Currently scientific research points to multiple genes, which may or not may coincide in the affected persons. That is why different authors try to describe the global psychological disorder underlying the behavioural symptoms that are observed in people with ASD.
The most recognised theories are the following:
- The Theory of Mind
- The Theory of Executive Dysfunction
- The Theory of Weak Central Coherence
- The Theory of Empathising-Systemizing
The theory of mind was created by Simon Baron-Cohen, Alan Leslie and Uta Frith in 1985 and is the explanatory theory of the first symptom criteria (A) of the DSM-5 and it tries to explain the persistent deficits in communication and social interaction in various contexts with people with ASD.
The theory of mind is the ability that neurotypical people (people with no apparent mental disorder) have to represent the mental states of others. This ability appears innately during the first stages of child development and is established at around 4-5 years old. Thanks to this ability, we look at social cues in our development and we develop socially. People with ASD have this capacity impaired (there are different degrees of affect), which is why it is necessary to work on it to strengthen it.
This mental ability not only deals with anticipating behaviour in terms of intentions (understanding what they think and/or want another person to do), but it also includes more profound mental states: thinking, believing, knowing, dreaming, cheating, etc. With this ability, we can explain and anticipate the social behaviour of other people around us the people who surround us.
The ability to attribute mental states to another implies:
1. Being capable of having beliefs on the beliefs of others. That is to say, reading the other’s mind, knowing and anticipating what they think.
2. Being capable of doing or anticipating a function of the attributed beliefs. This refers to recognising “why” another person has a certain thought.
3. Requiring certain skills that tend to develop in neurotypical children naturally, including:
- Joint attention: this is the skill to steadily pay attention to the same stimulus and it appears at 9 months of age.
- Cognitive and emotional empathy: this refers to the capacity to put oneself in the place of another and it appears at around 2 years of age.
Moving in a mentalist terrain is very difficult for people with ASD, since the people with normal development infer information that is not explicit, but a person with autism has a lot of difficulties doing it. People with autism need to break social behaviour down into small pieces in order to understand and learn gradually.
In order to assess this mentalist skill, two tasks must be carried out: first-order false belief (“Joan thinks and the other one thinks”), with tests like the Sally-Anne test, by Wimer Perner; and the second-order false belief (“Joan thinks that the other one thinks that he thinks”) with tasks such as the birthday task, by Sullivan and Cols.
The theory of executive dysfunction was created by Pennington and Ozonoff, 1996; Russell, 1997, and others, and it is the explanatory theory of the second symptom criteria (B) of the DSM-5, and it tries to explain the restricted and stereotyped patterns of behaviour, interests and activities of people with ASD.
Executive functions (EF) are a set of cognitive skills that are put into practice through autonomous activities. These skills, which are also innate, allow us to organise ourselves, be flexible, anticipate, plan, set objectives and goals, control our impulses, etc.
These are a set of cognitive processes that act in new situations where we don’t have a previous plan of action.
These are located in the prefrontal cortex. It is the last part of the brain to mature, which occurs from 12 months to 18 years of age, with two notable peaks at 4 and 18 years old.
There are various neuropsychological functions of EF:
1. Response control. It is the skill to inhibit (not respond voluntarily) immediate motor and emotional responses to a stimulus, event or incident, postponing immediate satisfaction for more important goals in the long term. For example, avoiding crying in a job interview, or shouting when we are angry, since we are capable of anticipating that not doing it, even if we want to, would be better. Another skill also forms part of the capacity for response control: resistance to distraction. This allows us to avoid stimuli that could interfere in the monitoring of a process (distracting us).
2. Working memory. We use this to store information as a pre-requisite or tool to solve future problems. Authors divide them into two types: on the one hand, we find Verbal Working Memory (VWM) which is self-directed talk that allows us to regulate our behaviour independently, that is to say, give ourselves instructions to follow rules and direct our behaviour towards a certain goal.
On the other hand, we have Nonverbal Working Memory (NVWM), which is thinking in visual images of the past to guide us in the present. In order to be able to develop NVWM, we need to have retrospective perception, prediction capacity, consciousness and command of times, and the capacity to mimic new behaviour.
3. Self-regulation of alertness, emotions and motivations. This is another skill that people have to change our behaviour (conduct) depending on the context. We don’t behave in the same way when we are with the family as we do with work colleagues, even though we continue to be the same person. In order to self-regulate, these aspects require:
- Modulating responses to situations
- Containing and understanding emotional reactions
- Changing emotional reactions if they distract us from the ultimate goal
- Generating new emotions or motivations
4. EFs are necessary for conflict resolution. It is the skill to anticipate and predict the results of an action, activity, etc. It involves:
- Establishing goals and identifying objectives
- Planning actions
- Putting steps in a time and space sequence
- Prioritising needs and tasks
- Starting a task
- Flexibility in moving from one focus of attention to another, tolerating changes, etc.
The theory of Weak Central Coherence was created by Uta Frith in 1989; Joliffe and Baron-Cohen in 1999, and it deals with explaining the difficulty that people with ASD have in including information in a single coherent and general “everything”, focusing their attention on small details (fragmented processing).
Two parts are involved:
• Perceptual: this involves the preference that people with ASD have for processing local information before global information. As is observed in many cases, people with ASD first focus on specific details of images or objectives rather than on their entirety. This can be assessed using the Navon Test (1977).
• Conceptual: people with ASD tend to fail in the process of contextual meaning and prior knowledge. Often they do not understand situations or contexts they have already seen before. This can be assessed using Gestalt images (optical illusions).
Therefore, people with ASD are local information processors, and people with normal development are global processors.
They are less susceptible to optical illusions, and thanks to their local processing they are quicker at tests in finding details and they have advanced skills in visual searches. They obtain very high marks on tests such as the block design test and the embedded figures test (both by Shah and Frith, 1993).
The theory of Empathising-Systemising (e-s) was created by Simon Baron-Cohen in 2009 and tries to explain the difficulties of people with ASD in establishing communication and creating social relationships.
It is theorised that there is a gradation of empathy and systemisation, that is to say, the author defends that there are excessively empathetic brains (with high capacities to place oneself in the position of the other but with low skills in systematisation) and excessively systematic brains, that is to say, with few empathetic capacities). People with ASD tend to be closer to the systematic extreme, showing hypoactivity in almost all brain areas of the empathy circuit.
Using learning, people with ASD may develop “cognitive empathy”, a learned empathy. But this will never be intuitive or primitive, as it is in neurotypical persons. There is also affective empathy, which is the reactive element of cognitive empathy, that is to say, to see if an emotional reaction matches the thoughts and feelings of another people.
People who systemise look for rules governing a system in order to be able to predict how they will progress, to manipulate a variable, to modify a system or to invent a new one. In this sense, people with ASD tend to show interests related to collection systems (types of dinosaurs), mechanical systems (functioning of a radio), numerical systems (train schedules, calendars), abstract systems (music), natural systems (meteorology), social systems (dance routine with a dance partner) and motor systems (jumping on a trampoline).
It is also characteristic of them to look for and create patterns in “non-systematic” things in order to find a safe space, within a world that is not secure for them.
This strong tendency towards systematisation may also explain the difficulties in generalisation of people with ASD.
These difficulties may be assessed using the “Empathy Quotient” test, by Baron-Cohen.