ATTENTION CONTROL IN ADULTS WITH HIGH AUTISTIC TRAITS AND ATTENTION TRAINING IN CHILDREN WITH AUTISM By Mayra Muller Spaniol A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY School of Psychology College of Life and Environmental Sciences University of Birmingham January 2017 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. ABSTRACT Attentional selection is crucial for successful interaction with the environment, including the ability to select relevant information while suppressing irrelevant distractors. While attention is not thought of as a core component of the autism phenotype, attention atypicalities are often reported in research. However, contradicting findings regarding attention in autism and the Broader Autism Phenotype (BAP) imply that the circumstances under which selection is successful or impaired are not yet clear. In a series of experiments this thesis attempts to delineate more clearly the contexts under which attentional control is enhanced or impaired in the BAP. Specifically, the question of whether differences in attentional control are driven by perceptual atypicalities (e.g., in face processing or a local bias) is investigated in Chapters 2 & 3, where both global/local stimuli and face/scene pairs are used while participants are asked to select one aspect and ignore the other. In Chapter 3, I also investigate the possibility that attentional atypicalities in the BAP are linked to the mode of attentional control that is called upon, using visual attention tasks that tap separately proactive and reactive distractor suppression. In Chapter 4, I ask whether attentional atypicalities in the BAP translate to the motor domain using a simple reaching task that may also tap proactive and reactive control processes as distractors appear and need to be avoided. As the results in these chapters all support the notion of attention atypicalities in the BAP, in Chapter 5 I move on to test whether attention training could prove beneficial for children with autism. The Computerized Progressive Attentional Training (CPAT) programme was therefore carried out in a special and mainstream school setting with children with autism, while transfer effects were tested (in behaviour, cognitive and academic performance). Results give evidence for enhanced distractor suppression in adults with more autistic traits, when preparatory control is utilized, while the CPAT is shown to bring transfer effects from attention training to cognitive and academic skills of children with autism. Results are further discussed in Chapter 6. i DEDICATIONS To all the people out there in the Spectrum and especially to the lovely children I had the pleasure to work with, I hope my small contribution finds its way to help brighten your future. ii ACKNOWLEDGEMENTS I would firstly like to thank my parents, Miriam Muller and Afonso Spaniol, who brought me to life and gave me the strength to pursue this PhD. I thank my supervisors Carmel Mevorach and Lila Kossyvaki for the support and guidance throughout the course of my degree. Special thank you to all the participants and volunteers that took part in the experiments in this thesis. This research would not have been possible without your participation. Special gratitude to Topcliffe and Hamilton schools and its governing body for opening your schools and supporting the intervention program. I would also like to thank all volunteer research assistants that aided me conducting research. I wish to thank CAPES for funding this PhD. This work was conducted during a scholarship supported by the International Cooperation Program CAPES at the University of Birmingham, financed by CAPES – Brazilian Federal Agency for Support and Evaluation of Graduate Education within the Ministry of Education of Brazil. Thank you to all the people I met along this journey. Your presence in my life made this possible. iii TABLE OF CONTENTS Chapter 1: General Introduction .......................................................................................... 1 Autism and disengagement of attention .................................................................... 2 Attention allocation in the context of faces ................................................................ 6 Global and local processing in autism ........................................................................ 11 Brief account of executive function in autism ............................................................ 14 Enhanced performance in visuospatial tasks .............................................................. 15 Dual Mechanism of Control (DMC) theory ……………………………………………………………… 17 Developmental model ……………………………………………………………………………………………. 19 Attention training in autism ……………………………………………………………………………………. 20 Autistic traits in the TD population …………………………………………………………………………. 21 Thesis outline ………………………………………………………………………..................................... 23 Chapter 2: High autistic traits in the typical population are associated with improved distractor filtering .............................................................................................................. 27 Abstract ………………………………………………………………………………………………………………….. 27 Introduction …………………………………………………………………………..................................... 28 Methods …………………………………………………………………………………………………………………. 33 The Global-Local Task ……………………………………………………………………………………………. 34 The Face-Scene Task ……………………………………………………………………………………………… 36 Results ……………………………………………………………………………………………………………………. 40 Global-local task ……………………………………………………………………………………………………. 40 Face-scene task ……………………………………………………………………………………………………… 46 Discussion ……………………………………………………………………………………………………………….. 52 iv Chapter 3: Preparatory and reactive suppression in individuals with high autistic traits …………………………………………………………….…………………………………..……………………………………… 59 Abstract ………….…………………………………..……………………………………………………………………59 Introduction …………………………………………………………………………..................................... 60 Methods ………………………………………………………………………………………………………………….. 66 Proactive control (Experiment 1): The morphed faces tasks ……………………………….….. 67 Reactive control (Experiment 2): The visual-search task …………..…………………………….. 71 Results ……………………………………………………………………………………………………………………… 73 Proactive control (Experiment 1): The morphed faces tasks ………………………………….. 74 Reactive control (Experiment 2): The visual-search task ………………………….…………….. 78 Discussion ………………………………………………………………………………………………………………… 80 Chapter 4: Motor distractor suppression in individuals with high and low autistic traits …………………..…………………………………………………………………………………………….………………………. 85 Abstract …………………………………………………………………………………………………………………… 85 Introduction …………………………………………………………………………..................................... 86 Methods ………………………………………………………………………………………………………………….. 90 Results …………..………………………………………………………………………………………………………… 96 Discussion ……………………………………………….……………………………………………………………… 103 Chapter 5: Effects of a computerized progressive attentional training program on children with autism: a control group school-based study ……………………….…………………..………. 107 Abstract ……………………………………………………………………………………………………………………. 107 Introduction …………………………………………………………………………...................................... 108 Methods ………………………………………………………………………………………………………………….. 107 The intervention protocol……………………………………………………………………………………….. 115 v Active control protocol ………………………………………………………………………………………… 120 Pre- and post-intervention assessments .……………………………………………………………… 121 Results ………………………………………………………………………………………………………………….. 125 Pre vs. post intervention analyses ……………………………………………………………………….. 126 Interviews ……………………………………………………………………………………………………………. 130 Discussion …………………………………………………………………………………………………………….. 134 Chapter 6: General Discussion ………………………………………………………………………………… 142 Summary of chapters …………………………………………………………………………………………… 142 Perceptual and attentional atypicalities in autism and the BAP .…………………………… 145 Dual Mechanism of Control (DMC) Theory …………………………………………………………… 147 Limitations and future directions …………………………………………………………………………. 153 Conclusion ……………………………………………………………………………………………………………. 154 References ……………………………………………………………………………………………………………… 156 Appendices …………………………………………………………………………………………………………….. 186 vi LIST OF FIGURES Figure 2.1. 2.1A. Example of stimuli for the global-local task. 2.1B. Typical display and sequence of the task. ...………………………………………………………………………. 34 Figure 2.2. 2.2A. Stimuli used in the face-scene recognition task. 2.2B. Faces and scenes in salient/non-salient, congruent/incongruent and neutral conditions. 2.2C. Typical trial display sequence for congruent and incongruent stimuli …………………………….……………… 37 Figure 2.3. Overall performance for the global-local task, showing the mean AdjRT (±SEM) for congruent (black) and incongruent (light grey) conditions. Data are presented for the global and local target level and the relative salience (target or distractor salient)…………………. 42 Figure 2.4. Congruency effect in AdjRT