Jaswal & Akhtar (J&A) make a convincing case that while individuals with autism may appear to lack social motivation, this may not be an accurate reflection of their wish to connect with others and be close to them. An additional, important body of research that supports the target article comes from studies of attachment in autism. These studies have convincingly shown that although children with autism have difficulties communicating and interacting with others, their attachment system – the system whose main goal is to seek others, particularly in times of distress – is by and large intact.
Attachment studies indicate that children with autism seek closeness to their caregivers when distressed, are soothed by the caregivers’ presence, and use their caregivers as a secure base for exploration (for a review, see Rutgers et al. Reference Rutgers, Bakermans-Kranenburg, van IJzendoorn and Van Berckelaer-Onnes2004). In other words, they form attachments similarly to typically developing children. Moreover, about one-half form secure (rather than insecure) attachments (Rutgers et al. Reference Rutgers, Bakermans-Kranenburg, van IJzendoorn and Van Berckelaer-Onnes2004), a figure lower than that of typically developing children, but not different from those of other clinical groups (Feniger-Schaal et al. Reference Feniger-Schaal, Oppenheim, Koren-Karie, Yirmiya and Burak2011).
The security of a child's attachment to the caregiver is assessed using Ainsworth's Strange Situation Procedure (SSP; Ainsworth et al. Reference Ainsworth, Blehar, Waters and Wall1978), an observational procedure that includes two separations and reunions between the child and the caregiver and is designed to assess how the child uses the caregiver as a secure base for exploring an unfamiliar environment and as a haven of safety when distressed. Securely attached children explore in the caregiver's presence, show search behaviors and varying levels of distress following the separation, seek contact with the caregiver upon reunion and find the contact comforting, and resume exploration. Secure children with autism show the same underlying balance between attachment and exploration, although its behavioral manifestation is shaped by the child's autism. We illustrate this next with an example of a 3.5-year-old non-verbal boy with autism spectrum disorder (ASD; the child's diagnosis was confirmed with gold standard assessments of ASD; for details, see Koren-Karie et al. Reference Koren-Karie, Oppenheim, Dolev and Yirmiya2009).
In the pre-separation episodes of the SSP, Dan was calm and deeply immersed in his play with cars and crayons. He did not look at his mother or otherwise interact or establish contact with her, and he seemed relaxed and content. However, immediately upon his mother's leaving of the room, Dan showed obvious distress. He cried loudly, looked at the closed door, and went decisively to the door and tried to open it. The experimenter who stayed with him (the “stranger”) talked to him soothingly and tried to comfort him and offer him toys, but he did not look at her and did not cease his search. His weeping grew louder, and the separation episode was shortened (standard SSP procedure with all children).
In typically developing children, such profound distress upon separation is usually followed by active proximity and contact seeking combined with establishing eye contact with the mother. These behaviors are thought to indicate the activation of the child's attachment behavioral system, and once contact has been reestablished, children typically calm down and resume exploration. Dan showed the same underlying organization, but expressed differently. When his mother entered the room, he stopped crying immediately and stood very close to her while turning his back to her and holding her hand. Dan's mother bent over and gave him a kiss, to which he responded by moving his head slightly away. He then began walking toward the area in the room where he was previously playing, “pulling” his mother behind him while holding her hand. He did not look at her, vocalize, or ask to be held, and in fact was turning his back to her throughout, but he did keep her physically close to him. Upon reaching the area in the room where he previously played, he resumed his solitary play, calm and content, and his mother returned to her chair. Dan returned to his “baseline” behavior: content, completely immersed in his play, and appearing oblivious to the “outside world.” This was what he looked like prior to the separation and the distress described above, but it is obvious from his strong reaction to his mother's leaving that he just appeared oblivious. Also, careful observation showed that during his solitary play, he glanced once very briefly at his mother, as if confirming her whereabouts. Thus, while Dan did not show most of the interactive behaviors that we typically see in the SSP, the underlying secure organization of his attachment to his mother was evident: calm exploration prior to the separation; stopping exploration and elevated attachment behaviors upon separation; active search of the absent mother; failure of the stranger's attempts to comfort him, indicating the specificity of his attachment to his mother; immediate soothing upon the mother's return; finding proximity to the mother comforting; and resuming exploration and returning to a calm state. In line with the target article's point, this patterning of the child's behavior indicates the need and interest of this autistic child (and many like him) in his specific attachment relationship with his mother and the effectiveness of this relationship as a secure base.
Group-level statistics support this conclusion: Several studies have shown that secure attachment is related to maternal sensitivity in children with ASD, just as it is with typically developing children (e.g., Koren-Karie et al. Reference Koren-Karie, Oppenheim, Dolev and Yirmiya2009). In other words, the secure organization of the child's behavior in the SSP is associated with a history of having a sensitive caregiver who sees and feels things from the child's point of view (Oppenheim et al. Reference Oppenheim, Koren-Karie, Dolev and Yirmiya2009), reads the child's emotional signals correctly, and responds to them appropriately, even when the child, due to his or her autism, seeks very little eye contact, does not communicate effectively verbally or non-verbally, and shows stereotypies and repetitive behaviors. Therefore, studies of attachment in autism also support the reframing of the difficulties of children with ASD as indicating not a lack social interest but primarily as difficulties expressing this interest in typical and conventional ways.
Jaswal & Akhtar (J&A) make a convincing case that while individuals with autism may appear to lack social motivation, this may not be an accurate reflection of their wish to connect with others and be close to them. An additional, important body of research that supports the target article comes from studies of attachment in autism. These studies have convincingly shown that although children with autism have difficulties communicating and interacting with others, their attachment system – the system whose main goal is to seek others, particularly in times of distress – is by and large intact.
Attachment studies indicate that children with autism seek closeness to their caregivers when distressed, are soothed by the caregivers’ presence, and use their caregivers as a secure base for exploration (for a review, see Rutgers et al. Reference Rutgers, Bakermans-Kranenburg, van IJzendoorn and Van Berckelaer-Onnes2004). In other words, they form attachments similarly to typically developing children. Moreover, about one-half form secure (rather than insecure) attachments (Rutgers et al. Reference Rutgers, Bakermans-Kranenburg, van IJzendoorn and Van Berckelaer-Onnes2004), a figure lower than that of typically developing children, but not different from those of other clinical groups (Feniger-Schaal et al. Reference Feniger-Schaal, Oppenheim, Koren-Karie, Yirmiya and Burak2011).
The security of a child's attachment to the caregiver is assessed using Ainsworth's Strange Situation Procedure (SSP; Ainsworth et al. Reference Ainsworth, Blehar, Waters and Wall1978), an observational procedure that includes two separations and reunions between the child and the caregiver and is designed to assess how the child uses the caregiver as a secure base for exploring an unfamiliar environment and as a haven of safety when distressed. Securely attached children explore in the caregiver's presence, show search behaviors and varying levels of distress following the separation, seek contact with the caregiver upon reunion and find the contact comforting, and resume exploration. Secure children with autism show the same underlying balance between attachment and exploration, although its behavioral manifestation is shaped by the child's autism. We illustrate this next with an example of a 3.5-year-old non-verbal boy with autism spectrum disorder (ASD; the child's diagnosis was confirmed with gold standard assessments of ASD; for details, see Koren-Karie et al. Reference Koren-Karie, Oppenheim, Dolev and Yirmiya2009).
In the pre-separation episodes of the SSP, Dan was calm and deeply immersed in his play with cars and crayons. He did not look at his mother or otherwise interact or establish contact with her, and he seemed relaxed and content. However, immediately upon his mother's leaving of the room, Dan showed obvious distress. He cried loudly, looked at the closed door, and went decisively to the door and tried to open it. The experimenter who stayed with him (the “stranger”) talked to him soothingly and tried to comfort him and offer him toys, but he did not look at her and did not cease his search. His weeping grew louder, and the separation episode was shortened (standard SSP procedure with all children).
In typically developing children, such profound distress upon separation is usually followed by active proximity and contact seeking combined with establishing eye contact with the mother. These behaviors are thought to indicate the activation of the child's attachment behavioral system, and once contact has been reestablished, children typically calm down and resume exploration. Dan showed the same underlying organization, but expressed differently. When his mother entered the room, he stopped crying immediately and stood very close to her while turning his back to her and holding her hand. Dan's mother bent over and gave him a kiss, to which he responded by moving his head slightly away. He then began walking toward the area in the room where he was previously playing, “pulling” his mother behind him while holding her hand. He did not look at her, vocalize, or ask to be held, and in fact was turning his back to her throughout, but he did keep her physically close to him. Upon reaching the area in the room where he previously played, he resumed his solitary play, calm and content, and his mother returned to her chair. Dan returned to his “baseline” behavior: content, completely immersed in his play, and appearing oblivious to the “outside world.” This was what he looked like prior to the separation and the distress described above, but it is obvious from his strong reaction to his mother's leaving that he just appeared oblivious. Also, careful observation showed that during his solitary play, he glanced once very briefly at his mother, as if confirming her whereabouts. Thus, while Dan did not show most of the interactive behaviors that we typically see in the SSP, the underlying secure organization of his attachment to his mother was evident: calm exploration prior to the separation; stopping exploration and elevated attachment behaviors upon separation; active search of the absent mother; failure of the stranger's attempts to comfort him, indicating the specificity of his attachment to his mother; immediate soothing upon the mother's return; finding proximity to the mother comforting; and resuming exploration and returning to a calm state. In line with the target article's point, this patterning of the child's behavior indicates the need and interest of this autistic child (and many like him) in his specific attachment relationship with his mother and the effectiveness of this relationship as a secure base.
Group-level statistics support this conclusion: Several studies have shown that secure attachment is related to maternal sensitivity in children with ASD, just as it is with typically developing children (e.g., Koren-Karie et al. Reference Koren-Karie, Oppenheim, Dolev and Yirmiya2009). In other words, the secure organization of the child's behavior in the SSP is associated with a history of having a sensitive caregiver who sees and feels things from the child's point of view (Oppenheim et al. Reference Oppenheim, Koren-Karie, Dolev and Yirmiya2009), reads the child's emotional signals correctly, and responds to them appropriately, even when the child, due to his or her autism, seeks very little eye contact, does not communicate effectively verbally or non-verbally, and shows stereotypies and repetitive behaviors. Therefore, studies of attachment in autism also support the reframing of the difficulties of children with ASD as indicating not a lack social interest but primarily as difficulties expressing this interest in typical and conventional ways.