like it to be. In: Autism and the myth of the person alone, ed. Biklen, D., pp. 249–53. New York University Press.Google Scholar
Cage, E., Bird, G. & Pellicano, E. (2016) ‘I am who I am’: Reputation concerns in adolescents on the autism spectrum. Research in Autism Spectrum Disorders 25:1223. Available at: https://doi.org/10.1016/j.rasd.2016.01.010.Google Scholar
Cain, S. (2012) Quiet: The power of introverts in a world that can't stop talking. Crown.Google Scholar
Calder, L., Hill, V. & Pellicano, E. (2013) ‘Sometimes I want to play by myself:’ Understanding what friendship means to children with autism in mainstream primary schools. Autism 17(3):296316. Available at: http://dx.doi.org/10.1177/1362361312467866.Google Scholar
Camaioni, L. (1997) The emergence of intentional communication in ontogeny, phylogeny, and pathology. European Psychologist 2:216–25. Available at: http://dx.doi.org/10.1027/1016-9040.2.3.216.Google Scholar
Carpenter, M., Nagell, K. & Tomasello, M. (1998) Social cognition, joint attention, and communicative competence from 9 to 15 months of age. Monographs of the Society for Research in Child Development 63 (4, Serial No. 255):1–143. Available at: http://dx.doi.org/10.2307/1166214.Google Scholar
Chamberlain, B., Kasari, C. & Rotheram-Fuller, E. (2007) Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders 37:230–42. Available at: http://dx.doi.org/10.1007/s10803-006-0164-04.Google Scholar
Chevallier, C., Grèzes, J., Molesworth, C., Berthoz, S. & Happé, F. (2012) Brief report: Selective social anhedonia in high functioning autism. Journal of Autism and Developmental Disorders 42(7):1504–49. doi: 10.1007/s10803-011-1364-0.Google Scholar
Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S. & Schultz, R. T. (2012a) The social motivation theory of autism. Trends in Cognitive Sciences 16(4):231–39. doi:10.1016/j.tics.2012.02.007.Google Scholar
Clements, C. C., Zoltowski, A. R., Yankowitz, L. D., Yerys, B. E., Schultz, R. T. & Herrington, J. D. (2018) Evaluation of the social motivation hypothesis of autism: A systematic review and meta-analysis. JAMA Psychiatry 75(8):797808. Available at: https://doi.org/10.1001/jamapsychiatry.2018.1100.Google Scholar
Colonnesi, C., Stams, G. J. J. M., Koster, I. & Noon, M. J. (2010) The relation between pointing and language development: A meta-analysis. Developmental Review 30:352–66. Available at: http://dx.doi.org/10.1016/j.dr.2010.10.001.Google Scholar
Comer, R. J. (2013) Abnormal psychology (8th ed.). Worth.Google Scholar
Connors, J. L. & Donellan, A. M. (1993) Citizenship and culture: The role of disabled people in Navajo society. Disability, Handicap & Society 8:265–80. Available at: http://dx.doi.org/10.1080/02674649366780271.Google Scholar
Costa, P. T. & McCrae, R. R. (1980) Influence of extraversion and neuroticism on subjective well-being: Happy and unhappy people. Journal of Personality and Social Psychology 38:668–78. Available at: http://dx.doi.org/10.1037/0022-3514.38.4.668.Google Scholar
Csibra, G. & Gergely, G. (2009) Natural pedagogy. Trends in Cognitive Sciences 13:148–53. Available at: http://dx.doi.org/10.1016/j.tics.2009.01.005.Google Scholar
Cunningham, A. B. & Schreibman, L. (2008) Stereotypy in autism: The importance of function. Research in Autism Spectrum Disorders 2:469–79. Available at: http://dx.doi.org/10.1016/j.rasd.2007.09.006.Google Scholar
Dawson, G. (2008) Early behavioral intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology 20:775803. Available at: http://doi.org/10.1017/S0954579408000370.Google Scholar
Dawson, M., Mottron, L. & Gernsbacher, M. A. (2008) Learning in autism. In: Learning and memory: A comprehensive reference, Vol. 2: Cognitive psychology of memory, ed. Roediger, H. L. III, pp. 759–72. Elsevier.Google Scholar
DeMarchena, A. B. & Eigsti, I.-M. (2014) Context counts: The impact of social context on gesture rate in verbally fluent adolescents with autism spectrum disorder. Gesture 14:375–93. Available at: http://dx.doi.org/10.1075/gest.14.3.05mar.Google Scholar
DeThorne, L. S., Hengst, J. A., Valentino, H. A. & Russell, S. A. (2015) More than words: Examining communicative competence through a preschool-age child with autism. Inclusion 3:176-96. Available at: http://dx.doi.org/10.1352/2326-6988-3.3.176Google Scholar
Dinishak, J. & Akhtar, N. (2013) A critical examination of mindblindness as a metaphor for autism. Child Development Perspectives 7:110–14. Available at: http://dx.doi.org/10.1111./cdep.12026.Google Scholar
Dixon, S. D., Tronick, E. Z., Keefer, C. & Brazelton, B. (1981) Mother-infant interaction among the Gusii of Kenya. In: Culture and early interactions, ed. Field, T. M., Sostek, A. M., Vietze, P., & Leiderman, P. H., 149–70. Erlbaum.Google Scholar
Doherty-Sneddon, G. & Phelps, F. G. (2005) Gaze aversion: A response to cognitive or social difficulty? Memory & Cognition 33:727–33. Available at: http://dx.doi.org/10.3758/BF03195338.Google Scholar
Donnellan, A. M. (1984) The criterion of the least dangerous assumption. Behavioral Disorders 9:141–50. Available at: http://dx.doi.org/10.1177/019874298400900201.Google Scholar
Donnellan, A. M., Hill, D. A. & Leary, M. R. (2013) Rethinking autism: Implications of sensory and movement differences for understanding and support. Frontiers in Integrative Neuroscience 6: Article 124. Available at: http://dx.doi.org/10.3389/fnint.2012.00124.Google Scholar
Donvan, J. & Zucker, C. (2010) Autism's first child. Atlantic Monthly 7:7890. Available at: https://www.theatlantic.com/magazine/archive/2010/10/autisms-first-child/308227/.Google Scholar
Drew, G. (2017) An adult with an autism diagnosis: A guide for the newly diagnosed. Jessica Kingsley.Google Scholar
Edwards, M. J., Lang, A. E. & Bhatia, K. P. (2012) Stereotypies: A critical appraisal and suggestion of a clinically useful definition. Movement Disorders 27:179–85. Available at: http://dx.doi.org/10.1002/mds.23994.Google Scholar
Elsabbagh, M. & Johnson, M. H. (2010) Getting answers from babies about autism. Trends in Cognitive Sciences 14:8187. Available at: http://dx.doi.org/10.1016/j.tics.2009.12.005.Google Scholar
Epstein, L. J., Taubman, M. T. & Lovaas, O. I. (1985) Changes in self-stimulatory behaviors with treatment. Journal of Abnormal Child Psychology 13:281–93. Available at: http://dx.doi.org/10/1007/BF00910648.Google Scholar
Escalona, A., Field, T., Nadel, J., Lundy, B. (2002) Brief report: Imitation effects on children with autism. Journal of Autism and Developmental Disorders 32:141–44. Available at: http://dx.doi.org/10.1023/A:1014896707002.Google Scholar
Feldman, R. & Reznick, J. S. (1996) Maternal perception of infant intentionality at 4 and 8 months. Infant Behavior and Development 19:483–96. Available at: http://dx.doi.org/10.1016/S0163-6383(96)90008-9.Google Scholar
Field, T. M. (1981) Infant gaze aversion and heart rate during face-to-face interactions. Infant Behavior & Development 4:307–15. Available at: http://dx.doi.org/10.1016/S0163-6383(81)80032-X.Google Scholar
Fischer, J., Smith, H., Martinez-Pedraza, F., Carter, A. S., Kanwisher, N. & Kaldy, Z. (2016) Unimpaired attentional disengagement in toddlers with autism spectrum disorder. Developmental Science 19:1095–103. Available at: http://dx.doi.org/10.1111/desc.12386.Google Scholar
Fishman, I., Ng, R. & Bellugi, U. (2011) Do extraverts process social stimuli differently from introverts? Cognitive Neuroscience 2:6773. Available at: https://doi.org/10.1080/17588928.2010.527434.Google Scholar
Flatow, I. (Narrator) (2006, January 20) A conversation with Temple Grandin [Interview]. Available at: http://www.npr.org/templates/story/story.php?storyId=5165123.Google Scholar
Fleischmann, A. & Fleischmann, C. (2012) Carly's voice: Breaking through autism. Simon & Schuster.Google Scholar
Fournier, K. A., Hass, C. J., Naik, S. K., Lodha, N. & Cauraugh, J. H. (2010) Motor coordination in autism spectrum disorders: A synthesis and meta-analysis. Journal of Autism and Developmental Disorders 40(10):1227–40. doi:10.1007/s10803-010-0981-3.Google Scholar
Fox, E., Russo, R., Bowles, R. & Dutton, K. (2001) Do threatening stimuli draw or hold visual attention in subclinical anxiety? Journal of Experimental Psychology: General 130:681700. Available at: http://dx.doi.org/10.1037//0096-3445.130.4.681.Google Scholar
Fraiberg, S. (1977) Insights from the blind: Comparative studies of blind and sighted infants. Basic Books.Google Scholar
Friedner, M. & Block, P. (2018) Deaf studies meets autistic studies. The Senses and Society 12:282300. Available at: http://dx.doi.org/10.1080/17458927.2017.1369716.Google Scholar
Frith, U. & Happé, F. (1999) Theory of mind and self-consciousness: What is it like to be autistic? Mind & Language 14:122. Available at: http://dx.doi.org/1111/1468-0017.00100.Google Scholar
Frugone, A. (2005) Salient moments in the life of Alberto, as a child, a youth, a young Man. In: Autism and the myth of the person alone, ed. Biklen, D., pp. 185–97. New York University Press.Google Scholar
Garman, H. D., Spaulding, C. J., Webb, S. J., Mikami, A. Y., Morris, J. P. & Lerner, M. D. (2016) Wanting it too much: An inverse relation between social motivation and facial emotion recognition in autism spectrum disorder. Child Psychiatry & Human Development 47:890902. Available at: https://doi.org/10.1007/s10578-015-0620-5.Google Scholar
Gernsbacher, M. A. (2006) Toward a behavior of reciprocity. Journal of Developmental Processes 1:138-152. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296736/pdf/nihms617098.pdf.Google Scholar
Gernsbacher, M. A. (2007a) On not being human. APS Observer 20(5):532. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266404/.Google Scholar
Gernsbacher, M. A. (2007b) The true meaning of research participation. APS Observer 20(4):513. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260421/.Google Scholar
Gernsbacher, M. A. (2017) Editorial perspective: The use of person-first language in scholarly writing may accentuate stigma. Journal of Child Psychology and Psychiatry 58:859–61. Available at: http://dx.doi.org/10.1111/jcpp.12706.Google Scholar
Gernsbacher, M. A., Morson, E. M. & Grace, E. J. (2016) Language and speech in autism. Annual Review of Linguistics 2 413–25. Available at: http://dx.doi.org/10.1146/annurev-linguistics-030514-124824.Google Scholar
Gernsbacher, M. A., Stevenson, J. L., Khandakar, S. & Goldsmith, H. H. (2008b) Why does joint attention look atypical in autism? Child Development Perspectives 2:3845. Available at: http://dx.doi.org/10.1111/j.1750-8606.2008.00039.x.Google Scholar
Gilbert, D. T. & Malone, P. S. (1995) The correspondence bias. Psychological Bulletin 117:2138. Available at: http://dx.doi.org/10.1037/0033-2909.117.1.21.Google Scholar
Gillespie-Lynch, K., Kapp, S. K., Brooks, P. J., Pickens, J. & Schwartzman, B. (2017b) Whose expertise is it? Evidence for autistic adults as critical autism experts. Frontiers in Psychology 8:438. Available at: http://dx.doi.org/10.3389/fpsyg.2017.00438.Google Scholar
Glazebrook, C. M., Elliott, D. & Szatmari, P. (2008) How do individuals with autism plan their movements? Journal of Autism and Developmental Disorders 38:114–26. Available at: http://dx.doi.org/10.1007/s10803-007-0369-1.Google Scholar
Glenberg, A. M., Schroeder, J. L. & Robertson, D. A. (1998) Averting the gaze disengages the environment and facilitates remembering. Memory & Cognition 26:651–58. Available at: http://dx.doi.org/10.3758/BF03211385.Google Scholar
Goldin-Meadow, S. (2009) How gesture promotes learning throughout childhood. Child Development Perspectives 3:106–11. Available at: http://dx.doi.org/10.1111/j.1750-8606.2009.00088.x.Google Scholar
Goldin-Meadow, S., Goodrich, W., Sauer, E. & Iverson, J. (2007) Young children use their hands to tell their mothers what to say. Developmental Science 10:778–85. Available at: http://dx.doi.org/10.1111/j.1467-7687.2007.00636.x.Google Scholar
Goldman, S., Wang, C., Salgadd, M. W., Greene, P. E., Kim, M. & Rapin, I. (2009) Motor stereotypies in children with autism and other developmental disorders. Developmental Medicine & Child Neurology 51:3038. Available at: http://dx.doi.org/10.1111/j.1469-8749.2008.03178.x.Google Scholar
Goodhart, F. & Baron-Cohen, S. (1993) How many ways can the point be made? Evidence from children with and without autism. First Language 13:225–33. Available at: http://dx.doi.org/10.1177/014272379301303804.Google Scholar
Gralow, C. (2008, October 15) It bears repeating. New York Times. Available at: https://lessonplans.blogs.nytimes.com/2008/10/15/it-bears-repeating/.Google Scholar
Grandin, T. (1992) An inside view of autism. In: High-functioning individuals with autism. Current issues in autism, ed. Schopler, E. & Mesibov, G. B., 105–26. Springer. Available at: http://dx.doi.org/10.1007/978-1-4899-2456-8_6.Google Scholar
Grelotti, D. J., Gauthier, I. & Schultz, R. T. (2002) Social interest and development of cortical face specialization: What autism teaches us about face processing. Developmental Psychobiology 40:213–25. Available at: http://dx.doi.org/10.1002/dev.10028.Google Scholar
Grice, H. P. (1975) Logic and conversation. In: Syntax and semantics. Vol. 3: Speech acts, ed. Cole, P. & Morgan, J. L., pp. 4158. Academic Press.Google Scholar
Grimes, J. O. (2010) Introversion and autism: A conceptual exploration of the placement of introversion on the autism spectrum. Unpublished master's thesis. Available at: https://scottbarrykaufman.com/wp-content/../Grimes_Jennifer_O_201005_MA.pdf.Google Scholar
Gros-Louis, J., West, M. J. & King, A. P. (2014) Maternal responsiveness and the development of directed vocalizing in social interactions. Infancy 19:385408. Available at: http://dx.doi.org/10.1111/infa.12054.Google Scholar
Grosse, G., Behne, T., Carpenter, M. & Tomasello, M. (2010) Infants communicate to be understood. Developmental Psychology 46:1710–22. Available at: http://dx.doi.org/10.1037/a0020727.Google Scholar
Haber, S. N. & Knutson, B. (2010) The reward circuit: Linking primate anatomy and human imaging. Neuropsychopharmacology Reviews 35:426. Available at: http://dx.doi.org/10.1038/npp.2009.129.Google Scholar
Hadjikhani, N., Johnels, J. A., Zürcher, N. R., Lassalle, A., Guillon, Q., Hippolyte, L., Billstedt, E., Ward, N., Lemonnier, E. & Gillberg, C. (2017) Look me in the eyes: constraining gaze in the eye-region provokes abnormally high subcortical activation in autism. Scientific Reports 7: Article 3163. Available at: http://dx.doi.org/10.1038/s41598-017-03378-5.Google Scholar
Happé, F. (1991) The autobiographical writings of three Asperger syndrome adults: Problems of interpretation and implications for theory. In: Autism and Asperger Syndrome, ed. Frith, U., 207–42. Cambridge University Press. Available at: http://dx.doi.org/10.1017/CBO9780511526770.007.Google Scholar
Happé, F. & Frith, U. (2006) The weak central coherence account: Detail focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders 36:525. Available at: http://dx.doi.org/10.1007/s10803-005-0039-0.Google Scholar
Happé, F. & Ronald, A. (2008) The ‘fractionable autism triad’: A review of evidence from behavioural, genetic, cognitive and neural research. Neuropsychology Review 18:287304. Available at: http://dx.doi.org/10.1007/s11065-008-9076-8.Google Scholar
Harris, K. M., Mahone, E. M. & Singer, H. S. (2008) Nonautistic motor stereotypies: Clinical features and longitudinal follow-up. Pediatric Neurology 38:267–72. Available at: http://dx.doi.org/10.1016/j.pediatrneurol.2007.12.008.Google Scholar
Harris, R. L. (2015) My autistic awakening: Unlocking the potential for a life well lived. Rowman & Littlefield.Google Scholar
Harrop, C., McConachie, H., Emsley, R., Leadbitter, K., Green, J. & The PACT Consortium (2014) Restricted and repetitive behaviors in autism spectrum disorders and typical development: Cross-sectional and longitudinal comparisons. Journal of Autism and Developmental Disorders 44:1207–19. Available at: http://dx.doi.org/10.1007/s10803-013-1986-5.Google Scholar
Helt, M., Kelley, E., Kinsbourne, M., Pandey, J., Boorstein, H., Herbert, M. & Fein, D. (2008) Can children with autism recover? If so, how? Neuropsychology Review 18:339–66. Available at: http://dx.doi.org/10.1007/s11065-008-9075-9.Google Scholar
Higashida, N. (2013) The reason I jump. Random House.Google Scholar
Hill, E. L. (2004) Executive dysfunction in autism. Trends in Cognitive Science 8:2632. Available at: http://dx.doi.org/10.1016/j.tics.2003.11.003.Google Scholar
Holt-Lunstad, J., Smith, T. B. & Layton, J. B. (2010) Social relationships and mortality risk: A meta-analytic review. PLOS Medicine e1000316. Available at: https://doi.org/10.1371/journal.pmed.1000316.Google Scholar
Huws, J. C. & Jones, R. S. P. (2010) ‘They just seem to live their lives in their own little world:’ Lay perceptions of autism. Disability & Society 25:331–44. Available at: http://dx.doi.org/10.1080/09687591003701231.Google Scholar
Jaswal, V. K., Akhtar, N. & Burack, J. A. (2016) Building bridges: Cognitive development in typical and atypical populations. Journal of Cognition and Development 17:549–52. Available at: http://dx.doi.org/10.1080/15248372.2016.1199633.Google Scholar
Jivraj, J., Sacrey, L., Newton, A., Nicholas, D. & Zwaigenbaum, L. (2014) Assessing the influence of researcher-partner involvement on the process and outcomes of participatory research in autism spectrum disorder and neurodevelopmental disorders: A scoping review. Autism 18:782–93. Available at: http://dx.doi.org/10.1177/1362361314539858.Google Scholar
Jones, R. S. P., Quigney, C. & Huws, J. C. (2003) First-hand accounts of sensory perceptual experiences in autism: A qualitative analysis. Journal of Intellectual & Developmental Disability 28:112–21. Available at: http://dx.doi.org/10.1080/1366825031000147058.Google Scholar
Joyce, C., Honey, E., Leekam, S. R., Barrett, S. L. & Rodgers, J. (2017) Anxiety, intolerance of uncertainty and restricted and repetitive behaviour: Insights directly from young people with ASD. Journal of Autism and Developmental Disorders 47:37893802. Available at: http://dx.doi.org/10.1007/s10803-017-3027-2.Google Scholar
Kanner, L. (1943) Autistic disturbances of affective contact. Nervous Child 2(3):217–50. Available at: https://simonsfoundation.s3.amazonaws.com/share/071207-leo-kanner-autistic-affective-contact.pdf.Google Scholar
Kanner, L. (1946) Irrelevant and metaphorical language in early infantile autism. American Journal of Psychiatry 103:242–46. Available at: http://dx.doi.org/10.1176/ajp.103.2.242.Google Scholar
Kasari, C., Locke, J., Gulsrud, A. & Rotheram-Fuller, E. (2011) Social networks and friendships at school: Comparing children with and without ASD. Journal of Autism and Developmental Disorders 41:533–44. Available at: https://dx.doi.org/10.1007/s10803-010-1076-x.Google Scholar
Kedar, I. (2012) Ido in autismland: Climbing out of autism's silent prison. Sharon Kedar.Google Scholar
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C. & Pellicano, E. (2016) Which terms should be used to describe autism? Perspectives from the UK autism community. Autism 20:442–62. Available at: http://dx.doi.org/10.1177/1362361315588200.Google Scholar
Klin, A., Jones, W., Schultz, R. & Volkmar, F. (2003) The enactive mind, or from actions to cognition: Lessons from autism. Transactions of the Royal Society of London B: Biological Sciences 358:345–60. Available at: http://dx.doi.org/10.1098/rstb.2002.1202.Google Scholar
Klin, A., Jones, W., Schultz, R., Volkmar, F. & Cohen, D. (2002) Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Archives of General Psychiatry 59:809–16. Available at: http://dx.doi.org/10.1001/archpsyc.59.9.809.Google Scholar
Kohls, G., Chevallier, C., Troiani, V. & Schultz, R. T. (2012) Social “wanting” dysfunction in autism: Neurobiological underpinnings and treatment implications. Journal of Neurodevelopmental Disorders 4:120. Available at: http://dx.doi.org/10.1186/1866-1955-4-10.Google Scholar
Krstovska-Guerrero, I. & Jones, E. A. (2016) Social-communication intervention for toddlers with Autism Spectrum Disorder: Eye gaze in the context of requesting and joint attention. Journal of Developmental and Physical Disabilities 28:289316. Available at: http://dx.doi.org/10.1007/s10882-015-9466-9.Google Scholar
Landry, R. & Bryson, S. E. (2004) Impaired disengagement of attention in young children with autism. Journal of Child Psychology and Psychiatry 45:1115–22. Available at: http://dx.doi.org/10.1111/j.1469-7610.2004.00304.x.Google Scholar
Langen, M., Durston, S., Kas, M. J. H., van Engeland, H. & Staal, W. G. (2011) The neurobiology of repetitive behavior: … and men. Neuroscience and Biobehavioral Reviews 35:356–65. Available at: http://dx.doi.org/10.1016/j.neubiorev.2010.02.005.Google Scholar
Lanovaz, M. J., Robertson, K. M., Soerono, K. & Watkins, N. (2013) Effects of reducing stereotypy on other behaviors: A systematic review. Research in Autism Spectrum Disorders 7:1234–43. Available at: http://dx.doi.org/10.1016/j.rasd.2013.07.009.Google Scholar
Leary, M. R. & Hill, D. A. (1996) Moving on: Autism and movement disturbance. Mental Retardation 34:3953.Google Scholar
LeBarton, E. S. & Iverson, J. M. (2016) Associations between gross motor and communicative development in at-risk infants. Infant Behavior & Development 44:5967. Available at: http://dx.doi.org/10.1016/j.infbeh.2016.05.003.Google Scholar
Lederberg, A. R. Schick, B. & Spencer, P.E. (2013) Language and literacy development of Deaf and hard-of-hearing children: Successes and challenges. Developmental Psychology 49:1530. Available at: http://dx.doi.org/10.1037a0029558.Google Scholar
Leekam, S. R., Nieto, C., Libby, S. J., Wing, L. & Gould, J. (2007) Describing the sensory abnormalities of children and adults with autism. Journal of Autism and Developmental Disorders 37:894910. Available at: http://dx.doi.org/10.1007/s10803-006-0218-7.Google Scholar
Leekam, S. R., Prior, M. R. & Uljarević, M. (2011) Restricted and repetitive behaviors in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin 137(4):562–93. Available at: http://dx.doi.org/10.1037/a0023341.Google Scholar
LeVine, R. A. (2004) Challenging expert knowledge: Findings from an African study of infant care and development. In: Childhood and adolescence: Cross-cultural perspectives and applications, ed. Gielen, U. P. & Roopnarine, J., 149–65. Praeger.Google Scholar
LeVine, R. A., Dixon, S., LeVine, S., Richman, A., Leiderman, P. H., Keefer, C. H. & Brazelton, T. B. (1994) Child care and culture: Lessons from Africa. Cambridge University Press.Google Scholar
Lewis, M. H., Tanimura, Y., Lee, L. W. & Bodfish, J. W. (2007) Animal models of restricted repetitive behavior in autism. Behavioural Brain Research 176:6674. Available at: http://dx.doi.org/10.1016/j.bbr.2006.08.023.Google Scholar
Lieven, E. V. M., Pine, J. M. & Barnes, H. D. (1992) Individual differences in early vocabulary development: redefining the referential-expressive distinction. Journal of Child Language 19:287310. Available at: http://dx.doi.org/10.1017/S0305000900011429.Google Scholar
Light, J. C., Roberts, B., DiMarco, R. & Greiner, N. (1998) Augmentative and alternative communication to support receptive and expressive communication for people with autism. Journal of Communication Disorders 31:153–80. Available at: http://dx.doi.org/10.1016.S0021-9924(97)00087-7.Google Scholar
Liszkowski, U. (2005) Human twelve-month-olds point cooperatively to share interest with and helpfully provide information for a communicative partner. Gesture 5:135–54. Available at: http://dx.doi.org/10.1075/gest.5.1.11lis.Google Scholar
Liszkowski, U., Brown, P., Callaghan, T., Takada, A. & de Vos, C. (2012) A prelinguistic gestural universal of human communication. Cognitive Science 36:698713. Available at: http://dx.doi.org/10.1111/j.1551-6709.2011.01228.x.Google Scholar
Liszkowski, U., Carpenter, M., Henning, A., Striano, T. & Tomasello, M. (2004) Twelve-month-olds point to share attention and interest. Developmental Science 7:297307. Available at: http://dx.doi.org/10.1111/j.1467-7687.2004.00349.x.Google Scholar
MacDonald, M., Lord, C. & Ulrich, D. A. (2014) Motor skills and calibrated autism severity in young children with autism spectrum disorder. Adapted Physical Activity Quarterly 31:95105. Available at: http://dx.doi.org/10.1123/apaq.2013-0068.Google Scholar
MacDonald, R., Green, G., Mansfield, R., Geckeler, A., Gardenier, N., Anderson, J., Holcomb, W. & Sanchez, J. (2007) Stereotypy in young children with autism and typically developing children. Research in Developmental Disabilities 28:266–77. Available at: http://dx.doi.org/10.1016/j.ridd.2006.01.004.Google Scholar
Manning, A. L. & Katz, K. B. (1989) Language-learning patterns in echolalic children. Child Language Teaching and Therapy 5:249–61. Available at: http://dx.doi.org/10.1177/026565908900500301.Google Scholar
Marks, S. U., Schrader, C., Longaker, T. & Levine, M. (2000) Portraits of three adolescent students with Asperger's syndrome: Personal stories and how they can inform practice. Journal of the Association for Persons with Severe Handicaps 25:317. Available at: http://dx.doi.org/10.2511/rpsd.25.1.3.Google Scholar
Marschark, M. (2006) Intellectual functioning of deaf adults and children: Answers and questions. European Journal of Cognitive Psychology 18:7089. Available at: http://dx.doi.org/10.1080/09541440500216028.Google Scholar
McAdams, D. (2000) Extraversion and introversion. In Encyclopedia of psychology, Vol. 3, ed. Kazdin, A., pp. 305308. Oxford University Press. Available at: http://dx.doi.org/10.1037/10518-113.Google Scholar
McGlensey, E. (2016) 16 People with autism describe why eye contact can be difficult. Available at: http://themighty.com/2016/02/why-eye-contact-can-be-difficult-for-people-with-autism/.Google Scholar
Medin, D., Bennis, W. & Chandler, M. (2010) Culture and the home-field advantage. Perspectives on Psychological Science 5:708–13. Available at: http://dx.doi.org/1037/a0029558.Google Scholar
Mendelson, J. L., Gates, J. A. & Lerner, M. (2016) Friendship in school-age boys with autism spectrum disorders: A meta-analytic summary and developmental, process-based model. Psychological Bulletin 142:601–22. Available at: http://dx.doi.org/10.1037/bul0000041.Google Scholar
Miller, J. M., Singer, H. S., Bridges, D. D. & Waranch, R. (2006) Behavioral therapy for treatment of stereotypic movements in nonautistic children. Journal of Child Neurology 21:119–25. Available at: http://dx.doi.org/10.1177/08830738060210020701.Google Scholar
Mitchell, D. (2013) Introduction. In: The reason I jump, by Higashida, N., pp. vixvii. Random House.Google Scholar
Moriuchi, J. M., Klin, A. & Jones, W. (2017) Mechanisms of diminished attention to eyes in autism. American Journal of Psychiatry 174:2635. Available at: http://dx.doi.org/10.1176/appi.ajp.2016.15091222.Google Scholar
Mottron, L. (2017) Should we change targets and methods of early intervention in autism, in favor of a strengths-based education? European Child & Adolescent Psychiatry 26(7):815–25. Available at: https://doi.org/10.1007/s00787-017-0955-5.Google Scholar
Mottron, L., Dawson, M., Soulières, I., Hubert, B. & Burack, J. (2006) Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception. Journal of Autism and Developmental Disorders 36(1):2743. doi:10.1007/s10803-005-0040-7.Google Scholar
Mukhopadhyay, T. R. & Biklen, D. (2005) Questions and answers. In: Autism and the myth of the person alone, ed. Biklen, D., 117–43. New York University Press.Google Scholar
Mundy, P. (2016) Autism and joint attention: Development, neuroscience, and clinical fundamentals. Guilford Press.Google Scholar
Mundy, P., Delgado, C., Block, J., Venezia, M., Hogan, A. & Seibert, J. (2013) A manual for the early social communication scales (ESCS). MIND Institute.Google Scholar
Mundy, P., Sigman, M., Ungerer, J. & Sherman, T. (1986) Defining the social deficits of autism: The contribution of non-verbal communication measures. Journal of Child Psychology and Psychiatry 27:657–69. Available at: http://dx.doi.org/10.1111/j.1469-7610.1986.tb00190.x.Google Scholar
Neely, L., Gerow, S., Rispoli, M., Lang, R. & Pullen, N. (2016) Treatment of echolalia in individuals with autism spectrum disorder: A systematic review. Review Journal of Autism and Developmental Disorders 3:8291. Available at: http://dx.doi.org/10.1007/s40489-015-0067-4.Google Scholar
Nelson, K. (1981) Individual differences in language development: Implications for development and language. Developmental Psychology 17:170–87. Available at: http://dx.doi.org/10.1037/0012-1649.17.2.170.Google Scholar
Nicolaidis, C., Raymaker, D., McDonald, K, Dern, S., Ashkenazy, E., Boisclair, C., Robertson, S. & Baggs, A. (2011) Collaboration strategies in nontraditional community-based participatory research partnerships: Lessons from an academic-community partnership with autistic self-advocates. Progress in Community Health Partnerships: Research, Education, and Action 5:143–50. Available at: https://dx.doi.org/10.1353/cpr.2011.0022.Google Scholar
Norbury, C. F. & Sparks, A. (2013) Deficit or disorder? Cultural issues in understanding neurodevelopmental disorders. Developmental Psychology 49:4558. Available at: https://dx.doi.org/10.1037/a0027446.Google Scholar
O'Brien, K. (2017, May 24) Trump's budget takes aim at my sweet son. New York Times. Available at: https://nyti.ms/2r0Ko4j.Google Scholar
Ochs, E. & Solomon, O. (2010) Autistic sociality. Ethos 38:6992. Available at: http://dx.doi.org/10.1111/j.1548-1352.2009.01082.x.Google Scholar
Ochs, E., Solomon, O. & Sterponi, L. (2005) Limitations and transformations of habitus in child-directed speech. Discourse Studies 7:547–83. Available at: http://dx.doi.org/10.1177/1461445605054406.Google Scholar
O'Neill, D. K. & Happé, F. G. E. (2000) Noticing and commenting on what's new: Differences and similarities among 22-month-old typically developing children, children with Down syndrome, and autistic children. Developmental Science 3:457–78. Available at: http://dx.doi.org/10.1111/1467-7687-00139.Google Scholar
O'Neill, M. & Jones, R. S. P. (1997) Sensory-perceptual abnormalities in autism: A case for more research? Journal of Autism and Developmental Disorders 27:283–93. Available at: http://dx.doi.org/10.1023/A:1025850431170.Google Scholar
Oner, P., Oner, O. & Munir, K. (2014) Three-item Direct Observation Screen (TIDOS) for autism spectrum disorder. Autism 18:733–42. Available at: http://dx.doi.org/10.1177/1362361313487028.Google Scholar
Ozonoff, S., Garcia, N., Clark, E. & Lainhart, J. E. (2005) MMPI-2 profiles of high-functioning adults with autism spectrum disorders. Assessment 12:8695. Available at: https://doi.org/10.1177/1073191104273132.Google Scholar
Page, T. (2009) Parallel play. Anchor Books.Google Scholar
Pallathra, A. A., Calkins, M. E., Parish-Morris, J., Maddox, B. B., Perez, L. S., Miller, J., Gur, R. C., Mandell, D. S., Schultz, R. T. & Brodkin, E. S. (2018) Defining behavioral components of social functioning in adults with autism spectrum disorder as targets for treatment. Autism Research 11:488502. Available at: http://dx.doi.org/10.1002/aur.1910.Google Scholar
Pellicano, E. & Burr, D. (2012) When the world becomes ‘too real’: A Bayesian explanation of autistic perception. Trends in Cognitive Sciences 16(10):504–10. Available at: http://dx.doi.org/10.1016/j.tics.2012.08.009.Google Scholar
Pellicano, E. & Stears, M. (2011) Bridging autism, science and society: Moving towards an ethically-informed approach to autism research. Autism Research 4:271–82. Available at: http://dx.doi.org/10.1002/aur.201.Google Scholar
Peltola, M. J., Leppanen, J. M., Vogel-Farley, V. K., Hietanen, J. K. & Nelson, C. A. (2009) Fearful faces but not fearful eyes alone delay attentional disengagement in 7-month-old infants. Emotion 9:560–65. Available at: http://dx.doi.org/10.1037/a0015806.Google Scholar
Pérez-Pereira, M. & Conti-Ramsden, G. (1999) Language development and social interaction in blind children. Psychology Press.Google Scholar
Petrina, N., Carter, M., Stephenson, J. & Sweller, N. (2017) Friendship satisfaction in children with autism spectrum disorder and nominated friends. Journal of Autism and Developmental Disorders 47:384–92. Available at: http://dx.doi.org/10.1007/s10803-016-2970-7.Google Scholar
Phelps, F. G., Doherty-Sneddon, G. & Warnock, H. (2006) Helping children think: Gaze aversion and thinking. British Journal of Developmental Psychology 24:577–88. Available at: http://dx.doi.org/10.1348/026151005X49872.Google Scholar
Prince-Hughes, D. (2004) Songs of the gorilla nation: My journey through autism. Harmony Books.Google Scholar
Prizant, B. M. (2015) Uniquely human: A different way of seeing autism. Simon & Schuster.Google Scholar
Rapp, J. T. & Lanovaz, M. J. (2014) Introduction to the special issue: Assessment and treatment of stereotypy. Behavior Modification 38:339–43. Available at: http://dx.doi.org/10.1177/0145445514540914.Google Scholar
Rapp, J. T. & Vollmer, T. R. (2005) Stereotypy I: A review of behavioral assessment and treatment. Research in Developmental Disabilities 26:527–47. Available at: http://dx.doi.org/10.1016/j.ridd.2004.11.005.Google Scholar
Reddy, V. & Trevarthen, C. (2004) What we learn from babies from engaging with their emotions. Zero to Three 24:916.Google Scholar
Rentenbach, B. & Prislovsky, L. (2012) I might be you: An exploration of autism and connection. Mule & Muse.Google Scholar
Rice, K., Moriuchi, J. M., Jones, W. & Klin, A. (2012) Parsing heterogeneity of autism spectrum disorders: Visual scanning of dynamic social scenes in school-aged children. Journal of the American Academy of Child & Adolescent Psychiatry 51:239–48. Available at: http://dx.doi.org/10.1016/j.jaac.2011.12.017.Google Scholar
Richman, A. L., Miller, P. M. & LeVine, R. A. (1992) Cultural and educational variations maternal responsiveness. Developmental Psychology 28:614–21. Available at: http://dx.doi.org/10.1037/0012-1649.28.4.614.Google Scholar
Risley, T. R. (1968) The effects and side effects of punishing the autistic behaviors of a deviant child. Journal of Applied Behavior Analysis 1:2134. Available at: http://dx.doi.org/10.1901/jaba.1968.1-21.Google Scholar
Roberts, J. M. A. (2014) Echolalia and language development in children with autism. In: Communication in autism, ed. Arciuli, J. & Brock, J., pp. 5573. Benjamins.Google Scholar
Robins, D. L., Fein, D., Barton, M. L. & Green, J. A. (2001) The modified checklist for autism in toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders 31:131–44. Available at: http://dx.doi.org/10.1023/A:1010738829569.Google Scholar
Robledo, J., Donnellan, A. M. & Strand-Conroy, K. (2012) An exploration of sensory and movement differences from the perspective of individuals with autism. Frontiers in Integrative Neuroscience 6:107. http://dx.doi.org/10.3389/fnint.2012.00107.Google Scholar
Rubin, S. (2005) A conversation with Leo Kanner. In: Autism and the myth of the person alone, ed. Biklen, D., pp. 82109. New York University Press.Google Scholar
Rutter, M., Greenfield, D. & Lockyer, L. (1967) A five to fifteen year follow-up study of infantile psychosis: II. Social and behavioral outcome. British Journal of Psychology & Psychiatry 133:1183–99. Available at: http://bjp.rcpsych.org/content/113/504/1183.short.Google Scholar
Ryan, R. M. & Deci, E. L. (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 55:6878. Available at: http://dx.doi.org/10.1037/0003-066X.55.1.68.Google Scholar
Schultz, R. (2005) Developmental deficits in social perception in autism: The role of the amygdala and fusiform face area. International Journal of Developmental Neuroscience 23:125–41. Available at: https://dx.doi.org/10.1016/j.ijdevneu.2004.12.012.Google Scholar
Schwartzman, B. C., Wood, J. J. & Kapp, S. K. (2016) Can the five factor model of personality account for the variability of autism symptom expression? Multivariate approaches to behavioral phenotyping in adult autism spectrum disorder. Journal of Autism and Developmental Disorders 46:253–72. Available at: https://dx.doi.org/10.1007/s10803-015-2571-x.Google Scholar
Scott-Van Zeeland, A. A., Dapretto, M., Ghahremani, D. G., Poldrack, R. A., & Bookheimer, S. Y. (2010) Reward processing in autism. Autism Research 3(2):5367. Available at: https://dx.doi.org/10.1002.aur.122.Google Scholar
Seltzer, M. M., Krauss, M. W., Shattuck, P. T., Orsmond, G., Swe, A. & Lord, C. (2003) The symptoms of autism spectrum disorders in adolescence and adulthood. Journal of Autism and Developmental Disorders 33:565–81. Available at: http://dx.doi.org/10.1023/B:JADD.0000005995.02453.0b.Google Scholar
Senju, A. & Johnson, M. H. (2009a) Atypical eye contact in autism: Models, mechanisms, and development. Neuroscience and Biobehavioral Reviews 33:1204–14. Available at: http://dx.doi.org/10.1016/j.neubiorev.2009.06.001.Google Scholar
Sequenzia, A. (2012) Just me. In: Loud hands: Autistic people, speaking, ed. Bascom, J., pp. 114–15. Autistic Press.Google Scholar
Shwe, H. I. & Markman, E. M. (1997) Young children's appreciation of the mental impact of their communicative signals. Developmental Psychology 33:630–36. Available at: http://dx.doi.org/10.1037/0012-1649.33.4.630.Google Scholar
Smith, E. A. & Van Houten, R. (1996) A comparison of the characteristics of self-stimulatory behaviors in “normal” children and children with developmental delays. Research in Developmental Disabilities 17:253–68. Available at: http://dx.doi.org/10.1016/0891-4222(96)00007-8.Google Scholar
Snow, C. E. & Ferguson, C. A. (1977) Talking to children: Language input and acquisition. Cambridge University Press.Google Scholar
Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Robinson, C., Carpenter, L., Giarelli, E., Lee, L.-C., Wiggins, L. D., Durkin, M. S. & DiGuiseppi, C. (2016) Brief report: Prevalence of self-injurious behaviors among children with autism spectrum disorder – A population-based study. Journal of Autism and Developmental Disorders 46:3607–14. Available at: http://dx.doi.org/10.1007/s10803-016-2879-1.Google Scholar
South, M., Ozonoff, S. & McMahon, W. M. (2005) Repetitive behavior profiles in Asperger Syndrome and high-functioning autism. Journal of Autism and Developmental Disorders 35:145–58. Available at: http://dx.doi.org/10.1007/s10803-004-1992-8.Google Scholar
Sperry, L. A. & Symons, F. J. (2003) Maternal judgments of intentionality in young children with autism: The effects of diagnostic information and stereotyped behavior. Journal of Autism and Developmental Disorders 33:281–87. Available at: http://dx.doi.org/10.1023/A:1024454517263.Google Scholar
Sterponi, L., de Kirby, K. & Shankey, J. (2015) Rethinking language in autism. Autism 19:517–26. Available at: http://dx.doi.org/10.1177/1362361314537125.Google Scholar
Stiegler, L. N. (2014) Examining the echolalia literature: Where do speech-language pathologists stand? American Journal of Speech-Language Pathology 24:750–62. Available at: http://dx.doi.org/10.1044/2015_AJSLP-14-0166.Google Scholar
Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., White, S. W., Lecavalier, L. & Vitiello, B. (2008) Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology 36:117–28. Available at: http://dx.doi.org/10.1007/s10802-007-9165-9.Google Scholar
Suskind, R. (2014) Life, animated: A story of sidekicks, heroes, and autism. Kingswell.Google Scholar
Symons, F. J., Sperry, L. A., Dropik, P. L. & Bodfish, J. W. (2005) The early development of stereotypy and self-injury: A review of research methods. Journal of Intellectual Disability Research 49:144–58. Available at: http://dx.doi.org/10.1111/j.1365-2788.2004.00632.x.Google Scholar
Tammet, D. (2006) Born on a blue day: Inside the mind of an extraordinary autistic savant. Hodder & Stoughton.Google Scholar
Thelen, E. (1981) Rhythmical behavior in infancy: An ethological perspective. Developmental Psychology 17:237–57. Available at: http://dx.doi.org/10.1037/0012-1649.17.3.237.Google Scholar
Tomasello, M. (2014) The ultra-social animal. European Journal of Social Psychology 44:187–94. Available at: http://dx.doi.org/10.1002/ejsp.2015.Google Scholar
Tomasello, M. & Farrar, M. J. (1986) Joint attention and early language. Child Development 57:1454–63. Available at: http://dx.doi.org/10.2307/1130423.Google Scholar
Torres, E. G. & Donnellan, A. M. (2015) Editorial for research topic “Autism: The movement perspective.” Frontiers in Integrative Neuroscience 9:12. Available at: http://dx.doi.org/10.3389/fnint.2015.00012.Google Scholar
Valentino, A. L., Shillingsburg, M. A., Conine, D. E. & Powell, N. M. (2012) Decreasing echolalia of the instruction “say” during echoic training through the use of the cues-pause-point procedure. Journal of Behavioral Education 21:315–28. Available at: http://dx.doi.org/10.1007/s10864-012-9155-z.Google Scholar
van Santen, J. P. H., Sproat, R. W. & Hill, A. P. (2013) Quantifying repetitive speech in autism spectrum disorders and language impairment. Autism Research 6:372–83. Available at: http://dx.doi.org/10.1002/aur1301.Google Scholar
Verbeke, E., Peeters, W., Kerkhof, I., Bijttebier, P., Steyaert, J. & Wagemans, J. (2005) Lack of motivation to share intentions: Primary deficit in autism? Behavioral and Brain Sciences 28:718–19. Available at: http://dx.doi.org/10.1017/S0140525X05510124.Google Scholar
Wakabayashi, A., Baron-Cohen, S. & Wheelwright, S. (2006) Are autistic traits an independent personality dimension? A study of the autism spectrum quotient (AQ) and the NEO-PI-R. Personality and Individual Differences 41:873–83. Available at: https://doi.org/10.1016/jpaid.2006.04.003.Google Scholar
Webb, S. J., Jones, E. J. H., Kelly, J. & Dawson, G. (2014) The motivation for very early intervention for infants at high risk for autism spectrum disorders. International Journal of Speech-Language Pathology 16:3642. Available at: https://doi.org/10.3109/17549507.2013.861018.Google Scholar
Whalen, C. & Schreibman, L. (2003) Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry 44:456–68. Available at: http://dx.doi.org/10.1111/1469-7610.00135.Google Scholar
Williams, D. (1992) Nobody nowhere: The extraordinary autobiography of an autistic. Times Books.Google Scholar
Wilson, T. D. (2002) Strangers to ourselves: Discovering the adaptive unconscious. Belknap Press/Harvard University Press.Google Scholar
Wing, L. & Gould, J. (1979) Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders 9(1):1129. Available at: http://dx.doi.org/10.1007/BF01531288.Google Scholar
Yergeau, M. (2012) Socializing through silence. In: Loud hands: Autistic people, speaking, ed. Bascom, J., pp. 208209. Autistic Press.Google Scholar
Yu, C. & Smith, L. B. (2013) Joint attention without gaze following: Human infants and their parents coordinate visual attention to objects through eye-hand coordination. PLOS ONE 8(11):e79659. Available at: http://dx.doi.org/10.1371/journal.pone.0079659.Google Scholar
Zhang, J., Wheeler, J. J. & Richey, D. (2006) Cultural validity in assessment instruments for children with autism from a Chinese cultural perspective. International Journal of Special Education 21:109–14. Available at: http://digitalcommons.brockport.edu/ehd_facpub/5.Google Scholar
Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts, W., Brian, J.A. & Szatmari, P. (2005) Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience 23:143–52. Available at: http://dx.doi.org/10.1016/ijdevneu.2004.05.001.Google Scholar