Autism and Representation
Case Western Reserve Univ
Cleveland, Ohio
28-30 October 2005

 

"Human, but More So:
What the Autistic Brain Tells Us about the Process of Narrative"


Matthew K. Belmonte
Autism Research Centre
University of Cambridge

Do not cite without permission of author

"Human, but More So:
What the Autistic Brain Tells Us about the Process of Narrative"


NARRATIVE AS DEFENCE AGAINST DISORDER

The human mind occupies a unique status in nature, able to contemplate the eternal and the absolute, and yet bound within a mortal animal and a mutable world. This juxtaposition of mental and physical existence creates a tension fundamental to human psychic development which Becker [1973] has labelled 'the denial of death.' As Becker describes, this denial can be more generally construed as an aversion to direct experience of disorder and impermanence - the death of the self being an ultimate, personal manifestation of this universal tendency. Psychic life requires the construction of defences against this disorder, albeit temporary and in a sense ultimately futile ones. Both the implicit, mental narrative that implements human perception and cognition and the explicit, written narrative of literature can be read as the mechanism of this defence. A fear of death drives us to become narrators, to transform the disconnected chaos of our sensorium into representative mental texts whose distinct scenes contain recognisable characters that act in coherent plots. This capacity to project the concrete and intractable complexity of direct experience onto abstract and predictable scripts is fundamental to human cognition: in this sense there is no thought without narrative, and in fact a strong argument has been made for the genesis of language as an externalised representation of the narrative structure of human thought [Turner 1996]. As long as we're able to keep up this substitution of perceptual representation for sensory referent, cognition is maintained and death is forestalled.

This narrative denial of death, though, produces its own reactive fear which may be described as a denial of life. In projecting particular elements of sensory experience onto mental representations, the process of narrative inevitably discards many more elements for which no projection can be formed. Thus in constructing abstract or global meaning, the process of narrative destroys (or rather excludes from higher-order representation) concrete or local detail. Which details are so elided depends on the narrative frame onto which experience is being projected, and the authorial decision as to what frame to apply thus carries life-or-death responsibility. This responsibility is a heavy burden, and in order to avoid bearing it humans look to parents, deities, ideologies, or other externalised authorities. In short, we seek escape from the status of being a narrator into that of being narrated. In Freud's Oedipal frame, we want to displace the father who dictates narrative order but at the same time to be dominated by the mother who protects us from unnarrated chaos. Or as Szasz (1961: 179) frames this conflict, `man's [sic] need for rules and his propensity to follow them is [sic] equaled only by his burning ambition to be free of rules.' Others too have induced that the human tendency to ritualised behaviour is a manifestation of the desire to be protected by rules [Werner 1948; Bettelheim 1967: 83], and from this perspective it can be discerned that ritual operates to relieve not just the pathological anxieties of psychiatric conditions but also the everyday anxieties of healthy human living.

These construals in terms of the denial of death (Becker), the Oedipal conflict (Freud), rule-following (Szasz), and the narrative nature of human thought (Turner) all are statements of the same observation, and rather than arguing over which terms should be treated as primary we may do well, for the moment, to accept that all these formalisms are theoretical projections of one and the same phenomenon of narrative organisation - an activity that simultaneously permits and limits cognitive life. In neuropsychological terms, narrative organisation is implemented by interacting and not entirely separable processes of perceptual organisation, attention, and memory. Perceptual organisation is that process which binds separate stimuli into coherent higher-order objects, replacing, for example, a horizontal plane and four perpendicular posts with the single entity of a table. Attention, a group of many subprocesses, focuses processing on those parts of a scene judged relevant to the current script or story. And memory, by holding in mind the higher-order representations of what one has seen before and what one expects to see next, informs attention and perceptual organisation with the context of this story. It is only after treatment by these processes of cognitive organisation that conscious perception is attained. This distance between sensory input and narrative consciousness is the root of Proust's insight that events are most real not when they are experienced, but when they are remembered or imagined.

The tension between self and environment that gives rise to narrative structure, scripts, and rituals is particularly close to the surface of the psyche during the early years of human development, and indeed children's rituals bear great similarity to behaviours which in older individuals would qualify as pathologically obsessive-compulsive [Evans 2000]. Lacking as yet a large and flexible repertoire of scripts onto which phenomena can be projected, and lacking efficient cognitive mechanisms with which to implement such projections, children attempt the converse solution to the problem of psychic life: they try, through ritualised behaviour, to constrain experience to fit their limited repertoire of scripts. A clue to this origin of such rituals as a consequence of the denial of death (or more generally as a consequence of narrative organisation) can be glimpsed in the trait-based correlation of normally developing children's fear of death with their repetitive behaviours and compulsive arrangement of objects [Evans et al. 1999]. A crucial corrollary for autism research is that repetitive behaviours, despite their diagnostic validity, are aetiologically not a primary symptom and should not be studied as though they were. They are, rather, an adaptive strategy aimed at rendering the environment tractable enough to be modelled by a pathologically restricted process of narrative organisation.

AUTISM AS A PHYSIOLOGICAL IMPAIRMENT OF NARRATIVE

In addition to their role in normal child development, ritualistic and compulsive behaviours are one of the three broad diagnostic symptoms of autism. This similarity between autistic and normal development becomes comprehensible in light of recent evidence that autistic neurophysiology may impair the processes subserving narrative organisation. Autism's other two diagnostic symptoms, impairment in communication and impairment in social interaction, can be even more immediately construed as consequences of disrupted narrative. To understand this relationship between autistic behaviour and narrative disruption, we need to know something about autism's abnormal neurobiology, and about the abnormal psychology that develops around it.

Rather than a single mutated gene or a single abnormal region of the brain, recent theoretical syntheses of the neurobiology of autism have focused on abnormalities in the ways in which many genes interact to produce abnormal neural connectivity within and between many brain regions [Belmonte et al. 2004a, 2004b; Courchesne & Pierce 2005]. A synergy of genetic and environmental factors may produce either abnormally strong or abnormally weak connections within local groups of neurones, sabotaging a network's ability to represent information. In the case of abnormally weak connectivity, incoming signals do not activate the network. In the case of abnormally strong connectivity, the entire network activates in response to input noise within which the signal is lost. The former case is analogous to that of a blackboard that cannot be written on, the latter to that of a blackboard that turns completely white at the first touch of the chalk. Either situation impoverishes representational capacity within local networks, and may prevent long-range transfer of information between networks [Belmonte et al. 2004a]. The end result would be a collection of brain regions each of which may be more or less intact when considered by itself but in which regional activities are not coordinated or modulated in response to cognitive demands. This pattern is, in fact, exactly what is observed in neurophysiological studies of autism [Belmonte & Yurgelun-Todd 2003].

This deficit at the network level impairs the associative processes essential to narrative thought, those that automatically and fluidly extract structural similarities and draw attention to those features most relevant to the scene and the story. Since there is no neuroanatomical 'Cartesian theatre' wherein all the separate elements of the perceptual scene are integrated, narrative organisation must depend on coordination of activity amongst widely separated brain regions [Tononi et al. 1992] - exactly the capacity that seems impaired in autism. Narrative connectivity therefore depends on corresponding functional connectivity between all the brain regions and subsystems that participate in perceptual and cognitive experience, and disrupted neural organisation implies disrupted narrative organisation. Autism's characteristic pattern of impairment in cognitive tasks that demand contextual processing and superiority at tasks that demand piecemeal processing of individual features has been described as 'weak central coherence' [Frith 1989; Happé 1996], that is, an abnormally weak tendency to bind local details into global percepts. An ostensibly competing neuropsychological theory of autism is that of executive dysfunction [Ozonoff et al. 1991; Pennington et al. 1997; Russell 1997], an impairment in coordinating and sequencing cognitive activities. The idea of impaired neural connectivity and disrupted narrative organisation reveals weak central coherence and executive dysfunction as two sides of the same coin, describing the impacts of narrative disruption on perception and on action, respectively.

When narrative is so disrupted, what fallback cognitive strategies can be substituted as ways of finding learnable associations in one's environment? One possible understudy for narrative organisation is the simpler sort of associative learning that underlies behavioural conditioning. Indeed, a learning style founded on statistical association rather than on instructive focus on relevant stimuli well describes autistic cognition and behaviour [Belmonte & Baron-Cohen 2004], in which both essential and incidental correlations amongst perceptual inputs are learnt equally strongly. Others have noted that ritualised behaviour is associated with an excessively perceptual (rather than conceptual) style of interaction with one's environment [Evans 2000] - another indication of poor narrative organisation.

Although autism is not the only neuropsychiatric disorder featuring repetitive and ritualistic behaviour, autistic rituals and preoccupations are distinguished by their frequent focus on mechanical or other deterministic systems [Baron-Cohen & Wheelwright 1999]. This cognitive style in which mechanistic details are elaborated into complex preoccupations contrasts with schizophrenia, in which preoccupations are most often founded on social stimuli such as gaze or voice. Schizophrenic ritual is centred on elaborate beliefs about other minds that conspire against one, whereas autistic ritual centres on elaborate beliefs about impersonal systems. Schizophrenic ritual is mentalism run amok, whereas autism is mechanistic explanation run amok [Badcock 2003]. Or, if in Werner's [1948] terms schizophrenia is an animistic de-differentiation of self and other, autism is if anything a solipsistic hyper-differentiation of self and other [Belmonte in press]: precisely because the narrative defence against sensory chaos is so impaired in autism, people with autism are unusually sensitive to the problem of constructing this defence, and their solutions to this problem tend to be more deliberate and explicit than those implemented by the rest of us.

In understanding the role of ritual in the autistic defence against disorder, we find useful the metaphor of film [Belmonte in press]. Imagine that your life is a film, being screened in some Cartesian cinema (a metaphorical one, to be sure, since no such Cartesian representation exists neuroanatomically). The trouble is that this film is being screened by an incompetent projectionist. Perhaps the aperture is wrong, so that you can see only a small corner of the image at a time, or perhaps the sound track is absent, or distorted, or out of synchrony with the picture. In any case, you can glean only disconnected fragments. Everyone around you is talking about this film, and you'd very much like to understand it. So you ask the projectionist to rewind the film and to play it again and again. Keeping this one film in the Cartesian projector serves two purposes: it allows you to build an understanding of the story by picking up new fragments each time the film is screened, and, perhaps even more importantly, by monopolising the projector it prevents any new, unpredictable and incomprehensible film from being screened. When people with autism replay films in the Cartesian cinema, we say that they are engaging in repetitive or ritualistic behaviours.

We have seen how repetitive and ritualised behaviour in autism can be understood as an adaptive response secondary to a neurobiologically based impairment in narrative organisation. Szasz [1961] contended that all abnormal behaviours are best understood in this way, as rational responses to abnormal experience. Szasz took as his example the case of hysteria, a socially constructed disorder which was not supposed to have any concrete and definite biological foundations. However, his reframing of abnormal behaviour as a product of rationality applies equally to disorders involving psychological response to abnormal neurobiology. Szasz [1961: 11] wrote that 'The sociohistorical context of the learning experience must not be confused with the history of the subject.' This insight can be extended: the perceptual and cognitive context of the learning experience must not be confused with the (rest of) the history of the subject. This realisation is crucial to understanding the abnormal psychology of autism, and of developmental disorders in general: much of autism's abnormal psychology arises not directly from abnormal neurobiology but rather in the interaction of a normal human mind with an abnormal perceptual and cognitive environment. Such psycho-biological interactions can produce developmental outcomes as deterministic as those produced by direct biological causation. Thus autism's core symptoms of repetitive and ritualised behaviours, impaired communication, and impaired socialisation, though diagnostically valid, clinically significant, and psychologically informative, are unlikely to be aetiologically primary [Belmonte 2004b].

Ironically and tragically, this psychological nature of certain aspects of autistic development was touched on by the person whose work did the most damage to autism research and to autism families: Bruno Bettelheim. Bettelheim's [1967] utterly false description of autistic social withdrawal as a reaction to the mother's rejection of her infant was responsible for a generation of suffering during which medical authority focused blame on parents for supposedly causing their children's autism. As with so many arguments within the autism research community, Bettelheim's error lay in setting his own theory and opposing theories against each other, instead of seeking synthesis. Bettelheim actually was correct in characterising autistic withdrawal as a consequence of rejection, but wrong in assuming that this rejection was a social phenomenon originating with the parent. Combining part of Bettelheim's autistic psychology with what we now know about autistic neurobiology reveals autistic withdrawal as a response to rejection by one's own internal cognitive and perceptual environment, an environment whose limited capacity for narrative modelling often cannot encompass the complex and not concretely scripted phenomena of social interaction.

Social interaction depends on the ability rapidly to update and to apply one's mental representations of others' beliefs and intentions, to place oneself within the context of a developing social story. This capacity is known as 'theory of mind.' Although impairment in theory-of-mind has been read as a cardinal or even a primary cognitive symptom of autism [Baron-Cohen et al. 1985], the framework of narrative organisation supplies a deeper interpretation, one that more effectively unifies autism's social and non-social abnormalities. In this view, impaired theory-of-mind (or, as it has been more recently and more generally construed, impaired empathising [Baron-Cohen 2002]) is but one of many specific abnormalities that arise from a general disruption of narrative organisation (or, in alternate terms, executive function [Russell 1997]), and stands out as an especial deficit only because it is so frequently applied during normal social interaction.

As for the autistic impairment in communication, although the relationship between communication and narrative may seem trivial there is some complexity to be explored because of the great variability in autistic communicative impairment. At one extreme is the person with high-functioning autism or Asperger syndrome, in whom the mechanics of vocabulary and syntax are intact (and often superior) but the pragmatic application of language is impaired [Bishop & Baird 2001], and at the other extreme is the person with low-functioning autism who may entirely lack the ability to speak. Pragmatic language, like social interaction, depends on rapidly updating mental models and translating those models into external speech. Although the vocabulary and syntax are scripted and static, the pragmatic application of these capacities can overwhelm a pathologically limited mechanism of narrative organisation, leaving the person with autism to fall back into a strategy of cobbling together rote phrases. Pragmatic language impairment in high-functioning autism thus can be explained straightforwardly as a consequence of disrupted narrative organisation. The low-functioning case of impaired speech production seems, on the face of it, a more difficult nut to crack. Speech articulation demands complex and rapid translation of sequences of words into sequences of movements of the vocal tract. Though long ignored in favour of autism's more socially debilitating, cognitive symptoms, motor impairment seems a general feature of autism and is perhaps its earliest behavioural sign in the developing infant [Teitelbaum et al. 1998]. The sequencing of movements shares structure with the sequencing of words and concepts, and thus motor function can be viewed computationally as a narrative activity.

In responding psychologically to the constraints of abnormal neurobiology, the developing autistic mind makes virtue of necessity. Social interactions are difficult, so the child replaces them with self-directed activities such as 'parallel play,' in which (s)he stands at the edge of a group and mimics its activities without engaging in its social give-and-take. Pragmatic communication is difficult, so the child replaces it with rote phrases and with self-directed discourses on topics that (s)he knows well. Unscripted phenomena are difficult, so the child replaces them with ritual. In general, the cognitive capacities that remain intact are developmentally redirected towards non-social (and therefore more easily scriptable) phenomena [Gerrans 1998], rather than being applied in a narratively coordinated and flexible manner. People with cases of high-functioning autism, Asperger syndrome, and the Broader Autism Phenotype which occurs in many autism families [Piven et al. 1997] are of particular interest in this regard because, although their impairment in the narrative organisation of experience requires them to work harder at defending against perceptual disorder, their intact language skills allow them in the end to succeed in rendering such defences explicit. This abnormally effortful, abnormally intense, and abnormally deliberate process of narrative organisation can produce abnormally deep insights, as exemplified in the developing genre of autistic memoir. The narrator who is more conscious of the effort of narration can, almost paradoxically, in the end achieve a deeper understanding of the characters and events around him or her precisely because (s)he is so impaired at automatic social perception and must concentrate harder to construct a theory of reality, to piece it together from perceptual fragments. (A case in point is the work of Sean Barron [1992], who writes retrospectively and introspectively about his mental life before he developed speech.) In this regard, people with autism can be described as "human, but more so"-- they are confronted by the same fundamental problem of organising perceptual experience into coherent stories that confronts all of us, but must overcome greater fragmentation of perceptual and cognitive experience in order to solve this problem.

This description of autistic cognition as "human, but more so" may seem contradictory to Grandin's [2005] view of autistic cognition as similar to animal cognition - in a way "human, but less so." The contradiction evaporates when one examines the specific comparisons on which these ideas are based: Grandin's view takes its impetus from the piecemeal and fragmented nature of autistic perception and cognition, an absence of narrative order which she argues is part of what distinguishes human cognition from animal cognition. It is precisely this narrative disruption that elicits an abnormally deliberate effort to construct reality. Thus although absence of narrative organisation may seem to make people with autism neurobiologically "human, but less so," the deliberate ordering strategies and the consciousness of representation that are evoked by this absence make people with autism neuropsychologically "human, but more so."

Support for this concept of autism as in some sense an exaggerated state of humanity comes from psychometric findings of autistic traits within the normal population. Autistic social traits are in fact continuously distributed within the normal population [Constantino et al. 2005], making the exact point of discrimination between normal and autism-spectrum behaviour somewhat arbitrary. (This is not to diminish the validity of autism spectrum conditions as a diagnostic category; it is, rather, only to state that the exact, quantitative boundary of the diagnosis is open to some interpretation.) Especially at the ages of 2 through 4 years, normal children often manifest repetitive behaviours, sensory preoccupations, and particular sensitivity to environmental change [Evans et al. 1997]. They are upset when their routines are disrupted or when their environments are rearranged - behaviours common in kind albeit not in degree to autism (and to other neuropsychiatric disorders with obsessive-compulsive features). The very fact that such sensitivities are overlooked as normal childish behaviour says a great deal about the psychological continuity between some aspects of normal child development and disordered development. Indeed, the developmental timing with which such behaviours resolve in normal children correlates strongly with the development of frontal white matter and the refinement of synaptic connectivity [Gogtay et al. 2004], neurobiological hardware essential to theory-of-mind [Giedd 2003] and to mature narrative organisation in general. Further support for this relationship between autism and normality arises from the observation that compulsive-like behaviours in normal children correlate positively with performance on measures of perceptual coherence such as the Embedded Figures Task [Evans et al. 2001], at which people with autism are superior, and negatively with measures of executive function [Evans et al. 2004], at which people with autism are impaired. Even in adults, the content of culturally normative rituals resembles that of childhood rituals, suggesting that all such behaviours may be manifestations, pathological or not, of a human disposition to perform socially meaningful rituals [Fiske & Haslam 1997] - a disposition which in autism is redirected away from social phenomena [Gerrans 1998].

Such comparisons between autistic and normal behaviour raise the possibility that a liability to autism may be inevitable in a species whose brain is complex enough to implement narrative organisation. In contexts in which attention to detail rather than to theme confers cognitive advantages, people with autism-spectrum conditions and people with the Broader Autism Phenotype tend to excel [Belmonte et al. 2004b], suggesting that pseudo-autistic qualities in moderate measure may be adaptive. It is hardly surprising, given autism's cognitive profile, that first-degree relatives of people with autism are over-represented in engineering occupations [Baron-Cohen et al. 1997] (and, conversely, the incidence of autism is heightened in family members of engineers, mathematicians, and physicists [Baron-Cohen et al. 1998]). The genetic influence on autism is multifactorial, arising not from any single gene but rather from interactions amongst a large number of genes [Veenstra-VanderWeele et al. 2004] whose point of convergence may consist in their effect on neural connectivity [Belmonte et al. 2004b]. This multifactorial convergence could not but produce within the population a continuous distribution of abnormal neural connectivity, and therefore a continuous distribution of narrative organisation. From a genetic perspective as well as from behavioural and neurophysiological perspectives, autism seems an extreme case of normality.

AUTISM AND SELF-CONSCIOUS NARRATIVE

If we accept, as argued above, that autism is an exaggeration of humanity, and if we accept that human thought is essentially a narrative activity [Turner 1996], then literature ought to contain reflections of autistic thinking. Indeed, the externalisation of thought into text is a particularly deliberate and self-conscious case of narrative, and therefore ought to have in common with autism an attention to ritual and an awareness of its role as a defence against disorder. This is, of course, all true. The examples are too many to enumerate, but it may suffice here to cite some representative cases. In the Judeo-Christian creation myth, the first action of Adam and Eve after eating from the Tree of Knowledge is to clothe themselves against the impermanence of flesh, a move that can be read as a metaphor for narrative defence against disorder. In the Anglo-Saxon poem 'The Battle of Maldon,' Englishmen are celebrated as dying in a necessary but ultimately futile defence against the Viking personification of disorder, fighting for not only for their physical lives but also, metaphorically, for their psychic lives (and ultimately for their culture and their very language). In Woolf's To the Lighthouse, artistic representation functions as a defence against the war, weather, and decay that rage just outside. In Pynchon's Gravity's Rainbow, arbitrary boundaries signified by race, geography, clothing, mathematics, and script or predestination seem all that stand between life and chaos. The same desperation for narrative order that drives autistic psychological development also drives the creation of literature.

In autism, when failures of neural connectivity impede narrative linkage, when each element of a scene or a story exists in isolation, the surrounding world can seem threateningly intractable. Autistic withdrawal into repetitive behaviours and scripted interactions can be read as an effort to gain control over such arbitrariness and unpredictability. In this regard, people with autism differ from other human beings only in the degree of concreteness with which this problem of control is approached: the tension between our mortal nature and our capacity to contemplate the eternal makes us desperate to impute narrative order and authorial intent in a universe where there may be only chaos and arbitrariness, and is what drives us as artists and scientists to construct themes within which our observations and experiences can be represented, and therefore realised. In this regard, people with autism can be described as "human, but more so" - for we all are driven by the same desperation to control or at least to predict what is going to happen to us, to keep chaos, entropy, and death at bay. The study of autism has much to tell us about theories of normal neural and psychological development, and about the nature of human cognition and literary representation.

BIBLIOGRAPHY
Badcock, Christopher. "Mentalism and Mechanism: The Twin Modes of Human Cognition." In: Human Nature and Social Values: Implications of Evolutionary Psychology for Public Policy (Charles Crawford & Catherine Salmon, eds.). Lawrence Erlbaum, 2003.

Baron-Cohen, Simon. "The Extreme Male Brain Theory of Autism." Trends in Cognitive Sciences 6 (2002): 248-254.

Baron-Cohen, Simon, Patrick Bolton, Sally Wheelwright, Victoria Scahill, Liz Short, Genevieve Mead, and Alex Smith. "Autism Occurs More Often in Families of Physicists, Engineers, and Mathematicians." Autism 2 (1998): 296-301.

Baron-Cohen, Simon, Alan M. Leslie, and Uta Frith. "Does the Autistic Child Have a 'Theory of Mind'?" Cognition 21 (1985): 37-46.

Baron-Cohen, Simon, and Sally Wheelwright. "Obsessions in Children with Autism or Asperger Syndrome: a Content Analysis in Terms of Core Domains of Cognition." British Journal of Psychiatry 175 (1999): 484-490.

Baron-Cohen, Simon, Sally Wheelwright, Carol Stott, Patrick Bolton, and Ian Goodyer. "Is There a Link between Engineering and Autism?" Autism 1 (1997): 153-163.

Barron, Judy, and Sean Barron. There's a Boy in Here. New York: Simon & Schuster, 1992.

Becker, Ernest. The Denial of Death. New York: Free Press, 1973.

Belmonte, Matthew K. "The Yellow Raincoat." In: Evocative Objects: Things We Think With (Sherry Turkle, ed.). Cambridge, Massachusetts: MIT Press, in press.

Belmonte, Matthew K., Greg Allen, Andrea Beckel-Mitchener, Lisa M. Boulanger, Ruth A. Carper, Sara Jane Webb. "Autism and Abnormal Development of Brain Connectivity." Journal of Neuroscience 24 (2004a): 9228-9231.

Belmonte, Matthew K., Edwin H. Cook Jr., George M. Anderson, John L.R. Rubenstein, William T. Greenough, Andrea Beckel-Mitchener, Eric Courchesne, Lisa M. Boulanger, Susan B. Powell, Pat R. Levitt, Elaine K. Perry, Yong-hui Jiang, Timothy M. DeLorey, Elaine Tierney. "Autism as a Disorder of Neural Information Processing: Directions for Research and Targets for Therapy." Molecular Psychiatry 9 (2004b): 646-663. Unabridged edition at http://www.cureautismnow.org/media/3915.pdf

Belmonte, Matthew K., and Simon Baron-Cohen. "Small-World Network Properties and the Emergence of Social Cognition: Evidence from Functional Studies of Autism." In: Proceedings of the 2004 International Conference on Development and Learning (Jochen Triesch and Toni Jebara, eds.). La Jolla: UCSD Institute for Neural Computation, 2004.

Belmonte, Matthew K., and Deborah A. Yurgelun-Todd. "Functional Anatomy of Impaired Selective Attention and Compensatory Processing in Autism." Cognitive Brain Research 17 (2003): 651-664.

Bettelheim, Bruno. The Empty Fortress: Infantile Autism and the Birth of the Self. New York: Free Press, 1967.

Bishop, Dorothy V., and Gillian Baird. "Parent and Teacher Report of Pragmatic Aspects of Communication: Use of the Children's Communication Checklist in a Clinical Setting." Developmental Medicine and Child Neurology 43 (2001): 809-818.

Constantino, John N., and Todd, Richard D. "Intergenerational Transmission of Subthreshold Autistic Traits in the General Population." Biological Psychiatry 57 (2005): 655-660.

Courchesne, Eric, and Karen Pierce. "Why the Frontal Cortex in Autism Might be Talking Only to Itself: Local Over-Connectivity but Long-Distance Disconnection." Current Opinion in Neurobiology 15 (2005): 225-230.

Evans, David W. "Rituals, Compulsions, and Other Syncretic Tools: Insights from Werner's Comparative Psychology." Journal of Adult Development 7 (2000): 49-61.

Evans, David W., Julie Marie Elliott, and Mark G. Packard. "Visual Organization and Perceptual Closure Are Related to Compulsive-Like Behavior in Typically Developing Children." Merrill-Palmer Quarterly 47 (2001): 323-335.

Evans, David W., F. Lee Gray, and James F. Leckman. "Rituals, Fears, and Phobias of Young Children: Insights from Development, Psychopathology, and Neurobiology." Child Psychiatry and Human Development 29 (1999): 261-276.

Evans, David W., James F. Leckman, Alice Carter, J. Steven Reznick, Desiree Henshaw, Robert A. King, and David Pauls. "Ritual, Habit, and Perfectionism: The Prevalence and Development of Compulsive-Like Behaviors in Normal Young Children." Child Development 68 (1997): 58-68.

Evans, David W., Marc D. Lewis, and Emily Iobst. "The Role of the Orbitofrontal Cortex in Normally Developing Compulsive-Like Behaviors and Obsessive-Compulsive Disorder." Brain and Cognition 55 (2004): 220-234.

Fiske, Alan Page, and Nick Haslam. "Is Obsessive-Compulsive Disorder a Pathology of the Human Disposition to Perform Socially Meaningful Rituals? Evidence of Similar Content." Journal of Nervous and Mental Disease 185 (1997): 211-222.

Frith, Uta. Autism: Explaining the Enigma. Oxford: Blackwell, 1989.

Philip Gerrans. "The Norms of Cognitive Development." Mind and Language 13 (1998): 56-75.

Giedd, Jay N. "The Anatomy of Mentalization: A View from Developmental Neuroimaging." Bulletin of the Menninger Clinic 67 (2003): 132-142.

Gogtay, Nitin, Jay N. Giedd, Leslie Lusk, Kiralee M. Hayashi, Deanna Greenstein, A. Catherine Vaituzis, Tom F. Nugent III, David H. Herman, Liv S. Clasen, Arthur W. Toga, Judith L. Rapoport, and Paul M. Thompson. "Dynamic Mapping of Human Cortical Development during Childhood through Early Adulthood." Proceedings of the National Academy of Sciences of the United States of America 101 (2004): 8174-8179.

Grandin, Temple. Animals in Translation: Using the Mysteries of Autism to Decode Animal Behavior. New York: Scribner, 2005.

Happé, Francesca. "Studying Weak Central Coherence at Low Levels: Children with Autism Do Not Succumb to Visual Illusions. A Research Note." Journal of Child Psychology and Psychiatry 37 (1996): 873-877.

Ozonoff, Sally, Bruce Pennington, and Sally J. Rogers. "Executive Function Deficits in High-Functioning Autistic Individuals: Relationship to Theory of Mind." Journal of Child Psychology and Psychiatry 32 (1991): 1081-1085.

Pennington, Bruce, Sally Rogers, L. Bennetto, E. Griffith, D. Reed, and V. Shyu. "Validity Test of the Executive Dysfunction Hypothesis of Autism." In: Autism as an Executive Disorder (James Russell, ed.). Oxford: Oxford University Press, 1997.

Piven, Joseph, Pat Palmer, Dinah Jacobi, Debra Childress, Stephan Arndt. "Broader Autism Phenotype: Evidence from a Family-History Study of Multiple-Incidence Autism Families." American Journal of Psychiatry 154 (1997): 185-190.

James Russell. "How Executive Disorders Can Bring about an Inadequate Theory of Mind." In: Autism as an Executive Disorder (James Russell, ed.). Oxford: Oxford University Press, 1997.

Szasz, Thomas. The Myth of Mental Illness. New York: Hoeber-Harper, 1961.

Teitelbaum, Philip, Osnat Teitelbaum, Jennifer Nye, Joshua Fryman, and Ralph G. Maurer. "Movement Analysis in Infancy May Be Useful for Early Diagnosis of Autism." Proceedings of the National Academy of Sciences of the United States of America 95 (1998): 13982-13987.

Tononi, Giulio, Olaf Sporns, Gerald M. Edelman. "Reentry and the Problem of Integrating Multiple Cortical Areas: Simulation of Dynamic Integration in the Visual System." Cerebral Cortex 2 (1992): 310-335.

Turner, Mark. The Literary Mind. New York: Oxford University Press, 1996.

Veenstra-VanderWeele, Jeremy, Susan L. Christian, and Edwin H. Cook Jr. "Autism as a Paradigmatic Complex Genetic Disorder." Annual Review of Genomics and Human Genetics 5 (2004): 379-405.

Werner, Heinz. The Comparative Psychology of Mental Development. Chicago: Follett, 1948.