Self-recognition and self-understanding in young people with autism

Clinical descriptions allude to abnormalities in 'the self of young people with autism. Bettleheim (1967)

discussed the child's undifferentiated self; Omitz and Ritvo (1968) felt that the inadequate modulation

of sensory input in young people with autism interferes with the development of a stable sense of self and others; a British working party, in attempting to define the impaired capacity for human

relationships observed in young people with autism, included the apparent unawareness o f his own

of social skills in young people with autism was presumed to be related to their capacity for self- awareness - that is, awareness of their own 'peculiarities' (Kanner, Rodriguez and Ashenden, 1972).

Attempts to empirically examine these clinical suggestions have met with difficulty. One reason for this may have to do with establishing an operational definition of the concept of self. In the past a rather rigid empirical definition in terms of the presence or absence of the ability to recognise the physical features of the self, as in mirror self-recognition studies, was adopted. In the following section, the early studies that have examined mirror self-recognition in young people with autism will be considered, before considering more recent investigations which have employed a broader definition and understanding of the self.

Self-recognition in young people with autism

Self-recognition is operationally defined as the ability of the young child to pass the rouge test (Amsterdam, 1971; Gallup, 1970). This procedure involves surreptitiously marking the face of the young child and then exposing them to their altered image (e.g., in front of a mirror). Self-recognition is confirmed if the child either touches or acknowledges the mark on her/his face. The rationale underlying the rouge test is that for a child to correctly appreciate the source of the individual depicted in the mirror, there must be a mental representation of self onto which this perception of the reflection is mapped.

Neuman and Hill (1978) examined self-recognition in seven young boys with autism who ranged from 5‘/2 to 11‘A years of age. The mental ages of these children were not reported. Their performance was compared with that of ten normally developing children who were at or above 14 months of age (i.e., at an age where self-recognition would be expected). Each participant was covertly videotaped for ten

minutes, then videotaped in each of three experimental conditions. In the Choice Session each young

person was seated in front of two monitors; one showing the pre-taped session, the other showing real

time ongoing activity. In the Marked Session all participants were surreptitiously marked with one, two

mirror image on a television monitor for ten minutes. Those who did not demonstrate mark directed

behaviour took part in a series of five ten-minute Confrontation Sessions, where they watched a monitor

of their ongoing activity. The marked and choice sessions were repeated. Judgements were made on the young person's mood and activity level. The investigators also measured the amount of time spent watching the videotaped image for each session, the number of face touching incidents in the pre-tape and choice sessions, and the number of mark-directed responses fiom the marked session.

Neuman and Hill found that the mean number of face-touching incidents increased significantly from the pre-tape and choice to the marked sessions for both groups. They concluded that six of the seven young people with autism and seven of the 10 control participants demonstrated self-recognition in this way. The young people with autism, however, viewed their mirror image longer than their pre-taped image, which was in contrast to the control group, who spent more time looking at the pre-taped image than at their mirror image. This pattern was judged to be significant by the investigators (ANOVA, F = 3.4 (1,13), p<0.10). Regarding the mirror reactions of the autistic group, Neuman and Hill commented:

A ll o f the autistic children showed intense interest in their mirror images. They made a variety o f movements and watched to see i f the image responded. Movements included bobbing, jumping, dancing, grimacing, and lying down. One child showed a lack o f tolerance when the pretaped image did not respond to his movements. One child showed extreme avoidance o f his image. Even when touching his marks he would sneak covert glances at the monitor and quickly avoid eye contact. Five o f the six children who showed self-recognition deliberately rubbed and attempted to remove the marks from their faces (p. 575 - 576).

Spiker and Ricks (1984) studied self-recognition in a group of 52 young people with autism who ranged

from VA to 12% years of age. The mental ages of the sample was not assessed. Each participant sat on

the lap of a familiar adult and faced a mirror for at least 10 seconds, or until they appeared to notice the mirror. Subsequently, and away from the mirror, rouge was surreptitiously placed on their noses while they were playing with a favourite toy. The adult then turned the young person to face the mirror. If they did not touch the mark within 15 seconds, the adult gave them a tissue without verbal comments or gesmres. In addition data was collected on the presence or absence of 12 clinical features associated with autism and overall fimctioning levels as defined by (a) appropriateness of social interactions; (b) differentiation of significant others; (c) self-care skills; (d) communication skills; (e) academic skills; and (f) degree of bizarre psychotic behaviour.

Thirty-six of the 52 young people with autism showed self-recognition as evidenced by mark-directed response in front of the mirror. Those young people with autism who failed to show self-recognition in the mirror were significantly more likely to be mute (or lacking communicative speech) than those who did show evidence of self-recognition. Seven of the 16 non-recognisers were receiving medication. None of those who showed self-recognition were on medication. When those on medication were excluded from the analysis, the group difference in the use of communicative speech was reduced but remained significant. Overall level of functioning showed that non-recognisers were more likely to be functioning at a lower level than those who did show self-recognition.

Ferrari and Matthews (1983) began their investigation by posing the question: Can the lack o f self- dijferentiation noted in autism be regarded as diagnostically significant for the syndrome, or rather, can it be reducible to mental age? They examined 15 young people with autism who ranged from 2Vt. to

10'/2 years of age, and who were all severely to profoundly mentally retarded. Each participant was videotaped in front of a mirror for 20 seconds before having rouge surreptitiously applied to the tip of their nose, and turned back to face the mirror for a further 20 seconds. The videotapes were scored for gaze behaviour, affective expression, vocalisations, and motor behaviours (e.g., leans toward mirror, touches mirror, touches face). A behaviour checklist was also completed by the teacher of each child to assess attention skills, stereotypic behaviour, overall cognitive skills, expressive and receptive language, self-care, interpersonal skills, emotional responsiveness, and affect giving.

Eight of the 15 children showed clear self-recognition by touching the rouge on their noses when placed in front of the mirror. Three of the non-recognisers touched the mirror as if the rouge were on the surface of the mirror, while the other four children either avoided their mirror image or reacted in an indifferent fashion. While the recognisers and non-recognisers were similar in terms of their chronological age, the former had a significantly higher mental age than did the latter. Further, recognisers were rated as significantly more attentive, higher in expressive and receptive language, more skilled interpersonally, more emotionally responsive, and more affectionate than non-recognisers. The investigators mention that these differences may be attributable to the significant group differences in mental age. The small number of subjects precluded further analysis to resolve this issue. The

investigators conclude that the existence of the relationship between mental age and mirror self­ recognition in young people with autism ...

... undermines theoretical contentions that an undeveloped, or less than adequately differentiated, sense o f self is characteristic o f autism. It appears, instead, that problems related to the differentiation o f the self are a reflection o f a lower level o f cognitive function ... rather than a phenomenon related specifically to the syndrome (p. 322).

Dawson and McKissick (1984) considered the role of sensori-motor skills in the development of self- recognition in 15 young people with autism, who ranged from 4 to 6% years of age, and in full-scale IQ from 17 to 89 points. Each participant was assessed for their capacity to imitate at different levels of sophistication, as well as their object permanence skills. The procedure and coding system devised by Lewis and Brooks-Gurm (1979) were used to assess the capacity for se lf recognition. There were three conditions in which the young people were videotaped. They were initially positioned in front of a mirror and encouraged to look at their reflection. In the second condition their noses were wiped with a clean tissue before being, once again, positioned in front of the mirror. This condition enabled the investigator to know whether wiping the nose with the tissue in itself influenced mark-directed behaviour. In the third condition rouge was applied to the nose of each participant with the tissue, and they were observed in front of the mirror for the final time. The mirror responses were coded for the presence or absence of each of the following reactions: (a) little if any response; (b) responds as if the mirror image were that of another person by smiling, waving, vocalising, touching, kissing, or kicking the mirror; (c) attempts to imitate the image by bouncing, waving, and imitating facial movements; and (d) demonstrates mark directed behaviour, or the child may show more elaborate facial imitation.

The investigators found that 11 of the 15 young people with autism exhibited se lf recognition as evidenced by mark-directed behaviour. Two young people with autism imitated their image and the other two showed no response. This pattern of response was significantly different to that of the two non-rouge conditions, both of which were performed similarly. The investigators went on to consider the pattern of specific behaviours shown in front of the mirror by the young people with autism who demonstrated se lf recognition, and compared this to those reported by Lewis and Brooks-Gunn for both the 21- and the 24-month-olds. Descriptively, the young people with autism were found to vocalise less than these two groups (36 percent versus 80 percent and 80 percent, respectively). Given that seven of

the eleven young people with autism who showed self-recognition were mute, however, this finding is not surprising. Also, compared with the two normal groups, the young people with autism were less likely to touch the mirror itself (45 percent versus 81 percent and 67 percent) and more likely to touch their own noses (18 percent versus 7 percent and 7 percent). Furthermore, the young people with autism were as likely to smile at their mirror image as were the 21 and 24-month-olds (73 percent versus 63 percent and 60 percent). All of the young people with autism who achieved Stages V or VI in object permanence were also capable of higher levels of self-recognition. The two participants who failed to achieve object permanence were the same two who failed to show evidence of self-recognition. The investigators observed no consistent relationship between imitation ability and self-recognition, and suggest that imitation may not be of critical importance in the development of self-recognition.

It is likely that when an impairment in self-recognition is exhibited by an autistic child, it is a function o f global mental retardation, not a specific feature o f autism (p. 392).

The investigators conclude:

... it appears that the autistic child’s lack o f social relatedness and unusual motor behavior, such as staring at own hands, cannot be attributed to a basic lack o f differentiation between self and others. Instead, it is likely that these children's failure to imitate others, which is one o f the earliest forms o f communication, along with deficits in verbal processing, account for their lack o f social relatedness (p. 393).

In summary, those young people with autism who have demonstrated self-recognition have also been found to be more intellectually able and demonstrate better social functioning than those who do not meet the criterion. This has allowed for the conclusion that impairments in the self are not syndrome specific. As commented upon earlier, however, this technique is not a comprehensive index of self- understanding: the ability to recognise one's own face altered by rouge is but a single aspect of self- identity, and caimot be regarded as fully representing, for example, the capacity for self-differentiation in yoimg people with autism as implied by Ferrari and Matthews. A more adequate test of self-awareness might be whether young people with autism manifest signs of 'self-consciousness'. Evidence relating to this is examined in the next section.

Self-conscious behaviour in young people with autism

Neuman and Hill (1978) observed that none of the young people with autism who showed self- recognition demonstrated either embarrassment or self-conscious reactions, while all of the normally

developing children who comprised the control group did so. Dawson and McKissick (1984) made the same observation in their sub-sample of young people with autism who exhibited mark-directed behaviour. Spiker and Ricks (1984) judged the affective expression of their sample after the rouge placement. Of the 36 children who showed self-recognition, 30 showed neutral affective expressions in response to their image. Unfortunately, Ferrari and Matthews (1983) did not measure this aspect of self- awareness in their sample of young people with autism who showed self-recognition. The reporting of self-conscious reactions in the other three studies appeared to be incidental as none of the investigators provided the criteria used to assess self-consciousness. It is conceivable that the lack of self-conscious reactions plays a greater part in forming the clinical impression of the impaired self in young people with autism than does the child's formal ability to show self-recognition.

A more sophisticated aspect of self-consciousness is pride. Pride is assumed to require the development of a concept of self as a distinct entity, one that appears in normally developing children at around 18 months. Kasari, Sigman, Baumgartner, and Stipek (1993) considered the reactions of pride in a group of 30 young people with autism that had a mean chronological age 31/2 years (SD 11 months) and a mean mental age of 2 years (SD 1016 months). This study group were matched with 30 young people with mental retardation for both chronological age and mental age, and 30 normally developing young people for mental age. A week prior to testing each participant's puzzle solving level was assessed. At testing, the participants were initially presented with a developmentally appropriate puzzle to complete. On completion, and after a delay of 5 seconds, the experimenter commented with a neutral affect that the participant had ftnished the puzzle and suggested a second puzzle. On completion of the second puzzle, and after a delay of 3 seconds, the experimenter and the parent of the young person both praised her/him. The investigators measured direction of gaze, affect response (facial, gestural and postural) and overall emotional response to completion of the task at each of three points: on completion of the first puzzle; on completion of the second puzzle; and after being praised.

Kasari, Sigman, Baumgartner, and Stipek found that the young people with autism were as likely as the two control group participants to smile on completion of the tasks. This was taken as evidence that young people with autism took as much pleasure in their achievements as non-autistic children. In

contrast to this, young people with autism were less likely to seek either the experimenter's or her/his parent's attention on completion of the task. Indeed one-third of the autistic group looked away from the experimenter on completion of the first task. Such attention seeking in toddlers is assumed to show self- reflective processes that are presumed to be associated with pride. The results failed to provide evidence for pride - in the sense of a self-reflective and socially mediated emotion - in autistic children. Young people with autism were less likely to respond positively to praise, and less likely to attempt to make contact with the praising adult by looking up or turning towards her. Indeed, young people with autism frequently avoided contact with the praising adult by looking or turning away.

In both the context of mirror self-recognition, therefore, and that of task completion in the presence of others, there does seem to be evidence for a lack of self-awareness in young people with autism. This matter has been explored further in a study that most closely approaches parts of the present investigation - a study of self-description in young people with autism.

Self-description in young people with autism

Capps, Sigman and Yirmiya (1995) were interested in how high-functioning young people with autism perceive themselves, and in particular to assess the extent to which their self-awareness was mediated by intelligence and the ability to read and share the emotions of others. T h ^ studied 18 young people with autism who ranged from 9% to just under 17 years of age, and in full scale IQ from 75 to 136 points. This stu(fy group was closely group matched with 20 normally developing children for chronological age, full scale IQ, socio-economic status, sex and ethnicity. All participants completed the Perceived Competence Scale fo r Children (Harter, 1982) which taps the child's sense of cognitive, social, physical competence and general self-worth. In addition the participants were given a list of four emotions (sadness, happiness, embarrassment, and pride) and asked to tell about a time she/he had felt each emotion. Finally, the participants were shown five videotaped vignettes each involving a child- protagonist experiencing one of tlie following emotions: happiness, pride, sadness, fear, and anger, and asked to circle the emotion from a list of emotions being experienced by the protagonist. In addition the participant was also asked to report on her/his own emotional response to the different scenes.

The investigators found that the young people with autism perceived themselves to be significantly less