Autism as a disorder of prediction

• Published in: Proceedings of the National Academy of Sciences - PNAS 2014-10, Vol.111 (42), p.15220-15225
• Main Authors: Sinha, Pawan, Kjelgaard, Margaret M., Gandhi, Tapan K., Tsourides, Kleovoulos, Cardinaux, Annie L., Pantazis, Dimitrios, Diamond, Sidney P., Held, Richard M.
• Format: Article
• Language: English
• Subjects: Autism; Autistic disorder; Autistic Disorder - diagnosis; Autistic Disorder - genetics; Basal Ganglia - metabolism; Behavioral neuroscience; Biological Sciences; Causality; Cerebellum - metabolism; Child psychiatry; Children; Cognition; Corpus Striatum - metabolism; Correlation analysis; Genotype & phenotype; Habituation; Humans; Humor; Infant; Language; Markov Chains; Models, Theoretical; Neuronal Plasticity; Pervasive child development disorders; Phenotype; Phenotypes; Phenotypic traits; Probability; Social Behavior; Time Factors; Unpredictability
• ISSN: 0027-8424; 1091-6490
• DOI: 10.1073/pnas.1416797111

A rich collection of empirical findings accumulated over the past three decades attests to the diversity of traits that constitute the autism phenotypes. It is unclear whether subsets of these traits share any underlying causality. This lack of a cohesive conceptualization of the disorder has complicated the search for broadly effective therapies, diagnostic markers, and neural/genetic correlates. In this paper, we describe how theoretical considerations and a review of empirical data lead to the hypothesis that some salient aspects of the autism phenotype may be manifestations of an underlying impairment in predictive abilities. With compromised prediction skills, an individual with autism inhabits a seemingly “magical” world wherein events occur unexpectedly and without cause. Immersion in such a capricious environment can prove overwhelming and compromise one’s ability to effectively interact with it. If validated, this hypothesis has the potential of providing unifying insights into multiple aspects of autism, with attendant benefits for improving diagnosis and therapy. Significance Autism is characterized by diverse behavioral traits. Guided by theoretical considerations and empirical data, this paper develops the hypothesis that many of autism's salient traits may be manifestations of an underlying impairment in predictive abilities. This impairment renders an otherwise orderly world to be experienced as a capriciously “magical” one. The hypothesis elucidates the information-processing roots of autism and, thereby, can aid the identification of neural structures likely to be differentially affected. Behavioral and neural measures of prediction might serve as early assays of predictive abilities in infants, and serve as useful tools in intervention design and in monitoring their effectiveness. The hypothesis also points to avenues for further research to determine molecular and circuit-level causal underpinnings of predictive impairments.