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06. meyer, pp.

152-160 8/29/02 10:37 AM Page 152

An Update on Neurocognitive
Profiles in Asperger Syndrome
and High-Functioning Autism

Jessica A. Meyer and Nancy J. Minshew

This article provides an overview of the similarities and distinctions between individuals memorized meaningless facts, whereas
with autism and those with Asperger syndrome (AS). First, we review the cognitive and Asperger’s prototypical cases were so-
neurocognitive profile underlying deficits characteristic of autism spectrum disorders. cially awkward but interested in others,
Particular emphasis is placed on recent comparisons of high-functioning autism to AS spoke fluently (albeit in an unusual man-
on the basis of neuropsychological testing, and implications of neuropsychological ner), lacked common sense, and were
profiles for the cognitive deficits and clinical presentation of AS.
“specialists in unusual fields” (Frith,
1991, p. 12). Yet, both accounts also
contained strikingly similar symptoms,
including impoverished social interaction
and use of language for communication,

sperger syndrome (AS) is cur- had imagined it or from what he was stereotypic patterns of behavior, special
rently conceptualized as a neu- used to, he was upset and confused and interests, and resistance to change.
rodevelopmental disorder, re- would go into long tirades” (p. 61). Several of Asperger’s and Kanner’s
lated to autism with regard to deficits in Originally, he wrote that this disorder cases overlapped to the point of almost
social interaction and restricted or obses- could occur on a continuum, at any level identical symptom presentation (Schop-
sive interest patterns, but characterized of ability, from mental retardation to in- ler, 1998). The diagnostic criteria de-
by less severe language and cognitive im- tellectual genius. scribed by Asperger, including atypical
pairments (Volkmar & Klin, 2000). Al- Just a year prior to the publication of social behavior, egocentricity, communi-
most 60 years ago, an Austrian pediatri- Asperger’s (1944/1991) paper, Leo cation difficulties, and circumscribed in-
cian, Hans Asperger (1944/1991), Kanner (1943) published an account of terests, can be found in Kanner’s defini-
introduced this disorder as “autistic 11 children with “early infantile autism” tion of autism (Schopler, 1998). In fact,
psychopathy” to the German-speaking in English. Kanner’s and Asperger’s pa- as Wing (1998) observed, the primary
world when he described four unusual pers provided case illustrations with difference appears to be one of severity.
boys with fluent language skills but pe- salient distinguishing features between The closer intelligence and language
culiar ways of using language, social iso- these conditions. Wing (1998) com- abilities are between comparison groups,
lation, abnormal voice prosody, a desire mented that individuals could be selected the more similar the clinical symptoms.
for sameness, repetitive behavior, and from each group to represent contrasts in This suggests that these disorders may be
odd nonverbal communication. Asper- behavior and clinical presentation. Mem- described differently on the basis of
ger’s case descriptions emphasized odd bers of Kanner’s group of children were severity and cognitive ability. However,
use of eye gaze, speech, and movements, characterized by severe language delays aside from these severity-dependent dif-
as well as difficulty with learning in a con- or the absence of language, whereas As- ferences, the disorders have not been dis-
ventional manner. The need for predict- perger’s cases were characterized by their tinguished as valid separable categories.
ability, routine, and sameness was under- pedantic, long-winded, and precocious In spite of such similar descriptions, each
scored in a case example where Asperger speech. The prototypical cases described manuscript initially received attention
commented, “If something was only by Kanner were either mute or echolalic, and interest primarily in the language in
slightly different from the way that he lined up toys, were socially oblivious, and which it was published—Kanner in the


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English-speaking world and Asperger in (DSM-IV-TR; American Psychiatric As- Cognitive Differences
the German-speaking world—for almost sociation, 2000) provides updated infor-
40 additional years. mation on the basis of empirical data. Given the substantial symptom overlap
The revision reflects not an update to the between AS and autism, it is not surpris-
diagnostic criteria but rather new infor- ing that several recent studies question
Diagnostic Criteria mation available since the literature re- whether these disorders are truly separa-
views of 1992 prepared for DSM-IV. At ble. Although the majority of persons
Following extensive literature reviews the time of the original DSM-IV publica- with autism are also debilitated by men-
conducted in 1992, AS was included as a tion, information on AS (aside from di- tal retardation, individuals with high-
separate diagnosis in the Diagnostic and agnostic criteria) was limited. Among as- functioning autism have a normal IQ and
Statistical Manual of Mental Disorders, sociated features of AS, the DSM-IV-TR may be indistinguishable from those with
4th Edition (DSM-IV; American Psychi- mentions variable cognitive functioning, AS. When comparisons on intellectual,
atric Association, 1994), under the class mild motor clumsiness or awkwardness, motor, visual–spatial, and executive func-
of pervasive developmental disorders overactive behavior, inattention, and an tion tasks failed to reveal group differ-
(PDD). At approximately the same time, association with secondary emotional ences in their recent empirical study,
the World Health Organization’s ICD- difficulties, such as depression. The revi- Miller and Ozonoff (2000) concluded
10 (WHO, 1993) also included AS, with sions specifically state that although no that Asperger syndrome “may simply be
the recognition that its features might clinically significant language delays may high-IQ autism” (p. 227). Ozonoff,
overlap significantly with autism and that be present, the more subtle features of South, and Miller, (2000) compared
this diagnosis might also be difficult to social communication may indeed be children with HFA and AS on cognitive
differentiate from other variants of per- impaired. In addition, the DSM-IV-TR function, current presentation, and early
vasive developmental disorders. Individ- (APA, 2000) specifies that rather than history, reporting that the fundamental
uals with both autism and AS are charac- “social and emotional indifference” differences in symptom presentation
terized by DSM-IV and ICD-10 criteria (p. 80), which is often viewed in autism, were best described as a matter of symp-
as having abnormalities of reciprocal so- the individual with AS displays an “ec- tom severity. A review of their specific
cial interaction and restricted, stereo- centric and one-sided approach to oth- findings suggests that, certainly, there
typed, repetitive interests. They differ ers” (p. 80; such as pursuing a conversa- may be subtle differences in presentation.
only with respect to onset and severity of tional topic regardless of the reactions of For example, the group with AS was
symptoms. others). Furthermore, the repetitive and more likely to display circumscribed in-
According to DSM-IV, individuals restricted behaviors, which characterize terests, while the HFA group demon-
with AS do not have a delay in language autism as well, are described as “primar- strated greater insistence on sameness.
acquisition and exhibit normal intelli- ily manifest in the development of en- However, these may be differences of de-
gence. Thus, in order to meet criteria for compassing preoccupations about a cir- gree. Ozonoff et al. concluded that AS is
AS, an individual would need to demon- cumscribed topic or interest, about on the same spectrum as autism but that
strate normal development prior to the which the individual can amass a great “it remains to be seen whether the mag-
age of 3 in language and cognitive devel- deal of facts and information” (p. 80). It nitude and type of group differences
opment, as well as in self-help and adap- is important to note that communication found in the current study are sufficient
tive skills, and general curiosity about the difficulties are also described, related to to provide external validation for the As-
environment. However, this leaves a mi- topic preoccupation, excessive verbosity, perger Syndrome label” (p. 43).
nority of persons with high-functioning limited self-monitoring, failure to use Although one of the key diagnostic
autism (HFA) who do not have a lan- appropriate conversational conventions, distinctions between these conditions is
guage delay and whose level of intellec- and failure to use and respond to non- early language development, Mayes, Cal-
tual functioning is within the normal verbal cues. The DSM-IV-TR points out houn, and Crites (2001) provided empi-
range, to be distinguished from AS on that although early adaptive behavior, rical evidence that presence or absence of
some diagnostic grounds. The DSM-IV language, and cognitive development are speech delay is irrelevant to later presen-
does not stipulate that the abnormalities within normal limits prior to age 3, care- tation of autistic symptoms, language, and
of social interaction and circumscribed givers may have noted unusual behaviors ability profile among high-functioning
interests or repetitive behavior are fewer earlier in development. These revisions, children diagnosed with either autism or
or less severe in AS, as compared to HFA then, suggest that individuals with AS do AS. With respect to the use of early lan-
(Mayes, Calhoun, & Crites, 2001). How- indeed present with unusual behaviors guage development as a distinction be-
ever, if an individual meets diagnostic cri- early in development and in fact may also tween the conditions, empirical studies
teria for autism, then the diagnosis of present with language abnormalities. In do not use consistent criteria for separat-
autism takes precedence. sum, then, the most recent DSM-IV-TR ing individuals with AS from those with
The text revision of the Diagnostic explanations serve to highlight the over- HFA prior to making comparisons. For
and Statistical Manual–Fourth Edition lap between these conditions. example, the current gold standard in
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autism spectrum disorder diagnoses, the to determine whether differences were puppet show is presented to the partici-
Autism Diagnostic Interview–Revised present. pant in which a doll named Sally places
(ADI-R; Lord, Rutter, & LeCouteur, her marble into a basket and goes out to
1994), does not require delayed or dis- play. While she is away, a second doll,
ordered language development as a cri- Ann, moves Sally’s marble into a box.
terion for a diagnosis of autism. There- One contribution of major importance The question is posed to the child: When
fore, it is common to find individuals to the understanding of atypical social Sally comes back, where will she look for
who meet criteria for a diagnosis of HFA behavior in autism was the identification her marble? Although typical 4-year-olds
without language delay. At best, then, we of perspective-taking deficits, or theory- are able to pass this task easily, knowing
currently have no clear distinction be- of-mind deficits, as the basis for the dis- that Sally will look where she believes her
tween a high-functioning person with tinctive quality of social behavior ob- marble to be—where she left it—rather
autism and one with AS. It seems that the served in autism. The key feature of than where it really is, adolescents with
differences between autism and AS are social deficits in autism is the lack of rec- autism assumed that Sally would know
severity dependent, with symptom pre- iprocity: an inability to appreciate that what they knew—that she would look in
sentation most similar between individu- others think, feel, and view the world in the box. This is a very well replicated
als with AS and HFA. a manner different from oneself. Lack of phenomenon in autism; persons with
For this reason, many researchers are interest in the ideas or feelings of others, autism fail this and a variety of tasks de-
advocating the use of one broad label of a key feature of autism spectrum disor- signed to assess ability to understand
“autism spectrum disorder” (ASD) to ders, would clearly stem from such a false belief (Baron-Cohen, 1995; Ozo-
apply to both categories. Wing (1998) deficit. In addition, poor capacity to read noff, Pennington, & Rogers, 1991;
proposed that the spectrum of autistic social cues, use and respond to commu- Perner, Frith, Leslie, & Leekum, 1989),
disorders is characterized by impairments nicative gestures, and establish peer rela- deception (Sodian & Frith, 1992), and
in three categories: social interaction, tionships would potentially stem from intention and desire (Phillips, Baron-
communication, and imagination, with such a deficit. Cohen, & Rutter, 1995).
rigid/repetitive activity patterns. Each The cognitive view of autistic spec- In the course of these empirical stud-
category could range with regard to de- trum disorders, as described by Frith ies, some important differences between
gree of impairment as well as common (1991), holds that the ability to represent participants with AS and those with
associated features, such as sensory ab- mental states, such as thoughts, feelings, autism have been observed. Specifically,
normalities and language deviance, po- or beliefs, is impaired among individuals participants with AS have been found to
tentially yielding numerous manifesta- with autism. Indeed, several empirical perform better on false-belief tasks than
tions of the disorder ranging from subtle studies conducted in the late 1980s and those with high-functioning autism
to marked to severe. early 1990s provided strong evidence of (Bowler, 1992; Ozonoff, Rogers, & Pen-
Szatmari, Tuff, Finlayson, and Bar- impaired information processing in the nington, 1991). As a result, Ozonoff
tolucci (1990) posed two important ability to recognize that others could be- et al. suggested that AS may be separable
questions with regard to neurocognitive lieve something that is not, in fact, true from autism with regard to cognitive
abilities in AS and HFA. These re- (Baron-Cohen, 1995; Baron-Cohen, profile and empathic ability. In fact, As-
searchers asked whether the two disor- Leslie, & Frith, 1985; Leslie, 1987). By perger (1944/1991) also stated that his
ders have similar or different cognitive the age of 3 or 4 years, the typically de- original cases often demonstrated a
profiles and whether the core deficits in- veloping individual is able to rely on remarkable ability to “be a judge of char-
volved are in language or problem solv- representations of mental states, such as acter” (p. 73). Using a younger and more
ing. Although the external validity of AS believing, thinking, knowing, and pre- verbally capable sample, however, Dahl-
apart from HFA continues to be uncer- tending. This deficit in the capacity to gren and Trillingsgaard (1996) found no
tain, at best, examining and comparing represent the mental states of others has differences between children with HFA
neurocognitive patterns in HFA and AS been referred to as a “metarepresenta- versus AS on the same theory-of-mind
may prove useful in enhancing our un- tional” deficit. tasks. In fact, both groups performed al-
derstanding of social and behavioral Over the past decade, based on obser- most as well as a sample of normally de-
symptoms along the autism spectrum, as vations that the ability to attribute men- veloping children. In this case, language
well as in sorting out potential areas of tal states to others was absent or impaired competence was thought to explain pro-
overlap or demarcation. In the search to in persons with autism spectrum disor- ficiency on these tasks. Within the nor-
understand the abnormal behavior pre- ders, a variety of experimental tasks were mal range of intelligence, it was con-
sentation associated with autism, a num- devised to document the perspective- cluded, children with AS and those with
ber of cognitive deficits have recently taking deficit. Numerous studies con- HFA perform similarly, and not as
been defined. Within each of these devel- firmed the failure of individuals with poorly, on false-belief tasks.
opments, comparisons have been made autism to pass false-belief tasks. For ex- An explanation for these results was
between individuals with AS and HFA ample, on the classic “Sally/Ann” task, a provided by Baron-Cohen, O’Riordan,
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Stone, Jones, & Plaisted (1999), who perspective-taking skills seem to improve An abstract reasoning deficit has long
pointed out that the sorts of tasks de- with increasing language competence, been viewed as a fundamental cognitive
scribed above are relatively simple. In- perhaps due to the use of verbal com- impairment in autism and has been doc-
deed, these simple tasks can be viewed as pensatory strategies to solve such prob- umented across the spectrum of the dis-
assessing the earliest developing theory- lems, albeit via a circuitous route. Yet, the order. For example, Rutter (1978) ob-
of-mind skills, usually achieved between last finding, regarding the inability to in- served that among individuals with
the ages of 4 and 6 years. However, so- tegrate information within a context, autism, lower general intellectual ability
cial cognition continues to develop be- may also be related to the behavioral fea- was related to sharp decreases in abstrac-
yond those years. Fortunately, tests of tures of autism spectrum disorders. tion ability. There is clear evidence of a
more advanced theory-of-mind skills universally present deficit in abstraction
were also continuing to be developed. In abilities in individuals with autism, as well
one such study, children with AS and Complex Information as a range of severity in its expression
HFA who were able to pass false-belief Processing (Minshew, Goldstein, Muenz, & Payton,
tasks of varying difficulty showed impair- 1992; Prior & Hoffman, 1990; Rumsey,
ments in the detection of faux pas, or so- The particular pattern of responding in 1985; Schneider & Asarnow, 1987; Szat-
cial blunders. Using stories in which “a which participants with autism spectrum mari et al., 1990). Recently, a dissocia-
speaker says something without consid- disorders failed to integrate context into tion was found between concept identi-
ering if the listener might not want to their interpretations pointed to another fication, or rule learning, and concept
hear or know, and which typically has realm of hypothesized cognitive deficit in formation, or complete understanding of
negative consequences which the speaker autism spectrum disorders: abstract rea- concepts and generation of novel ideas
never intended,” participants with AS soning. Abstract reasoning can be de- among participants with HFA (Minshew,
and HFA found these items to be signif- fined as the capacity for generating men- Meyer, & Goldstein, in press). Minshew
icantly more difficult than control par- tal representations, thereby permitting et al. argued that deficits in concept for-
ticipants (Baron-Cohen et al., 1999; the development of novel thoughts and mation and the inflexibility resulting
p. 408). In another study, Jolliffe and behaviors, hypothetical thinking, and from an incomplete understanding of
Baron-Cohen (1999) presented a series flexible interaction with others and the concepts also provide a potential cogni-
of naturalistic theory-of-mind stories, the environment. A capacity for abstract tive explanation for a variety of symptoms
Strange Stories test (Happé, 1994), to reasoning also involves the propensity on the autism spectrum, including the
groups of normally intelligent individuals toward meaning making, or organizing inability to generalize learned concepts
with AS, HFA, or typical development. simultaneous events or parts into a mean- to other situations, consider context in
Acceptable performance on these tasks ingful whole. Rather than synthesizing applying a concept, and cope with novel
requires that the participant be able to aspects of a situation into a complete pic- situations and problems for which rules
comprehend a series of everyday situa- ture, individuals with autism spectrum are not known. Deficient concept forma-
tions in which people say things they do disorders tend to focus on parts, regard- tion may also explain these individuals’
not really mean, and provide justification less of their relevance, and either fail to narrow ranges of interests and their focus
for the characters in the stories, such as appreciate higher order meaning or dis- on details as the result of an inability to
ascribing the motivation of sparing the regard it altogether. organize information around conceptual
feelings of another by pretending to like Minshew, Goldstein, and Siegel themes.
a gift. These tasks require the recognition (1997) referred to this as a pattern of Frith (1991) also described this phe-
of sarcasm, irony, and pretense. Interest- deficits in higher order cognitive abilities, nomenon, stating that among persons
ingly, the autism and Asperger groups had with a selective deficiency in complex in- with autism, low-level processing is intact
difficulty providing context-appropriate formation processing. These authors and high-level or conceptual integration
interpretations, instead tending to be- suggested that individuals with autism ability impaired. While typically develop-
come overly focused on the statement in have a heightened awareness of details, ing individuals have a preference for con-
isolation. For example, the participants coupled with impoverished capacity for structing meaning by integrating infor-
with autism and AS misattributed state- the active organization of information. mation into context, individuals affected
ments of pretense as “a joke” and sar- Under these conditions, it is not surpris- by autism spectrum disorders may tend
casm as pretense. These mistakes did not ing that reasoning and problem-solving to focus narrowly on details without see-
occur among the typical participants. In skills are severely affected. Such coexist- ing the gestalt, or the larger picture. This
sum, then, a deficit in theory of mind, or ing deficits and strengths would make it deficit in conceptual integration skill ex-
perspective-taking ability, appears to be difficult to process complex information. plains the success of individuals with
present to some degree among indi- Given the inherent unpredictability and HFA on block design and embedded-
viduals with autism. This deficit may ex- complexity of social information, it is lit- figures tests, which require the partici-
plain their unusual social behaviors. How- tle wonder that the individual with pant to ignore context in favor of details
ever, it is also important to note that autism finds it so difficult to interpret. (Joliffe & Baron-Cohen, 1997; Shah &
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Frith, 1993), coupled with impairment changed to include assessment of capac- For example, Craig and Baron-Cohen
on object integration and scenic tasks ity to form a concept under novel condi- (1999) conducted a set of studies reveal-
(Jolliffe & Baron-Cohen, 2001); concept tions, individuals with HFA were found ing impoverished creativity among chil-
formation tasks such as 20 Questions, to exhibit a significant impairment in dren with AS and autism. Both groups
Absurdities, and Object Sorting (Min- cognitive flexibility (Minshew et al., generated fewer novel changes to ob-
shew, Meyer, & Goldstein, in press); and 1992). Minshew and colleagues (in jects, and when they did generate ideas,
prototype formation (Klinger & Daw- press) stated that among the highest these were reality-based rather than
son, 2001), all of which require the par- functioning individuals with autism, the imaginative. A deficit in pretense, imagi-
ticipant to synthesize various aspects of a deficit in concept formation results in nation, and creativity, possibly related to
presented stimuli simultaneously to form cognitive inflexibility and the inability to capacity for abstraction, was equally evi-
a meaningful whole. In fact, recent evi- spontaneously form schemata, or para- dent among participants with AS and
dence regarding the abstraction deficit in digms that organize information. This is HFA. This set of studies suggested, how-
autism suggests that ability to categorize consistent with impressions that the ca- ever, that the abstraction deficit may have
new information by forming prototypes pacity for creativity, or “the generation, existed in both groups.
or concepts is impaired. This may explain manipulation, and transformation of im-
the need for rote practice, the tendency ages to generate novel representations,”
for inflexible behavior, and the poor so- is impoverished among individuals with Joint Attention
cial functioning of individuals with HFA (Craig & Baron-Cohen, 1999,
autism in social situations, which tend to p. 319). Another important neurocognitive do-
be highly variable and unpredictable. In Thus, among individuals with HFA, main that has contributed to our under-
addition, this may be linked to the ten- the abilities to integrate information into standing of autism spectrum disorders is
dency of individuals with autism spec- context and generate new ideas or con- nonverbal communication skills, specifi-
trum disorders to rely on individual facial cepts are impaired. In other words, the cally, joint attention. Joint attention, or
features rather than processing the face as tendency to seek out the gestalt, impress the capacity to share attention between
a whole—in other words, processing meaning upon, or use context in pro- other individuals and objects, is a capac-
faces piecemeal as if they were objects cessing experiences is diminished, yield- ity that develops during the first year of
(Hobson, Ouston, & Lee, 1988). ing a bottom-up, piecemeal processing life. Joint-attention deficits are present
Abstract reasoning deficits also help style that fails to take context into ac- among individuals with autism prior to
explain the findings of extensive research count. This weakness may help explain theory-of-mind and abstraction deficits,
on the executive dysfunction hypothesis, poor theory of mind, as it is probably not as they have been observed during in-
namely, that individuals along the autism natural for the individual with HFA to fancy and prior to the onset of the other,
spectrum have difficulty with planning generate hypothetical ideas regarding later developing abilities (Mundy &
and organizing, shifting cognitive set be- what others may be thinking or feeling in Markus, 1997; Mundy & Sigman, 1989).
tween two representations, monitoring context. In addition, pragmatic language Joint-attention deficits are the earliest in-
performance and making use of feed- deficits would likely be evident when a dicators of an autism spectrum disorder.
back, and generating novel ideas. Execu- communicative partner fails to account For example, individuals with autism
tive dysfunction was originally viewed as for context, such as what the speaker spectrum disorders use gaze abnormally,
an abstraction deficit characterized by knows or does not know, cares to hear, fail to monitor the gaze of others to share
poor capacity to disengage from the im- or may intend during a conversation. experiences, point to make requests but
mediate external context but, instead, This tendency toward part–whole pro- not typically to share attention, and fail
guiding action via internal mental repre- cessing and abstract reasoning deficits to monitor the gaze of others to infer
sentations (Dennis, 1991). This defini- that range from an inability to identify intended reference in conversation. Al-
tion was subsequently applied to autism concepts and learn rules to limited un- though the relationship between a meta-
as cognitive inflexibility, or the impaired derstanding of concepts (which causes representational deficit—such as in the-
capacity to shift between two mental rep- inflexibility in their application) to poor ory of mind or abstraction—and joint
resentations (Ozonoff, Pennington, & concept or strategy formation has been attention is as yet unclear, Mundy and
Rogers, 1991). Indeed, executive dys- documented among the highest func- Sigman (1989) suggested that these def-
function under the present definition is tioning individuals with autism and most icits could both reasonably reflect “diffi-
pervasive among individuals with autism likely applies to individuals with AS, al- culty with abstracting contingencies in
spectrum disorders. However, recent though a direct comparison study has not social interaction” (p. 180). Deficits in
empirical evidence suggests that the yet been published. joint attention may help explain such
highest functioning individuals with Several studies have begun to directly nonverbal communication abnormalities
autism are able to shift set flexibly when compare individuals with AS and those as the abnormal gaze (aversion or star-
provided the rules by the experimenter with HFA on a variety of measures in the ing), failure to use conventional gestures,
or situation. Yet, when task demands were abstraction and social-cognitive domains. and inappropriate or stilted facial expres-
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sion seen in individuals with both AS and tellectual ability, rather than qualitative ity). However, these differences were re-
HFA. differences. The domains mentioned ear- ported to be minor. Thus, when the AS
Abnormalities in the use of nonverbal lier have also been explored in a variety and HFA groups were combined and
communication, such as gaze, are perva- of combinations. Research has begun to compared with other control groups, the
sive among individuals along the autism demonstrate impaired social communica- children on the autism spectrum (re-
spectrum. As mentioned earlier, individ- tive skills in individuals with AS, poten- gardless of AS vs. HFA diagnosis) showed
uals with ASD tend to focus on details of tially linked to the same deficits as found outstanding deficits in motor coordina-
faces, processing them as if they were in persons with autism. Ellis, Ellis, Fraser, tion, higher order nonverbal problem
objects (Hobson et al., 1988; Schultze and Deb (1994) studied a small sample solving, and language comprehension. In
et al., 2000). In addition, they focus on of young people with AS and found a 1997, Ehlers and colleagues conducted a
the mouth region of the face, rather than tendency toward impaired social judg- comparative study of cognitive profiles
the eyes, to ascertain emotion (Klin, ments. Given that the participants with among children with AS and HFA and
Jones, Schultz, Volkmar, & Cohen, in AS were often unable to answer ques- discovered that the group with AS
press). Using only photographs of the tions about the appropriateness of social showed poorer results on nonverbal
eyes, participants with HFA and AS were behaviors and often guessed at their re- visual–motor tasks (Object Assembly and
impaired at recognizing complex mental sponses, these authors suggested links to Coding), scored better on a number of
states when compared with nondisabled theory of mind as well as difficulties with verbal tasks (Information, Similarities,
adults (Baron-Cohen, Wheelwright, & forming abstract representations of ideas. Comprehension, and Vocabulary), and
Joliffe, 1997), suggesting that using in- In another recent study, participants performed more poorly on arithmetic
formation from the eye region as cues to with AS revealed an interesting process- than those with autism. Participants with
the mental state of another person was a ing pattern when presented with facial- autism demonstrated strength on the
poorly developed skill in this group. emotion photos paired with a written Block Design task. Therefore, it was ob-
Clinical experience suggests that from word; they exhibited a bias for stating the served that the groups may be differenti-
a very early age, the typically developing written word, rather than the emotion ated by better verbal ability in the AS
child actively searches for ways to orga- displayed, when the two did not corre- group and better visuospatial function in
nize information to make sense of his or spond (Grossman, Klin, Carter, & Volk- the HFA group. These authors sug-
her environment. After finding an empir- mar, 2000). The participants did not gested that the AS group may not be as
ical relation between theory of mind and show a specific deficit in recognition of severely impaired in capacity for abstrac-
central coherence, Jarrold, Butler, Cot- facial affect, and this suggests they are ca- tion as those with autism. Again, this
ington, and Jimenez (2000) suggested pable of perceiving and comprehending points to differences in degree.
that the drive to integrate information in basic emotions. However, the authors ar- Miller and Ozonoff (2000) conducted
a meaningful way is likely a developmen- gued that they are capable of this “be- another empirical study to investigate the
tal precursor to joint-attention and cause their thinking is analytic and ver- external validity of AS from the perspec-
theory-of-mind skills. The capacity to bally mediated rather than holistic and tive of neuropsychology. Although par-
abstract contingencies across modalities intuitive as it would be in individuals ticipants with AS had significantly higher
begins in infancy, and perhaps some of without AS.” This is consistent with verbal and full scale IQ scores, larger ver-
the first experience doing so comes about Frith’s (1989) argument that the theory- bal and performance IQ discrepancies,
through social interaction. Thus, the ca- of-mind deficit is less severe among indi- and better visual–perceptual skills than
pacity to co-create meaning, understand viduals with AS than among individuals the autism group, these differences were
information in a relational rather than with autism because it develops late and diminished once the two groups were
concrete sense, use sets of related ab- atypically, and the former apply it halt- matched on intellectual ability. At that
stract notions, resolve ambiguities, and ingly in the real world, but it is never- point, a trend toward poorer fine-motor
think in degrees are all processes that may theless present enough to warrant a di- performance was found in the AS group,
be affected by a disorder that targets agnosis of a mild autism subtype. but performance on other cognitive mea-
complex information processing. Many researchers have argued that the sures, including executive function, was
diagnostic validity of AS separable from similar. Once again, this speaks to the im-
autism ought to be revealed in patterns portance of matching the groups on
Summary of deficit on psychological testing. Szat- cognitive ability in order to ascertain
mari et al. (1990) directly compared in- whether differences between the groups
Many of the studies looking specifically dividuals with AS and HFA on neu- are apparent as a function of cognitive
at each of the above domains provided an rocognitive measures and found that ability and severity of the disorder, rather
opportunity for specific comparisons be- participants with HFA differed from than indicative of two separate disorders.
tween individuals with AS and those with those with AS on a grooved pegboard test It should also be noted that other stud-
HFA, and the results suggested quantita- (visual–motor planning) and the Wiscon- ies have performed direct comparisons of
tive differences based on severity and in- sin Card Sorting Test (cognitive flexibil- fine and gross motor skills in AS and
06. meyer, pp. 152-160 8/29/02 10:37 AM Page 158



HFA and found similar impairments rel- clear desire to interact with others. The AUTHORS’ NOTE
ative to normally developing control student may become a victim of social
This research was supported by National Insti-
groups (Ghaziuddin, Butler, Tsai, & harassment, bullying, or outright rejec-
tute of Child Health and Human Development
Ghaziuddin, 1994; Szatmari, Bartolucci, tion by peers. Many children and adoles- Grant HD35469 and National Institute of
& Bremner, 1989). Given that motor cents with AS are aware of social rejec- Neurological Disorders Grant NS33355 to
deficits can be found in HFA as well as in tion and develop anxiety with regard to Nancy J. Minshew. This research was supported
AS, this diagnostic feature also does not social interaction, which serves to com- by an NICHD Collaborative Program of Ex-
consistently differentiate the two groups plicate their handicaps. cellence in Autism.
(Ghaziuddin et al., 1994; Ghaziuddin, With regard to developing social com-
Tsai, & Ghaziuddin, 1992). petence, the Relationship Development
In sum, studies to date indicate that Intervention (Gutstein, 2001) provided
the two disorders are relatively indistin- a programmatic intervention to teach American Psychiatric Association. (1994).
guishable on the basis of cognitive mea- experience-sharing as an end in itself, and Diagnostic and statistical manual of mental
sures, with a few minor exceptions, which at the same time target ability to think disorders (4th ed.). Washington, DC: Au-
may be attributable to diagnostic severity from multiple perspectives, process infor- thor.
in one or another domain. In addition, it mation in gradations rather than in black American Psychiatric Association. (2000).
seems that individuals with AS occasion- and white (or concrete) thinking, appre- Diagnostic and statistical manual of mental
ally perform better on tasks assessing the- ciate and seek out novelty or variety in disorders (4th ed., text revised). Washing-
ory of mind and abstract reasoning—to experiences, and develop greater imagi- ton, DC: Author.
the extent that these skills have been nation and creativity. This intervention Asperger, H. (1944/1991). “Autistic psy-
chopathy” in childhood (U. Frith, Trans.,
compared systematically. And yet, this targets deficits in social reciprocity, com-
Annot.). In U. Frith (Ed.), Autism and As-
better performance can easily be attrib- munication, and inflexibility. The key to
perger syndrome (pp. 37–92). New York:
uted to higher intellectual ability and ver- this intervention is targeting the capacity Cambridge University Press. (Original work
bal compensatory strategies. Both AS for social relatedness, which is often de- published 1944)
and HFA appear to share metarepresen- layed to an infant or toddler level, even Baron-Cohen, S. (1995). Mindblindness.
tational, abstract reasoning, and nonver- among very cognitively capable individu- Boston: MIT Press.
bal communication difficulties that are als on the autism spectrum. By providing Baron-Cohen, S., Leslie, A. M., & Frith, U.
providing the foundations for a cognitive the motivation to share experience, (1985). Does the autistic child have a
explanation of the symptom profile in which can be accomplished only through “theory of mind?” Cognition, 21, 37–46.
ASD. the balance of predictability and novelty, Baron-Cohen, S., O’Riordan, M., Stone, V.,
symptoms of rigidity, need for sameness, Jones, R., & Plaisted, K. (1999). Recogni-
and impaired communication are also ad- tion of faux pas by normally developing
children with Asperger syndrome or high-
Treatment Implications dressed. Indeed, it is through the co-
functioning autism. Journal of Autism &
creation of shared experience that indi-
Developmental Disorders, 29, 407–418.
Gutstein (2001) referred to the tendency viduals with autism and AS are learning
Baron-Cohen, S., Wheelwright, S., & Joliffe,
of the child with autism to seek out pre- to play, develop symbolic competence,
T. (1997). Is there a “language of the
dictability as an end in itself, avoiding the and appreciate multiple perspectives. eyes”? Evidence from normal adults and
processes of variability and change in so- adults with autism or Asperger syndrome.
cial encounters that must be experienced ABOUT THE AUTHORS Visual Cognition, 4, 311–331.
to bring true experience-sharing and en- Jessica A. Meyer, PhD, is an adjunct assistant Bowler, D. (1992). “Theory of mind” in As-
joyment. Thus, individuals on the autism professor at Louisiana State University. She also perger’s syndrome. Journal of Child Psy-
spectrum tend to interact with others as works in private practice at the Neuropsychol- chology and Psychiatry, 33, 877–893.
if they were objects, for instrumental ogy Center of Louisiana as a postdoctoral clin- Craig, J., & Baron-Cohen, S. (1999). Cre-
rather than social reasons. Abnormal so- ical associate and behavioral specialist. Her ativity and imagination in autism and As-
cial behavior in HFA and AS ranges from current interests include social-cognitive devel- perger syndrome. Journal of Autism & De-
opment and early intervention for children velopmental Disorders, 29, 319–326.
aloof and indifferent to others to intru-
with autism spectrum disorders. Nancy J. Min- Dahlgren, S. O., & Trillingsgaard, A. (1996).
sive and odd. However, the main quality
shew, MD, is an associate professor of psychiatry Theory of mind in non-retarded children
to be observed is a lack of reciprocity in
at the University of Pittsburgh School of Medi- with autism and Asperger syndrome: A re-
social interactions. Due to profound search note. Journal of Child Psychology and
cine. Her research focuses on the cognitive and
deficits in nonverbal communication, ab- neural bases of autism. Address: Jessica A. Psychiatry, 37, 759–763.
stract reasoning, and perspective taking, Meyer, Neuropsychology Center of Louisiana, Dennis, M. (1991). Frontal lobe function in
the student with AS will exhibit severe L.L.C., 2356 Drusilla Lane, Baton Rouge, LA childhood and adolescence: A heuristic for
difficulties in social interactions. They 70809; e-mail: jmeyer@louisiananeuropsych. assessing attention regulation, executive
may have few or no friends, in spite of a com control, and the intentional states impor-
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Louisa C. Moats, University of Texas-Houston

Alba Ortiz, University of Texas-Austin,Texas