Patricia Howlin

Bio: Patricia Howlin is an academic researcher from King's College London. The author has contributed to research in topics: Autism & Autism spectrum disorder. The author has an hindex of 66, co-authored 237 publications receiving 18551 citations. Previous affiliations of Patricia Howlin include St. George's University & St Thomas' Hospital.

Adult outcome for children with autism

Abstract: Background: Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 50, but there have been few systematic studies of individuals with an IQ above this. Method: Sixty-eight individuals meeting criteria for autism and with a performance IQ of 50 or above in childhood were followed up as adults. Their mean age when first seen was 7 years (range 3–15 years); at follow-up the average age was 29 years (range 21–48 years). Outcome measures included standardised cognitive, language and attainment tests. Information on social, communication and behavioural problems was obtained from the Autism Diagnostic Interview (ADI). Results: Although a minority of adults had achieved relatively high levels of independence, most remained very dependent on their families or other support services. Few lived alone, had close friends, or permanent employment. Communication generally was impaired, and reading and spelling abilities were poor. Stereotyped behaviours or interests frequently persisted into adulthood. Ten individuals had developed epilepsy. Overall, only 12% were rated as having a ‘Very Good’ outcome; 10% were rated as ‘Good’ and 19% as ‘Fair’. The majority was rated as having a ‘Poor’ (46%) or ‘Very Poor’ (12%) outcome. Individuals with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below this. However, within the normal IQ range outcome was very variable and, on an individual level, neither verbal nor performance IQ proved to be consistent prognostic indicators. Conclusions: Although outcome for adults with autism has improved over recent years, many remain highly dependent on others for support. This study provides some information on prognostic indicators, but more fine-grained research is needed into the childhood variables that are associated with good or poor outcome.

The functional neuroanatomy of social behaviour: changes in cerebral blood flow when people with autistic disorder process facial expressions.

Abstract: Although high-functioning individuals with autistic disorder (i.e. autism and Asperger syndrome) are of normal intelligence, they have life-long abnormalities in social communication and emotional behaviour. However, the biological basis of social difficulties in autism is poorly understood. Facial expressions help shape behaviour, and we investigated if high-functioning people with autistic disorder show neurobiological differences from controls when processing emotional facial expressions. We used functional MRI to investigate brain activity in nine adults with autistic disorder (mean age +/- standard deviation 37 +/- 7 years; IQ 102 +/- 15) and nine controls (27 +/- 7 years; IQ 116 +/- 10) when explicitly (consciously) and implicitly (unconsciously) processing emotional facial expressions. Subjects with autistic disorder differed significantly from controls in the activity of cerebellar, mesolimbic and temporal lobe cortical regions of the brain when processing facial expressions. Notably, they did not activate a cortical 'face area' when explicitly appraising expressions, or the left amygdala region and left cerebellum when implicitly processing emotional facial expressions. High-functioning people with autistic disorder have biological differences from controls when consciously and unconsciously processing facial emotions, and these differences are most likely to be neurodevelopmental in origin. This may account for some of the abnormalities in social behaviour associated with autism.

Outcome in high-functioning adults with autism with and without early language delays: implications for the differentiation between autism and Asperger syndrome

Abstract: The question of whether Asperger syndrome and high-functioning autism should be considered as the same or different conditions has been a source of debate and controversy over recent years. In the present study, 34 adults with autism who had shown early delays in language were compared with 42 individuals who were reported to have had no such delays, either in their use of words or phrases. All participants were at least 18 years of age, had a nonverbal IQ of 70 or above and met ADI-R criteria for age of onset, communication and social impairments, and stereotyped behaviors. Those in the language delay group were diagnosed as having high-functioning autism. The remainder were designated as having Asperger syndrome. The groups were matched for age, nonverbal IQ and gender. No significant differences were found between the groups either in their total ADI-R algorithm scores, or in their algorithm scores on individual domains. Social outcome ratings and ADI-R scores based on current functioning also failed to differentiate between the groups. Scores on tests of language comprehension and expression were also similar, but in both groups language abilities were well below chronological age level. The implications of these results with respect to the differences between Asperger syndrome and high-functioning autism are discussed. The poor performance on language tests also challenges the assumption that early language development in Asperger syndrome is essentially normal.

Autism and Developmental Receptive Language Disorder—a Follow‐up Comparison in Early Adult Life. II: Social, Behavioural, and Psychiatric Outcomes

Abstract: This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7-8 years. At that time, although matched for nonverbal IQ (mean 92-93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence. As in the follow-up of cognitive and linguistic functioning (see Mawhood et al., 2000, this volume, pp. 547-559), discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, there was little association between any measures of childhood functioning and prognosis in the Language group. Theoretically, these findings have implications for our understanding of the nature of autism and other pervasive language disorders, and of the relationship between them. Practically, they demonstrate the very persistent problems experienced by individuals with developmental language disorders, and their need for much greater help and support than is presently available.

Empathy: Its ultimate and proximate bases.

Abstract: There is disagreement in the literature about the exact nature of the phenomenon of empathy. There are emotional, cogni- tive, and conditioning views, applying in varying degrees across species. An adequate description of the ultimate and proximate mecha- nism can integrate these views. Proximately, the perception of an object's state activates the subject's corresponding representations, which in turn activate somatic and autonomic responses. This mechanism supports basic behaviors (e.g., alarm, social facilitation, vicar- iousness of emotions, mother-infant responsiveness, and the modeling of competitors and predators) that are crucial for the reproduc- tive success of animals living in groups. The Perception-Action Model (PAM), together with an understanding of how representations change with experience, can explain the major empirical effects in the literature (similarity, familiarity, past experience, explicit teach- ing, and salience). It can also predict a variety of empathy disorders. The interaction between the PAM and prefrontal functioning can also explain different levels of empathy across species and age groups. This view can advance our evolutionary understanding of empa- thy beyond inclusive fitness and reciprocal altruism and can explain different levels of empathy across individuals, species, stages of de- velopment, and situations.

Relational Frame Theory: A Post-Skinnerian Account Of Human Language And Cognition

Abstract: Part I: The Basic Account. 1. Language and Cognition: Constructing an Alternative Approach Within the Behavioral Tradition S.C. Hayes, et al. 2. Derived Relational Responding as Learned Behavior S.C. Hayes, et al. 3. Multiple Stimulus Relations and the Transformation of Stimulus Functions D. Barnes-Holmes, et al. 4. Relations Among Relations: Analogies, Metaphors, and Stories I. Stewart, et al. 5. Thinking, Problem-Solving, and Pragmatic Verbal Analysis S.C. Hayes, et al. 6. Understanding and Verbal Regulation D. Barnes-Holmes, et al. 7. Self and Self-Directed Rules D. Barnes-Holmes, et al. 8. Relational Frame Theory: A Precis S.C. Hayes, et al. Part II: Extensions and Applications. 9. Psychological Development Y. Barnes-Holmes, et al. 10. Education Y. Barnes-Holmes, et al. 11. Social Processes B. Roche, et al. 12. Psychopathology and Psychotherapy K.G. Wilson, et al. 13. Religion, Spirituality, and Transcendence D. Barnes-Holmes, et al. Epilogue. References. Index.

The phonological loop as a language learning device.

Abstract: A relatively simple model of the phonological loop (A. D. Baddeley, 1986), a component of working memory, has proved capable of accommodating a great deal of experimental evidence from normal adult participants, children, and neuropsychological patients. Until recently, however, the role of this subsystem in everyday cognitive activities was unclear. In this article the authors review studies of word learning by normal adults and children, neuropsychological patients, and special developmental populations, which provide evidence that the phonological loop plays a crucial role in learning the novel phonological forms of new words. The authors propose that the primary purpose for which the phonological loop evolved is to store unfamiliar sound patterns while more permanent memory records are being constructed. Its use in retaining sequences of familiar words is, it is argued,