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.
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.