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1. Self-awareness, inner speech and autism
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Section one: Background-Autism, metacognition and inner speech
Introduction
My interest in inner speech stems from the fact that we spend a large amount of our
conscious lives talking to ourselves, i.e. we verbally mediate frequently. Since we
often engage in inner speech, I am interested in potential dysfunctions in our capacity
to use inner dialogue, and what the consequences of such dysfunctions are. With this
in mind, one specific aim of my exposition is to investigate whether inner speech is
impaired in autism. However, I want to dedicate part of my analysis to cross-cultural
issues in autism, since I believe such issues have been neglected in previous autism
research studies. I will cover various related topics along the way, ranging from (but
not limited to) issues of specific self-awareness deficits in autism, conflicting
evidence from experimental psychology on inner speech dysfunction in autism, and
possible parallel socio-cognitive deficits between autism and schizophrenia.
Importantly, I will discuss autism from a multi-disciplinary perspective, as this will
give the reader a broader appreciation of the complexity (and difficulties) associated
with the investigation of autism, inner speech and self-awareness.
Vygotsky, inner speech and social cognitive development
Central to Vygotsky’s (1934/1987) theory of socio-cognitive development is the
crucial role [s] of language and inner speech. From Vygotsky’s perspective, language
mediates interaction with the intellectual and social environment, which, in turn,
promotes the development of additional skills required for self-thought (Whitehouse,
Murray & Durkin, 2006). Hence, Vygotsky (1934/1987) argued that inner speech
represents a stage in the gradual internalization of interpersonal linguistic exchanges
whose final ontogenetic destination is verbal thought, or inner speech (Fernyhough &
Fradley, 2005). More specifically, Vygotsky’s socio-cultural approach postulates that
inner speech represents an internalized form of inner dialogue with others, and this
serves to guide/regulate one’s ongoing behaviour, thus permitting a multitude of
alternative perspectives to be adopted in a given social situation (Williams, Happé &
Jarrold, 2008). In relation to autistic disorder, relatively weak verbal skills, coupled
with the social-interactional atypicalities that are characteristic of autism, can be
thought of as factors preventing participation in the type of linguistically-mediated

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social interaction on which inner speech is supposedly dependent upon (Lidstone,
Fernyhough, Meins & Whitehouse, 2009).
What is autism?
Autistic disorder (i.e. autism) and related autistic spectrum disorders (ASD) are a
group of neurodevelopmental disorders characterised by impairments in social
interaction, in communication and repetitive/restricted behavioural irregularities
(Vanvuchelen, Roeyers & De Weerdt, 2011). To avoid terminological confusion, I
will use the terms autism and ASD interchangeably hereafter, unless I specify
otherwise. Children diagnosed with ASD typically experience impairments in two
core areas important for social cognitive development, namely socialization and
communication (Matson et al. 2011). Thus, autism impairs one’s capacity to
adequately form social relationships and to effectively communicate with others.
Williams et al. (2008) sum up autism as a condition diagnosed on the basis of severe
impairments in social interactions. Finally, Rutter (2000) asserts that autism is one of
the most highly inheritable developmental disorders, yet the mode of inheritance (and
specific variant genes or gene groups) remains elusive!
Metacognition, self-awareness and autism
Broadly speaking, metacognition enables one to monitor and adaptively control
cognitive processes (Hampton, 2009). According to one dominant theoretical
standpoint, the ability to recognize one’s one mental states depends on the same
cognitive mechanism, process or core knowledge structure employed to recognise
mental states in others (Frith & Happé, 1999; Carruthers, 2009). What are the
implications of the above theoretical perspective for autism? Autism is a
developmental disorder widely acknowledged as involving an impaired understanding
of other minds’. Frith & Happé (1999) published an influential paper which asserted
that individuals diagnosed with autism might have as little awareness of their own
mental states as they have of the mental states of others’. However, the above
controversial claim has been questioned by various researchers who maintain that
certain metacognitive processes, such as self-awareness (of mental states) are intact in
the case of autism, despite an impairment in recognizing the mental states of others’
(Nichols & Stich, 2003; McGeer, 2004; Goldman, 2006). More generally, Frith &

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Happé (1999) aimed to investigate the developmental relationship between theory of
mind (ToM) and self-awareness in autism. For present purposes, I will focus on the
relationship between self-awareness, inner speech in autism.
Are there impaired self-awareness sub-components in the case of autism?
It seems plausible to assume that self-awareness is not a unitary cognitive
phenomenon, since one can become aware of various aspects of self. As Williams
(2010) explicitly states, there may be other aspects of self-awareness that are impaired
in autism, and such deficits may interact with ToM in important (yet unknown) ways.
Some theorists (see Russell, 1996) argue that ASD involves a ‘monitoring’ deficit in a
basic form of non-reflexive, ‘ecological’ self-awareness, i.e. a deficit in the capacity
to monitor one’s own actions (Williams and Happé, 2010). To test the above
hypothesis, Williams and Happé (2010) conducted two experiments designed to
assess the extent to which individuals with autism experience difficulties in
monitoring their own actions, both in memory and on-line. Results from the Williams
and Happé (2010) experiments oppose the hypothesis advocated by Russell (1996), as
individuals with autism exhibited similar performances on both experimental tasks.
However, the discrepancy in the aforementioned studies (i.e. the Williams & Happé
/Russell studies) might have been due to a more ‘developmentally able’ group of
individuals with autism taking part in the former study.
Possible links between inner speech and self-awareness
One function of inner speech that has been neglected in past research is its role in self-
awareness and the acquisition of self-information (Morin and Everett, 1990). Morin
(2004) recently proposed a neurocognitive/socioecological model of self-awareness,
one where inner speech plays a fundamental role. Morin’s model takes into
consideration most of the known mechanisms and processes leading to self-awareness,
whilst additionally examining their complex and multiple interactions. Inner speech
presumably plays a crucial role in this model, as it establishes important connections
between many of the model’s elements. Morin’s (2004) global model of self-
awareness postulates the existence of three primary sources of self-awareness: The
self, the social environment and the physical world. Despite the fact that cognitive,
ecological, neurological and social factors all play important contributory roles to

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self-awareness, the most influential contributory factor to the development/acquisition
of self awareness is inner speech (Morin, 2004). This model articulates that inner
speech can internally expand and reproduce social and physical (ecological) sources
of self-awareness, and it can also generate psychological distance between the self
and the mental events it experiences, thus facilitating self-observation (Morin, 2004).

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Section two: Literature review and theoretical discussion on inner
speech and socio-cognitive deficits in autism
In the forthcoming section, I will focus (though not exclusively!) on the following
hypotheses/research questions: (1) Is inner speech intact in the case of autism? (2) Are
there self-awareness deficits specific to autism? (3) Is a deficit in inner speech a
consequence of executive dysfunction in autism? (4) Is socio-cognitive information
atypically processed in the case of autism? (5) What are the neurobiological
underpinnings of autism? (6) Are there parallel socio-cognitive deficits in the cases of
autism and schizophrenia?
Previous research on self-awareness, inner speech and autism: A critical
review
Evidence from experimental psychology
Surprisingly, there has been virtually no cross-cultural research conducted on the role
of inner speech in autism! However, within the vast arena of experimental psychology,
two key research articles on inner speech and autism are worthy of discussion, namely,
Whitehouse, Mayberry & Durkin’s (2006) article entitled ‘Inner Speech Impairments
in Autism’, and Williams, Happe´& Jarrold’s (2008) study entitled ‘Intact inner speech
use in autism spectrum disorder: Evidence from a short-term memory task’. In many
ways, these articles are at the heart of contemporary debates over inner speech in
autism. In a nutshell, Whitehouse et al. (2006) contend that individuals with autism
are limited in their capacity to use inner speech. In response, Williams et al. (2008)
found that, under certain experimental conditions, individuals with ASD use inner
speech to the same extent as do non-autistic individuals of a similar mental age.
Lidstone, Fernyhough, Meins & Whitehouse (2009) re-analyzed the Whitehouse et al.
(2006, Experiment 3) data on inner speech in children with autism (CWA). Their
reanalysis showed that inner speech impairment in CWA is associated with greater
nonverbal than verbal skills.
One article that is important in light of the present exposition is Williams (2010)
article ‘Theory of own mind in autism: Evidence of a specific deficit in self-
awareness’. This article partly inspired my thesis, and although my specific aim is to
investigate inner speech in autism, I am more broadly interested in establishing what
self-awareness deficits are specific to autism? Williams (2010) raises the issue of self-

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awareness being multi-component in nature, as opposed to unitary, and further argues
that, in the case of autism, there is a particular deficit in the ‘psychological self’ (i.e.
theory of own mind), but not in the physical self. Additionally, Williams (2010)
contends that this deficit renders autistic individuals at least as impaired in
recognising their own mental states as they are in recognising the mental states of
others’. I tend to disagree with the later point made by Williams (2010).
Why am I in disagreement with Williams (2010)? The current state of knowledge on
self-awareness indicates that self-attention is central to our conceptions of the self and
related constructs (for example, self-efficacy, self-perception, self-adaptation and self-
presentation), since these all involve thinking reflectively about oneself (Leary &
Tangney, 2003b). What this illustrates is the complexity and multi-faceted nature of
self-awareness. And whilst psychologists, anthropologists and other researchers have
discovered various related constructs of self-awareness (as noted above), we have no
idea as to how self-awareness and related constructs interact at the cognitive level, nor
any clue as to why the severity of self-awareness deficits vary along the autistic
spectrum, i.e. do they vary because of deficits in the complex interactions of the
multi-faceted self-awareness system, due to deficits in the actual components of self-
awareness, or a combination of the two? And how does culture impinge upon self-
awareness and inner speech in autism? Hence, due to the complexity of self-
awareness, and the fact that we are still in the dark about how self-awareness, related
constructs and other cognitive/cultural mechanisms interact to produce the observed
deficits in autism, it is premature of Williams (2010) to assume that individuals with
autism are as impaired in recognising their own mental states as they are in
recognising the mental states of others.
Autism, inner speech impairments and executive control
The capacity to use inner speech is said to play an important role in the executive
control of thought and action (Holland & Low, 2010). And autism is typically
characterized by executive impairments in self-monitoring, planning and mental
flexibility (Hill, 2004). With this in mind, Whitehouse et al. (2006) argue that, despite
accumulating evidence of a strong relationship between inner speech and executive
function, few studies have investigated the use of inner speech in autism. One
exception is a study conducted by Russell, Jarrold & Hood (1999), who demonstrated

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that when the use of inner speech is disrupted (e.g. via participants being required to
respond verbally), the performances of typically developing children on an executive
function task is comparable to children with autism. This opposes findings elsewhere
which have shown that when inner speech is not interrupted, children with autism
show inferior performance to typically developing children on tasks of executive
function (Whitehouse et al. 2006). Yet, without any direct method of measuring the
inner speech capabilities of individuals with autism, this remains a speculative
interpretation of the data.
Neuroimaging and autism: Deficits in connectivity and social cognition
Neurobiological paradigms of social cognition: How are social stimuli processed?
Neurobiological models of social cognition assume that social stimuli are processed
by a network of neural structures. More specifically, such models focus
predominantly on particular regions of the occipital and temporal cortices, including
the fusiform gyrus (FG) and the superior temporal sulcus (STS), both of which appear
to be heavily involved in the processing of faces and facial expressions (Winston,
Henson, Fine-Goulden & Dolan, 2004) and the amygdala, a brain structure assumed
to play a pivotal role in recognizing emotions, making complex social judgments and
detecting threat (Amaral, Bauman & Schumann, 2003). Pinkham, Hopfinger,
Pelphrey, Piven & Penn (2008) argue that such neurobiological models provide a
foundation for understanding the underlying neural mechanisms involved in several
clinical disorders, particularly in autism. However, there appears to be conflicting
evidence with regards to the particular brain regions supposedly disrupted in ASD, e.g.
there is conflicting evidence on possible amygdala dysfunction in ASD (see Piggot et
al. 2004).

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Neuroanatomy of social cognition in humans. Only some
of the most central structures are shown for clarity: the amygdala
(blue), the ventromedial prefrontal cortex (red), the cingulate cortex
(yellow), and somatosensory-related cortices in the right hemisphere
(green). Not shown are the sectors in the temporal lobe, such as the
fusiform gyrus and the superior temporal sulcus, that are involved in
the visual perception of social stimuli; nor does the figure show
structures closer to the output end that are involved in directly
triggering social and emotional behaviors, such as the hypothalamus,
periaqueductal gray, and other brainstem nuclei. Also not shown are
additional structures involved in social cognition that are intimately
connected with the structures shown: dorsolateral prefrontal cortex,
frontal polar cortex, temporal polar cortex. Segmented structures
shown in color were co-rendered onto a partially transparent brain to
obtain the images shown (right lateral view of whole brain at top,
medial view of the right hemisphere at bottom). R Adolphs, H Damasio,
Human Neuroimaging and Neuroanatomy Laboratory. Taken from
The neurobiology of social cognition: by Ralph Adolphs (2001).
Abnormal processing of social information in autism and schizophrenia
There is evidence of abnormal activation in the neural systems of the social cognitive
processes underlying autism and schizophrenia (Williams, Das, Harris, Liddell,
Brammer & Olivieri, 2004). Pinkham et al. (2008) used fMRI to compare autistic and
schizophrenic individuals with a control group and a non-paranoid schizophrenic (NP-
SCZ) group on complex social cognition tasks. Reductions in neural activation were
evident in the amygdala, the ventrolateral prefrontal cortex (VLPFC) and the fusiform
face region. Reduced activity in the amygdala and fusiform face region in ASD is
consistent with various studies that have investigated this group of disorders
independently, although such studies have utilized more basic social cognition tasks,
e.g. recognizing emotions and observing faces (Pinkham et al. 2008). It is worth
noting, however, that Piggot, Kwon, Mobbs, Blasey, Lotspeich & Menon (2004)
found reduced neural activity in the FG in ASD, but found no difference in amygdala
neural activity between controls and individuals with ASD. This finding opposes
previous/present data on reduced amygdala activation in autism. Interestingly, Uddin
& Menon (2009) argue that the anterior insula appears to be under-connected in ASD,
and they propose a novel ‘anterior insula-based systems-level model’ for the
investigation of the neural basis of autism. They hold that the anterior insula is
involved in introceptive, empathetic and affective processes, and emerging evidence
indicates that the anterior insula is part of a ‘‘salience network’’ integrating external
sensory stimuli with internal states (Uddin & Menon, 2009).

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Table 1 summarises research findings on the primary brain regions implicated in autism: Taken from ‘The
neurobiology of autism: Theoretical implications’ (Schroeder, Desrocher, Bebko & Cappadocia, 2010).
Reduced neural connectivity in ASD
Wass (2011) maintains that “core” autistic impairments in social interaction,
repetitive/restricted behaviours and language, arise because these seem to be the
domains which place the largest cognitive demands on the time-sensitive integration
of incoming information from spatially disparate brain areas. According to the long
distance under-connectivity theory of ASD, any facet of psychological function which
is dependent upon the coordination/integration of brain regions is susceptible to
disruption, especially when the computational demand associated with such
coordination is large (Just, Cherkassky, Keller & Minshew, 2004). In some ways, the
above theory is a neural substantiation of central coherence theory (Happé & Frith,
2006) which postulates a cognitive style skewed more toward local as opposed to
global information processing. However, Just et al. (2004) argue against the neural
substantiation of central coherence theory, claiming that this theory assumes a core
deficit in central processing (Happé & Frith, 2006), whereas under-connectivity
theory treats coherence as an emergent property of collaborating brain regions (Just et
al. 2004). Furthermore, local over-connectivity has been linked to findings of inferior
generalization and behavioural hyper-specificism in ASD (Cohen, 2007), and to
superior discrimination performance on particular tasks, e.g. the embedded figures
task (Cohen, 2007).

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Parallel social cognition research in schizophrenia and autism
Recent research has shown that autism and schizophrenia are genetically linked
(Burbach & van der Zwaag, 2009), and both disorders supposedly share some
common genotypical features, hence phenotypical (cognitive) and endophenotypical
(behavioural) overlap is expected (Braff, freedman, Schork, & Gottesman, 2007).
Whilst autism and schizophrenia have different symptom presentations,
developmental courses and ages of onset, one hallmark characteristic of both
disorders is impaired social functioning (DSM-IV-TR), and such social deficits are
connected to deficits in social cognition (Pinkham, et al. 2008). Recent research
indicates that social cognitive deficits in both autism and schizophrenia may emerge
due to dysfunctions in the neural systems which underlie social cognition (Pinkham et
al. 2008). Furthermore, judging by behavioural data, both disorders show comparable
social cognitive deficits, especially on paradigms where high levels of social cognitive
skill are required, e.g. on tasks of social judgment (Craig, Hatton, Craig & Bentall,
2004). However, our understanding of the above socio-cognitive deficits, and the
potential similarities between autism and schizophrenia, remains incomplete
(Pinkham et al. 2008).
The social world and autism: An anthropological interpretation
An intriguing exposition put forth by Ochs, Kremer-Sadlik, Sirota & Solomon (2004)
illustrates the importance of an anthropological perspective on autism and the social
world. The crux of their argument is that individuals with autism need to be
considered not only as individuals in relation to other individuals, but also as
members of social communities/groups who act in conjunction with socially and
culturally ordered expectations of behaviour, exhibiting both social difficulties and
competencies. Hence, an anthropological perspective of the above type is (I believe)
crucial, as it attempts to expand the scope of autism inquiry from a predominantly
circumscribed interpersonal domain, to a broader socio-cultural perspective. With
autism, self-awareness deficits and inner speech in mind, one important aspect of
Ochs et al. (2004) argument is that, members of social groups are simultaneously
shaped by, and are agents of, cultural understanding and social life. Hence, the fact
that there are cultural differences in various aspects of social life makes it extremely

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difficult to draw any sound conclusions about the emergence and development of
autism cross-culturally.
Integrating the social and communicative domains of functioning in autism
Whilst the domain of ‘social functioning’ in autism covers phenomena beyond
communication, and despite the fact that some researchers concede that the
boundaries between the social and communication domains in autism are ambiguous,
this remains a deeply problematic diagnostic division (Ochs et al. 2004). This division
is problematic in the sense that the use and interpretation of language in everyday life
(i.e. communication) is crucial for social functioning, and is an outcome of both local
socialization practices and innate social predispositions. Furthermore, it is been
argued on anthropological and/or socio-cognitive grounds that language use and
interpretation mediate experimental assessments of social skills, hence, language use
and interpretation cannot be factored out when assessing participants’ level of social
understanding (Ochs et al. 2004). An alternative perspective is that language
interpretation (and use) is quintessentially ‘social’, and this insight illuminates the
importance of the linguistic anthropological hypothesis that language competence
extends beyond tacit knowledge of context-independent grammatical systems to entail
context-sensitive knowledge of language as praxis (Hymes, 1972).
Socio-cultural and interpersonal understanding in autism: An integrated
approach
Ochs et al. (2004) argue that psychological accounts of social functioning in autism
should be modified and expand the domain of social functioning to include, not only
knowledge and skills required for interpersonal interactions, but also socio-cultural
skills and knowledge which enable members of social groups to impersonate and
interpret conventional behaviours, roles, activities, and importantly, to include the
institutional norms which organize families, work places, youth organizations,
religious communities and schools. When one scrutinizes autistic impairments, it
becomes evident that no distinction is made between the socio-cultural
knowledge/skills which facilitate social encounters, and the interpersonal
knowledge/skills required for such encounters, e.g. the DSM-IV-TR (American
Psychiatric Association, 2000: p. 75) lists ‘failure to develop peer relationships
appropriate to developmental level’ as a diagnostic criterion for autism, yet no

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distinction between interpersonal and socio-cultural acumen is listed (Ochs et al.
2004). It is worth noting that the distinction between interpersonal and socio-cultural
knowledge is difficult to delineate, as socio-cultural knowledge/skills are not
universally shared by all members of a social group, and because members of social
groups hold appropriate socio-cultural frameworks for interpreting the world in
idiosyncratic ways, thus individuating them in accordance with their personal life-
worlds (Shore, 1996).
Autistic self-awareness viewed through a philosophical lens
A fascinating special issue of articles on philosophical debates which focus
specifically on infantile autism (see Gallagher, 2004a, 2004b; McGeer, 2004 &
Shanker, 2004) and schizophrenic autism (see Stanghellini & Ballerini, 2004),
illuminate the importance of philosophical discourse in clarifying research findings
and theoretical paradigms/interpretations within the active area of autism research.
However, I will focus primarily on the Victoria McGeer article entitled ‘Autistic self-
awareness’, as this philosophical thesis is relevant to the current exposition. McGeer
(2004) begins by outlining what one prominent view of autistic cognitive
abnormalities is, namely, one in which there is a defective capacity for cognizing
about other minds. Frith & Happé (1999) have extended this assumption, arguing that
autistic individuals appear to have further deficits in self-consciousness (McGeer,
2004). However, McGeer speculates that how Frith & Happé treat autistic self-report
is problematic, both on philosophical and methodological grounds. With the above in
mind, I will now briefly explore some of McGeer’s philosophical musings on autism.
McGreer (2004) argues that, generally, the wide range of autistic atypicalities has
presented a problem for previous theories of autism, and this is evident in the
somewhat narrow Frith & Happé (1999) neoperceptual model. Avoiding a detailed
analysis of Frith & Happé’s theory (McGreer analyzes it in much detail), McGreer
generally argues that Frith & Happé’s speculations with regards to self-awareness in
autism are not generated from first principles, since such speculations are directed
toward characteristic features of autism. Consequently, McGreer reframes Frith &
Happé’s speculations in the following question form: How could the hypothesis of
impaired self-consciousness account for these particular autistic features? She then
poses the following broader question: How do individuals with autism become aware

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of their own cognitive and experiential states, i.e. how do they become aware of their
own beliefs, desires, immediate perceptual states and emotions? Furthermore, how do
beliefs, desires, immediate perceptual states and emotions interact in the case of
autistic self-awareness?
From a philosophical perspective, it is important to consider how individuals with
autism become aware of various cognitive and experiential states, and how such states
interact to produce the cognitive deficits evident in autistic self-awareness. Traditional
philosophy long considered self knowledge to be dependent upon inner perception,
which quite literally refers to a capacity for introspecting about one’s own subjective
states and processes (McGreer, 2004; p. 243). Through this capacity, we make
judgements, i.e. we form metarepresentations (second-order beliefs) about the
contents of our own minds; and it is these second-order judgements which are
expressed in self-report. Whilst self-reports express second-order judgements, they
presumably do not express first-order states at all; hence, according to the prevailing
neoperceptual model, first-order states are only contingently connected to the second-
order states which make self-report possible (McGreer, 2004). If second-order states
are only contingently related to first-order states/processes, then in principle, this
implies a gap between how things really are and how we judge them to be.

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Section three: The relationship between culture and autism
Is the relationship between culture and autism reciprocal?
What is culture? And how does it interact with autism? Culture can be conceptualized
as a socially interactive process of construction consisting of two primary components:
Shared activity (cultural practices) and shared meaning (cultural interpretation)
(Greenfield, 1999). The above components of cultural processes are supposedly
accumulative in nature, since they occur both between and within generations.
Furthermore, cultural activities and meanings not only accumulate, but additionally
transform over both developmental time (across a single life cycle) and historical time
(between generations). Can the study of autism inform theories of culture and vice
versa? Greenfield, Keller, Fuligni & Maynard (2003) maintain that the study of
autism holds promise for enhancing and refining theories of culture and society, in
that both the successes and struggles of individuals with autism illuminate the most
crucial aspects associated with participation in human society. Furthermore, the social
competencies of persons with autism have implications for delineating the
foundational properties of sociability (Greenfield et al. 2003). Hence, there appears to
be a reciprocal relationship between autism and culture, one which, to date, very little
is known about!
Socio-cultural and interpersonal dimensions of impairments in autism
Greenfield et al. (2003) assert that, problematically, the interpersonal and socio-
cultural dimensions of the pragmatic impairments associated with autism are not
differentiated. They argue that the capacity to recognize, interpret, and respond to
speech acts embraces socio-cultural perspective-taking, and minimally includes an
awareness of the following: (1) the socio-cultural conventions required for performing
such acts; (2) the social roles enacted by social performers; (3) the social activities in
which the acts are both embedded in, and which they help comprise; (4) the default
beliefs, emotions, knowledge states and intentions conventionally associated with the
social performers of such acts; and (5) the anticipated, possible and preferred next
social-interactional moves conventionally projected by the performance and
performers of these acts (Greenfield et al. 2003). However, the capacity to recognize,
interpret and respond to speech acts also involves interpersonal perspective-taking, in
that interlocutors are expected (minimally) to situate speech acts in the context of

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particular present, past, hypothetical or future circumstances and particular
individuals, and to fine-tune their responses and interpretations accordingly.
The cultural variability of autistic symptomatology
Matson et al. (2011) claim that a lack of research exists on ASD across cultures.
Despite this, some researchers/practitioners insist that there is very little variation in
the behavioural manifestation of ASD, and that symptoms hold across ethnicity,
social class and culture (Campbell, 1996). From this perspective, autism is not a
culturally variable developmental disorder, and autistic symptomatology is cross-
culturally stable. However, as Daley (2002) argues, whilst ASD symptoms occur
across all cultures, there are subtle (and perhaps crucial!) differences in the
presentation of autistic symptomatology. Furthermore, core ASD symptom expression
may be susceptible to the culture in which an individual is acculturated (Daley, 2002).
Hence, cultural variability in the presentation of autistic symptoms, and the
susceptibility of ASD core symptom expression to individual acculturation must be
taken into consideration when assessing the legitimacy of research findings in the
domains of autism and self-awareness.
Autism and the importance of cultural context
Daley (2002) argues that research on the pervasive developmental disorders within a
cultural context has received little attention from both the fields of anthropology and
mental health. Despite this claim, one interesting line of research which places autism
in a sociocultural context focuses on class factors. Research has ‘consistently shown
that there are no differences between the socio-economic backgrounds of autistic and
matched samples’ (Daley, 2002; p. 534). However, it seems that social class factors
can and do influence clinical diagnoses of autism, e.g. Cuccaro and associates gave
educational psychologists, physicians and speech pathologists vignettes depicting
children with autism and children with attention-deficit hyperactivity disorder
(ADHD), and found that the above professionals associated autistic children with
higher socio-economic status (Cuccaro, Wright, Rownd, Abramson, Waller & Fender,
1996). Daley (2002) summarizes his argument as follows: If any developmental
condition can be categorized as ‘culturally invariant’, then autism appears to be a
worthy candidate given its neurobiological underpinnings. Yet the existing literature

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and limited amount of ethnographic studies suggests that the most precise conception
of autism is one of a neurobiological condition that is culturally shaped in symptoms
and course.
Cross-cultural obstacles and unanswered research questions
Do autistic individuals have an impaired capacity to verbally mediate? Are there
impaired self-awareness sub-components in the case of autism? Are deficits in autistic
self-awareness culturally variable? Are there parallel socio-cognitive deficits in
autism and schizophrenia? All of the above questions (and many others!) remain
unanswered, for one reason or another. This is not to say that researchers are unaware
of the theoretical, diagnostic and cross-cultural obstacles they face when investigating
autism! My concern is that there is so much we have yet to discover about autism, that
some researchers, e.g. Williams (2010), are much too premature in assuming that
individuals with autism are as impaired in their capacity to recognize their own
mental states as they are in recognizing the mental states of others’. As my exposition
explicitly illustrates, there is virtually no cross-cultural research on inner speech and
self-awareness in autism, and studies that have been conducted are rare! Furthermore,
research on autism has overlooked the importance of a socio-cultural perspective, e.g.
the capacity to recognize, interpret, and respond to speech acts embraces socio-
cultural perspective-taking, yet no research within the area of autism has focused on
such perspective taking! Furthermore, various types of norms, such as institutional
norms, are basically non-existent in the autism literature, yet such norms are clearly
important in shaping the cognitive processes of members of social groups.
The universality of autism: A critical appraisal
To conclude, I believe that Daley (2002) is correct when he argues that the most
precise conception of autism is one of a neurobiological condition that is culturally
shaped in symptoms and course, as noted previously. And yet, what do we actually
know about how culture shapes the developmental pattern evident in autism? The
answer to this question is that, to date, we simply do not know enough about the
impact of cultural norms on autism. As Ochs et al. (2009) note, members of social
groups are simultaneously shaped by, and are agents of, cultural understanding and
social life, and this must be kept in mind when generalizing our hypotheses and

17. Self-awareness, inner speech and autism
17
research findings. Furthermore, individuals with autism need to be considered as
members of social communities/groups who act in conjunction with socially and
culturally ordered expectations of behaviour, rather than being considered only as
individuals in relation to other individuals. Crucially, I believe that future researchers
must expand the scope of autism inquiry from a predominantly circumscribed
interpersonal domain, to a broader socio-cultural perspective, a point I raised earlier.
Only in this way can we fully understand (and appreciate) the complex and intriguing
developmental condition known as autism.
Word count = 4, 751 (excluding sub-headings)

18. Self-awareness, inner speech and autism
18
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