MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES
RESEARCH REVIEWS 4: 65–72 (1998)
SOCIAL DEFICITS AND INTERPERSONAL
RELATIONSHIPS IN AUTISM
Lisa L. Travis* and Marian Sigman
Department of Psychiatry, School of Medicine, University of California Los Angeles, Los Angeles, California
In autism, many of the building blocks of interpersonal
relationships, such as communication, social cognition, and process-
ing of emotional signals, are impaired. In spite of these deficits,
children with autism are able to establish relationships with their
parents, siblings, and peers, although these relationships are fre-
quently more limited than those of other children. This paper
reviews the literature on the social deficits and interpersonal relation-
ships of autistic individuals, with a focus on the possible impact of
the former on the latter. We conclude by suggesting that more
information about the effects of social deficits on relationships in
autism would expand our view of the disorder and would provide
direction for interventions. r 1998 Wiley-Liss, Inc.
MRDD Research Reviews 1998;4:65–72.
Key Words: Emotions; Communications
I
nterpersonal relationships are a centrally important aspect of
human life. There is every reason to believe that many
individuals with autism have difficulty forming and maintain-
ing relationships. In autism, the basic building blocks for
interpersonal relationships are known to be impaired, including
communication, social understanding, and emotional responsive-
ness. Relatively little research has directly investigated the social
relationships of people with autism. Still less is known about
specific ways in which the social deficits of autism may affect
interpersonal relationships. In this paper, we will review research
on the social impairments in autism, with a focus on the potential
impact of these deficits on social relationships. We will also
review research that has directly examined the social relation-
ships of people with autism. We conclude by suggesting that
knowledge of the specific strengths and weaknesses in social skills
in people with autism can be usefully applied to develop
interventions that might improve social relationships.
COMMUNICATION
One of the most dramatic developments in communica-
tive functioning occurs in typically developing infants between 9
and 12 months of age. Prior to this age, communication consists
mainly of face-to-face turn-taking episodes that involve sharing
of affect. Thereafter, two emergent forms of communication are
observed. First, infants begin to use gestures to request aid in
obtaining access to objects or events. Second, they display joint
attention, indicating their own attentional focus by pointing and
also accommodating their own focus to coordinate it with
others. In individuals with autism, both these forms of nonverbal
communication occur less frequently than in either typically
developing infants or infants with developmental delay. Joint
attention is especially impaired [Mundy et al., 1986], and this
r 1998 Wiley-Liss, Inc.
deficit is particularly good for discriminating autism from other
conditions associated with developmental delay [Lewy and
Dawson, 1992; Mundy et al., 1986].
Joint attention deficits appear to be characteristic of
individuals with autism throughout their lives, although the
specific form of the deficit may vary with intellectual ability and
developmental level. For example, Mundy et al. [1994] found
that children with low mental ages (MAs) exhibited more
pronounced deficits in lower level components of joint attention
(e.g., eye contact) than children with higher MAs. The latter
group, however, showed deficits in more advanced behaviors
(e.g., pointing). Recently, Leekam et al. [1997] found that high
functioning adolescents and adults with autism may have
reasonably well-developed joint attention capabilities, but fail to
display them in the appropriate circumstances. People with
autism were as accurate as controls in identifying the target of
another person’s gaze when prompted. However, they were
much less likely to turn spontaneously to look in the same
direction that the other person was looking.
For a number of reasons, researchers agree that joint
attention deficits may be one of the key symptoms of autism.
First, joint attention has been theorized to be a critical precursor
to developing an understanding of other persons and to
intentional communication in typical development [e.g., Bates,
1979; Tomasello, 1995]. Second, joint attention deficits in
autism are robust, early appearing, and virtually universal. Third,
many other deficits in autism are similar to joint attention
deficits, or are plausible developmental consequences of them.
What is the origin or cause of joint attention deficits in
autism? Three major suggestions appear in the current literature,
each deriving from a different theoretical viewpoint on the
nature of autism. Perhaps the most well-known of these is the
‘‘theory of mind’’ position. According to this view, joint
attention deficits in children with autism are an early
manifestation of their failure to grasp that other people are able to
represent the world mentally (i.e., have minds) [Baron-Cohen,
1995; Frith, 1989; Leslie, 1987]. Joint attention behaviors, such
as gaze following and pointing, are directed at achieving a
connection with another mind. Without an appreciation of
others’ mental states, such behaviors would be unlikely to occur,
because their purpose would not be grasped. An alternative
proposal focuses on the affective component of joint attention.
*Correspondence to: Lisa L. Travis, U.C.L.A., Neuropsychiatric Institute, 760
Westwood Plaza, 6-8237, Los Angeles, CA 90024–1759. E-mail: travis@psych.ucla.edu
Early in typical child development, joint
attention is often associated with positive
affect [Kasari et al., 1990]. Shared positive
affect may be an important incentive for
establishing and maintaining joint atten-
tion. For children with autism, however,
some researchers have proposed that
mechanisms involved in the sharing of
affect are disrupted, thus undermining the
typical motivation for joint attention
[Hobson, 1993; Mundy, 1995]. A third
account suggests that joint attention
deficits may stem from a general inability
to shift attention rapidly between two
targets [Courchesne et al., 1994]. Teasing
apart these three accounts of joint atten-
tion deficits is likely to prove challenging,
especially because more than one of the
factors proposed could contribute to the
deficit.
Although the causes of the joint
attention deficit are still a matter of
debate, its developmental consequences
are less controversial. First, joint attention
abilities have been found to have develop-
mental continuity, across both a 1-year
span in early childhood [Mundy et al.,
1990] and a longer span from early
childhood to adolescence [Sigman and
Ruskin, personal communication]. In
autistic and typically developing children,
joint attention abilities are also related to
indices of social relatedness [Mundy et al.,
1994; Sigman and Ruskin, personal commu-
nication]. Perhaps most importantly, re-
sponsiveness to the joint attention bids of
others is the major predictor of language
acquisition in individuals with autism
[Mundy et al., 1990; Sigman and Ruskin,
submitted]. Notably, only about half of
individuals with autism achieve func-
tional language [see Wilkinson, this
volume]. Language ability is likely to be a
limiting factor on many other aspects of
development in children with autism.
Why might joint attention be such
an important predictor of language devel-
opment? At least two factors may link
early joint attention to later language.
First, joint attention may index the child’s
awareness of the purpose of the commu-
nicative enterprise or motivation to
engage in communication. Thus children
more capable of joint attention may
participate more in social exchanges that
provide opportunities for language learn-
ing. Joint attention may also be involved
in critical language learning processes,
such as mapping words to meanings.
When faced with an unfamiliar word, for
example, infants restrict their interpreta-
tions to objects that are within the
attentional focus of the speaker [Baldwin,
1991, 1993]. Doing so reduces the
number of possible word-meaning map-
66 MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
pings that must be considered, thus
facilitating word learning. Children with
joint attention deficits associated with
autism do not successfully exploit this
strategy [Baron-Cohen et al., 1997],
undoubtedly making their word learning
slow and prone to error.
For individuals with autism who
eventually acquire language, exchange of
information through conversation poses
particular difficulty. Some aspects of
conversational impairments have close
parallels with joint attention deficits. For
example, individuals with autism often
abruptly shift topics, rather than follow-
ing a conversational partner’s utterance
with contingent, relevant information
[Capps et al., in press; Tager-Flusberg and
Anderson, 1991]. People with autism also
have difficulties selecting appropriate mes-
sage content [Loveland et al., 1989],
distinguishing between given and new
information [Baltaxe, 1977; Perner et al.,
1989], and other aspects of tailoring
conversation for the needs of the partner.
These difficulties appear to be related to
an inability to gauge the partner’s knowl-
edge state. This problem is quite similar
to joint attention deficits in that both
problems involve an inability to monitor
others’ mental states and the factors that
influence them.
With limited joint
attention skills, it is
unlikely that children
with autism can advance
to the later stages of the
attachment relationship.
Joint attention deficits and delayed
or absent language are likely to affect
social interactions and relationships in
many ways. As noted previously, joint
attention deficits are related to other
indices of social relatedness, and they may
well be a manifestation of general social
awareness and interest. However, joint
attention deficits are likely also to exert an
independent effect on social interactions
and relationships. For example, early in
development, such deficits may affect the
parent-child attachment relationship by
reducing opportunities for sharing of
positive affect. These lost opportunities
may take a toll on even the most
dedicated parents’ motivation to engage
the child, leading to decreased rates of
interaction overall. Furthermore, in the
absence of joint attention, parents must
work much harder to communicate with
their children. They may become more
focused on jointly achieving instrumental
goals and less on sharing affect and
information. Without joint attention
skills, it is unlikely that children with
autism can advance to the later stages of
the attachment relationship, often de-
scribed as a goal-corrected partnership
[Bowlby, 1969]. In the goal-corrected
partnership, children and parents negoti-
ate issues concerning the child’s behavior,
based on shared understanding of each
others’ expectations. In autism, it is likely
that this form of mutual understanding
and negotiation fails to develop, leading
to more directive, less reciprocal interac-
tions.
It is probably impossible to exagger-
ate the impact of language impairment on
social functioning in autism. Individuals
who do not acquire language are isolated
from all but the most basic of social
exchanges. Also, individuals without lan-
guage lose the opportunity to benefit
from verbally mediated social lessons,
such as the importance of sharing,
respecting ownership, and not hurting
others. For those individuals with autism
who do acquire language, there are
deficits in conversational skills that are
likely to contribute to interaction and
relationship difficulties. Such deficits will
impair young children’s ability to coordi-
nate play with others, thus reducing
opportunities to develop social relation-
ships. In adolescence, conversational diffi-
culties may undermine the development
of feelings of intimacy and shared under-
standing that are critical components of
close peer relationships. In summary,
difficulties with joint attention, language,
and conversation are likely to have major
repercussions for social relationships across
the life span.
SOCIAL COGNITION
Leslie was one of the first to
propose that children with autism had a
‘‘theory of mind’’ deficit, failing to
interpret others’ behavior using the nor-
mal explanatory framework of concepts
such as beliefs, desires, emotions, and
intentions [Leslie, 1987; Leslie and Roth,
1993]. According to Leslie, this explana-
tory framework fails to develop in
children with autism because they are
unable to grasp the representational
nature of others’ minds. This deficit is
assumed to reflect the dysfunction or
absence of a biologically based system
specialized for processing mental state
information.
One prediction of the theory of
mind proposal is that difficulty under-
standing mental states in autism should
not be attributable to other factors such as
general representational problems, execu-
tive function impairments, or language
difficulties. A large number of studies
have investigated these issues, and for the
most part have found results consistent
with the theory of mind position [see
Happé, 1995 for a review]. A second
prediction is that among the various kinds
of mental states, beliefs should pose the
most difficulty for individuals with au-
tism. Understanding of belief absolutely
requires a representational understanding
of mind, whereas some limited under-
standing of other mental states such as
desires and emotions could be approxi-
mated by conceiving of them as behav-
ioral dispositions. We will emphasize
research that is relevant to the second
prediction by contrasting the understand-
ing of belief and desire of children with
autism.
Understanding of Desire and Belief
A direct method for investigating
children’s understanding of mental states
is to examine their use of mental state
terms. In a study comparing young
children with autism and Down Syn-
drome, Tager-Flusberg [1992] found that
both groups used words referring to
desire with comparable frequency. Words
referring to attention or cognition, how-
ever, were used less often by children
with autism, a finding consistent with a
theory of mind deficit.
Children with autism seem to
understand desire in terms of its causes,
effects, and ontological status. For ex-
ample, they understand that desires can
be different in different individuals, and
they grasp the distinction between desires
and reality. Children with autism are as
good as comparable children with mental
retardation in understanding relations
between their own and others’ desires
being satisfied and emotional reactions.
For example, when asked how another
child will feel if she is given a cereal she
likes to eat, they appropriately predict
that she will feel happy; they also predict
that she will be less happy if the cereal is
not one that she prefers [Baron-Cohen,
1991; Tan and Harris, 1991].
By contrast, there is evidence that
children with autism have difficulty with
even the basic precursors to understand-
ing beliefs. For example, these children
do not appear to understand that seeing
leads to knowing [Baron-Cohen and
Goodheart, 1994; Leslie and Frith, 1988;
Perner et al., 1989], a fact that is grasped
by typically developing children by about
MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
3 years [Pillow, 1989]. For example, after
watching an experimenter view an object
in a cup, the child with autism typically
answers correctly that the experimenter
has seen what is in the cup. The child is
less able, however, to attribute knowl-
edge of the cup’s contents to the
experimenter. Individuals with autism
also have small deficits in understanding
that two individuals in different locations
perceive the same scene differently
[Yirmiya et al., 1994].
Another important precursor to
understanding the beliefs of others is the
ability to pretend. As Leslie [1987] points
out, both require a representational under-
standing of mind. In typically developing
children, pretense emerges in the second
year, but children with autism very rarely
engage in spontaneous pretense at any age
[Baron-Cohen, 1987; Sigman and Un-
gerer, 1984a].
Lacking the ability to
pretend, the child with
autism loses a valuable
opportunity to acquire
social skills and social
knowledge.
The most unambiguous evidence
for a representational understanding of
mind comes from a demonstration that
the child understands the nature of false
beliefs. For this reason, many researchers
have investigated false belief understand-
ing in typical children and in children
with autism. A typical example of a false
belief task is as follows. The child is
shown a scene in which a young boy
places an object in a cupboard and then
exits the room. Next, the boy’s mother
enters the room, removes the object from
the cupboard, places it in another loca-
tion, and exits the room. Finally, the boy
re-enters the room. The critical question
is whether or not the individual being
tested understands that the boy now has a
false belief (i.e., that the object is still in
the cupboard). False belief tests are passed
by typically developing and developmen-
tally delayed groups with MAs of 4 years
and above. Consistent with Leslie’s pre-
diction, however, children with autism
perform poorly on false belief tasks even
with MAs well above 4 years.
To summarize, children with au-
tism appear to have great difficulty
understanding belief and closely related
mental states such as perceiving, attend-
ing, and pretending, whereas they appear
to have a fairly good rudimentary grasp of
desire. This pattern is predicted by the
theory of mind proposal. It should be
emphasized, however, that understand-
ing of desire is not unaffected by autism,
as is also predicted by the theory of mind
proposal. Nonrepresentational under-
standing of desire will only approximate
the representational understanding of an
unaffected individual. Indeed, there is
some evidence that children with autism
do have certain difficulties applying their
understanding of desire in social situa-
tions. For example, when asked to
explain the behavior of protagonists in
particular scenarios, they are less likely to
invoke desire in their explanations [Baron-
Cohen et al., 1986; Tager-Flusberg and
Sullivan, 1994]. Whether this problem
stems from a mental-state-specific diffi-
culty or a more general problem generat-
ing coherent explanations remains a
matter of debate.
Understanding the Self
An alternative view of the social
cognitive deficits in autism focuses on
impaired understanding of self-other cor-
respondence. This impairment is particu-
larly evident in autistic children’s difficul-
ties with imitation [Meltzoff and Gopnik,
1993; Rogers and Pennington, 1991].
Developmental theory holds that there is
an integral relationsip between under-
standing the self and understanding oth-
ers, and both should be affected by
autism. To develop this point, we will
focus on Hobson’s [1990] argument that
the particular pattern of deficits in
self-understanding provides support for
Neisser’s [1988] distinction between the
ecological and the interpersonal self.
According to Neisser, the ecologi-
cal self concerns the self as distinct from
and causally effective in the physical
world. The interpersonal self concerns
the self as distinct from others, as socially
effective, and as an object of others’
regard. Hobson makes a convincing
argument that the ecological self remains
intact in autism, but that the interpersonal
self fails to develop normally. Evidence
that the ecological self is intact comes
from findings showing that children with
autism have mental-age-appropriate un-
derstanding of the relationship between
means and end, and the fact that objects
continue to exist even after they are
removed from sight (object permanence)
[Sigman and Ungerer, 1984a]. Appar-
ently, children with autism proceed
normally through the stages of infancy in
which the physical self is differentiated
from the rest of the physical world and
67
the causal powers of the physical self are
explored. However, a number of findings
suggest atypical development of the
interpersonal self.
Perhaps the clearest evidence for
the divergence of development of the
ecological and interpersonal self in autism
comes from findings on self-recognition
tasks. In typical development, the ability
to recognize one’s own image in a mirror
emerges in the second year. Notably
‘‘self-conscious’’ emotions such as pride
and shame begin to be evident at the same
time. The appearance of these emotions
suggests that children are aware of
themselves as objects of others’ evalua-
tions. In children with autism, self-
recognition abilities are appropriate to
mental age [Dawson and McKissick,
1984; Spiker and Ricks, 1984], suggest-
ing intact understanding of the physical
aspects of the self. However, children
with autism who are able to recognize
themselves fail to show evidence of
self-conscious emotions. In contrast to
normal 2-year-olds, for example, they do
not exhibit coy or embarrassed responses
to detecting some unexpected feature in
their mirror image (e.g., a spot of rouge
on the nose). This suggests a lack of
awareness and/or concern for others’
evaluations. Further support for this
interpretation comes from studies of
pride and mastery in children with
autism. For example, Kasari et al. [1993a]
monitored children’s affective responses
to success in a challenging puzzle task.
Children with autism smiled in response
to completing the task. Unlike typically
developing children, however, they did
not look up at an adult to share their
positive emotions. Apparently, the chil-
dren with autism were indifferent to the
adult’s reaction to their success.
Impaired social cognitive abilities
in autism are likely to contribute to social
interaction and relationship difficulties in
many ways. First, they may be implicated
in some of the communication deficits
discussed earlier. Independently of those,
impairments of pretense and imitation
may be especially detrimental to socializ-
ing experiences in early childhood. Pre-
tend play offers children rich opportuni-
ties to engage in complex social
negotiations and to practice for later
social roles. Lacking the ability to pre-
tend, the child with autism loses a
valuable opportunity to acquire social
skills and social knowledge. Failures of
imitation also result in lost learning
opportunities and may be perceived by
other children as failure to exhibit
expected, affiliative social signals, which
68 MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
may lead to active rejection or social
neglect.
Impaired ability to take others’
perspectives on one’s own behavior may
also lead to social relationship difficulties.
One consequence is likely to be awk-
ward, inappropriate, or impolite social
behavior that may jeopardize relation-
ships. Indeed, individuals with autism are
well known for their tendency to disre-
gard tact and social conventions unknow-
ingly [Frith, 1989]. It is also likely that
impaired social perspective taking inter-
feres with the development of intimacy in
adolescent and adult relationships.
EMOTIONS
When Kanner [1943] first identi-
fied autism, he described it as a ‘‘distur-
bance of affective contact’’. The view
that a deficit in processing and responding
to emotions is central to autism is still
influential [e.g., Hobson, 1993]. A num-
ber of studies have attempted to deter-
mine which aspects of emotional func-
tioning may be impaired. Results suggest
that children with autism have difficulties
perceiving emotions, but that these may
be a result of more general perceptual
processing problems. However, children
with autism do show a striking lack of
responsiveness to the emotions of others
and appear to have difficulty understand-
ing emotion.
. . . processes underlying
lack of emotional
responsiveness in children
with autism remain to be
explained
Perceiving the Emotions of Others
Results of a number of studies in
the 1980s suggested an emotion percep-
tion deficit in children with autism
[Braverman et al., 1989; Hobson, 1986;
Hobson et al., 1989; Weeks and Hobson,
1987]. However, more recent studies
have led to a reconsideration of these
findings. One objection is that emotion
processing deficits may not be specific to
autism but may be associated with
developmental delays more generally.
The earlier studies tended to use mental-
age matched control groups. However,
when verbal-age-matched control groups
are used, autism-specific emotion process-
ing deficits are not found [Haviland et al.,
1996; Loveland et al., 1995; Ozonoff, et
al., 1990; Prior et al., 1990]. In general,
verbal-age matching is likely to be more
appropriate for many of the tasks used to
assess emotion processing, because these
tasks may be verbally mediated.
A second objection is that emotion
processing deficits may not be specific to
emotions, but may reflect more general
information processing deficits. For ex-
ample, difficulties in processing emo-
tional expressions in autism may stem
from more general difficulties in process-
ing faces [Boucher and Lewis, 1991], or
still more general perceptual difficulties
related to the processing of relational
information [Shah and Frith, 1993].
Recently Davies et al. [1994] performed
two experiments specifically designed to
tease apart these various possibilities.
Their results support the conclusion that
emotion processing deficits and face
processing deficits in autism can be
attributed to more general impairment in
processing of relational information. Par-
ticipants in their study showed similar
deficits in processing emotional, facial
and nonfacial stimuli.
The same study also found that MA
may have an impact on whether or not
autism-specific deficits in emotion pro-
cessing are apparent. Low-ability partici-
pants with autism were not significantly
different from MA-matched controls on
emotion tasks. By contrast, higher-ability
individuals with autism and children with
Asperger’s syndrome were impaired rela-
tive to controls on a variety of tasks. IQ
was also strongly correlated with perfor-
mance on emotion tasks for low-ability
but not for high-ability children. These
findings suggest that low IQ may essen-
tially mask emotion processing deficits in
some children with autism. Below a
certain minimum level, IQ may be a
limiting factor on children’s ability to
process emotional information both for
autistic and for other children. Above this
minimum level, autistic children may fail
to advance in their emotion processing
skills as much as MA-matched counter-
parts.
Producing Emotional Expressions
Abnormalities in the quality of
emotional expression appear to character-
ize individuals with autism at all ages and
ability levels. For example, during social
interactions, children with autism are
more likely than other children to display
‘‘blends’’–facial expressions that combine
features from different emotions. Unlike
other groups, children with autism also
occasionally display blends in which
positive and negative emotions are mixed
[Yirmiya et al., 1989]. Similarly, the vocal
expressions of young children with au-
tism do not convey emotion as unambigu-
ously as do the vocalizations of other
children [Ricks, 1979]. When older
individuals have been asked to pose
various facial expressions, their expres-
sions are rated by observers as being
poorer examples of the target emotions
than those of both normal and mentally
retarded controls [e.g., Macdonald et al.,
1989; Loveland et al., 1994]. Such
findings suggest that abnormalities of
emotional expression in both facial and
vocal channels are a characteristic of
autism that persists throughout develop-
ment. However, emotional expression in
autism is not completely disorganized.
Parents and researchers are frequently
able to identify the emotions expressed by
children with autism without much
difficulty.
Responsiveness to Emotions in
Others
Children with autism fail to exhibit
typical responsiveness to the emotions of
others. Although difficulties perceiving
emotions may account for some of this
difference, deficiencies in emotional re-
sponsiveness are much more dramatic
than impairments in emotion perception.
This suggests that failure to respond to
emotions in autism is not simply due to a
general cognitive or perceptual impair-
ment. Rather, failures of emotional
responsiveness suggest some breakdown
of a system specialized for interpreting
and responding to emotional signals.
A study by Sigman et al. [1992]
provided a particularly good illustration
of the lack of emotional responsiveness in
children with autism. They compared
responses of typically developing children
and those with autism and Down’s
syndrome to two situations involving
adults displaying negative affect. One
situation was the standard social referenc-
ing paradigm. Children were exposed to
a novel, potentially threatening toy ro-
bot, to which parents displayed apparent
fear. The other situation involved an
adult who pretended to injure herself and
then feigned distress. In both cases,
children with autism were much less
likely than controls to respond to the
emotional signals of adults. For example,
in the social referencing situation, chil-
dren with Down’s syndrome looked at
the adult about six times longer than the
children with autism. Thus, children
with autism appear to be much less
responsive to negative emotions than are
other children of similar mental age.
MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
It has been suggested that children
with autism find emotional displays
aversive and actively avoid them. Alterna-
tively, such children may have difficulties
differentiating different types or degrees
of affect, leading to decreased responsive-
ness. A recent study from our laboratory
investigated these hypotheses by examin-
ing behavioral and heart rate responses to
emotional displays [Corona et al., in
press]. Behavioral and heart rate responses
suggested that neither lack of awareness
nor aversion to emotional displays medi-
ates the lack of emotional responsiveness.
Thus, factors underlying lack of emo-
tional responsiveness in children with
autism remain to be discovered.
Several early childhood
measures predicted the
amount of play with peers
later in life, including
tendency to engage in
joint attention, emotional
responsiveness, and
demonstrations of
functional play.
Understanding Emotions
Studies of emotional understanding
in autism have concentrated on older,
high-functioning individuals who have
the verbal ability to understand instruc-
tions and provide complex verbal re-
sponses. A number of different methods
have been used to assess understanding,
such as matching emotions to situations
[Macdonald et al., 1989; Yirmiya et al.,
1992], recounting from personal experi-
ence the situations that have elicited
particular emotions [Capps et al., 1992],
and assessments of empathy [Yirmiya et
al., 1992]. All these methods reveal some
deficits in individuals with autism. The
deficits are often not large, however, and
they are not uniform. Although individu-
als with autism show some deficits in
understanding belief-related emotions
[Baron-Cohen, 1991; Baron-Cohen et
al., 1993a] and in understanding self-
conscious emotions such as pride and
shame [Capps et al., 1992], in general
they show impressive competence in
identifying and explaining their own and
others’ emotions [Capps et al., 1995;
Yirmiya et al., 1992].
One might predict that children
with autism would show very little
empathy, based on their lack of emo-
tional responsiveness in early childhood.
However, high-functioning children with
autism are only slightly less likely than
typically developing children to report
experiencing an emotion that is concor-
dant with the emotion displayed by
another person [Yirmiya et al., 1992].
Both empathy and understanding of
emotions appear to be related to intellec-
tual ability in autism [Capps et al., 1995;
Yirmiya et al., 1992]. However, one
unfortunate correlate of greater intellec-
tual ability and emotional awareness for
children with autism appears to be
awareness of their own social incompe-
tence [Capps et al., 1995].
In summary, children with autism
show certain deficits in perceiving and
producing emotional displays, and in
understanding of emotions. However,
these deficits are small in comparison to
their dramatic lack of emotional respon-
siveness, especially in early childhood.
Individuals with higher intelligence seem
able to compensate for their deficits in
emotional understanding, empathy, and
responsiveness later in life to some extent.
However, the processes by which they
achieve understanding and responsiveness
may be quite different from those that
characterize typical development.
Lack of skill in perceiving, produc-
ing, and responding to emotional signals
in autism is likely to be one of the most
important obstacles to smooth interac-
tions and successful social relationships.
In infancy and early childhood, the
inability to send clear signals and to
respond to the signals of others is likely to
affect caregiver-child interactions in ways
that could negatively impact the attach-
ment relationship. Parents are likely to
have more difficulty learning to tailor
their responses to their child’s needs, and
children are likely to have difficulty
anticipating their parents’ behavior, lead-
ing to awkward and difficult interactions.
Peer interactions are also likely to be
affected. Failure to express positive affect
during social interactions may lead peers
to perceive the individual with autism as
socially uninterested. Perhaps even worse,
the failure to exhibit normal responsive-
ness to negative emotions in others may
be judged harshly as self-absorption or
even cold indifference. Thus difficulties
in emotional signaling and emotional
responsiveness are likely to cause difficul-
ties in the parent-child relationship and to
deter peer interactions.
69
SOCIAL RELATIONSHIPS
Finally, we will review research
that has directly focused on the social
relationships of individuals with autism.
For many reasons, some of which we
have discussed in previous sections, it is
natural to expect that communication,
social cognitive, and emotional deficits
will lead to relationship difficulties. How-
ever, current research suggests that people
with autism do succeed in forming
relationships with others, and that at least
some kinds of relationships withstand
challenges presented by the social deficits
associated with autism.
Attachment
Early reports of children with
autism included striking descriptions of
their indifference to their parents [Kan-
ner, 1943]. Some theorists have even
considered the possibility that autism
might be primarily a disorder of the
parent-child attachment relationship
[Mahler, 1968]. However, recent re-
search has not supported the view that
children with autism do not develop
these attachments. In fact, studies compar-
ing attachment behaviors in children with
autism or other developmental delays
have consistently found no differences.
Children with autism respond preferen-
tially to caregivers, show distress on
separation, and seek proximity upon
reunion [Shapiro et al., 1987; Sigman and
Mundy, 1989; Sigman and Ungerer,
1984b; Rogers et al., 1993].
With the existence of the attach-
ment relationship firmly established, re-
searchers have turned their attention to
the more difficult issue of assessing its
quality. Assessing attachment quality in
children with autism is difficult for two
reasons. One problem is that criteria for
determining attachment quality change
with age. In young children with autism,
there is typically a large discrepancy
among verbal, mental, and chronological
ages. Which should be used to make
comparisons? Also, children with autism
exhibit failures of joint attention, stereo-
typed motor movements, and other
idiosyncracies. When typically develop-
ing children exhibit these behaviors in
separation-reunion episodes, they indi-
cate serious disturbances in attachment.
In children with autism, however, these
behaviors may be merely symptomatic of
their disorder.
Recent studies that have assessed
attachment quality in children with
autism have tailored assessments to the
children’s MA and have taken into
account the children’s idiosyncratic be-
haviors (e.g., by adopting appropriate
70 MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
coding criteria). These studies have found
no differences between autistic and con-
trol groups of developmentally delayed
children on measures of quality of
attachment [Rogers et al., 1993; Shapiro
et al., 1987]. Two studies have used
Ainsworth’s coding scheme [Ainsworth
et al., 1978] or a modified version of it, to
classify attachment behavior in autistic
samples. These studies found that approxi-
mately one-third to one-half of the
children show secure attachment, pro-
vided that idiosyncratic behaviors associ-
ated with autism are discounted [Capps et
al., 1994; Shapiro et al., 1987]. Although
this is substantially less than the rate of
secure attachment in typically developing
samples, it nonetheless indicates that
some children with autism succeed in
establishing secure attachments. Attach-
ment behaviors in children with autism
are related to indices of developmental
level such as cognitive, nonverbal and
verbal communication, and gross motor
abilities [Capps et al., 1994; Rogers et al.,
1993]. These same correlations are not
found in comparison samples, suggesting
that different processes may be at work in
developing attachment relationships in
autism. However, one similarity between
correlates of attachment in typically
developing children and those with
autism is that for both groups, quality of
attachment appears to relate to maternal
sensitivity to their needs [Capps et al.,
1994].
Sensitivity may take different forms
for children with autism than for typically
developing children, as parents adjust
their behavior to compensate for some of
the associated social and cognitive defi-
cits. Many aspects of interaction between
caregivers and young children with au-
tism do not differ from those between
parents and infants at the same develop-
mental level [Kasari et al., 1988]. Parents
respond similarly to nonverbal communi-
cation efforts and engage in similar
amounts of mutual play with their
children. However, parents of children
with autism are different from other
parents in some respects. For example,
they are more likely to use physical means
to hold the child on task and they point
less frequently. In addition, there is some
evidence that caregivers shoulder more
of the burden for initiating interactions
with children with autism [Kasari et al.,
1993b].
Siblings
Little is known about sibling rela-
tionships in autism. This gap in our
knowledge is unfortunate, because sibling
relationships may provide a particularly
important context for social development
[Dunn, 1988]. In the case of children
with autism, siblings may represent an
intermediate level of social challenge
between the highly supportive conditions
provided by parents and the less support-
ive conditions encountered with peers.
Like parents, siblings are highly familiar
social partners who are also likely to be
highly motivated to interact with the
child with autism. Unlike parents and
more like peers, siblings are close to the
child in terms of cognitive and social
abilities. In one recent naturalistic home
study, children with autism were found
to initiate and respond to fewer social
interactions with their siblings when
compared with matched children with
Down’s syndrome [Knott et al., 1995].
However, the children with autism did
respond to about one-fourth of their
siblings’ initiations. Even more interest-
ing, these children spent the majority of
their time together with their siblings.
Indeed, the amount of time spent with
siblings was only slightly less than was
observed in children with Down’s syn-
drome. These results suggest that sibling
relationships may be particularly impor-
tant for children with autism, because
they may represent an opportunity to
interact with other children in maximally
supportive conditions.
Peers
Although adults and siblings may
be willing to provide extra support
necessary for individuals with autism to
function at higher levels of social compe-
tence, peers may be less able or less
willing to do so. After age 5, children
with autism tend to improve in their
interactions with adults but their relation-
ships with peers remain problematic.
They interact very little with their peers
in group settings, and the interactions
they do have are often awkward and
unsuccessful [e.g., Stone and Caro-
Martinez, 1990].
Consistent with their early diffi-
culty initiating social interactions with
their caregivers, older individuals with
autism have difficulty initiating interac-
tions with peers. One study found that
children with autism made only about
one-third as many initiations to their
peers as did verbally matched children
with mental retardation [Hauck et al.,
1995]. These differences were not attrib-
utable to the failure of any one particular
form of initiation. Both positive and
negative, as well as simple and complex,
forms of initiations were used less by the
individuals with autism. The results of
several studies also suggest that children
with autism frequently fail to respond to
the initiations of other children [Lord,
1984; McHale, 1983; Sigman and Ruskin,
personal communications].
Although peer relationships are
impaired in autism, they are not com-
pletely absent, at least in high-function-
ing individuals. For example, a recent
study of high-functioning 8 to 14 year-
old children with autism found that all
children reported having at least one
friend [Kasari and Bauminger, personal
communications]. However, the children
were less able to give complete defini-
tions of friendship than were typically
developing MA-matched children. In
this study, children with autism reported
more feelings of loneliness than other
children. However, their definitions of
loneliness tended to focus solely on
exclusion from or dissatisfaction with
social relationships; there was little men-
tion of negative affect associated with
these situations.
Sigman and Ruskin [personal com-
munications] have recently completed a
longitudinal study that included a mea-
sure of the amount of peer play occurring
in older children and adolescents with
autism in a school setting. This study
allowed for the examination of predictors
and correlates of peer competence. As for
other developmentally delayed groups,
measures of language and cognitive devel-
opment were related to the degree of
engagement with peers for children with
autism. However, for these children
alone, responsiveness to distress in others
and the degree of prosocial behavior, as
measured independently in laboratory
tasks, were correlated with involvement
in high-level social play. In addition,
several early childhood measures pre-
dicted the amount of play with peers later
in life, including tendency to engage in
joint attention, emotional responsiveness,
and demonstrations of functional play.
These findings are consistent with some
of our earlier speculations about the
importance of joint attention, play, and
emotional responsiveness for the develop-
ment of relationships with peers.
SUMMARY
Despite their social impairments,
children with autism can succeed in
developing social relationships. Indeed,
the attachment relationship appears to be
particularly well preserved in spite of the
potentially disruptive social deficits char-
acteristic of autism. Although these chil-
dren have increased rates of insecure
attachment relative to typically develop-
ing children, many have secure attach-
ments. Children with autism also appear
MRDD RESEARCH REVIEWS • INTERPERSONAL RELATIONSHIPS IN AUTISM • TRAVIS & SIGMAN
to develop relationships with their sib-
lings [Knott et al., 1995]. They spend
substantial amounts of time with them,
and show greater rates of interaction with
them than they do with other children.
Although peer relationships are an area of
difficulty for children with autism, many
high-functioning individuals report hav-
ing friends in childhood and adolescence
[Kasari and Bauminger, personal commu-
nication]. These findings are encouraging
because they suggest that despite social
impairments, children with autism are
able to develop relationships with others
and thereby participate in one of the most
fundamental components of social life.
These findings also suggest that
interventions designed to help people
with autism improve their social relation-
ships can build on the strengths that they
have. For example, in attempting to
improve peer relationships, work with
siblings may serve as an important inter-
mediate step. Our knowledge about the
social impairments in autism and their
likely consequences for social relation-
ships can also be implemented in interven-
tions. For example, one can target skills
that are likely to have far reaching
consequences for social relationships,
such as joint attention. We can also
consider the specific social impairments
in autism in order to identify the kinds of
situations that will most effectively sup-
port their existing ability to interact.
Improving the social relationships of
people with autism is likely to be an
important contributor to their quality of
life. In turn, such improvements may be
associated with experiences that will
ameliorate some of the social deficits in
autism. j
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