Investigating distinct and related contributions of Weak Central Coherence, Executive Dysfunction, and Systemizing theories to the cognitive profiles of children with Autism Spectrum Disorders and typically developing children

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Highlights

  • Cognitive theories of ASD have accounted for some distinct patterns of performance.

  • Comparing theories in children with HFA and AS can identify cognitive differences.

  • Results support Weak Central Coherence and Executive Dysfunction Theories in ASD.

  • No support was found for Systemizing Theory in children with ASD.

  • The study supports the need for multiple measures to assess cognitive theories.

Abstract

Many attempts have been made to explain the cognitive profiles of children and adults with Autism Spectrum Disorders (ASD). The current study investigated three prominent theories of cognitive processing – Weak Central Coherence, Executive Dysfunction, and Systemizing – to determine how they could define the cognitive patterns of performance in children with ASD. Utilizing tasks that tapped into visuospatial and linguistic domains, and both parent-report and child performance, the present research found support for the Weak Central Coherence and Executive Dysfunction theories in accounting for distinct cognitive profiles in children with ASD. No differences were observed between children with ASD and TD children on Systemizing abilities or preferences. The results also indicate that cognitive profiles in ASD may manifest in different ways in children historically considered High-Functioning Autism and Asperger's Syndrome. Additionally, the present research demonstrated the importance of using comprehensive measures to assess cognition and behavior in children with ASD. These results provide support for the consideration of individual differences in cognitive profiles of children with HFA and children with AS when developing educational and therapeutic programming.

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that presents a pattern of impairments across social communication and restricted/repetitive behaviors and interests (American Psychiatric Association [APA], 2013). The current overall prevalence rate of ASD diagnoses is 1 in 68 children (Center for Disease Control, 2014) and as low as 1 in 50 among school-aged children (Blumberg et al., 2013). As more children are diagnosed with ASD, empirical investigations into the cognitive mechanisms underlying ASD are increasingly vital. Current proposals have suggested that consideration of multiple theories may provide a more thorough understanding of the mechanisms underlying cognitive processing in ASD (e.g., Brundson and Happé, 2014, Happé and Ronald, 2008). In addition to utilizing a multifold theoretical approach to studying cognitive processes in individuals with ASD, it is well established that individual characteristics are also just as important considering the heterogeneity of abilities observed in ASD (e.g., López and Leekam, 2003, Loth et al., 2008).

Consistent with that thought, the present research uses multiple methods to assess three current and prominent cognitive theories of ASD, Weak Central Coherence (Frith, 1989), Executive Dysfunction (Pennington & Ozonoff, 1996), and Systemizing (Baron-Cohen, 2002), with the main objective being to examine the extent to which these theories, together and alone, provide a viable explanation for the cognitive profiles of individuals with ASD. Through the use of comprehensive measures to capture each cognitive theory and exploring individual differences across historical diagnostic classifications, the present study will investigate the unique contributions, as well as the relations between Weak Central Coherence, Executive Dysfunction, and Systemizing theories in children with ASD and typically developing (TD) children.

Weak Central Coherence theory was first proposed by Frith (1989) and rests on two basic principles: (1) individuals with ASD possess a natural bias to focus on the local properties of information and (2) individuals with ASD exhibit difficulties integrating the local properties of information into meaningful representations. Support for the Weak Central Coherence theory has been found across visuospatial and linguistic tasks in children with ASD. Superior performance has been observed in children with ASD on the Children's Embedded Figures Test (CEFT; Witkin, Oltman, Raskin, & Karp, 1971), a task that requires disengaging from a larger, meaningful picture in order to locate a hidden figure. Multiple studies have found that children with ASD as young as three years of age were able to complete this task faster than TD children (e.g., Jarrold et al., 2005, Keehn et al., 2009). In linguistic tasks, children with ASD have also shown difficulties in global processing and a preference for local processing. Children with ASD commit more errors on tasks that require the use of context in pronouncing words and completing sentences (e.g., Booth and Happé, 2010, Burnette et al., 2005, López and Leekam, 2003). These studies indicate that Weak Central Coherence theory has viability in accounting for the cognitive profile across domains in children with ASD.

Several recent findings, however, suggest that not all paradigms demonstrate context insensitivity or weak global processing in ASD across visuospatial and linguistic tasks (e.g., Henderson et al., 2011, López and Leekam, 2003). Some studies have found that global or contextual processing depends primarily on individual characteristics, such as language (e.g., Brock, Norbury, Einav, & Nation, 2008) or task instructions (e.g., López et al., 2004, Plaisted et al., 1999). Furthermore, others have found that Weak Central Coherence profiles may vary across visuospatial and linguistic tasks, with some individuals with ASD exhibiting greater local processing and weaker global processing across both domains, and others displaying this pattern in only the visuospatial or linguistic domain (e.g., Loth et al., 2008). To address these uncertainties, the present research will utilize both visuospatial and linguistic tasks to assess Weak Central Coherence in children with ASD and TD children. The findings will illustrate whether there are distinct profiles of Weak Central Coherence across task domains.

The Executive Dysfunction theory has also been proposed to account for the cognitive and behavioral profiles in ASD (e.g., Ozonoff, Pennington, & Rogers, 1991). Individuals with ASD have demonstrated Executive Dysfunction, with difficulties in inhibition (e.g., Verté, Geurts, Roeyers, Oosterlaan, & Sergeant, 2006), planning (e.g., Geurts, Verté, Oosterlaan, Roeyers, & Sergeant, 2004), and cognitive flexibility (e.g., Semrud-Clikeman, Fine, & Bledsoe, 2014).

However, some studies evaluating executive functioning in ASD have yielded conflicting results due to the definitions and methods employed (e.g., Joseph et al., 2005, Robinson et al., 2009). Moreover, findings may not always be replicated (e.g., Hill, 2004, Hill and Bird, 2006, Kleinhans et al., 2005). Nevertheless, there is a growing body of research that has shown that Executive Dysfunction in children with ASD is more consistently found in cognitive flexibility tasks or tasks that require children to shift from one frame of thought to another (e.g., Reed et al., 2013, Rosenthal et al., 2013, Van Eylen et al., 2011).

Studies of Executive Dysfunction may be further complicated by the discrepancies between lab-based tasks and real-life behavioral reports (e.g., parent, teacher). Reviews of Executive Dysfunction in children with ASD have recommended the use of both types measures as vital in obtaining a comprehensive analysis of children's abilities (e.g., Isquith et al., 2013, Toplak et al., 2013). However, studies that actually implement these methods to our knowledge are few. The present study addresses this issue by incorporating a lab-based task and real-life behavioral report to measure Executive Dysfunction in children with ASD and TD children.

According to Systemizing theory, individuals with ASD learn new information by seeking predictable relationships and following set rules (Baron-Cohen, 2002). To systemize one must initially observe the Input, understand its Operation, or the rules by which the Input functions, and finally arrive at the predicted Output. By following these steps, individuals can reliably predict change (Baron-Cohen, 2006).

Systemizing has been proposed as the cognitive drive for repetitive (“stimming”) behaviors, obsessions, and resistance to change (Baron-Cohen, 2006, Wheelwright and Baron-Cohen, 2011), thus presenting a compelling framework to understand cognitive processes in children with ASD. Assessments of Systemizing ability have typically relied on behavioral observations of activities and preferences and direct applications of rule-based processing. Parent-reports of children and adolescents’ behaviors and activities representing Systemizing tendencies have demonstrated a continuum of Systemizing abilities in children with and without ASD, although children with ASD are routinely reported using systemizing strategies to greater extents than TD children (e.g., Auyeung et al., 2009, Auyeung et al., 2012).

Direct measures have also found that children with ASD were more accurate in sequencing causal relationships (i.e., Picture Sequencing Test; Baron-Cohen, Leslie, & Frith, 1986) and adolescents with Asperger Syndrome (AS) were more accurate on questions of causal relationships of physical properties between objects (i.e., Intuitive Physics Test; Baron-Cohen, Wheelwright, Spong, Scahill, & Lawson, 2001). However, to date, only one study has compared both parent-report and direct child measures of Systemizing (i.e., Intuitive Physics Test) in boys with AS, finding no relationship between the two (Krajmer, Spajdel, Celec, & Ostatníková, 2011). Thus, further studies are needed to determine the validity of existing Systemizing measures and possible relations with other cognitive processes. The present study will incorporate both parent-report and direct child assessment of Systemizing behaviors to evaluate how these may or may not be related in children with ASD and TD children. The relation between Systemizing and other cognitive processes (i.e., Weak Central Coherence, Executive Dysfunction) will also be explored.

There may be alternative explanations in understanding why individuals with ASD may exhibit distinct cognitive processes from TD children. Researchers have suggested that local processing, executive dysfunction, and systemizing may each contribute to how children with ASD process information (e.g., Baron-Cohen & Belmonte, 2005). To test this conceptual model, studies assessing Weak Central Coherence, Executive Dysfunction, and Systemizing are needed to disentangle the connections between each. Miller, Odegard, and Allen (2014) suggest that gist/global traces of information have weaker connections in individuals with ASD and therefore may not be readily accessible. Other cognitive processes, such as rule-based processing or executive functioning, may afford the individual with additional resources to operate on incoming information. Thus, the presence of weak gist/global traces of information along with possible collaboration of rule-based processing and executive function components may provide a plausible account for the differences in performance on Weak Central Coherence, Executive Dysfunction, and Systemizing tasks observed within children with ASD.

Past studies have presented some support linking Weak Central Coherence and Executive Dysfunction. In fact, there is some debate whether Weak Central Coherence contributes to the executive function difficulties observed in ASD or rather that it is the executive function challenges that underlie Weak Central Coherence in ASD (e.g., Mottron, Belleville, & Menard, 1999). Studies that have compared Weak Central Coherence and executive function performance in children with ASD have demonstrated that these processes may in fact follow distinct developmental pathways (e.g., Pellicano, 2010). Other studies have found that individuals with ASD do not all exhibit the same patterns of executive function performance (Loth et al., 2008, Teunisse et al., 2001). It is imperative to evaluate how these patterns of performance may align with other cognitive processes proposed by the Weak Central Coherence and Systemizing theories.

Many executive function abilities have also been associated with Systemizing theory. It has been suggested that when children with ASD demonstrate executive function difficulties on inhibition tasks such as the Windows Task or Detour-Reaching Task, it may be due to an inability to understand arbitrary rules and this drives the observed executive function differences when compared to TD children (e.g., Hill, 2008, Jones et al., 2013). If children with ASD are approaching these tasks with a Systemizing viewpoint, this may explain the observed difficulties in following rules that are arbitrary and not predictable. Thus, it is vital to distinguish the cognitive processes children employ when completing executive function tasks.

Moreover, only one study to our knowledge has empirically assessed elements of each cognitive theory within the same group of children with ASD. Pellicano et al. (2011) developed a life-size visual search task that could be solved by extracting rules (Systemizing). Children with ASD and TD children were assessed in their accuracy and search time on the visual search task and on measures of spatial working memory (Executive Dysfunction) and the Children's Embedded Figures Test (Weak Central Coherence). Contrary to the predictions proposed by the Systemizing theory, children with ASD were not systematic in their search or proficient at extracting visual search strategies. Additional comparisons showed that poor spatial working memory (Executive Dysfunction) and better visuospatial local processing (Weak Central Coherence) were related to continued attempts to locate the target. Thus, it appears that higher levels of executive dysfunction and a weak central coherence were associated with less use of systemizing. These results provide an important foundation to understanding cognitive theories of ASD, however, additional research is needed to decipher the distinct nuances of how children with ASD process and utilize information.

In evaluating how cognitive theories can account for the performance of children with ASD, it is important to also consider the impact of individual characteristics given the heterogeneity observed in ASD. For example, past studies have typically controlled for nonverbal and verbal IQ in evaluating task performance in children with ASD, however, it has been suggested that these methods limit the interpretation of participant characteristics and their influence on outcome measures (Charman, 2004, Dennis et al., 2009, Facon et al., 2011). Moreover, although the current DSM-5 no longer identifies subgroups within Autism Spectrum Disorders (i.e., Autistic Disorder, Asperger Syndrome), there is substantial evidence suggesting underlying cognitive differences between children historically diagnosed as High-Functioning Autism (HFA) and historically diagnosed with Asperger Syndrome (AS; e.g., Chiang et al., 2014, Planche and Lemonnier, 2012, Tsai, 2013). Past studies on Weak Central Coherence, Executive Dysfunction, and Systemizing have not systematically explored these constructs between children with HFA and children with AS, therefore it was determined crucial to assess the theoretical relevance of Weak Central Coherence, Executive Dysfunction, and Systemizing within each ASD group.

Furthermore, due to the exploratory nature of the present research, a “language-cautious approach” was adopted in order to obtain an unbiased model of cognitive profiles in ASD (Charman, 2004). This approach addresses the interpretation issues that arise when language ability is used as a covariate as it assumes that language functions in the same manner across populations (Joseph et al., 2005). Therefore, in addition to evaluating the performance of children with HFA and children with AS separately, nonverbal/verbal IQ measures would not be entered as covariates in the statistical analyses in order to maintain the integrity of each group.

In light of past studies, four primary objectives underlie the present research. Firstly, the present study is designed to examine how Weak Central Coherence, Executive Dysfunction, and Systemizing theories together and individually can better explain how children with ASD process information. Secondly, the role of individual characteristics within each group (i.e., nonverbal reasoning, language) will be evaluated in relation to each theory. Thirdly, relations between theories will be assessed within each group (i.e., HFA, AS, and TD) in order to obtain a more complete conceptualization of information processing in typical and atypical development. Finally, the present research will explore how measures of each theory adequately capture their intended construct, particularly when information is obtained across domains (i.e., visuospatial, linguistic) or informants (i.e., child, parent). In meeting these objectives, four central questions will be addressed:

  • 1.

    Are there differences between diagnostic groups (i.e., HFA, AS, TD) on cognitive processes? Based on the evidence reviewed supporting each cognitive theory, it is expected that children with HFA and children with AS will exhibit higher levels of local processing, higher levels of Executive Dysfunction and higher levels of rule-based processing than TD children. Past studies have not reported significant differences between children with HFA and children with AS on these constructs, it is expected that children with HFA may exhibit higher levels of these constructs than children with AS although differences between these groups may not be statistically significant.

  • 2.

    What are the underlying relations between individual child characteristics and their cognitive processes? It is hypothesized that core language abilities will be significantly related to performance on Weak Central Coherence and Systemizing tasks based on past studies suggesting links between language and local processing and between language and rule-based processing in children with HFA and AS. There are no specific hypotheses regarding core language abilities and Executive Dysfunction as past research has not fully explored this relation.

  • 3.

    How do common measures of Weak Central Coherence, Executive Dysfunction, and Systemizing theories align within each diagnostic group? Building on past research, the relation between each theory will be evaluated to identify distinct cognitive processing frameworks for each diagnostic group (i.e., HFA, AS, TD). It is expected that Weak Central Coherence and Executive Dysfunction will be positively related in children with HFA, however, this relation may not be evident for children with AS and TD children. It is also expected that Executive Dysfunction and Systemizing will be positively related in children with HFA, AS, and TD children. This is due to similarities between these constructs in detecting and following patterns of information. It is also expected that Weak Central Coherence will be related to Systemizing in all children, as past studies have suggested that attention to detail is necessary to construct a rule-based system.

  • 4.

    Do the common measures across domains (Weak Central Coherence) and across informants (Executive Dysfunction, Systemizing) within each theory represent a collective construct? It is hypothesized that visuospatial and linguistic local processing measures will be positively correlated with each other across all groups. It is expected that that parent-reported Executive Dysfunction will be related to children's performance on a cognitive flexibility task. Thus, children who exhibit higher levels of executive dysfunction as reported by their parents will have greater difficulties with cognitive flexibility. It is uncertain whether children's performance on a rule-based sequencing task will be related to parent-reported systemizing as there is limited empirical support comparing these tasks in children with HFA, children and AS, and TD children.

Section snippets

Participants

Children with ASD between 7 and 11 years of age participated in the study (n = 24, M = 9.70 years, SD = 1.35 years). The children in the ASD group had a historical diagnosis of High-functioning Autism (HFA: n = 13, M = 9.94 years, SD = 1.32 years) or Asperger's Syndrome (AS: n = 11, M = 9.42 years, SD = 1.40 years). Children with ASD were recruited with the assistance of the Interactive Autism Network (IAN) Research Database at the Kennedy Krieger Institute and Johns Hopkins Medicine – Baltimore, sponsored by

Results

Mean scores for tasks measuring Weak Central Coherence, Executive Dysfunction, and Systemizing theories are shown in Table 1. In order to make comparisons across different scales, scores for each measure were standardized. This was done by converting raw scores for the Weak Central Coherence (CEFT accuracy proportion score, SCT completion score), Executive Dysfunction (BRIEF-Global Executive Composite t-score, WSCT perseverative errors t-score), and Systemizing (PST accuracy proportion score,

Discussion

The present study evaluated three cognitive theories to obtain a more in-depth understanding of the cognitive processes in ASD. Standard measures were used to capture the unique cognitive profiles of children between 7 and 11 years of age. Four main hypotheses were explored. Firstly, it was expected that children with ASD would exhibit higher levels of local processing (Weak Central Coherence), higher levels of Executive Dysfunction, and higher levels of Systemizing than TD children. Secondly,

Conclusions and future directions

In the ASD literature, three dominant theories have attempted to account for the cognitive repertoire of children with ASD: Weak Central Coherence, Executive Dysfunction, and Systemizing Theory. Although past studies investigating these theories have been able to explain certain behaviors and/or abilities, many unanswered questions could be answered by bringing together the claims of the three theories. This study is the first to systematically assess the tenets of Weak Central Coherence,

Acknowledgements

I would like to thank Salem Christian School and St. Peter Catholic School as well as all the children and parents who participated in this study. I would also like to thank Markie Falotico, Ramsha Khan, and Colleen Prendergast for their assistance in recruitment and data collection. Additionally, I would like to thank parent support groups for their interest in promoting this research among their members and the Interactive Autism Network (IAN) for their assistance in recruitment. Funding for

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