Intelligence and Cognition in a Child with High Functioning Autism
Thomas M Kishore
Centre for Health Psychology, University of Hyderabad, Hyderabad, Andhra Pradesh, India
|Date of Web Publication||7-Mar-2013|
Thomas M Kishore
Centre for Health Psychology, University of Hyderabad, Hyderabad 500 046, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Intelligence is assessed for ruling out mental retardation and to find out the relative cognitive strengths in autism. Of special interest is to know the nature of intelligence and cognition in high functioning autism. But very little is known how the assessments are carried given the deficits in communication, socialization in autism. This cross-sectional study aims to describe the nature of intelligence and cognition in a child with HFA and drawing implications for assessment in the Indian setting. Results indicate that there is no evidence for superior crystallized intelligence in HFA, though a jagged profile could be expected both across and within cognitive domains.
Keywords: Assessment process, cognition, high functioning autism, intelligence
|How to cite this article:|
Kishore TM. Intelligence and Cognition in a Child with High Functioning Autism. Indian J Psychol Med 2012;34:385-7
A significant proportion of individuals with autism will have either comorbid mental retardation  or atypical cognitive processes.  Hence intelligence assessment is necessary to rule out both. But as in case of people with high functioning autism (HFA), defined operationally as those with an intelligence quotient (IQ) of 70 and above,  the same may help us understand the cognitive resources in light of autistic features. For this reason there is a considerable interest in the nature of both cognition and intelligence in HFA. There is a general view that people with HFA will have an intact or superior functioning in selective attention, rule-learning, visuospatial areas, motor learning, and perceptual motor integration. ,,, With regards to intelligence, verbal quotient was usually reported to be higher than the performance quotient  lending support to a conventional hypothesis that probably superior crystallized intelligence is a characteristic feature of HFA.  Nevertheless there are no studies from India to corroborate the above findings. In this context, the present case study aimed to describe the nature of intelligence and cognition in a child with HFA and drawing implications for assessment in the Indian setting.
SA, a 5-year and 7-month-old boy was brought by his parents with the complaints of delayed speech. Birth history was uneventful though there was significant delay in attaining meaningful speech, communicable phrases, and social skills. Medical and therapeutic assessments ruled out sensory-motor impairments and significant organic brain pathology. Behavioral observation revealed that he was neat and tidy; continuously curling up in chair, flapping, and vocalizing. He needed repeated prompts for both arousing and sustaining attention. He followed repetitive commands very mechanically. His eye contact was brief, deviant and at times, vacant. His affect ranged from normal state to an inappropriately cheerful state. Rapport could not be developed. He demonstrated little pragmatic social skills or any age-appropriate gestures. Based on this presentation, an International Classification of Diseases, Version 10 diagnosis of autism was made. Further rating on Childhood Autism Rating Scale  by psychiatrist indicated that the child had severe autism. Asperger's disorder was ruled out by applying Gilliam Asperger's Disorder Scale.  Special educator's report indicated that he could simplify ratios and identify degree of given area or angles in circle and triangle, respectively in written form. He could even solve some randomly selected arithmetic of grade VI and VII. But he could not apply these skills in a social context or for functional purposes. Similar performance was not reported or identified in other subjects.
Developmental Screening Test (DST)  and Vineland Social Maturity Scale (VSMS)  were administered first to reduce the test anxiety and also to gain insight about applicability of intelligence scales based on the developmental profile. On DST his developmental age was 2 year and 10 months and the developmental quotient was 52; and on VSMS his social age was 3 years and the social quotient of 55 [Figure 1].
|Figure 1: Vineland social maturity scale profile. SHG - Self-help general; SHE - Self-help eating; SHD - Self-help dressing; SD - Self-direction; OCC - Occupation; COM - Communication; LOC - Locomotion; SOC - Socialization|
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Intelligence assessment was carried in a quiet room in a single day, with adequate breaks suiting the child's attention, motivation. Gessell's Drawing Test  was used as a screening measure of intelligence. Since he did not copy beyond the first design (i.e., circle) the test was suspended and his mental age was estimated to be around 3 years. Binet-Kamat Test of Intelligence (BKT)  yielded a basal age of 6 years, ceiling age of 19 years, and a mental age of 10 year and 6 months, though he passed items up to 16 years. The corresponding IQ was 188. He did not have any problem in attention to specific tasks nor in immediate recall and short-term memory. He failed on several visuospatial tasks whereas a better performance was noted for non-meaningful memory, conceptual thinking, social intelligence, and numerical reasoning. Further, the profile analysis of BKT based on the description of Lezak  indicated that the performance across various cognitive domains was very uneven albeit with relatively equal performance on verbal items (60%) and non-verbal items (57%) [Figure 2].
|Figure 2: Binet– Kamat test of intelligence profile. The graph is not continuous as the child did not pass any item in non-verbal reasoning domain, where the items start at 12 years|
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Nevertheless, certain adaptations were required for administering BKT. For example, items requiring verbal responses were tested through written form to understand the level and quality of his conceptual thinking. For example, he could not say a sentence with three key words, a skill expected by 9 years age, but expressed the same in writing. The only qualitative difference was that the letters were as large as two inch and were poorly aligned. However, responses were noted but not credited when they had to be in specific form. For example, no credit was given when the child failed to repeat sentences as part of testing.
Studying intelligence and cognition in persons with HFA may offer insights about cognitive resources in the backdrop of autism. Contrary to previous studies,  HFA may not always be characterized by superior crystallized intelligence. Rather there could be an uneven performance across subtests of IQ measures, which is already acknowledged.  Additionally, this study indicates that there could be intra-domain unevenness, as noted particularly in the areas of attention, short-term memory, and visuospatial skills. That is, a superior skill can be noted in these areas despite a failure on considerably lower tasks. However, further validation is required to understand whether it is a limitation of the test or a characteristic feature of HFA, though the response pattern indicates a possibility of the latter.
A superior performance on tasks tapping selective attention together with complexity-dependent memory deficits but not modality-dependent memory deficits; and modality specific language deficits and poor social cognition only adds to the view that cognitive deficits in autism are not primarily due to attention deficits.  Despite a very high level of intelligence, failure on items related to repeating complex sentences, recalling stories, and adaptive behavior was also found in previous studies. ,
This study also has specific implications for assessment, that is, global intelligence scales could be applied even when the screening measures and behavioral observation indicate inferior skill repertoire. Further, lack of appropriate communication skills does not rule out the ability to express concepts in writing. Therefore, clinicians may uncover the conceptual levels in HFA by allowing them to express by writing. This kind of adaptation is necessary keeping in view that age and IQ-appropriate writing skills may distinguish autism from other developmental disorders. 
In conclusion, intact or superior crystallized intelligence is not necessarily found in all cases of HFA. Uneven performance may be found not only across cognitive domains but also within a cognitive domain. Global intelligence scales could be applied to understand this pattern even when behavioral observations and screening measures indicate a poor response pattern. Future studies may compare the profiles of intelligence, cognition, and language in children with HFA with that of the typically developing children, and children with specific speech and language impairments to understand cognitive markers of autism.
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[Figure 1], [Figure 2]
1. Eigsti IM, Shapiro T. A systems neuroscience approach to autism: Biological, cognitive, and clinical perspectives. Ment Retard Dev Disabil Res Rev. 2003;9:205–15.[PubMed]
2. Dawson M, Soulières I, Gernsbacher MA, Mottron L. The level and nature of autistic intelligence. Psychol Sci. 2007;18:657–62.[PMC free article][PubMed]
3. Goldstein G, Allen DN, Minshew NJ, Williams DL, Volkmar F, Klin A, et al. The structure of intelligence in children and adults with high functioning autism. Neuropsychology. 2008;22:301–12.[PMC free article][PubMed]
4. Bölte S, Poustka F. Comparing the intelligence profiles of savant and nonsavant individuals with autistic disorder. Intelligence. 2004;32:121–31.
5. Minshew NJ, Goldstein G. Autism as a disorder of complex information processing. Ment Retard Dev Disabil Res Rev. 1998;4:129–36.
6. Smalley SL, Asarnow RF. Cognitive subclinical markers in autism. J Autism Dev Disord. 1990;20:271–8.[PubMed]
7. Boucher J. The Autistic Spectrum: characteristics, Causes and Practical Issues. Los Angeles: Sage; 2009. Spectrum Model of Autism: Concept and Definitions; pp. 22–41.
8. Lincoln AJ, Courchesne E, Kilman BA, Elmasian R, Allen M. A study of intellectual abilities in high-functioning people with autism. J Autism Dev Disord. 1988;18:505–24.[PubMed]
9. Schopler E, Reichler RJ, Renner BR. Los Angeles: Western Psychological Services; 2002. The Childhood Autism Rating Scale (CARS)
10. Gilliam JE. Austin, TX: PRO-ED; 2001. Gilliam Asperger Disorder Scale.
11. Bharatraj J. Mysore: Swayam Sidha Prakashanam; 1977. Developmental Screening Test.
12. Bharatraj J. Mysore: Swayamsiddha Prakashanam; 1992. Vineland Social Maturity Scale-Indian Adaptation: Enlarged Version.
13. Verma SK, Pershad D, Kaushal P. Gessell Drawing Test as a measure of intelligence in the mentally retarded children. Indian J Med Res. 1972;5:64–8.
14. Kamat VV. 4th ed. London: Oxford University Press; 1967. Measuring Intelligence of Indian Children.
15. Lezak MD. Oxford: Oxford University Press; 1983. Neuropsychological Assessment.
16. Green L, Fein D, Joy S, Waterhouse L. Cognitive functioning in autism: An overview. In: Schopler E, Mesibov GB, editors. Learning and Cognition in Autism. New York: Plenum Press; 1995. pp. 13–31.
17. Boucher J. Memory for recent events in autistic children. J Autism Dev Disord. 1981;11:293–301.[PubMed]
18. Williams DL, Goldstein G, Minshew NJ. The profile of memory function in children with autism. Neuropsychology. 2006;20:21–9.[PMC free article][PubMed]