Author Archives: kmarston

Autism Spectrum Disorder and Decision-Making

Last semester I was roommates with a woman who has Autism Spectrum Disorder (ASD; She describes her diagnosis as Asperger’s, however the DMV-5 has nixed the Asperger Syndrome diagnosis to instead place higher level functioning individuals on the overall Autism Spectrum). Stereotypes dictate that (higher-functioning) people on the spectrum are academically brilliant, practically on the verge of OCD, and socially inept. My roommate however put off her assignments until the last minute, so much so that I learned to sleep through the overhead light of our dorm room. She was more fixated on specific things, such as the Lord of the Rings series and YouTube, than on academics and she struggled with quite a few classes. It wasn’t unusual for her to ask me a lot of questions and she often asked for my advice and assistance in walking her through decision-making steps that focus on bigger picture and future-oriented concepts.

I’ve worked with other people on the spectrum through my various therapeutic jobs and while every person is ‘uniquely’ different, I’ve noticed that ASD people almost always approach problems in a manner that many neurotypical people would not. An example of this would be the dozens of conversations my roommate and I have had concerning her job searching process. My roommate seemed to lack the ability to plan using sub-goals in order to reach her end goal (a job at Barnes and Noble). She put in an application, but other little steps, such as calling the manager to receive an application update, she did not plan ahead for. Based on living with my roommate and my future goal to become an occupational therapist specializing in disability work, I thought it would be interesting to reflect over the variations in the decision-making processes of people with ASD. Before doing research for this post, I found myself wondering what the decision-making trends are for those on the spectrum and whether the majority of individuals with Autism favor specific decision-making steps.

Decision-making has been a key component in understanding behavior differences in various neurological disorders, including ASD (Mussey et al., 2015). One study analyzed this through the Iowa Gambling Task (IGT) which measures decision-making under ambiguity. Originally developed to detect problems with ventromedial prefrontal cortex damage in patients, the IGT is commonly used to simulate real-life decision-making. In the IGT, participants are presented with four decks containing a series of cards from which they must make choices. They are asked to make decisions by choosing which decks are advantageous or disadvantageous, winning or losing money based on their decisions. They found that people with ASD were sensitive to magnitude of loss but ignored frequency of loss. Unlike the majority of neurotypical people who are risk seeking for losses, individuals on the spectrum are risk averse. This study additionally demonstrated the lack of future planning in ASD individuals by their neglect of multiple smaller losses. Another study found that people on the spectrum remained consistent and traditionally rational with their choices even with the inclusion of a third variable. This was different from the comparison group whose decisions irrationally shifted when a third irrelevant option was introduced. Other studies have found decision-making processes to have consistent response patterns despite outcome unpredictability, be individual-centered without taking into consideration other people during the decision-making process, and there appears to be a reduced influence of “framing effects” on ASD decision making (Wu et al., 2018; Mosner et al., 2017; Shah, Catmur, & Bird, 2016). Overall, research suggests an underlying neural and cognitive mechanism that differentiates the decision-making process of ASD individuals from neurotypical people. These studies all noted that as the brain functioning of people on the spectrum become better understood, a greater potential for diagnosing and treating the disorder exists.

Image result for autism gif

My roommate builds her life on a routine and her decision-making consequently reflects this. From her last-minute homework frenzy to her lack of goal planning for the future, she exhibits many characteristics notable for people on the spectrum. Although her actions may appear to be simple procrastination, her behaviors are systematically heightened in comparison to neurotypical people. Despite ASD individuals like my roommate gaining significant public attention over the past several decades, disability research is still limited in comparison to neurotypical populations. Research in decision-making provides an avenue for understanding those on the spectrum and learning how the differences in their brain allows them to process information. It’s studies like those noted above that help neurotypical people understand individuals on the spectrum and give people like myself, who are interested in therapy work, a chance to learn how to better aid ASD people, such as in areas of decision-making. It is my hope that more studies like the ones listed in this post will be conducted in the future and expand upon existing knowledge of decision-making theories.

Can Dogs Speak to Us?

I spent a lot of time racking my brain, trying to figure out what I should write for this blog post. I wanted to talk about a cognitive topic that has a lot of relevance in modern media, but I didn’t want to focus on memory which has made significant medical progress in the past decade and is consequently a frequently reported topic. I kept looking through news articles and paying attention to the things that are said and done in my Netflix shows, trying to find something that would spark my interest and be blog worthy. A few days ago, I happened to be taking a break from studying and was scrolling through Instagram when an old video caught my eye. I watched it and immediately realized that I could write a post about it. This video features a cute performance between an owner and his dog. The owner tells a chronicle of making and eating food and the dog ‘talks’ back to him responding comedically to his story. There are dozens of other videos that exist on the internet showing off dogs (and even cats) that can say basic words such as “yes,” “no,” “mama,” etc. While it’s amusing to listen to these animals and claim that they have the ability to speak to us, these scenarios can be attributed to the phoneme restoration effect.

Phonemic restoration is an auditory illusion where an individual “hears” parts of words that are not actually there. Studies often observe this effect by replacing sections of words with an extraneous sound. Richard Warren (1970) was the first to report this illusion by replacing the first ‘s’ in the word “legislatures” with a cough or a tone, in the sentence “The state governors met with their respective legislatures convening in the capital city.” Participants were given handwritten versions of the sentence and asked to find the location where the cough or tone had occurred. The results were poor and almost all subjects reported that the sentence was whole. The findings of this study showed that utterances were heard as intact, suggesting that participants restored the missing phoneme ‘s.’ Arthur Samuel (1981) furthered this research and found that through top-down and bottom-up expectations, encoding and linguistic knowledge influence speech perception. Leonard, Baud, Sjerps, and Chang (2016) noted that the neurological basis of phoneme restoration is still unknown, but they found that restoration of parts of words are preceded by neural activity patterns in the left frontal cortex of a separate language area. These patterns help predict the word that participants claim to hear. Other studies of phoneme restoration have begun to branch out to cover topics such as understanding other languages, the influence of cognitive load on the effect, and its role in developmental dyslexia.

As a deaf individual with a cochlear implant, the phonemic restoration effect is something that I often engage with when I’m having a conversation or listening to something without closed captions. More often than not, I miss a large majority of what I am hearing. Given the context of a conversation, I am able to fill in parts or even whole words that I did not hear. I particularly observe this when I am listening to music. Songs often rely heavily on instrumentals which significantly impedes on my ability to understand what is being sung. Most of the time I’m just hearing a bunch of gibberish and perhaps actually understanding a few words along to a nice beat. As soon as I read the lyrics for a song however, I ‘magically’ understand everything that has been said in the song when I previously could understand nothing. While this is a more complicated process than the restoration of individual phonemes, it goes to demonstrate an example of the brain’s ability to fill in missing information based on language competence. On a smaller scale, I use this process daily to restore phonemes for sounds my implant does not pick up.

Phonemic restoration has not been studied to the degree as other aspects of language research, but it is something that people engage in all the time. It affects not only me as a deaf person, but also the widespread human population from interpreting slurred speech, to understanding someone who may still be learning a new language, to inferring conversations in a loud environment. A dog does not have the motor mechanisms with its tongue, mouth, or teeth to properly say the word “mama.” Instead, through the process of phoneme restoration, we are able to infer specific utterances from dogs, such as an ‘a’ sound and replace another unintelligible sound with the missing phoneme ‘m’ to produce what we hear as “mama.” This understanding of language allows us to process and comprehend speech to the point that even dogs can ‘speak’ to us.

Expectation-Driven: The Relationship of Priming on Sense of Agency and Obsessional Compulsive Disorder

The sense of agency (SoA) refers to the understanding of individual control over one’s actions and the resulting consequences. It is partly dependent on matching outcomes to expectations and the prospective processes (decision making) that occur prior to a sensory action.

After learning about SoA, I was curious if there was any research about its relationship with individuals who have Obsessional Compulsive Behavior (OCD). As someone who has OCD, routines play a huge factor in my life. Specific routines (e.g., Arriving to class at least 10 minutes early) allow me to have certain expectations about the way [I think] the world should work and what the specific consequences will be. When something disrupts the routine (e.g., Something happens that prevents me from leaving for class on time and I become overwhelmed with the belief that I will miss the class period and consequently fail the entire semester, when in reality I will arrive a few minutes late at most), I feel a loss of control over my actions despite the fact that I theoretically have conscious awareness over them. In this case, my mindset does not match up with my SoA. This loss of control over my actions always feels like an impairing event when they occur, so it made me wonder whether actual priming has an impact on how expectations influence obsessive behaviors and whether failure of these expectations being met is responsible for compulsive behaviors as a result of a low sense of control.

SoA shares a crucial relationship with expectation-based and stimulus-based priming. Similar to Posner and Snyder’s study (1975) of the effects of these types of priming on response time, Nura Sidarus, et al. (2013) created an experiment with similar concepts exploring priming and its effect on sense of control. Using prime and mask stimuli, the researchers explored the effects of expectation-based priming.

Some studies suggest that SoA is a matter of monitoring outcomes to confirm that actions were successful. Others however suggest that priming effects on the SoA are independent of sensori-motor control and arise at a premotor (action selection) stage. Participants show similar outcomes in reaction times and error rates when presented with compatibly-primed actions (directions that match the primed target) and incompatibly-primed actions (directions that don’t match the primed target). When expectations are not met based on the primed target, participants show higher error rates that can be further impacted by timed intervals between targets. Based on these responses, participants report a feeling of control when their response target matches the primed target and a loss of it when they are misled.

Based on OCD and SoA studies, deficits in sensorimotor processing maintain an important relationship between the compulsive acts of OCD and SoA. While I could not find any specific articles tying the two topics with priming studies, similar theories exist like the ‘habit-driven’ hypothesis of OCD. This theory states that OCD dysfunction in habit formation is a result of imbalance between the goals of the executive system and the habit-forming system (Szalai, 2017). This dysfunction of the prefrontal cortex fails to inhibit automatic (compulsive) responses in OCD. Additionally, Judit Szalai adds to existing theories by arguing that OCD stems from motor experiences, particularly the feelings of incompleteness or loss of control, which cannot be overcome until the action reaches its goal. This drives the creation of OCD rituals. The SoA is then linked with harm-avoidance behaviors and a less coherent sense of self. The compensated sense of control is made up by moderating individual behavior with conscious effort. Behavior adjustments are maintained in order to receive convincing (explicit) cues about actual goal completion or to experience completeness. Although priming experiments specifically monitoring the interaction between OCD and SoA do not exist to my knowledge, the attributes of obsessive and compulsive behaviors and sense of control suggest an existing relationship. In order to maintain an understanding a sense of self, expectations are built upon belief of harmful outcomes and specific actions that will avoid these outcomes and maintain a sense of control. These expectation-specific behaviors may be monitored by expectation priming and explain the difference between feelings of despair when expectations are not met, like arriving to class late, compared to when they are, such as arriving to class routinely early. In the future, research studying this link could be beneficial for people like myself in finding better techniques for managing OCD and SoA expectation-related behaviors.

I found myself falling down the rabbit hole as I researched these articles as the topic was exciting and fascinating to me. SoA is something that most people do not have to think about, but I’ve lived with OCD for so long now (and have not received therapy or medication for it) that imagining the future without periods of experiencing a loss of control and self-doubt is difficult. This means giving up routines and rituals that have become imperative parts of my life in the form of coping mechanisms in order to avoid these lapses of control. I’ve recently been thinking quite often about how much my Generalized Anxiety Disorder (GAD) and OCD manifest themselves in ways that other people don’t give a second thought about. I took my little sister to the DMV to take her permit test this past weekend and she went without showering, brushing her teeth and forgot her study material. Her laid-back attitude about the situation baffled me, because I would be on the edge of my seat in a panicked state if I was not clean, proper and had forgotten important material. Reading all these articles gave me an additional chance to sit back and reflect on the dominant role my mental health plays in my life. Something as simple as a sense of control can mean a dramatically different mindset to someone who experiences disorders and other impairments in brain activity. It goes to show how important this kind of research is and what a difference new discoveries can have on the lives of people like myself.

Articles to reference for individual research:

Priming of actions increases sense of control over unexpected outcomes by Nura Sidarus, Valérian Chambon and Patrick Haggard (

What Is the Sense of Agency and Why Does it Matter? by  James W. Moore (

The Sense of Agency in OCD by Judit Szalai ( – access via interlibrary loan)

Looking for Outcomes: The Experience of Control and Sense of Agency in Obsessive-compulsive Behaviors by Sannaâ Belayachi and Martial Van der Linden ( – access via interlibrary loan)


In class the concept of blindsight was explored after reviewing an inattentional blindness experiment ( Individuals with blindsight have damage to their primary visual cortex (V1) and identify as blind even with residual vision. While they have an absence of visual awareness, they demonstrate appropriate responses to certain visual stimuli (most often in response to fast-moving and/or high-contrast visual stimuli). The primary explanation for this event is that retinal information is projected to subcortical structures and then projected directly to extrastriate regions, ultimately diverting V1. The exact process of blindsight however is unknown.

Blindsight can be explored to gain understanding of the connection between sensory areas and sensory awareness, as well as illuminate the organization of visual areas of the brain. Similarly, the phenomena of “deaf-hearing” can also be used to understand the relationship of the auditory system and of auditory awareness. Like blindsight, it’s important to recognize that there are multitudes of people, myself included, who are legally deaf but do not have a total inability to hear. Many have profound or severe hearing losses, some that can hear certain frequencies and sounds better than others or may be completely deaf in those areas. Brogaard (2017) refers to this form of deaf-hearing to be type-2 deaf hearing, because there is still “an ability to behaviorally detect or discriminate aspects of sounds that are not consciously perceived” (p. 23).

In this particular article ( a profoundly deaf individual, LS, was examined with and without his hearing aids (without the accommodation he reported being unable to hear any sounds) by completing five trials. LS’s conductive hearing (volume at which a sound must be played through the ear for it to be heard; how hearing aids assist an individual) averages 95 dB which makes it a profound loss. As with most deaf people he suffers from tinnitus (the perception of imagined noise in the ear- I occasionally experience this as a repetitive ringing or droning sound), but the symptom generally does not have a perceived relationship with deaf-hearing. He also experiences vision-sound synesthesia in which a perceived sound is heard in response to objects in his environment. For example, the motion of objects corresponds to imagined sound that he has always associated them with (i.e. the sound of birds chirping when seeing them even if they can’t physically be heard).

The trials featured a series of forced-choice paradigms to measure sound detection, localization, and content discrimination. Each trial featured a hearing aid condition and hearing aid off condition, where LS served as his own control when wearing his aids. In the source localization trials without his hearing aids LS performed by chance and does not have “unconscious hearing” when determining the presence or location of sounds. When discriminating sounds however he performed above chance in this forced-choice model which means he has the ability and awareness to detect auditory content. It’s important to note though that the tinnitus may have served as a mask during this scenario. Although LS could not detect or localize sounds, he was able to discriminate among auditory content which offers an impressive outcome. The nature of deaf-hearing is still unknown and subject to many possible mediating variables, but the existence of unaware consciousness is undeniable.

*At the top is LS’s audiogram and at the bottom is mine. I included both of these to serve for comparison of how different our hearing is from one another, yet we still experience similar symptoms as a result of being deaf.


As someone who is deaf with a cochlear implant, this article was fascinating to read and offered many explanations about things I’ve experienced but never consciously recognized. I often find myself having conversations with friends and will accidentally say something they said immediately prior. I never ‘hear’ what they say, but I somehow parrot them word-for-word. I also learned about vision-sound synesthesia which I never realized that I had. While I still have about 10% or less natural hearing left in my non-implanted ear, I don’t hear every sound around me or I’m sometimes too far away from the source to properly hear it. Despite these obstacles, I am so used to associating specific sights with specific sounds that I ‘hear’ the sounds despite the impossibility of being able to do so. The trials in the article are also remarkably similar to my audiologist mapping appointments (when I get my implant sound frequencies readjusted after a period of fluctuation) in which I have to sit in a soundproof booth and acknowledge beeps and words with my implant on and off.

It was difficult to find many articles about deaf-hearing and like blindsight the concept is not well understood. As someone who experiences deaf-hearing and similar symptoms, it would be fascinating to learn more about the phenomenon in the future and further discover the relationship between sensory areas and awareness processing in the brain.


If you’re interested in learning more about this topic, another older, associated article is (


Test Post

Hi I’m Kiele! Here’s my test post! I looked at previous test posts and some had pictures, so here’s a photo of some of my teammates rowing last semester.