DSM5 focusses more on nonverbal communication in autism spectrum disorder diagnosis, but does not specify what it is about nonverbal communication that is affected. In this presentation, I explain the reflexive nature of nonverbal communication, and why I call this the 'interbrain'. I also provide another explanation for dysempathy in ASD: the inability to recall empathic feelings

1. What are the "Persistent deficits in social communication
and social interaction" that constitutes the first required
criterion for a DSM-5 diagnosis of Autism Spectrum
Disorder?
Digby Tantam,
Universities of
Sheffield and
Cambridge, UK;
Septimus Ltd.

2. • Assume a difference of reflective and reflexive
nonverbal communication (NVC)
• Argue that reflexive NVC is not messaging, but
interlinking—’the interbrain’
• The interbrain has low bandwidth in ASD
• Empathy impairment is a mix of reduced
interbrain connection and narrative about
intentions (‘theory of mind’)
• A different kind of dysempathy results from a
lack of empathy recall
• The solitary brain has its advantages

3. Reflective
NVC
Reflexive NVC

4. The relationship of social communication disorder and ASD
Social communication Autism spectrum disorder
disorder
A. Persistent difficulties in pragmatics or A. Persistent deficits in social
the social uses of verbal and nonverbal communication and social interaction
communication in naturalistic contexts, across contexts, not accounted for by
which affects the development of social general developmental delays, and
reciprocity and social relationships that manifest by all 3 of the following:
cannot be explained by low abilities in 1. Deficits in social-emotional
the domains of word structure and reciprocity
grammar or general cognitive ability. 2. Deficits in nonverbal
communicative behaviors
B. Persistent difficulties in the acquisition and used for social interaction
use of spoken language, written language, and
other modalities of language (e.g., sign language) 3. Deficits in developing and
for narrative, expository and conversational maintaining relationships,
discourse. Symptoms may affect comprehension,
production, and awareness at a discourse level
appropriate to developmental
individually or in any combination that are likely to level (beyond those with
endure into adolescence and adulthood, although caregivers)
the symptoms, domains, and modalities involved
may shift with age.

5. Autism spectrum disorder, DSM5 criteria
A. Persistent deficits in social B. Restricted, repetitive patterns of
communication and social interaction behavior, interests, or activities as
across contexts, not accounted for manifested by at least two of the
by general developmental delays, and following:
manifest by all 3 of the following:
1. Deficits in social-emotional 1. Stereotypies
reciprocity
2. Routines and rituals
2. Deficits in nonverbal
communicative behaviors used 3. Special interests
for social interaction 4. Hyper-or hypo-reactivity to
3. Deficits in developing and sensory input or unusual
maintaining relationships,
interest in sensory aspects
appropriate to developmental
level (beyond those with of environment
caregivers)

6. Autism spectrum disorder, DSM5 criteria
A. Persistent deficits in social
communication and social interaction
across contexts, not accounted for
by general developmental delays, and
manifest by all 3 of the following:
1. Deficits in social-emotional Ranging from:
reciprocity poorly integrated- verbal and
2. Deficits in nonverbal nonverbal communication,
communicative behaviors used through abnormalities in eye
for social interaction contact and body-language, or
deficits in understanding and use
3. Deficits in developing and of nonverbal communication,
maintaining relationships, to total lack of facial expression
appropriate to developmental or gestures.
level (beyond those with
caregivers)

7. • What would it mean to have: “Deficits in
nonverbal communicative behaviors used for
social interaction”

8. Tantam,
Cordess,
Holmes
No difference in
between ASD
and
neurotypicals in
total other
directed gaze,
but difference in
timing.

9. Tantam, D. Characterizing the fundamental social handicap in
autism. Acta Paedopsychiatrica, 55, 83-91, 1991
• Gaze reflex 1
• Focus on eyes (but means suppression of
agonistic response)
• Gaze reflex 2
• Follow other’s gaze to its destination
• (Gaze reflex 3
• Follow back to the face of the person looking)

11. Animals that gain
information from
conspecifics gaze
direction

12. Brain regions showing positive change in coupling with the right pSTS (red to yellow) and FG
(blue to turquoise) while viewing gaze shifts versus opening/closing the eyes.
Nummenmaa L et al. Cereb. Cortex 2010;20:1780-1787
© The Authors 2009. Published by Oxford University Press.

13. Shannon Neeley, E., Bigler, E. D., Krasny, L., Ozonoff, S., McMahon, W.,
& Lainhart, J. E. (2007). Quantitative temporal lobe differences: Autism
distinguished from controls using classification and regression tree
analysis. Brain and development, 29(7), 389-399.

14. Atttention direction

16. Fig.
Castelli F et al. Brain 2002;125:1839-1849
©2002 by Oxford University Press

17. Perlman, S. B., Hudac, C. M., Pegors, T., Minshew, N. J., & Pelphrey, K. A. (2011). Experimental
manipulation of face-evoked activity in the fusiform gyrus of individuals with autism. Soc
Neurosci, 6(1), 22-30.

18. Tantam, D. Characterizing the fundamental social handicap in
autism. Acta Paedopsychiatrica, 55, 83-91, 1991: what I didn’t say
• Gaze reflex 1
• Focus on eyes (but means suppression
of agonistic response) Happens in ASD,
but does not
• Gaze reflex 2 linger, and does
• Follow other’s gaze to its destination not seem to
develop e.g. to
• Gaze reflex 3 determine who is
friendly to whom
• Follow direction of other’s gaze back to
their eyes to detect their expression

19. Gaze following and
the interbrain

20. The language of the eyes
Who is being
shot?
Terrorists or
partisans?

22. Schurmann M, Hesse MD, Stephan KE, Saarela M, Zilles K, Hari R, et al.
Yearning to yawn: the neural basis of contagious yawning. Neuroimage. [doi:
DOI: 10.1016/j.neuroimage.2004.10.022]. 2005;24(4):1260-4.

24. The Wright brothers
Synchrony
Armies, churches, organizations, and communities often engage in activities for
example, marching, singing, and dancing that lead group members to act in
synchrony with each other.….Across three experiments,
people acting in synchrony with others cooperated more in subsequent group
economic exercises, even in situations requiring personal sacrifice. Our results also
showed that positive emotions need not be generated for synchrony to foster
cooperation. In total, the results suggest that acting in synchrony with others can
increase cooperation by strengthening social attachment among group members
Wiltermuth and Heath, 2009, Psychological Science

25. Fan, Y.-T., Decety, J,Yang, C-, Liu, J-L, 1 Cheng, Y. (2010). Unbroken mirror
neurons in autism spectrum disorders. Journal of Child Psychology and Psychiatry
, doi:10.1111/j.1469-7610.2010.02269.x.

26. Rapid mirroring responses to black and white
photos of emotional facial expressions (Beall et al,
2008)
Neurotypical EMG Children (7-12) with ASD

27. Cheng, Y.,
Chou, K. H.,
Fan, Y. T., &
Lin, C. P.
(2011). ANS:
Aberrant
Neurodevelopm
ent of the Social
Cognition
Network in
Adolescents
with Autism
Spectrum
Disorders. PLoS
ONE, 6(4).
Decety suggests
inferior parietal
lobule confers
‘Agency’

28. What would having no NVC be like?
An analogic not digital problem

29. A lack of connectedness, or
intersubjectivity
• Of shared attention (via the gaze reflexes)
• Of shared emotion (via contagion)

30. Schippers, M. B., Roebroeck, A.,
Renken, R., Nanetti, L., & Keysers, C.
(2010). Mapping the information flow
from one brain to another during
gestural communication. Proceedings
of the National Academy of Sciences,
-

31. How do we know who has high social status?
pride

32. Ciccarelli, O., Catani, M., Johansen-Berg, H., Clark, C., & Thompson, A. (2008).
Diffusion-based tractography in neurological disorders: concepts, applications, and
future developments. [doi: DOI: 10.1016/S1474-4422(08)70163-7]. The Lancet
Neurology, 7(8), 715-727.
Sahyoun, C. P., Belliveau, J. W.,
& Mody, M. (2010). White matter
integrity and pictorial reasoning in
high-functioning children with
autism. Brain And Cognition,
73(3), 180-188.

33. Alter Ego

35. The interbrain
¡ Extended cognition
¡ Automatic processing
Jerry Ryan, 7 of 9 StarTrek
¡ Reflexive vs. reflective
processing
¡ ‘The borg’
Neurotypical
Aspie
Brookdale care

36. • Neurons are linked by electrical impulses and
chemicals into a network
• Our brains can be linked to other brains the
way that one computer can be linked to
another via the internet
• These links are the nonverbal communications
that pass between us, principally consisting of
imitation and of gaze following
• Imitation and gaze following are automatically
initiated by local brain networks apparently
specialized for this

37. From Hegelian aesthetics to empathy
Seeing feeling What’s the
in nature and difference?
therefore
The eyes
humanity,
‘empathizing’ The
movement

38. An idea
whose
time has
come?

39. Three kinds of empathy
• Affective (the brain’s empathy)
• Cognitive (the mind’s empathy)
• ??

40. The orbitofrontal cortex as cache? fNIRS evidence
Brink, T. T., Urton, K., Held, D., Kirilina, E., Hofmann, M. J., Klann-Delius, G., et al. (2011). The role of
orbitofrontal cortex in processing empathy stories in 4- to 8-year-old children. Front Psychol, 2, 80.
Negative
affective
empathy
Positive
affective
empathy
Logical
cognitive
empathy
Non-
logical
cognitive
empathy

41. Two kinds of empathy: fNIRS evidence
Brink, T. T., Urton, K., Held, D., Kirilina, E., Hofmann, M. J., Klann-Delius, G., et al. (2011). The role of
orbitofrontal cortex in processing empathy stories in 4- to 8-year-old children. Front Psychol, 2, 80.
Similar picture for auditory stimuli

42. All tool users that
understand words
and signs
and have a
theory of mind

43. Narrative impairment
• Narrative
•

44. Chiu, P. H., Kayali, M. A., Kishida, K. T., Tomlin, D., Klinger, L. G., Klinger, M. R., et
al. (2008). Self responses along cingulate cortex reveal quantitative neural
phenotype for high-functioning autism. Neuron, 57(3), 463-473.

46. Narrative
Contagious emotion
(STS/ DLPFC)
Emotional
dispositions/
cingulate
Agency Fight/ care-
(temporoparietal taking ?
junction) amygdala

47. What if one is alone? Are people with ASD and
neurotypicals the same then?

48. Palinkas, LA, Suedfeld, P
Psychological effects of polar
expeditions. Lancet 2008; 371:
153-63.

49. Atypical Asperger syndrome: a new clinical syndrome and linked
to impaired social interaction?
• Primary abnormality is lack of empathy
• May be conspicuous lack of a theory of
mind
• Lack of internal narrative
• Ability to make relationships but not to
keep them
• May be behavioural problems
(‘pathological demand avoidance’)
• Lack of persuasiveness and ‘social
influencing power’
• Strong overlap with ADHD and executive
dysfunction
• And other associations of ADHD,
including disorders of speech processing
and of working memory

50. Three kinds of empathy
• Affective (the brain’s empathy)
• Cognitive (the mind’s empathy)
• Empathy recall

51. Empathy disorders
• Psychopathy in which there may be:
• An impairment of response to threat expressions
• A turning off of normal empathic responsiveness
• Typical autism spectrum disorder (ASD)
• An impairment in the response to all nonverbal
expression, with a consequent reduction in emotional
responsiveness and accuracy
• (secondarily) lack of fellow feeling for others
• Atypical ASD
• An inability to anticipate other’s emotional response
• Impaired response to other’s emotions

52. Location and overlap of brain lesions according to emotional versus cognitive empathy
impairment-groups.
Right Left
Shamay-Tsoory S G et al. Brain 2009;132:617-627
© The Author (2008). Published by Oxford University Press on behalf of the Guarantors of Brain.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

54. Narrative impairment affects Sally-
Ann capacity and autobiography
equally.
Involves language and rhetoric i.e.
emotion
• Narrative
•

55. Social communication disorder: where PDD-NOS is to be found?
A. Persistent difficulties in pragmatics or the social uses of verbal and nonverbal
communication in naturalistic contexts, which affects the development of social
reciprocity and social relationships that cannot be explained by low abilities in the
domains of word structure and grammar or general cognitive ability.
B. Persistent difficulties in the acquisition and use of spoken
language, written language, and other modalities of language
(e.g., sign language) for narrative, expository and
conversational discourse. Symptoms may affect
comprehension, production, and awareness at a discourse
level individually or in any combination that are likely to endure
into adolescence and adulthood, although the symptoms,
domains, and modalities involved may shift with age.

56. • Other people’s accounts (ToM) in DL PFC
• Other people’s looks in OFC=cache
• Experience of dead partner or spouse or God
seeing what one does

59. Who is Jake? Look him up in the
brain index: the cache of all the
information about experiences with
Jake

60. The role of the orbitofrontal cortex
• Accesses narrative
• Rhinencephalic ‘emotional flavour’ and
intuitive judgements via insula?
• The memory of that Look in neurotypicals
• Absent in atypical AS?

61. The Look, or what determines how highly I
am regarded
“…let us imagine that moved
by jealousy, curiosity, or vice I
have just glued my ear to the
door and looked through the
keyhole….But all of a sudden I
hear footsteps in the hall.
Someone is looking at me… I
shudder as a wave of shame
sweeps over me”
(Sartre, Being and
Nothingness pp260-277).

62. Nodes on networks considered:
• Superior temporal sulcus
• Inferior parietal lobule
• Dorsolateral PFC
• Orbitofrontal cortex
• Insula
• Cingulate: anterior (difficult to distinguish from
orbitofrontal PFC) and possibly posterior
• Not cerebellum

63. Further information
Due out 2011

64. Further information

66. "How the mighty have fallen! The weapons
of war have perished!"

67. Schadenfreude: envy and gloating not recognized by
people with an ASD
Shamay-Tsoory, S. G. (2007). Recognition of 'Fortune of
Others' Emotions in Asperger Syndrome and High
Functioning Autism. J Autism Dev Disord.

68. A keen sense of justice

69. Owen Thor Walker
Home schooled from aged 13 because
of bullying, provided code to cyber
crime syndicate that took £10.3M from
private bank accounts (he got £15,500
in payment for botnet code).
New Zealand judge did not impose a
custodial sentence because of the
effect on his career, but fined him
£5000.
Subsequently hired by TelstraClear, a
telecomms company, to act as security
consultant

70. Many people accept that ‘systemizing’ is of value, and
that people with an ASD are good at it. Perhaps they
are more than usually successful:
• Computer programmers
• Mathematicians (perhaps Newton was one)
• Physicists (perhaps Einstein)
• Engineers
• Philosophers (perhaps Wittgenstein is an
example)

71. Is Asperger syndrome the future for communication, too?
Bram Cohen,
founder BitTorrent,
and self diagnosed
Professor Aspie
Temple Grandin
Derek Paravicini