The mismeasure of autism: a challenge to orthodox autism theory

Volume 1. No. 2

The mismeasure of autism: a challenge to orthodox autism theory

 

May 3, 2014

By Dr Nicholas Paul Chown

 

Abstract:

Thirty years ago Stephen Jay Gould wrote under the banner of The Mismeasure of Man about the use of science to justify a subordinate role for women, poor people, and black people based on an unfounded thesis that itwas natural. Twenty years ago, in her article entitled The Mismeasure of Woman, the feminist writer Carol Tavris wrote of the domination of women by men. In the light of these works concerning the apparent mismeasure of certain people, I consider the position of autistic people in the context of their relationship with the predominant (typically developing) neurotype and, more specifically, the treatment of autism as adisorder. I review current orthodox autism theory executive functioning, the extreme male brain theory, theory of mind, and weak central coherence as well as various newer, and arguably neglected, theories including the enactive mind hypothesis, interaction theory, and the narrative practice hypothesis. I conclude that autism has been mismeasured by a predominant neurotype medical community and propose a synthesis of autism theory that, in my view, provides a better explanation of autism than any synthesis of orthodox theory as well as providing support for my view that autism is natural human difference.


 

The mismeasure of autism: a challenge to orthodox autism theory

By Dr Nicholas Paul Chown

The mismeasure of autism: a challenge to orthodox autism theory

 

 

Introduction

Thirty years ago Stephen Jay Gould wrote under the banner of The Mismeasure of Man about the use of science to justify a subordinate role for women, poor people, and black people based on an unfounded thesis that it was natural (Gould, 1981). Twenty years ago, in her article entitled The Mismeasure of Woman, the feminist writer Carol Tavris wrote of the domination of women by men (Tavris, 1993). In this article I consider the position of autistic people[1] in the context of their relationship with the predominant (typically developing) neurotype and, more specifically, the treatment of autism as a disorder (the choice of the word treatment when classification might have been a better choice, being quite deliberate given its link with cure) rather than difference by a society that is 99% non-autistic (Brugha et al., 2009)[2]. The socially constructed nature of a diagnosis such as Asperger syndrome (AS) is highlighted by its projected removal from the, shortly to be published, fifth version of the American Psychiatric Associations Diagnostic and Statistical Manual (the DSM-V); although many people with AS feel part of a community (of people with AS), when their social difficulties might otherwise preclude them from experiencing such community spirit, it seems that no-one thought to ask them about the proposed removal of their diagnosis a diagnosis that may be an integral part of their lived experience from the DSM-V. AS is commonly associated with difficulties with change; the disappearance of their diagnosis may be one of the biggest changes they will ever have to cope with. For a scholar with AS, the unilateral discarding of the AS diagnosis by a predominantly non-autistic medical community emphasises the fact that autism can be measured (mismeasured) by society almost at will. Whilst accepting that people may not associate with other diagnoses quite as strongly as many diagnosed with AS associate with theirs, it might have occurred to a society that could empathise with autistic people (lack of empathy is not a one-way street) that, in this particular case, those with a diagnosis of AS should have been consulted as part of the process of revising the diagnostic manual. Separately, my colleague, Luke Beardon, and I will report the results of our survey to ascertain what people with AS think about having to get used to a new diagnosis, and whether they will continue to say they have AS.

 

The mismeasure of autism began long before autism was first described the pioneers (Kanner and Asperger), however, despite acknowledging that life for autistic people would be immeasurably worse than it is now if autism had not been discovered, I argue that the pioneers unwittingly contributed to the mismeasure of autism through their medicalisation of it. More importantly, this article focuses on my view that current orthodox autism theory mismeasures autism.[3] Instead of accepting received opinion that an incomplete (or absent) theory of mind in autism gives rise to difficulties with social communication, imagination, and interaction, I contend that incomplete theory of mind in autism is due to the social being less salient in autism (Klin et al., 2003). I argue that so-called executive functioning difficulties in autism can be mirrored in typically developing people whose different weaknesses are simply not seen as disabilities (in the way that weaknesses in autistic people are) because the former vastly outnumber the latter. Local processing (so-called weak central coherence) is no longer seen as a weakness in autism, indeed it is now regarded as a strength which co-exists with an equal facility with the predominant neurotype (PNT) in global processing (Happ and Frith, 2006). Whilst Baron-Cohen considers that In our society, there is considerable tolerance for persons with his extreme female brain type, and asks whether this brain type (carries) with it any necessary disability (Baron-Cohen, 2002, p. 253), his language use suggests that he regards autism as a disability; I shall argue that autism per se is an aspect of normal human difference. Finally, I want to say that certain new and/or neglected theories of autism, or theories that have been applied to autism, such as interaction theory (and the associated the narrative practice hypothesis) the enactive mind hypothesis, sensorially disturbed interaction hypothesis, and monotropism theory have much to add to an improved understanding of autism. This is an understanding of autism that dispenses with the need for theory of mind (ToM) (but not the acknowledged mindreading difficulties in autism) and executive functioning (EF) explanations, puts weak central coherence (WCC) in the place its originators now put it, and, although arguing that the original extreme male brain (EMB) theory is remarkably oversimplistic and patronising, finds a central place for a version of this theory that I describe as an increased maleness theory and which I believe may help to explain the under-diagnosis of females with autism. In conclusion, it is my considered opinion that in the same way that the mismeasure of man gave rise to struggles on behalf of oppressed minorities, and the mismeasure of woman led to feminism, the mismeasure of autism (and other exceptions to the PNT) fuelled the neurodiversity movement.

 

From Kanner and Asperger to the present day orthodoxy

 

In writing that Kanner and Asperger contributed to the mismeasure of autism I simply state my opinion that any medical perspective on autism that sees it as a disability mismeasures it. I do not underestimate the social impacts of autism on individuals (myself included) but, for me, these are an aspect of human difference to be overcome by a change of attitude by society towards autism. I also realise that co-morbid intellectual and social difficulties compound each others effects. But autism does not involve intellectual difficulties, only social difficulties which disable because the social interaction of 99% of the population differs from that seen in autism. Autism, per se, is simply a different cognitive style, and it is the medicalisation of autism that has turned it into a socially constructed disability. The medicalisation of autism has also resulted in the use of inappropriate language which tends to perpetuate the myth of autism as disability. For example, reference to high-functioning autism, in effect, implies that there are two forms of autism high-functioning autism and non-high (or low) functioning autism when an individual is either autistic or they are not autistic. The term high-functioning person with autism (if those who object to person-first language will excuse me for using the term) better describes the actual situation whereby functioning level and neurotype are quite separate and distinct human features.

 

At this juncture I want to discuss the ToM and EF theories which I reject as partial explanations of difficulties seen in autism (although I do not doubt the difficulty in reading other minds). Later on I shall discuss the WCC and EMB theories which I consider have contributions to make to an understanding of autism (although I argue that the latter needs to be revised substantially). It is not my intention to undertake a full review of either ToM or EF theory in relation to autism; in the current context I shall assume that readers have a working knowledge of current theory and focus solely on the reasons why I reject the claims of proponents of these particular theories that they are, necessarily, required as part of an overall synthesis of theory necessary to explain the main elements of autism.

 

ToM is a reference to an individuals ability to attribute mental states to themselves and to others (Frith and Happ, 1999). The descriptor ToM is a little misleading as this theory does not actually suggest that individual human beings develop their own hypotheses; rather it is a way of describing the need for individuals to develop an understanding that objects and other persons have separate existence, that other persons have their own mental state that differs from theirs, and to be able to put on the shoes of another person mentally. This latter function is often referred to as mindreading (Baron-Cohen, 1995) although this also is a misnomer since ToM involves use of sensory stimuli to guess the mental state of others. Many authors consider that ToM gives rise to social difficulties in autism; for example, Parsons and Mitchell (2002) typically write that The ToM hypothesis states that the social difficulties in people with ASDs [autism spectrum disorders] arise through an inability to recognize or think about the mental states of the self and others (p. 431). But why do ToM researchers appear generally to assume that incomplete theory of mind gives rise to problems with social communication and social interaction rather than vice versa? Why do very few such researchers consider that a qualitative and quantitative difference in social interaction may give rise to a failure to develop a complete (typically developing) level of ToM? In fact, do any ToM researchers adopt the opposite view, or is this a contradiction in terms?

 

It intrigues me that Korkmaz says of executive functioning deficits in congenital deafness, and congenital blindness that these deficits arise from difficulties associated with social interaction, writing that Deaf children have problems in ToM development because they have problems accessing conversational interaction (Korkmaz, 2011, p. 104R), and that congenitally blind people seem to have difficulty in developing a ToM due to the absence of information provided by joint referential attention and shared focus to an external referent (ibid., p. 105R). In the case of attention deficit hyperactivity disorder (ADHD) this author regards EF deficits as the likely cause of the problems associated with social interaction including ToM difficulties and although it is not absolutely clear where he considers the difficulties with ToM and social interaction to lie in the causal chain, in writing that it is likely that it is their impulsivity and lack of ability to focus attention, and the behavioral problems these give rise to, that hinder ToM development in children with ADHD (ibid., p. 104R), it seems that he regards the EF deficits as causing the difficulties with social interaction that, in turn, result in the ToM issues. So here we appear to have a researcher proposing that social interaction issues cause ToM difficulties in some cases (congenital deafness and congenital blindness) but that in others the reverse apparently applies (ADHD). If this is the case it suggests then we have a situation where an influential researcher considers that the causal link between ToM and social interaction can be in either direction. If, instead, Korkmaz would not agree with my interpretation of his stance on the link between EF, ToM, and social interaction in ADHD, then he must be supporting a case where difficulties associated with social interaction precede ToM difficulties in congenital deafness, congenital blindness and ADHD. He does not hazard a view as to the linkage in autism. My focus on his views is quite simply to demonstrate that, with other conditions, differences in the qualitative and quantitative nature of social interaction can be regarded as the precursor to ToM difficulties. Given, then, that social interaction difficulties (including the associated difficulties with social communication and social imagination) are to the fore in autism, why must it be the case that ToM issues in autism cause the difficulties with social interaction rather than vice versa? Given, also, that social interaction begins (in the typically developing child) on the day they are born, but ToM develops gradually during childhood, should the onus not be on the autism research community to prove that it is not the case that social difficulties cause incomplete development of ToM in autism because, by the very nature of autism, difficulties with social interaction in autism precede difficulties with all but the most basic facets of ToM?

 

In her unpublished thesis entitled Understanding autism spectrum disorders from an executive functioning point of view, and following a thorough review of the literature on the subject at the time, the autism researcher Silvie Vert defines EF as the cognitive processes that enable (the) self-control necessary for the attainment of a future goal (Vert, 2004, p. 4). She adopts the Pennington and Ozonoff proposal that there are five distinct but related abilities that go to make up EF, namely inhibition, working memory, planning, cognitive flexibility, and verbal fluency (Pennington and Ozonoff, 1996; Vert, 2004). There is disagreement as to the relative status of these five domains, with some arguing that (for example) inhibition and/or working memory are core (Barkley, 1997a, 1997b; Fuster, 1991, 1997; Goldman-Rakic, 1987) and others seemingly regarding the domains as equal. But my point is that, in each case, one can argue (1) that there are autistic people who do not have the deficit, and (2) that PNT individuals have one or more of these deficits or other similar EF-type deficits that, because the PNT are in a 99% majority, are not regarded as such in the literature on the subject, which, as is the case for most subjects, is a PNT literature. If inhibition is defined as the ability to delay behaviour then one can quite easily see this in the obsessive use of mobile telephones and social media by PNT individuals. Surely, it must be accepted that the autistic artist Stephen Wiltshire, whose incredibly detailed drawings of cityscapes capture the imagination, has an immense working memory? I, personally, have worked (and work) with a number of autistic professionals in both my previous career in risk management, and now in autism, who have an excellent ability to plan and fluid thinking of the highest order attesting to quite phenomenal cognitive flexibility in some cases. As to verbal fluency, I can think of quite a few autistic people in my own small circle who outperform their PNT peers. It is not even that autistic people are more likely to have more of these deficits, or of similar deficits, than PNT people although I accept that if one brings intellectual functioning into the picture the situation changes markedly. But as autism per se does not involve any intellectual functioning deficit, and if we focus on people who are autistic without a co-morbid intellectual disability, are we sure that we see deficits in autism that are not mirrored in the PNT? Are we sure that PNT researchers are cognitively flexible enough to appreciate that cognitive phenomena associated with their own neurotype might be regarded as deficits, rather than natural difference, were it not for the fact that the PNT constitute the vast majority of the population? We should be very careful before we too readily associate minority with deficit or, worse still, abnormality. That route resulted in homosexuality being illegal in the UK until relatively recently, when it is a natural human difference and, indeed, to some extent, a cultural construction given the different societal attitudes to homosexuality over the years and in different parts of the world.

 

WCC has been described as being remarkably good at attending to detail but (having) a weakness in perceiving and understanding the overall picture, or gist (Attwood, 2007, p. 241). Weak central coherence was originally regarded as a core deficit in autism (Frith, 1989)[4]. WCC has been described as being remarkably good at attending to detail but (having) a weakness in perceiving and understanding the overall picture, or gist (Attwood, 2007, p. 241). Central coherence theory states that persons with autism will tend to have WCC, tending to focus on detail rather than the big picture. In accordance with this theory it should be possible to see strengths in the manipulation of detail in addition to difficulties in forming a holistic picture from the detail. This profile of strengths and weaknesses is now described by Happ and Frith (2006) as a preference for local processing rather than the weakness they originally regarded it as. They now see WCC in autism (with the concomitant strengths) as a difference in information processing style, rather than an impairment, and argue that there is a continuum of central coherence along which all people vary, with persons with autism lying at the weak end (Happ and Frith, 2006).[5] With local processing (detail thinking) now being seen by the originators of the WCC theory as a cognitive strength in autism that may exist alongside a typically developing level of ability in global processing (holistic thinking) it is arguable that some autistic people may actually be superior cognitively to their PNT counterparts. This fits nicely with the findings of researchers such as Hayashi et al. (2008) who suggest that children with Aspergers syndrome may have superior fluid intelligence to their PNT peers. Clearly, it cannot be assumed that local processing is a deficit in autism in comparison to the PNT. And, as Happ and Frith now propose a continuum of central coherence along which all people vary, they would presumably agree with me that central coherence is another domain of natural human difference. Whilst they may still believe that autism is a disability, they cannot now, justifiably, see their own theory as even a partial explanation for holding that view. Importantly for my thesis that natural differences in social interaction in autism give rise to ToM difficulties and to an a set of EF difficulties that echo similar difficulties in the PNT, Happ and Frith write that weak coherence may be one aspect of cognition in ASD alongside, rather than causing/explaining, deficits in social cognition (Happ and Frith, 2006, p. 6) since this leaves open the possibility that differences in cognition in autism antecede ToM and EF difficulties.

New and neglected autism theory (or theory applied to autism)

Is it possible that people can gain direct access to another mind? In making the claim that direct access is not just possible but is the primary means by which individuals understand what another person is thinking, Shaun Gallagher relies on the developmental psychological concepts of primary intersubjectivity and secondary intersubjectivity. In what he calls a quick summary of the hard-won evidence provided by developmental psychology (Gallagher, 2008, p. 166) Gallagher writes of primary intersubjectivity that By the end of the first year of life, infants are capable of a non-mentalistic, perceptually-based embodied understanding of the intentions and dispositions of other persons (ibid., p. 166, my italics) and that secondary intersubjectivity builds on these primary perceptual and interactive capabilities when infants start to recognize context as significant (ibid., p. 166, my italics). He goes on to state that many theorists regard the capabilities of primary and secondary intersubjectivity to be precursors to full-blown ToM (ibid., p. 166, authors italics) in the sense that fully-fledged ToM either builds on or replaces primary and secondary intersubjectivity. However, in his opinion adult phenomenology attests to the continued role of primary and secondary intersubjectivity in our everyday understanding of and interaction with others (ibid., p.166), quoting Scheler (1954) and Wittgenstein (1967; 1980) in his defence and writing that Psychologists provide important empirical evidence that our everyday adult interaction is primarily perceptual and contextual (ibid., p. 167, my italics). In other words, he considers that direct access to other minds is achieved by means of perception of facial expressions and body language in the light of the context in which the person does the perceiving. In his own words, what is called for in interaction theory is:

not so much the capacity to make inferences about what is in the minds of other people as a capacity to recall other peoples publicly stated preferences, with the possibility of enquiring as to the nature of these preferences if such information is not available

(Wootton, 2002, p. 91).

 

 

Closely associated with interaction theory is Daniel Huttos narrative practice hypothesis (NPH). This theory claims that a child develops an understanding of folk psychology (FP) [6] by experiencing particular kinds of narrative, namely socially supported story-telling activities (Hutto, 2008, p. 177) i.e., narratives that teach about mental states such as beliefs and desires. (This hypothesis helps to show why the Social Stories intervention in autism is so effective.) Hutto is sure that there is no need for an innate, hard-wired ToM ability in human beings because typically developing individuals develop an understanding of FP through continuous exposure during the formative years to stories that teach them about folk psychological practice. He puts it this way: Encounters with narratives about those who act for reasons best explain the origins of folk psychological abilities, both phylogenetically and ontogenetically. Such stories familiarise us with the forms and norms of folk psychology. This is the core claim of the Narrative Practice Hypothesis (Hutto, 2007, pp. 47-48). This exposure to social stories is considered to be the developmentally normal pathway through which children come by their FP-competence (ibid., p. 17).

 

But why should it be that there are social difficulties in autism that lead to a reduction in the quality and quantity of social interaction, to the failure to develop typically developing levels of understanding of FP practice, and an incomplete (even a total lack of) ToM? The enactive mind (EM) hypothesis proposed by Klin, Jones, Schultz and Volkmar (2003) has it that the social is simply not as salient for autistic people as for the PNT. Rajendran and Mitchell summarise the EM hypothesis in the following manner: Klin et al. argue that from the very outset the autistic mind is not attuned to the social world; for example, the gaze and gaze following patterns of individuals with autism are different from neurotypicals and most notably the eye region does not capture attention as strongly in those with autism (Rajendran and Mitchell, 2007, p. 230). The key to the EM hypothesis is that, instead of a childs mind consisting of certain innate capabilities which are gradually given rein, the mind is an active mind that sets out to make sense of the social environment and that changes itself as a result of this interaction (Klin et al., 2003, p. 348, my italics). Unlike the disembodied cognition associated with computational models, with an active mind cognition and action are inextricably linked in the typically developing child but not in the autistic child (ibid.).

 

If space permitted I would have liked to introduce the sensorial disturbance hypothesis (McGeer, 2002), the time-parsing deficit hypotheses (Boucher, 2003), and the monotropism theory (Murray, Lesser and Lawson, 2005) which I believe have parts to play in a synthesis of autism theory capable of producing a better understanding of autism than current standard theory. These theories speak to the sensory sensitivities that feature so prominently in the autobiographical writing of autistic people (if not the diagnostic manuals), the difficulty people with autism often have with real-time conversation, special interests etc. However, it is not my intention in this article to set out my synthesis of autism theory but to show how current orthodox theory contributes to the mismeasure of autism. So far I have considered three of the four orthodox theories of autism; I now want to complete the set by discussing the EMB theory of Simon Baron-Cohen. This has been left to last as, adjusted, I believe it can play a part in developing a better understanding and more correct measure of autism.

 

Increased maleness rather than an extreme male brain?

As an extension of his empathising/systemising theory, which suggests that females are better at empathising[7] than males, whilst males are better at systemising[8] than females, Baron-Cohen proposes that autism involves an extreme version of the systemising make brain where empathising is very weak and systemising very strong. He writes of this as follows:

The evidence suggests that the male brain is characterised by Type S (where S > E), the female brain by Type E (where E > S), and that the autistic brain is an extreme of the male brain (S >> E). Referring back to Fig. 1, development of an autism spectrum condition means their brain type has shifted towards the lower right-hand quadrant. For males, it is a small shift, from Type S to extreme Type S. For females, the shift is bigger, from Type E to extreme Type S.

(Baron-Cohen, 2002, p. 253, my italics)

 

I consider the current manifestation of the EMB theory to be simplistic. It only reflects two apparent domains where the female and male brains are said to differ; why only two? Are the visual and spatial abilities he also refers to, together with empathising and systemising, the only relevant cognitive dimensions considered to differ between the sexes? What about the dimensions associated with ToM, EF and WCC? But, actually, Baron-Cohen has the empathising and systemising domains on one spectrum (so is it only one domain?). One has, therefore, to ask why empathising and systemising abilities would be on one combined spectrum rather than on separate spectra? Also, with one spectrum covering empathising and systemising (the full list of brain types looks like this: Extreme Type E (E>>S), Type E (E>S), Type B (a balanced brain where E = S), Type S (S>E), Extreme Type S (S>>E)), he writes that the shift he considers occurs in autism is a small shift, from Type S to extreme Type S (one shift to the right) for males but For females, the shift is bigger, from Type E to extreme Type S (three shifts to the right). Why would autism involve a much greater shift for females than males? If the theory has any validity at all, might it not be that autism involves one or more shifts in the case of females? If so, then autism in females would be much more difficult to identify as the shift would lead to more women having a Type B brain type than Type S, let alone the Extreme Type S associated by the theory with autistic males and which gives rise to the extreme male brain designation for the theory. Could this be one possible reason for the much lower apparent prevalence of autism in females than males? One has to be careful in referring to male and female brains. For example, whilst Baron-Cohen writes that more men (than women) value power, politics and competition (ibid., p. 249), I question whether (high-functioning) autistic people value power, politics, and competition more than PNT men; my view is that it is quite the reverse. Whilst I accept that I have no proof of this, neither has Baron-Cohen proof that autistic males are political animals!

 

Baron-Cohen muses as to what a person with an extreme female (Extreme Type E) brain would look like, importantly, asking: Would such a (cognitive) profile carry with it any necessary disability? The person with the extreme female brain would be system-blind. In our society, there is considerable tolerance for such individuals (ibid., p. 253). The clear implication here is that if an extreme empathising (Extreme E Type) brain is not a disability then why should an extreme systemising (Extreme S Type) brain be regarded as such? And in acknowledging that he considers the reason the former brain type is not considered a disability (note that he argues that it would only be a disability if it was considered to be a disability) is that in our society, there is considerable tolerance for such individuals, he must, logically, accept that autism is a socially constructed disability (even if it has biological as well as social determinants). However, whilst I am critical of various aspects of the EMB theory, if Baron-Cohen acknowledged that (1) cognitive matters are somewhat more complex than the theory suggests, and, (2) autism in females is likely to involve one or more shifts to the right on his empathising / systemising spectrum (or, more likely, more subtle shifts along two spectra), I believe his theory would have more to commend it. This would also imply an under-diagnosis of females with autism. Of course, he could no longer use the headline-friendly extreme male brain title for his theory; an increased maleness theory just does not have the same ring to it. Anyway, my tentative conclusion is that the brain of an autistic person is not an extreme male brain but an effect of the reduced salience of the social in autism (enactive mind hypothesis) giving rise to a reduction in the quantity and quality of social interaction in autism (interaction theory / NPH) that has a tendency to increase the maleness of a brain via a reduction in an individuals empathising skills and an increase in their systemising skills.

 

Final remarks on mismeasurement

In connection with a set of articles by a woman on premenstrual syndrome making women unfit to be mothers, Tavris writes that In any domain of life in which men set the standard of normalcy, women will be considered abnormal, and society will debate womans place and her nature (Tavris, 1993, p. 149, my italics). This could easily be rephrased to apply to autism i.e., In any domain of life in which the predominant neurotype set the standard of normalcy, autistic people will be considered abnormal, and society will debate their place and nature. I argue that it is not just ethnic minorities and women who have had to battle against mismeasurement since autistic people face the very same issue. However, the struggle to convince society that it is guilty of mismeasuring those of us who are autistic is likely to be very much harder to win because, unlike ethnic minorities and women (and I do not underestimate the difficulties they have faced), there are only one in a hundred of us.

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[1] There is much argument in the autism community about the relative de/merits of person first language (e.g., person with autism) and the alternative (e.g., autistic person) that seeks to avoid the implication with person first language that somehow there is a person struggling to get out from underneath the cloak of autism. If forced into expressing a choice I would choose to be called an autistic person but, actually, I regard attitudes to autistic people as far more important than the terms used; if the attitude is sound I dont care about the language.

[2] Brugha and his colleagues wrote that two recent, large-scale surveys estimated the prevalence of childhood ASD (autism spectrum disorders) to be around 1% (Brugha et al., 2009).

[3] Paradoxically, the discovery of autism was, of course, necessary for this subject to be discussed!

[4] It was Uta Friths 1989 book entitled Autism: Explaining the Enigma that proposed a synthesis of theory of mind, weak central coherence, and executive functioning deficits to explain autism. I propose a different synthesis in my doctoral thesis entitled A treatise on language methods and language-games in autism.

[5] The idea that there is a central coherence continuum straddling both autistics and the PNT makes no sense if one accepts that autism involves a distinct cognitive difference with people either being, or not being, autistic.

[6] Folk psychology, or commonsense psychology, is the natural capacity to explain and predict the behaviour and mental states of other people.

[7] Empathising is the drive to identify another persons emotions and thoughts, and to respond to these with an appropriate emotion. Empathising allows you to predict a persons behaviour, and to care about how others feel (Baron-Cohen, 2002, p. 248).

[8] Systemising is the drive to analyse the variables in a system, to derive the underlying rules that govern the behaviour of a system. Systemising also refers to the drive to construct systems. Systemising allows you to predict the behaviour of a system, and to control it (Baron-Cohen, 2002, p. 248).

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