(1) Awareness of Object

How can ECHOES II improve children’s social understanding?

Before the understanding that other people have thoughts, beliefs, desires and intentions develops, typically developing children are seemingly required to progress through various precursors in development. Therefore, before children develop the ability to pass a test of false belief (taken by some to be crucial test for understanding the mental states of others, e.g., Wellman, Cross & Watson, 2001), they must for example initially develop their joint attention and imitative behaviours.

It is yet unknown whether these precursors have to be followed in stage-like manner. What is known, however, is that children with autism (who do not follow the same developmental trajectories as their typically developing peers) show problematic development in these precursors; for example, in their joint attention (e.g., Charman, 2003), their imitative abilities (e.g., Ham, Corley, Rajendran, Carletta & Swanson, in press).

It is deficits in the precursor abilities that lead some researchers to believe that they have a cascading effect on development that therefore results leading to social problems that are so characteristic of autism (e.g., Rogers & Pennington, 1991).

One way of potentially influencing the developmental trajectories of all children (and not just those with autism) is to develop learning environment targeted at these developmental precursors. This is because typical development may be an average across average across diverse developmental trajectories rather than pathway that most children follow (Pennington, Synder & Roberts, 2007).

To investigate development, the ECHOES II environments will have the dual benefit of being places in which learning takes and in which learning could be studied. Furthermore, prospective (longitudinal) studies would allow researchers to attribute genuine casual relationships between these precursors and, thereby, take a truly developmental approach (Karmiloff-Smith, 1998).

Imitation 1

Imitation is currently viewed as a key driver for development and imitative behaviours are seen very early in typical developing children – in fact in newborns (see Rogers and Williams 2006; Williams et al. 2004, for reviews). Impairments in imitation have been proposed to lead to problems of joint attention that then impact on social and language learning, which then in turn impact ultimately on life outcomes.

Imitation is seen as key for both cognitive and affective development, and impairments in imitation in autism have been interpreted by both cognitive and affective accounts of development.

1 Rather than get into controversies about which order recognition of self, recognition of object, recognition of other, I have ordered the progression from imitation to dyadic, triadic, belief-desire reasoning, 1st order belief attribution, 2nd order belief attribution. The same detail and levels of progression are not seen in the non theory of mind theories. Leaving aside the cognitive versus affective argument, is seems clear that the ECHOES II environments involving imitation have clear role to play in this key developmental ability.

Additionally, the environments can be used to investigate and assist different categories of imitation. For example, the imitation of meaningless gestures is fairly robust finding in autism research (e.g., Ham, Corley, Rajendran, Carletta & Swanson, in press; Hamilton, in press; Smith & Bryson, in press). However, the imitation of meaningful gestures have provided more mixed results and more elusive to pin down (Ham et al, in prep; Smith & Bryson, in press). In the ECHOES II environment, the imitation of both meaningful and meaningless gestures can be both developed and investigated in children with and with autism, in order to facilitate and better understand this important ability.

Dyadic relationships

Dyadic interaction involves the child interacting with either a parent/caregiver or an object (e.g., Trevarthen & Hubley, 1978). In the ECHOES II children will be able manipulate objects in the environment and learn about agency (that is objects are moved by an agent – usually a person). They will also learn that objects can be moved without a conscious agent (by nature, e.g., the wind). This difference is key in understanding the difference between imitation and emulation (Thompson & Russell, 2004); that is, imitation concerns the understanding the modeller’s action and emulation concerns the modelling of the outcome of the action.

Joint attention (triadic relationship)

After dyadic interactions come triadic interactions, also known as joint-attention. These interactions involve self, other and object. These dyadic interactions came be modelled in the ECHOES II environment. For example, typically developing infants often engage in protodeclaritive pointing (pointing at an object for someone else to look at). The ECHOES II environment could be used to monitor joint attention behaviours using eye tracking and to see if learning in the imitation environment then leads to the development of joint attention behaviours.

Belief-desire reasoning

Wellman (e.g., Wellman & Bartsch, 1998) argues that beliefs and desires are initially separate and children understand desires over beliefs. Wellman and Bartsch (1998) tested this idea by asking three year olds simple stories about the distinction between thoughts and desires and whether those desires are fulfilled. For example, children were told a story about Sam. “Sam wants to find his puppy. His puppy might be hiding in the garage or under the porch. Sam thinks his puppy is under the porch. Where will Sam look for the puppy? Under the garage or under the porch?

In one manipulation of the experiment, the child is asked where she or he things the puppy is and told that Sam thinks his puppy is in the other location. The child is then asked where will Sam look for his puppy. Three year olds where able to go against their own guess and say that Sam will look for his puppy where he thinks it is. Wellman and Bartsch argue that this shows that typically developing children aged 3 have a good understanding of beliefs, and that this contrasts with the robust finding that 3 year old children generally fail tests of false beliefs (Wellman et al, 2001).

The idea that belief-desire reasoning is a precursor to ToM development is not uncontroversial. However, it seems like an appropriate pre-theory of mind stage and moreover may provide the opportunity to study any transition from this stage to the false belief understanding stage.

False Belief

The test of false belief usually appears in two standard forms: the unexpected transfer task (Wimmer & Perner, 1983) and the unexpected contents task (Gopnik & Astington, 1988; Hogrefe, Wimmer & Perner, 1986; Perner, Leekam, & Wimmer, 1987). In their meta analysis of false belief studies Wellman et al. (2002) found that typically developing children generally pass tests of false belief around the age of four2.

In a variation on the false belief task, Woofle, Want & Siegal (2001) created a non verbal version for testing Deaf children.

The ECHOES II environment will provide opportunities for developing scenarios using pictorial information (like those of Woolfe et al., 2001) and location change so that children learn about false beliefs through experience, rather than being taught explicit rules; an approach which has does not be found to generalise to everyday behaviour (Hadwin, 1996, 1997).

Central elements of the “thought picture” presented in the theory of mind “fishing” task (adapted from Custer, 1996). (A) The thought picture illustration as first presented to the child (with removable flap in place). (B) The False Belief (FB) version of the picture (with flap removed). (C) The True Belief version of the picture

2 Because typically developing children should pass the test of false belief and show precursor abilities the typically developing children may need to be younger than the children with AS for the ECHOES II project? The only task that may be challenging to typically developing children aged 5 is the Ice Cream Van task, which is typically passed aged 6-7. (with flap removed). (D) The four response cards, along with the thought bubble in which children had to place the card that illustrated the character’s belief. The four cards are (from left to right): distracter 1, belief item, distracter 2, and actual object (FB only).

Additionally, the ECHOES II environment can be adapted so that children and type text into both thought and speech bubbles and thereby have access to the mental worlds of characters through this medium. This usage of using comic strip environments has been successfully used with both typically developing children and children with autism (Rajendran & Mitchell, 2000; Rajendran, Mitchell & Rickards, 2005).

Furthermore, the eye tracking capability built into ECHOES II will allow us to look at implicit learning versus explicit learning. For example, the case of false belief, Clements and Perner (1994) found that children around 3 years old tended to look in the correct location by still made realistic errors (that saying the character will look in the current location, rather than where the doll protagonist originally left the item).

Second-order belief attribution

After false belief, the next level of belief attribution that children pass is second-order belief attribution. The standard test of second-order belief attribution is sometimes called the Ice Cream Van task, and was first devised by

by Perner and Wimmer (1985). The scenario is enacted using two toys, John and Mary, who lived in a toy village which contained two houses, a church and a park. The story consisted of four episodes:

Episode1. Mary and John see the ice-cream van in the park. Episode2. John goes home to get some money and meantime Mary sees the ice- cream van move to the church. Episode3. John unexpectedly sees the ice-cream van at the church (so his belief about the van’s location remains true). Episode 4. Mary sets out to look for John whom she is told, has gone for an ice- cream.

Baron-Cohen (1989) replicated the Perner and Wimmer paradigm and in his study recruited 10 typically developing children, 10 children with Down syndrome and 10 children with autism who were all matched for verbal mental age. They were all asked the test question:

“Where does Mary think John has gone to buy his ice-cream?”

The correct answer is “the park” because in the second-order belief attribution task, participants have to make a judgement about Mary’s belief about John’s belief; that is, a judgement about one person’s false belief about another person’s true belief.

Baron-Cohen (1989) found that 90 percent of the typically developing children (mean chronological age 7.5) passed the belief question, as did 60 percent of the children with Down syndrome (mean VMA of 7.5), but none of the children with autism (Mean VMA of 12.2) passed.

Executive Function

Executive Function is an umbrella term all the processes required for goal directed behaviour and include processes such as planning, and inhibition. Inhibition in children with and without autism has been studied at length (e.g., Russell e.g., Russell, Mauthner, Sharpe, & Tidswell, 1991, in the Windows Task).

In the Windows Task children, children are presented with two boxes and a simple rule: they must point to a box for someone else to open, and they will open the other box themselves. The child can see a treat in one box, and can see that the other box is empty. Thus, in order to obtain the treat, the child must point to the empty box. Although preschool children are able to report the rule, and correctly report who is to receive each box after they have pointed, these children commonly point to the box containing the sweet that they wish to obtain, and thereby lose the treat. Moreover, many children persist with this incorrect strategy over 15 or 20 repeated trials. More specifically, Russell et al (1991) found that children with autism and 3 year old typically developing children fail on this task, whereas typically developing 4 years olds tend to pass. This has led to the suggestion that children’s difficulty is with executive control, and in particular with the dual requirement that they hold in mind the task rules while inhibiting a prepotent response of pointing directly at the treat (Hala & Russell, 2001).

However, manipulations of this task suggest that children perform better if they are ‘helped’ by wording that enables them to formulate a correct response strategy (Carroll, Apperly & Riggs, 2007; Samuels, Brooks & Frye, 1996; Simpson, Riggs & Simons, 2004). That is if children are told “Point to a box for E1 [Experimenter 1] so that you get the sticker”; “Point to a box to tell E1 where to look so E1 does not get the sticker”; “Point to a box for E1 so that E1 does not get the sticker”; “Give a box to E1 so that you get the sticker”; “Give a box to E1 so that E1 does not get the sticker”. Unlike telling children to “point to the empty box” these prompts do not specify a single action for the child to perform.

A Windows task environment will be set up in ECHOES II, to investigate if training on the task can improve children’s performance and also if successful training then leads onto improvements in executive control in children’s everyday lives.

Weak Central Coherence

In a recent review of eye tracking studies in children Karatekin (2007) cites a study a by (Trueswell, Sekerina, Hill, & Logrip, 1999) in which eye movements of 5-year- olds and 18- to 22-year-olds were examined as participants were responding to spoken instructions to move objects around a table. The instructions involved syntactic ambiguities in the early part of the sentence, which could then be revised with the contextual information presented (e.g., ‘‘put the frog on the napkin in the box’’). The adults took into account the contextual information as they were listening to the instructions and changed their original interpretation when appropriate. The children, however, rarely changed their original interpretation, as indicated by the location of their fixations during the course of the instruction. In contrast, their fixation patterns were very similar to those of adults for syntactically unambiguous sentences. The findings were interpreted as indicating that children rely on local linguistic information to resolve ambiguities, and have difficulty revising their initial interpretations and coordinating multiple sources of linguistic and contextual information as they process language.

Eye tracking in tasks like these, in the ECHOES II environment, which involve the processing of contextual information could be used in studies investigating the development of weak central coherence in both children with autism and typically developing children.

Interpersonal connectedness

In addition to the cognitive theories of autism (of development) there also affective theories. The most prominent of which is arguably Hobson’s interpersonal intersubjective account (e.g., Hobson & Lee, 1999).

Deficits in imitation have also been interpreted as evidence for this affective account (cp. Rogers & Pennington, 1991). Therefore, because the ECHOES environment includes scenarios and tasks of imitation (of both meaningless and meaningful gestures).

The ‘holy grail’ of generalising behaviour from a learning environment to the real world

The experiential nature of the ECHOES II environments are crucial to expected learning outcomes. Not least because attempt to each mental state understanding by teaching rules have met with little success (see Rajendran & Mitchell, 2007, for a discussion). For example, there is no evidence of the success of this approach in terms of the individual generalising from how to pass an unexpected transfer task to their everyday social cognition: children “may have learned to pass the tasks rather than understand the concepts underlying the rules” (Hadwin et al., 1996, p. 359).

One theory that may be tested and used to help generalise behaviour is that of Reduced generalisation theory (Plaisted, 2001). Reduced generalisation theory comes research based on the Weak Central Coherence account of autism (Happe & Frith, 2007) and has a key strength in that it might explain why individuals with autism often have problems generalising newly learned behaviours to a novel environment (Mirenda & Donella, 1987). This is because, according to the theory of Reduced Generalisation an individual with autism’s concepts are narrower and have sharper and more clearly delineated boundaries. Thus, in order to facilitate generalising processes, practitioners may be inclined to change the environment more gradually, to ‘move in stages’, by progressing through graded contexts (Rajendran & Mitchell, 2007).

The ECHOES II environment would, therefore, provide perfect opportunity for testing this prediction, and if successful would be of applied value by offering individuals with autism a better chance to generalise their behaviour.

Metrics for measuring change

How can we detect if experiencing the ECHOES environments affects general social functioning?

Before experiencing ECHOES II autistic children’s social communication will be measured using The Social Communication Questionnaire (SCQ; Berument, Rutter, Pickles, Lord, & Bailey, 1999). This 40-item screening questionnaire (previously known as the Autism Screening Questionnaire) is completed by parents to obtain information about core diagnostic features of autism. The items cover aspects of behaviour identical to those asked about in the ADI-R (Lord, Rutter & LeCouter, 1994, one of the ‘gold standard’ diagnostic tools for autism). Berument et al. (1999) demonstrated excellent agreement between the SCQ and ADI-R, for parents who completed the SCQ after the ADI-R in a mixed sample of children with autism and non-autistic disorders.

As part of the ECHOES project, parents/guardians will be asked to completed the SQC at various time points, to that any change (hopefully improvements) in their child’s autistic symtomatology can be tracked along with their performance/learning the ECHOES environments.