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Question 1 Initially, Autism was described as a set of pervasive developmental disorders characterised by impairments in reciprocal social interaction and repetitive behaviours. Autism may be accompanied by global cognitive impairment, which is a characteristic that acts as a barrier to the cognition process what used to be called mental deficiency, or mental retardation but not necessarily so. In May 2013 changes in the diagnostic criteria for autism have been proposed by the new DSM-5 which may have great impact for psychological studies of the condition. Diagnostic criteria from the DSM-IV & DSM-IV-R included at least six items from either impairments in social interaction, qualitative impairments in communication and repetitive behaviours. Or at least two items from impairments in social interaction and one each from qualitative impairments in communication and repetitive behaviours. Impairment in social interaction include 4 points of which two must be present, these include marked impairment in the use of several nonverbal behaviours to modulate social interaction, failure to develop peer relationships appropriate to developmental level, lack of spontaneous sharing of interest with others, or absence of social or emotional reciprocity. Furthermore they must also have either a delay or abnormality of at least one from social interaction, social use of language, or symbolic or imaginative play. The current diagnostic criteria, from the point of view of counting symptoms can be considered problematic, in that a set of individuals, all with the label of autism may have little, symptomatologically speaking, in common with each other. For example, an individual suffering from some of the symptoms outlined may be experiencing those symptoms to a different extent to another individual, or that other individual is experiencing different symptoms yet they are still both marked with autism. But in reality, all the points under each diagnostic heading have a lot in common therefore ideally there shouldnt be many differences from individual to

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individual when suffering the symptoms outlined. The DSMproposed changes could affect the way diagnosis will be given to people on the autism spectrum as the current terms used in the DSM-4 are autistic disorder, aspergers disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified. The proposals mean that when people go for a diagnosis in the future, instead of receiving a diagnosis for one of these disorders, they would be given a diagnosis of autism spectrum disorder. The triad of impairments will also be reduced to two domains of behaviour and an individual must have difficulties in both. These include social and communicative behaviours, restrictive and repetitive behaviours (includes repetitive and stereotyped speech and hyper- or hypo-sensory reactivity). Patients receiving a new diagnosis must meet criteria currently or by history and symptoms must be present in early childhood, but may not manifest until social demands trigger difficulties. Such changes could mean that emphasis during diagnosis will change from giving a name to the condition, to better help identify all the needs someone has and how these affect their life. However, the latter may be problematic as in order to find suitable treatments and support, you need to recognise the individuals specific disorder rather than grouping them across a dimensional view of the autism spectrum disorder. Many researchers in the field of psychology have contradicting views on the approach for a dimensional rather than categorical framework for diagnosing the autism spectrum disorder. If diagnosis is now based on the grouping of all conditions under the spectrum as one then psychological studies will be limited in their research to gain better understanding for each of the disorders which previously fell under the autism spectrum. Research specifically into high-functioning autism or aspergers syndrome as relevant and useful as it may be will still have difficulties in gaining credibility as the changes to diagnostic criteria will mean dropping the distinction between such disorders. Therefore research may have to focus on the autism spectrum as a whole and thus conduct appropriate

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psychological studies in order for it to have more relevance in this day and age of what is now understood as the autism spectrum. Opposing views on whether to lump or split such disorders may provide further understandings of how these changes in the diagnostic criteria for autism spectrum disorder proposed by the DSM-5 may impact on psychological studies of the condition. A brief history of how Autism emerged and was defined may inform us of how it became to be considered a spectrum disorder, existing on a continuum of different symptoms and severity, as well as why the DSM-5 proposed the new changes. Autism was first identified by Kanner (1943); however several earlier accounts of autistic children were discovered although the syndrome had not been recognised as such at the time. There was no doubt that autistic children existed, but equally there was considerable confusion over the boundaries of the syndrome as well as about its nature and causation (Rutter, 1974). The term autism was originally coined by Bleuler (1911) to describe what he perceived as one of the key symptoms of schizophrenia, that of social withdrawal. Autism, literally meaning selfism, seemed to him to describe the active detachment which affected many of his patients. It was only Kanners 1943 paper which is a reflection on his clinical cases, in which he identified groups of symptoms that tend to cooccur, this led to the identification of an unrecognised syndrome and as he was beginning to identify the existence of autism, stumbling across the term he felt it described what he was witnessing in the children he was treating. Such symptoms included the inability to develop social relationships, delayed speech, non-communicative speech, delayed echolalia, pronominal reversal, repetitive and stereotyped play, obsessive insistence on sameness, lack of imaginative activities, good rote memory, and normal physical appearance. Any account of the definition of autism must start with Kanners observations, and it was these insights which originally led to the diagnostic criteria used in the DSM-IV to diagnose such a disorder. In the

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beginning, autism was thought to be a condition that was distinct from other childhood psychopathologies. But the epidemiological work of Wing & Gould (1978) showed that it might be better to consider it as a spectrum of different conditions linked by a common component existing on a continuum. This may be due to not all children meeting criteria specifically for the Kanner type autism, yet still showing some of the features of autism. Therefore, it could be argued that rather than thinking in terms of rigid diagnostic categories, we should recognise that the core syndrome of autism shades into other milder forms of disorder in which language or non-verbal behaviour may be disproportionately impaired. Such research may imply that the changes to the diagnostic criteria may be best appropriate in order to identify individuals all on the same continuum of disorder thus psychological studies may gain benefit by either having a more substantial number of individuals whom can participant in such studies for the future in autistic research gaining more reliability and thus being generaliseable to the wider population under the autism spectrum. However, most with the classic Kanner form of autism have some degree of global intellectual impairment. They also have characteristic language difficulties but by contrast, people with aspergers syndrome are of normal intelligence and have few or no language abnormalities. The question whether highfunctioning people with autism and those with aspergers syndrome are the same or different remain hotly debated. Howlin (2003) investigated whether high functioning autism and aspergers syndrome should be considered the same of different conditions. The study consisted of two groups the language delay group whom were diagnosed as having high functioning autism and those who reported to have no such delays were designated as having aspergers syndrome. No significant differences were found between the groups either in their total algorithm scores, or in their algorithm scores on individual domains. Social outcome ratings and scores based on

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current functioning also failed to differentiate between the groups. Scores on test of language comprehension and expression were also similar, but in both groups language abilities were well below chronological age level. Such findings suggest the differences between aspergers syndrome and high functioning autism is not a lot, and the poor performance on language tests also challenges the assumption that early language development in aspergers syndrome is essentially normal. This implies that the DSM-5 is correct in identifying both high functioning autism and aspergers syndrome as lying under the same condition, thus psychological studies into the separate disorders may prove invalid in that they are not measuring what they are ideally supposed to. Research may focus on language impairment on high functioning autism specifically, and due to the assumptions made that those with aspergers syndrome have normal language abilities psychological studies may not incorporate such people with this disorder into their research, and thus be irrelevant. Therefore the changes to the diagnostic criteria may provide a stricter framework for psychologist to work in; however such changes are useful in determining the relevant research, and not so relevant research in terms of the validity in measures gained from the sample being used. Yet, research in the autism field still attempts to distinguish the different categories lying under the autism spectrum suggesting that a dimensional view is not the most appropriate even if the diagnostic criteria may be the same for all that fall under the autistic spectrum. Ozonoff et al (1991) compared the neuropsychological profiles of individuals with high functioning autism and aspergers syndrome. In comparison with matched controls, both groups were impaired on executive functioning tests (cognitive processes that regulate, control and manage other cognitive processes). However, only the higher functioning autistic group demonstrated deficits in theory of mind (the ability to attribute mental states to one self and others) and verbal memory, performing poorly than both

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controls and aspergers syndrome subjects. Such results suggest that these two conditions are empirically distinguishable on measures independent of diagnostic criteria as impairment on theory of mind measures is not universally found among individuals with autistic spectrum conditions. Furthermore research outlines that different diagnostic tools were used for those representing behaviour that fits the full picture of typical autism to those people who have good grammatical language. Therefore, psychological studies which have previously attempted to support specific diagnostic tools for the different autistic spectrum conditions may now be discredited due to the changes in the DSM-5. Studies which have focused on making distinctions between the conditions and thus appropriate diagnosis, causes and treatment approaches will have less relevance now which is shameful to say due to the much relevant insight and understandings they have given us of autism. However, it is still questionable as to how these distinctions are credible, as previous research has implied not all people with high functioning autism have an impaired theory of mind. Therefore, may be the distinction is not necessary and it is more suitable to view the symptoms that lie on the autism spectrum as a continuum due to the individual differences in symptoms and impairments even within those who are classed as being in the same category condition. However, it has been argued that people with aspergers syndrome have an identity which will be taken away due to lumping the conditions together in the DSM-5. The term aspergers syndrome has become much more widely used in the English speaking world and some professionals have felt that the term is a more acceptable diagnosis from the point of view of parents. This may be due to the social stigma attached to autism which is not attached to the term aspergers syndrome. Furthermore psychological studies which have aimed to distinguish aspergers syndrome and their necessary requirements and needs will have a great impact from the changes to the DSM specialist services are often tailored for people with aspergers syndrome, therefore dropping the term

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could potentially reduce access to services for those who are in need and delay early intervention however they may be possible improvement for those that are mildly affected. To conclude, due to the similarity in conditions and symptoms, all autistic conditions in the new diagnostic criteria for the DSM5 now fall under the same heading of autism spectrum disorder. Such changes impose an impact on psychological studies of the condition in that many studies may be considered as irrelevant, discredited or outdated in the sense that they may make distinctions between autistic conditions or present research that is relevant to one category of autism whereas now all the individuals with the disorder are considered of the same. However benefits for future psychological studies of the condition include the opportunity for better reliability, validity and generaliseability in the sense that more participants can be used to represent the whole autistic population and thus findings would be more appropriate in the application to the majority of autistic individuals. Although it is thought that individuals with autistic spectrum disorders are best represented as a single diagnostic category this could affect children with autism differentially as they may now receive a different diagnosis when re-evaluated. This has the potential to be confusing for parents of children with these diagnoses as well as children and adults who identify strongly with their diagnosis. However, the proposed changes are based on research, analysis and expert opinion and have been made with hope that the diagnosis of autism spectrum disorders will be more specific, reliable and valid. There is also a plan to introduce dimensional elements this should give indication of how much someones condition affects them, as well as helping to identify how much support an individual needs. Although the change in diagnosis does narrow down who gets classified as having autism, the DSM is truly just a guide to diagnosing therefore clinicians will have to interpret the new guidelines and use their own clinical judgement to make informed decisions about treatment options for patients.

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Future research may wish to continue in identifying whether there are different types of autism or not, and what these types might be thus making it possible to give even more specific diagnostic details rather than focusing on individuals existing on a continuum of symptoms lying under the autism spectrum.

Question 4 Executive functions are a set of ideas developed out of clinical practice which is an umbrella term for cognitive processes that regulate, control, and manage other cognitive processes. Therefore executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. Individuals with autism commonly show impairment in three main areas of executive functioning fluency (the ability to generate novel ideas and responses), planning (complex, dynamic process, wherein a sequence of planned actions must be developed, monitored, re-evaluated and updated), and flexibility (poor mental flexibility, as demonstrated in individuals with autism, is characterised by perserverative, stereotyped behaviour, and deficits in both the regulation and modulation of motor acts). However, the findings from studies of executive function in autism are somewhat contradictory therefore it may prove difficult when drawing on conclusions from such research. The mixed findings are most likely due to the fact that executive functions are a variety of behaviours that make different demands on autistic spectrum disorder and non ASD participants. However the observation of similar executive function deficits in individuals with autism and with other psychopathologies could lead us to question whether the same behavioural capacity betokens similar underlying processes. The Wisconsin card sorting test is a neuropsychological test of set-shifting i.e. the ability to display flexibility in the face of changing schedules of reinforcement. It has been considered a measure of executive function because of its reported sensitivity to frontal lobe dysfunction which has been

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highlighted as controlling the actions of individuals. Hughes, Russell & Robbins (1994) showed that autistic groups were differentially impaired with respect to control groups on tests of executive function such as set shifting tasks and tower of London planning task. This impairment was specific to the stages of each task which placed greatest demands upon executive dysfunction in autism. Such deficits in executive control processes have therefore been proposed as a cause of not only the rigid and repetitive behaviour patterns that characterise autism but also the core impairments in communication and reciprocal social interaction. Pennington et al (1997) further suggests the executive dysfunction account for autism is an alternative to the theory of mind hypothesis. In that individuals are incapable of attributing mental states to themselves and others thus causing the symptoms outlined for autism. However, Pennington et al argues that executive deficits are potentially more primary and may possibly account for the theory of mind impairment in autism. Therefore, although research findings from studies into executive function in autism proves difficult it still can make useful conclusions by accounting for the theory of mind deficits in autism, suggesting that it is more likely to be an executive function impairment. However, the initial enthusiasm for an executive account for autism was misplaced as the main problem is that executive deficits are not only limited to autistic spectrum disorders. Therefore this could suggest that findings implicating the cause of autism to be determined by executive dysfunction are incorrect in concluding this, as others with different psychopathologies such as schizophrenia, ADHD and OCD also incur executive function difficulties. Furthermore, there is difficulty in determining ecological validity amongst research into executive functioning and autism. The question as to how much verisimilitude such tests have or close resemblance to real life demands could prove a problem when attempting to measure executive control functions in a lab or clinical setting.

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Kenworthy (2008) suggests that a multi-source approach emphasising veridcality may provide the most comprehensive assessment of executive control in autism. Therefore in an attempt to draw useful conclusions from studies into executive function in autism research must challenge the flaws in studies in hope to not be discredited. Ozonoff (2004) suggested using tasks that are known to activate the frontal lobes and Russell suggested identifying task demands that place uniquely difficult demands on individuals with autism spectrum disorder. More recent findings in an attempt to fix these problems were conducted by Ozonoff (2004), whom used certain executive function tasks that were known to involve the frontal lobes (on the basis of PET FMRI or animal lesion studies). Ozonoff tested 79 adolescents on computerised versions of these tests the ASD group solved significantly fewer problems and needed more trials to criterion in the later stages. Such results further imply that autistic individuals do indeed have an executive dysfunction. According to Russell (1997), there is something specific to those executive functions that are typically impaired in people with autism. People with autism specifically experience a particular difficulty when having to follow an arbitrary rule. As children with autism have pervasive executive difficulties then as can be concluded from findings it is necessary to determine whether these contribute to their often reported failure on the false belief task. Failure on this task is frequently taken to diagnose the lack of theory of mind however Russell (1999) reports two studies using two tasks that make similar executive demands to the false belief task. The first experiment showed that children with autism are significantly challenged by a conflicting desire task, which suggests that their difficulty with the false belief task is not rooted in difficulty with grasping the representational nature of belief. In the second study children with autism were also found to be impaired on a novel version of the false photo task. Such findings suggest that the difficulty with these tasks for autistic individuals is due to commonalities in the tasks executive

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structure. Therefore it has been suggested that the false belief task itself is an executive function task requiring the inhibition of a predominant response. Thus, such research can provide useful conclusions in that of accounting for the theory of mind impairment on such tasks may actually be down to executive dysfunction. However, due to the contradictory research it still remains questionable as to whether these conclusions are in fact reliable. Kenworthy et al (2008) showed computer administered tower tasks often failed to show executive dysfunction even though face to face administration produces greatest executive function related effect sizes. Due to such contradictory research into executive function in autism future research may wish to look further into why some fail executive function tasks and others dont or even why a computer administered task results in no executive dysfunction, yet face to face administration does. The executive function theory attempts to explain not only the repetitive behaviours but also the sociocommunicative difficulties in autism. While it is clear that some individuals with autism perform poorly on certain executive function tasks, it remains unclear what underlies these impairments. However the most consistent and striking difficulties are seen on tasks that are open-ended in structure, lack explicit instructions and involve arbitrary rules. Executive function has received extensive attention in the autism literature due to the influential proposal that the inherent rigidity and invariance of autistic behaviours could be explained by a primary impairment in executive control. These problems typically manifest as preservative responses and difficulties switching flexibly between response sets. However, despite the theorys apparent face validity not all individuals show executive function difficulties. For such reasons it may prove difficult to draw conclusions from such research with contradictory results. For this reason researchers have moved away from a framework that emphasises a single, primary atypicality such as executive dysfunction as the underlying

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cause of autism to one that encompasses multiple cognitive atypicalities. Whilst there is a general consensus that executive function problems are unlikely to play a primary causal role in autism, Pellicano (2012) suggests that it remains possible that the degree of difficulties in executive function could play a substantial role in autistic childrens developmental outcomes including their social competence, their adaptive behaviour and their success in school. Therefore executive dysfunction is likely to place the child with autism at risk for a poor developmental outcome either directly or indirectly. Contrary to popular opinion, children with autism do not grow up in a social vacuum rather they can show attachment security to caregivers, can engage in positive and collaborative interactions with siblings as well as actively seek out their non-autistic peers. Therefore it is plausible to conclude from research that social contact could influence autistic children developing executive functioning, which in turn might exert its effects on key real-life outcomes. Future research must focus on a richer understanding of the causal determinants of executive function growth in autism in order for the individual differences in executive functioning in those with autism as well as the contradictory research.