Wednesday, October 13, 2010

Who's That in the Mirror? Autism and the Developing Sense of Self

EXECUTIVE SUMMARY: A small, exploratory British study of preschoolers with either autism or Down syndrome and typically developing toddlers looked at how each group of children acted toward their reflections in a mirror. They looked for trends, both group trends (i.e., how do autistic children differ from their non-autistic developmental peers, represented in different ways by the Down syndrome group and the younger typically developing group, whose chronological age matched the developmental ages found for both developmentally-disabled groups), and within-group trends relating mirror behavior to performance on a test of mirror self-recognition (i.e., do they know that the person in the mirror is their own reflection).

They found that although the autistic children did not differ from the younger, typically developing children in the amount of time spent looking at their own faces, but that they did spend a lot more time looking at objects in the mirror, and that their behavior toward their reflections differed from that of either control group. The autistic children did not generally try to relate socially to the person in the mirror; what they did instead varied according to whether they recognized their own mirror images or not.

(The Evil Queen from "Snow White and the Seven Dwarfs" with her Magic Mirror)

BPS Research Digest spotlighted this study published in last month's issue of Autism, which claims to describe another type of subtle behavioral difference between autistic, otherwise developmentally disabled, and typically developing children.

Autistic children, they hypothesized, would act differently toward their own images in mirrors than either typically developing toddlers or developmentally delayed --- but not autistic --- children (in this case having Down syndrome) of similar ages to the autistic children. They would look in the mirror, and would experiment with it (i.e., doing things to see those things reflected back to them, using the mirror to look at things behind them, etc.), but would not try to engage the person in the mirror socially; would not talk to it, smile at it, or try to show it things.

(Reading this, I was kind of surprised to see that it was normal to treat the mirror image as if it were a real person! It doesn't act like one, and you'd think that if you recognized it as yourself, you'd know you couldn't actually talk to it or interact with it, because it would just do the same things you did. Of course, the children in this study were very young --- the typically-developing ones were about eighteen months old, and the Down syndrome and autistic kids three or four years old.)

Methodologically, the study's not that interesting: the researchers went into the homes of each of their subjects (38 in total: 12 with autism, 13 with Down syndrome, and 13 typically developing toddlers), produced a mirror, filmed the children interacting with it freely for two minutes, and then tested to see if the children recognized themselves in the mirror by having their parents put a sticker on their faces to see if they removed the sticker after seeing it reflected in the mirror. If they removed it, they were said to have passed the "Mirror Self-Recognition" (MSR) test*.

Later, the researchers watched the videos they'd made of the children interacting with the mirror, looking for group differences (between autistic, Down syndrome, and typically developing children, but also between passers and failers of the MSR) in such things as level of interest in one's own face (i.e., how long does the child look at hir own face, rather than at other things reflected in the mirror), kind of actions directed at one's reflection (i.e., does the child greet hir reflection, talk to it, perform in front of it, or show things to it), and affective response to one's reflection (does the child appear pleased to see hirself, do they appear self-conscious, coy or embarrassed, do they smile at themselves).

Compared with the other groups, the autistic children spent a lot more time looking at objects in the mirror. However, contrary to what you might expect given the common wisdom about autistic people avoiding eye contact/looking at faces, though, they did not differ much from the typically-developing ones in how long they spent looking at their own faces. (The children with Down syndrome spent the most time looking at their own faces).

Figure 1, in Reddy et al. (2010). The panel on the left shows the amount of time (expressed as a percentage) that the different groups of children (autism, Down syndrome and typically developing toddlers, each subdivided into passers and failers of the mirror self-recognition test) spent looking at their own faces. The panel on the right shows the amount of time they spent looking at other objects in the mirror. In both graphs, the placement of the bars (i.e., are they higher or lower) is what tells you how much time a given group spent doing a given thing. The size of the bars (i.e., are they long or short) tells you how much variation there is within that group.

The autistic children also differed from the other two groups in what kinds of things they did in front of the mirror; autistic children, whether they recognized themselves in the mirror or not, spent a lot less time trying to relate to their reflections socially. What they did instead varied with whether or not they understood that they were looking at themselves: autistic children who passed the MSR test spent most of their time experimenting with the mirror, tilting it to see things around the room, doing things with toys or with their faces while watching to see those actions reflected back to them, while autistic children who failed to recognize their own reflections spent more time simply watching the person in the mirror.
Children with Down syndrome also spent more time watching their reflections if they failed the MSR test; the typically developing children spent about the same amount of time watching themselves whether or not they seemed to know they were watching themselves. They also spent more time watching themselves, relative to other actions, than either of the atypical groups. The study authors hypothesize that "[a] watchful focus on the self could be due to imminent self-recognition (suggested by the finding of a short-term alignment between watching and self-recognition in typical development, Nielsen et al., 2003)."

The typically developing children also did not show any relationship between MSR and social-relating behavior toward the mirror: whether they recognized themselves or not, they were just as likely to act as if their reflection were a social partner or an audience, as opposed to just a reflection (which is how the autistic children tended to treat their reflections, if indeed they recognized them as such). The children with Down syndrome tended to do *more* social relating with the reflection if they passed the MSR test, which seems counterintuitive to me. You'd think someone would be more likely to try to establish a rapport with something they believed to be another person, rather than with what they knew was only an image of themselves. (Oh, well --- like I said before, I'm no developmental psychologist!)

So, what do this study's authors (the University of Portsmouth's Prof. Vasudevi Reddy and Cristina Costantini, the University of Surrey's Dr. Emma Williams, and Britta Lang) think their results mean?

Their study was published in a special issue of Autism pertaining to how a sense of "selfhood" develops in autism, and indeed they do manage to tie these findings to an alleged autistic impairment** in developing this sense:

Difficulties in interpersonal relatedness in autism appear to extend to difficulties in relatedness with the self, supporting arguments about a reciprocal relation between a sense of self and a sense of other (Hobson, 1990; Mclaren, 2008). In typical development the affordance of the face is almost unavoidably social, with direct gaze attraction attention from birth (Farroni et al., 2002) and acting as an ostensive signal (Senju & Csibra, 2008). In autism, perhaps particularly in mirrors where there is no one else to initiate engagement and no other social behaviour to highlight interpersonal cues, this affordance may be even less potent in inviting interaction. Engaging with the self can also provide opportunities for learning about expressions and interaction. Given the enjoyment that typically developing children and children with some other developmental disorders derive from such engagement, the loss of this opportunity in autism might potentially contribute to further impairments in the development of a sense of self.

This passage, along with a passage I will also excerpt from the Introduction ---

In developmental psychology the mirror has become synonymous with the identification of the self ... . But mirrors can also symbolise and allow a relation with the Other. They can reflect the self back as the Self, as an Other, as seen by an Other (Kernberg, 2006) or, indeed, as just another reflection. How one reacts to the self in a mirror allows us to study the extent to which the self is perceived and presented as a social being.

--- argues that there is a social dimension to the sense of self, which seems to start developing pretty early.

It also echoes the feedback-loop theory I've read about in connection to another early-childhood marker of autism that's been studied recently: eye gaze. Autistic infants have been found not to prefer looking at human faces, which, the theory goes, leaves them without motivation to pay special attention to them, while their typically developing peers, who do derive pleasure from looking at faces, learn to specialize in reading faces. Reddy and her colleagues' suspicion that the mirror does not "invit[e] interaction" for autistic children in the same way it does for their typically developing and Down syndrome peers extends this notion to the broader realm of reciprocal social behavior in general.

I have one more thing I'd like to bring up in connection with this study, and with mirror self-recognition tests in general: this earlier post on BPS Digest describing cross-cultural studies of mirror self-recognition tests. Apparently, children from different cultures perform differently on the mirror self-recognition tests (which involve placing a spot on the child's face and waiting for hir to remove it when ze sees it on hir reflection), with children in some cultures failing to remove the spot even at ages much older than the second year of life, which is when children in the U.S. (and similar cultures) start passing the test. This is not because these children don't understand that they are looking at themselves, but because their cultures have different standards for how children are supposed to behave in adult company. The children may not know if they're *supposed* to remove the spot, so they might choose to do nothing rather than act rudely and be punished for it.

I bring this up, even though I'm not sure it has any direct bearing on the results of this mirror self-recognition study, because I think it is important to remember that autistic children's social behavior, in this (U.S., white, middle-class) culture and others like it, is policed much more aggressively than typically developing children's behavior is. Autistic children learn quickly that their natural ways of speaking, acting and relating to people are wrong, so they might well adopt a more passive social posture until they've seen enough to know what's expected of them.

Again, I don't think that's necessarily at work in this particular study (the children are so young, I doubt they've yet gotten much negative feedback about how they act), but I want to mention it because I don't know that many autism researchers consider the effect of culture and socialization on autistic children, much less ways autistic children are socialized differently than non-autistic ones. Instead, the common wisdom seems to be that we are immune to culture and socialization.

*An explanation of this test, and what it supposedly says about sense of self, can be found here at Noah Gray's blog, Nothing's Shocking, hosted by Basically, if the subject (human or animal) knows to remove the sticker (or wipe off the spot of paint, or whatever) based on having seen it in the mirror, we can reasonably infer that they know the mirror is showing them an image of themselves, not another person or animal.

**I think it's funny, if only from an etymological standpoint, that AUTistic people are now thought to have an impaired sense of self.

Reddy, V., Williams, E., Costantini, C., & Lan, B. (2010). Engaging with the self: Mirror behaviour in autism, Down syndrome and typical development Autism, 14 (5), 531-546 DOI: 10.1177/1362361310370397


Leah Jane said...

I actually remember looking in the mirror as being one of my favourite activities from age 5-9. It wasn't because I was self absorbed or any particular reason related to social issues. I was just interested in figuring out how the mirror worked. I spent hours looking over it with my father's magnifying glass, and actually looked behind the mirror gently, to check. It wasn't until I was older and in my first physical science class that I figured it out.
Makes me wonder what those researchers would have had to say about me, going after my reflection with a screwdriver.

Anonymous said...

I can see another problem with the sticker: some kids might think it's fun to have stickers on their faces, and thus might not be inclinced to remove them. Or they may just not care about it at all: "Oh, there's a sticker on my face. Meh." It wouldn't necessarily mean that there was no self-recognition.

Amanda Forest Vivian said...

maybe the kids with Down Syndrome haven't seen a lot of faces that look like theirs, and they were excited. :)

seriously, thanks for posting about studies though because I suck at understanding them myself.

Lindsay said...

@Leah Jane - hah, that's awesome. And it looks to me like that's the main idea the autistic kids in this study had, too: messing with the mirror to see how it works. You could call that a sign of an impaired sense of social relatedness with the self, as the researchers did, or you could call it a sign of a robust, healthy curiosity about the physical environment! (That latter is what I'd call it, but hey, I'm biased).

I was also a big mirror-starer in childhood and adolescence: for me, it wasn't so much curiosity about the mirror as it was a way to stare at things without my staring being noticed or commented on. I have always stared, always needed a lot of time to take in the wealth of visual details that I notice. But I was also always being told not to stare at people's faces, because it was rude. That's actually where my eye-contact avoidance comes from; originally, I stared, and because I cannot modulate my staring I avoid directing my gaze at people's faces at all. But the mirror --- there is where you can find the one human face that won't mind being stared at.

@Amanda - good point about the Down syndrome children. They did measure "positive affect toward the self" in this study, and while the Down syndrome kids didn't differ from the typical ones in this parameter, both groups did seem very pleased to see themselves (both spent about 80-85% of their mirror time looking happy).

Cereus-Sphinx said...

Also, re: the "looking at their own faces". It reminds me of Rachel Cohen-Rottenberg's post on horses and "soft eyes".

I've always been able to look my boyfriend (also AS) in the eyes, although it's not that exciting to do all the time. They're like calm pools, as opposed to some people's who are moving all the time. So my own eyes aren't a big deal to look at either, they're also "soft".

Also on a tangent, how much I rely on smell to tell how people are feeling and feel warm towards people, makes me wonder how animals that communicate mostly through smell could have a mirror self-recognition test.

Casdok said...

My son only in the last few months has started looking at the person in the mirror. So very interesting to read about this.

Ole Ferme l'Oeil said...

Thank you for this post, I don't know if I can translate it in french one day ?
It show well how easily this kind of research can be problematic concerning the conclusion.
Definitely agree with you (and even while these children are so young I think you may have a point, if they are already on therapy and so on (with all this pression on "early interventions" it is very possible that it play a role)
@Leah Jane:
Yeah, sound familiar, mirrors are very fascinitating objects.
@Anonymous: This was exactly what I would have pointed out if you haden't before me, I'm not sure I would have removed it...
It is very troubling to see the assumptions these adults have of the atitude that a child should have in this situation... and that they keep this assumption at this point while they are workink with neuro-atypical children!
I would probably have asked myself why someone putted it there and what I was supposed to do.

Lindsay said...

@Ole Ferme l'Oeil - yes, feel free to translate this into French and repost it elsewhere.

Anonymous said...

Hi , I have ASD & have been trying to find info about my inability to use mirrors in relation to a driving license. I just wondered if anyone had thought that instead of staring at themselves in the mirror , these children, like me were trying to work out what was going on in the mirror.The things in it are things I recognise but they aren't the right way round & don't move in the same way. it sounds daft but it really is that simple, eg in a car mirror, the actual image of a car coming up behind you travelling in the same directionas you, moves from the bottom to the top of the mirror,but a car going away from you also moves from the bottom to the top of the mirror , so how do you know which is which?except that one is the back of a car 7 one is the front, but most cars look much the same to me back or front , then the trees etc go from right to left as you leave them behind & run from bottom to top really fast on the one where the cars are going past you , so work that one out because I can't, no wonder we are fascinated by & stare into mirrors lol they're like a slightly different version of everything that's familiar.

Lindsay said...

Hi, Anon!

I don't think what you're describing sounds daft at all. I have all sorts of trouble figuring out where things are in space, too --- in particular, I've never been able to tell left from right.

Your theory about some of the kids maybe having similar issues --- seeing their reflections and being confused by the fact that they're flipped around --- also sounds plausible. Thank you for bringing that up!

(Also, good luck with your driving exams, if you're still pursuing that --- I can't really offer advice there, since I've determined that I just can't think fast enough, or multitask well enough, to be a safe driver.)

Anonymous said...

Both my young son (AS) and I (AS) have challenges with mirrors. My own is definitely related to visual/spatial, proprioception type stuff - triggers balance problems etc. Mirrors will trigger major distraction for my son as I've noted in several of his classes (karate, yoga etc..) One of my guesses is that mirrors actually create DOUBLE "visual clutter" in a room. If I had options I would definitely choose workout rooms without any mirrors - or drape them for students with neurological differences.

Anonymous said...

The studies don't even seem scientific.

Remove the sticker from your face and it proves you know it's yourself? What if you think it's a copycat? What would the researchers have done if during the study a kid took off the sticker and started viewing his reflection and then said "Quit copying me!"? Would've ruined their entire study by undermining their central assumptions.

Equating sense of self or self-awareness with the mirror test also seems very flawed. I am not my image. I am not how I look. I am what I know, what I learn, and what I do and experience. My image can form parts within these things but I don't consider it central to who I am. I see it as more of a prop or a tool. I have a feeling that even many neurotypicals even if they had the typical response as children would say similarly about themselves that they don't consider their personal identities to be all about how they look. People who only care about how they look and spend hours in front of the mirror tend to be some of the most plastic, fake people. I question their self-awareness.

Lindsay said...

Hi, Anonymous.

That's a good point about self-awareness --- most of it is not visual --- but I think the children in this study were so young that "does the child recognize him/herself in a mirror?" is a good question to ask. I think they are talking about a much simpler concept of selfhood --- do you know that that's you in the mirror, and not another kid? --- than yours, which is more about knowing what kind of person you are and what's important to you. Not that kids that young aren't starting to form values, just that they're also still figuring the very basic stuff out, especially if they're developmentally disabled.

Lindsay said...

And for the earlier Anonymous, whom I never acknowledged before --- yes, I think draping the mirrors would be a good thing. Your "visual clutter" hypothesis is definitely in accord with what I've experienced, as an autistic person who exercises and also has proprioception problems. I don't know that I've ever been helped by being able to see myself in a mirror as I've tried to master a new series of movements: the visual information is 1) reversed, which I've mentioned above confuses me, and 2) not really "actionable", if that makes any sense. What I can feel my body doing doesn't always map obviously onto what I can see in the mirror, and sometimes trying to see it takes up so much of my concentration that I lose focus on whatever I was trying to do in the first place.

Anonymous said...

"Autistic children learn quickly that their natural ways of speaking, acting and relating to people are wrong, so they might well adopt a more passive social posture until they've seen enough to know what's expected of them."

Anyone else wondering about the non-autistic children of autistic parents and/or so-called "Tiger Parents"?

Back when came out, I remember a blogger on Autisable (the website's now down) talking about how what Amy Chua demanded of Chua's daughters is so close to what comes naturally to the blogger's daughter.

With parents like Chua was (and like my own parents were to a lesser degree - I could relate to so much of even though my parents are still NT)... feels like it's the non-autistic children who learn quickly that our natural ways of speaking, acting and relating to people are wrong in our homes, so we might well adopt a more passive social posture until we've seen enough to know what's expected of us from the adults who have the most control of our lives...

Anonymous said...

As a child I spend a lots of time looking at my image in front of a mirror and repeting. That is not me, and asking Who are you.