You and I
One of the first things that autism pioneer Leo Kanner noticed about the children he was seeing was that they had a tendency to refer to themselves as 'you,' echoing his phrasing of questions he asked them.
Nearly 70 years later, we have a technology — functional magnetic resonance imaging, or fMRI — that can peer into the brain to illuminate which regions are involved when people switch personal pronouns in conversation. This task, called deictic shifting, is impaired not just in children with autism, but also in some adults with the disorder.
A new fMRI study published in Brain in July reports that connectivity between two brain regions involved in self-awareness is greatly reduced in people with autism when they engage in deictic shifting.
In the study, researchers presented 15 adults who have high-functioning autism, all but one of them male, and 15 matched controls with images of the front and back covers of a book held by a woman named Sarah. The book covers depict different objects, for example, a carrot on the front and a house on the back. Sometimes Sarah opens up the book to display both covers and sometimes she folds the book so that only one cover is visible.
Over 24 trials, Sarah asked study participants four variations on a single question: "What can ? see now?" Half the time, the "?" was the proper name of the participant or Sarah. The other half of the time, Sarah used a pronoun, either 'you' or 'I.'
In this manner, participants had to execute a series of rapid shifts between "What do you see now?" to "What do I see now?", "What does Sarah see now?" and "What does (participant's first name) see now?"
The researchers found that people with autism respond more slowly and less accurately to questions that require them to shift perspective from 'you' to 'I.' The scans revealed that connectivity between the right anterior insula and the precuneus is significantly lower among individuals with autism when carrying out this task.
Conversely, the precuneus is far more active in the individuals with autism when they're confronted with proper names, suggesting that this brain region is working overtime to properly identify self versus other.
These results suggest that pronoun reversals in autism are not simple semantic glitches. Instead, they appear to provide yet another example of the profound impairment in autism of the ability to understand self and other in reciprocal relationships.
After all, if I can't distinguish between you and me, how can I ever get to the immeasurably more complex category: We.
Comments
Echolalia is not specific to autism. echolalia and pronoun reversal can occur transiently in typically developing children and in verbal autistic children who present with echolalia the condition also tends to be somewhat longer lasting but still transient. Echoallia has been also described in patients with Tourette's Syndrome, adult stroke patients, adults with brain tumors, in degenerative conditions like Alzheimers Disease and even in systemic lupus.
Echolalia is a language disorder associated with atypical brain structure and the claim that it is evidence for a lack of awareness of self is insulting to childen and adults with structual anomolies in the brain and their families and coold only have been invoked by a believer in discredited Freudian theory.
http://www.ncbi.nlm.nih.gov/pubmed/19585352
http://www.ncbi.nlm.nih.gov/pubmed/10967660
http://www.ncbi.nlm.nih.gov/pubmed/11213948
http://www.ncbi.nlm.nih.gov/pubmed/11296406
http://www.ncbi.nlm.nih.gov/pubmed/20964503
http://www.ncbi.nlm.nih.gov/pubmed/19062159
Mr. Jensen--I certainly meant no insult to individuals with autism or their families in this piece. Nor am I a believer in Freudian theory. You are correct in stating that some typically developing children also mix up 'you' and 'I' as do adults with other brain disorders. However, the study in question linked this persistent deficit in people with autism to related impairments in theory of mind. This is the point I was trying to make in the final two paragraphs. I'm sorry if this upset or offended you, or others.
As always, thank you for reading SFARI.
Deborah;
OK, I won't take it as an insult. My daughter was diagnosed with PDD/NOS in 1988 and for a brief period of time did have pronoun reversal and echolia but it was quickly resolved over time. Within four years her diagnosis flew out the window and she has had a normal outcome.
One of the problems over many decades is that researchers have tended to evolve into highly specialized areas of interest. Autism researchers focus exclusively on their speciic 'boutique' area of interest as do researchers specializing in schizophrenia, ADHD, intellectual disability, bi-polar disorder and so on. There is vritually no communication or collaberation between these groups.
There first question that should be always asked by any of these highly specialized groups when presenting evidence supporting a theory or hypothesis is 'Is this hypothesis or finding unique to the botique group being studied?.. The answer, invariably, is no.
By the way, Theory of Mind deficits are also not diagnostic specific.
Theory of Mind deficits have ben recorded in people with Downs Synrome, Acquired brain injury, Bi-Polar Disorder and schizophrenia to name a few:
http://www.ncbi.nlm.nih.gov/pubmed/8735448
http://www.ncbi.nlm.nih.gov/pubmed/20153762
http://www.ncbi.nlm.nih.gov/pubmed/21757324
http://www.ncbi.nlm.nih.gov/pubmed/19594509
I am looking for the article you referenced, I was unable to find it. Can you give me the citation? Thanks
Ms. Morgan: If you are referring to the article discussed in the piece, the citation is Mizuno A. et al. Brain, Epub ahead of print (2011).
http://www.ncbi.nlm.nih.gov/pubmed/21733887
Also, please note that in blogs and other articles, we link to citations and articles of interest. These links appear in purple compared to the normal black text. For example, we linked to the citation you requested from the words "greatly reduced" in the paragraph where we first described the study.
Thank you, RAJensen.
Also to take into consideration is the reliability of brain scans showing something as complex as self-awareness, not taking into consideration that there are as many types as there are people. Self-awareness is a very relative term.
http://deevybee.blogspot.com/2011/06/brain-scans-show-that.html Brains scans can be made to show a lot, if you hit the numbers just right.