Psychological factors in autism spectrum disorder

Social cognition in ASD is fundamentally compromised. In infancy, social engagement, attention and motivation are reduced and deficits in responding and initiating joint attention predict language and social development. Difficulties in emotion expression and processing occur frequently but not universally. Frequency of spontaneous imitation and accuracy of elicited imitation are reduced. Social understanding, from mentalizing to social reasoning, is often compromised. These social symptoms do not preclude the establishment of secure child-caregiver attachment. Intellectual disability (ID) occurs in a third of individuals with ASD and disproportionally among girls. Performance IQ is relatively better than verbal IQ and cognitive profiles are heterogeneously uneven. Across IQ and core symptomatology, impairments in adaptive functioning are pervasive. Difficulties with attention and executive functioning contribute to difficulties in core symptoms. Anomalies in orienting and executive attention are well documented; alerting attention is intact at school-age and compromised in adulthood. Impairments in the three core components of executive functions, working memory, shifting and inhibition, are not causal to ASD but are predictive of core and associated symptomatology. Non-declarative memory, particularly for non-social stimuli, is largely intact in absence of ID. Performance in declarative memory appears to be moderated by cognitive ability.