Monotropism

An autistic child performing a stimming movement.

Monotropism is a cognitive strategy posited to be the central underlying feature of autism. A monotropic mind is one that focuses its attention on a small number of interests at any time, tending to miss things outside of this attention tunnel. The theory of monotropism was developed by Dr Dinah Murray, Wenn Lawson and Mike Lesser starting in the 1990s, and published about in the journal Autism in 2005^[1]. Wenn Lawson's further work on the theory formed the basis of his PhD, Single Attention and Associated Cognition in Autism, and book The Passionate Mind.

A tendency to focus attention tightly has a number of psychological implications. While monotropism tends to cause people to miss things outside their attention tunnel, within it their focused attention can lend itself to intense experiences, deep thinking and flow states. However, this hyperfocus makes it harder to redirect attention, including starting and stopping tasks, leading to what is often described as executive dysfunction in autism, and stereotypies or perseveration where a person's attention is repeatedly pulled back to the same thing.

Neurobiology

Individuals with monotropism have problems sustaining performance because of attention regulation dysfunction, meaning that something is wrong with their behavioral control system, meaning the parts of the brain that control behavior and attention.^[2] Children with monotropism generally perform poorly at tasks involving executive function, attention, processing speed, and motor coordination. It has been found that children with autism have significantly lower reading scores than normal children and both children with autism and children with attention deficit hyperactivity disorder (ADHD) perform poorly in attention tasks as compared to a non-disabled child. Children with autism and ADHD also performed significantly worse in tasks pertaining to reading, attention, graphomotor skills, and processing speed. Neuropsychological functioning is similar in children with high-functioning autism and ADHD.^[3]

A defining characteristic of individuals with monotropism is that they have problems involving shifting, keeping, and engaging attention. Multiple studies have suggested that cerebellar abnormalities could correlate with these trends, and that in these individuals the cerebellum must work harder than normal to achieve tasks. The prefrontal areas have been known to have greater excitation in the brains of these children as well.^[4] The amount of attention available is limited, so cognitive processes are forced to compete. Tasks that require a broad attention span include social interaction, language, and shifting attention, therefore monotropic individuals have problems with all of these. They struggle with top down processing and do not react well to unanticipated change.^[5] Sometimes the individuals deregulation of thought turns into a psychotic disorder.^[2]

The fusiform gyrus is known to be activated by human faces and has been found to be hypoactive in autistic children, however this is not the only disorder in which this is the case. Eye gaze is also known to activate the superior temporal gyrus, which is less active in monotropic children with autism. These children often cannot imitate or comprehend gestures. However, some have hyperactive olfactory pathways and are able to identify people by their smell. Dysfunctional neural circuits are characteristic of autism ^[3] Some regions under investigation to be a potential source of autism include the frontal lobes, temporal lobes, insula, limbic system, corpus callosum, thalamus, brainstem, and cerebellum,^[4] and therefore these areas could be related to monotropism.

Signs and symptoms

Monotropic individuals have trouble processing multiple things at once, particularly when it comes to multitasking while listening. Some have trouble taking notes in class while listening to a teacher,^[8] while others are so extreme that they cannot look at a person's face and comprehend what they are saying simultaneously.^[1] A common tendency is for individuals to avoid multiple sensory situations because of this hypersensitivity.^[8] Some common signs of a monotropic individual include:

• Inability to infer and imply things from situations
• Short attention spans
• Difficulty multitasking
• Inappropriate reactions to situations
• Repetitive behaviors such as stereotypies or stimming
• Obsession with parts of objects
• No peer relationships
• Social problems
• Inability to share emotions, empathy
• Delayed or no speech
• Resistance to change
• Inability to step into someone else’s shoes ^[1]

In order for a child to be diagnosed with an ASD, he or she must exhibit a restricted and repetitive behavior (RRB). These behaviors arise due to the inability of the monotropic individual to shift attention and cause obsession with an object or ritual. A common symptom of ASD’s is a motor impairment, but that is not classified as a criterion for diagnosis.^[9] Lesser and Murray describe the mind of a monotropic individual to work much like that of a hunter, in which the person fully believes what is currently being seen, and suppresses knowledge learned previously. This mind is capable of suppressing pain and focusing attention on something else. It has the ability to develop great depth in an interest or skill rather than gaining breadth in an array of interests.^[10]

Behavioral experiments

In a study by Crane, Pring, Ryder, and Hermelin, savants were tested along with typical individuals with ASDs in the Wisconsin Card Sorting Test, which is designed to test design fluency and set-shifting. This test showed that savants have better fluency and monitoring than typical individuals with ASDs, but performed at similar levels on tasks unrelated to the individual's specific ability.^[11]

It has been found that there is decreased cerebellar activity in autistic children in areas regarding shifting peripheral attention, performing attention tasks, and tests quantifying the amount and time children explore new environments. Regarding attention related events, parietal lobe activity and frontal lobe activity have been seen to decrease as well.^[4]

A study in which autistic adults were tested via Positron Emission Tomography (PET) while performing language tasks showed that activity in the left frontal area and dentate nucleus was lower in the control group during the listening tasks, but was higher during the motor task of repeating language. Sturm, Fermell, and Gilberg conducted a study that tested children with ASDs, mostly Asperger’s, that had a normal to high Intelligence Quotient (IQ). They found that 99% of them had severe social interaction dysfunction, 75% had motor problems, and 94% had restricted interests.^[12]

Ravizza, Solomon, Ivry, and Carter tested the relationship between attention and motor impairments via a finger tapping task. They found that attention was not directly related to motor deficits and that there was also not a correlation of motor deficits and restricted interests. However, there was a direct correlation between motor deficits and stereotyped behaviors.^[9]

Treatment

Treatment for monotropic individuals currently is similar to treatment for autistic individuals. Mary Coleman in the book The Neurology of Autism, states "individualized, in-depth clinical and laboratory assessments and integrative parent-physician-scientist cooperation are the keys to a successful ASD management".^[4] Some typical management strategies include educational comprehensive programs, Applied Behavioral Analysis (ABA), speech and language therapy, Occupational Therapy, Sensory Integration Therapy, and psychopharmacology.^[13] To assist monotropic individuals in shifting their attention as well as understanding the emotions of others, Lawson, Lesser, and Murray propose that certain steps could be helpful. These include:

• Increasing connections with strangers through the child's interests.
• Improve understanding in lacking areas
• Make tasks more attainable by decreasing the number and complexity of them.
• Make tasks and connections more meaningful.^[1]

Certain drugs have also proven to be effective to treat specific behaviors characteristic of monotropic individuals. When children with monotropism have quickly changing moods, self injure themselves, and are aggressive, the anti psychotic risperidone is often prescribed. Serotonin has been shown to decrease repetitive behaviors and neuroleptic drugs can be prescribed for antidepressant and stimulant needs.

References