Social motivation in autism: a critique of Jaswal & Akhtar (2019)

(Cross-posted at FacilitatedCommunication.org.)

In a piece entitled Being versus appearing socially uninterested: Challenging assumptions about social motivation in autism, Jaswal & Akhtar (2019) set out to challenge the long-established view that many of the behavioral characteristics of autism indicate a lack of social interest. They propose “alternative explanations for four such behaviors: (a) low levels of eye contact, (b) infrequent pointing, (c) motor stereotypies, and (d) echolalia.”

Rita.obeid6, CC BY-SA 3.0, via Wikimedia Commons

Regarding the first of these, the authors correctly observe that many autistic individuals find eye contact aversive. But even if the infrequent/fleeting eye contact in autism simply reflects an eye-specific aversion rather than a lack of interest in others, it still reduces opportunities that autistic people have for social learning. In particular, it reduces opportunities for learning how to interpret more subtle facial expressions in which the region around the eyes plays a crucial role. Given that sometimes the only way to determine what a person is looking at is to look at their eyes first, reduced eye contact also reduces likelihood of autistic people jointly attending to the same visual stimulus as another person (what’s called Joint Attention). This in turn reduces the information that autistic people get about what others are referring to when they speak, and, therefore, opportunities to learn the meanings of new words.

In the course of their discussion of eye contact, Jaswal & Akhtar make several valid points that are, nevertheless, somewhat beside the point.

They note that, as far as interpersonal attachment goes, there are other ways to show attachment than looking someone in the eyes—for example, touch. But it has long been recognized that autism does not involve deficits in attachment. Intact attachment, however, does not rule out diminished social motivation. Nor is there any evidence that in autism touch, as Jaswal & Akhtar propose, serves social goals other than attachment—for example, getting someone to attend to something you’re attending to, or what’s called Initiating Joint Attention. (In general, given how much information, and how much of our focus of attention, comes through the visual channel as opposed to through touch, touch is generally not the best medium for Joint Attention).

Jaswal & Akhtar also point out, correctly, that there are different patterns of eye contact across the world’s cultures, with direct eye contact being more common in some cultures than in others. But direct eye contact shouldn’t be confused with looking at what other people are looking at, which, in all cultures, helps you learn from them and, in all cultures, can serve as a form of social engagement.

Finally, Jaswal & Akhtar point out that there are alternative ways for people to direct the attention of autistic individuals to objects of interest, like pointing to the object or manipulating it in front of them. But a great deal of learning happens in the absence of such deliberate instruction: much learning, in other words, is incidental. Incidental learning happens when we listen to other people talk—whether or not they are talking directly to us or pointing things out deliberately with their hands. And getting the most out of talk means deducing what people are attending to while they speak, which is often reflected only in what their eyes are doing.

Thus, even if the only initial social atypicality in autism is an aversion to eye contact, that atypicality can send autistic individuals down an atypical social pathway: one of reduced opportunities for social and linguistic learning and engagement. Jaswal & Akhtar, moreover, leave out another early atypicality in autism, namely a tendency not to attend to speech sounds. This also leads to reduced opportunities for language learning. Reduced language learning, in turn, means reduced opportunities for social engagement. Reduced language learning also means reduced opportunities to learn the many things that people generally learn through conversations, both direct and overheard, about the world around them, including the world of human interactions. Reduced language learning and reduced linguistic mastery, finally, can make social interactions difficult and confusing, thereby reducing social motivation.

Jaswal & Akhtar don’t acknowledge these diminished opportunities for incidental learning and these reasons for diminished social motivation. Instead they suggest that reduced eye contact, along with reduced smiling and cooing (all of which they blame on “perceptual, attentional, and sensorimotor systems”, as opposed to diminished attention to social stimuli and diminished social engagement), lead to suboptimal treatment by caregivers, In particular, they propose that it may cause caregivers who “expect [a child] to show her interest in conventional ways” to treat the child in ways that limit her healthy social, communicative, and cognitive development. Effectively, thus, they locate the proximate cause of atypical development in autism with the parents, ruling out autism-related social factors, and taking us back to the blame-the-parents version of autism promulgated by Bruno Bettelheim and his many followers.

Turning next to pointing, the authors cite Gernsbacher et al. (2008). Gernsbacher et al. note that it’s not just socially-motivated “declarative” pointing (pointing out an object of interest), but also instrumental “protoimperative” pointing (pointing to request things), that is reduced in autism. From this, they conclude that “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 pointing.” The problem with this explanation is that pointing is not a motor challenge for most kids, autistic kids included. Pointing is one of the earliest motor behaviors performed by young children. And, while it may be diminished in frequency and/or delayed in autism, Ricks and Wing (1976) have observed that pointing is one of the earliest gestures that autistic children learn.

The diminished frequency of pointing in autism is instead consistent with the standard social deficit model of autism. This is true even of protoimperative pointing—of pointing merely to ask for something. Both protoimperative and protodeclarative pointing presuppose some awareness of and attention to others as volitional actors—as entities who can help you out or share interests with you. Many young autistic kids who rarely if ever point are able to perform more complex motor activities like grabbing a caregiver’s hand and leading him/her to a desired object out of reach—something that treats the person they’re leading less as a volitional actor and more as a tool.

Nonetheless, Jaswal & Akhtar take all this a bit further, attempting to argue that autism is, in fact, primarily a motor disorder. Some of their testimonial comes from first-hand accounts. Some of these testimonials are highly problematic (more on that below). Other testimonials are irrelevant, inasmuch as they mention only mild or occasional issues with sensory-motor functioning, and/or focus on sensory sensitivities.

Some of these testimonials appear in a paper by FC proponents (who, as such, are biased towards the notion that autism is a motor disorder): namely, Robledo,  Donnellan, and Strandt-Conroy (2012). Robledo et al.’s participants report difficulty “executing” or “controlling” their “movements” or “actions”, or with “starting or stopping movements”. But the specific examples they describe are more about nervous energy or compulsions or perceptual issues than motor issues: “holding his body still, particularly when he was nervous”; suppressing the “urge to touch my body—rub my thighs or my stomach and chest”; a lack of depth perception such that “sometimes when she needed to go up the steps she got down on all fours.” Others are consistent with general observations about gross motor and complex fine-motor challenges in autism: “lack of coordination” that “caused her frustration”; difficulty with balance; challenges with “combining two or more movements or actions”, such that “If I am running and I look away from the sidewalk, I’ll trip on the next thing on the sidewalk.” Nowhere do the authors report difficulty with basic movements like pointing.

Turning, next to motor stereotypies (repetitive motor patterns), including echolalia, Jaswal & Akhtar tell us that these phenomena do not indicate a lack of social interest, but may instead “serve self-regularity and communicative functions.” While they are correct here, Jaswal & Akhtar haven’t added anything to their argument: stereotypies are not generally considered a part of the social deficit of autism. Indeed, within the diagnostic criteria for autism, they generally appear in a separate category.

In the DSM 5, this category combines “restricted, repetitive patterns of behavior, interests, or activities “ and it’s these last two items that underlie Jaswal & Akhtar’s strongest case for the idea that social motivation in autism has been underappreciated. As they point out, the interests of autistic people may not coincide with those of the people around them. Taking this a step further, they state that “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.”

But this brings us to one of the biggest problems with Jaswal & Akhtar’s article: their sources for this claim and others (particularly those about control) extend beyond the research on autism to highly problematic first-personal testimonials. These testimonials are problematic not just because they’re anecdotal, but because they are limited to two groups:

(1) several individuals with Asperger’s or High Functioning Autism, where social motivation is often highest. Even within this group, as Jaswal & Akhtar admit, “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.”

(2) a half dozen individuals whose testimonials are obtained through one or another form of facilitated communication, and therefore, as all the evidence suggests, are not actually the testimonials of individuals with autism (see Vyse et al., 2019 for a critique).


References:

Gernsbacher, M. A., Stevenson, J. L., Khandakar, S., & Goldsmith, H. H. (2008). Autistics’ Atypical Joint Attention: Policy Implications and Empirical Nuance. Child development perspectives, 2(1), 49–52. https://doi.org/10.1111/j.1750-8606.2008.00041.x

Robledo, J., Donnellan, A. M., & Strandt-Conroy, K. (2012). An exploration of sensory and movement differences from the perspective of individuals with autism. Frontiers in integrative neuroscience6, 107. https://doi.org/10.3389/fnint.2012.00107

Vyse, S., Hemsley, B., Lang, R., Lilienfeld, S., Mostert, M., Schlinger, H., Shane, H. C., Sherry, M. & Todd, J. T. (2019). Whose words are these? Statements derived from Facilitated Communication and Rapid Prompting Method undermine the credibility of Jaswal & Akhtar’s social motivation hypotheses. Behavioral and Brain Sciences, 42, E113. doi:10.1017/S0140525X18002236

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