How Self-Aware are People with Autism?

This question has always bugged me.

I’ve always wondered whether Chris knew about his Autism Spectrum Disorder (ASD). I have asked; he just replies with vague mumbles or changes the subject. What’s interesting though is that whenever he overhears someone talking about his condition saying he is stupid or dumb, he starts getting agitated and cross with everyone. Either he understands people are talking about him and he hates that its about his condition or it’s because he thinks he’s in trouble for something again. Call it Big Sister intuition, but I believe he has a vague idea about his condition mainly due to the fact that I have observed how upset he gets when he can’t do something- out of frustration he will cut the strings on his guitar because he isn’t capable of the proper motor coordination needed to play chords. Also, I believe he doesn’t care (or can’t) that much about it either, as he has never been able to think about himself in relation to other people.

As you’d expect, low-functioning individuals, who have more severe ASD traits, are likely to be less self-aware of their condition compared high-functioning individuals. Michael Lombardo and Simon Baron-Cohen, who both studied self awareness extensively in ASD, mentioned in a study that ASD individuals with more self-awareness had better mentalising skills and less autistic traits, indicating a relationship between self-awareness and ASD impairments

Now we get down to the deeper stuff!

Baron-Cohen and Lombardo (2010) described how the Self in ASD is in paradox. ASDs are both egocentric and self-awareness impaired at the same time! Individuals with ASD often do not understand the “Duality of Self” which is how we can understand how we are similar yet distinct from others at the same time. When asked, individuals with ASD will not immediately represent themselves in relation to others in a social situation. They have a hard time understanding that they are similar to another. They are unable to perceive how another will feel about a situation. They lack Theory of Mind. However, sometimes if you simulate another’s experience through their own, they may be able to understand, especially if that other person is similar in a way to them. I interpret this in terms of my brother being more comfortable with male strangers around his height.

Physiologically, it is found that the ventro-Medial Prefrontal Cortex (v-MPFC) and Medial Prefrontal Cortex is implicated in self awareness. Neuro-typicals, when confronted with self-reflective questions will have higher activity in the v-MPFC and MCC, whereas in ASD the results are atypical. Additionally, Lombardo (2009) found that in a mentalising context, ASD individuals with higher self-awareness were less socially impaired and vice versa for ASD individuals with lower self-awareness.

As I am unable to mind-read, there is just absolutely no possibility of me ever understanding what goes on my dear brother’s head, whilst he cackles to himself drawing toilet bowls. Repetitively.  Have a look below at Christopher’s masterpiece! You can download it as wallpaper for free. I did! ❤


Artist: Christopher.

Read Baron-Cohen and Lombardo’s paper here


Autistic symptoms may not be culturally ubiquitous

Having lived in both Singapore and England, it’s hard not to notice how different people in both countries are when it comes to personality and work ethic. Growing up in an Asian country, Maths and Science were the more important subjects to learn while Art and Drama remained nearly irrelevant in our development. Their curriculum is more memory and exam based while western curriculum concentrates on building character and imagination. Both types of curriculum definitely have their benefits and neither are better than the other.

However, one of the things I found difficult coping with when I was younger and when I moved to England for University was socialising. It could be due to my schooling , or partly due to being a sibling of one with ASD, who knows, but I definitely had found it hard to communicate with others at first, especially with a more open atmosphere, where everyone was encouraged to socialise more at university. Eventually, perhaps because of the environment I was in, I learned to socialise better and come out of my quiet personality. This is because, being a neurotypical, I suppose I am able to adapt.

My experience of both curricula has led me to wonder how differences in culture can affect the diagnosis of ASD, so I googled it-

Freeth and colleagues (2013)1 found that Indian and Malaysian students had higher Autism Spectrum Quotient (AQ) scores compared to UK students. They suggested that particular questions in the AQ are interpreted differently. From these results it seems that people from Asian countries possess more ASD traits than western populations. We must note though, these traits are valued in these societies, as they can be seen to have a focused  mindset on work.

It is culturally acceptable and polite for most Asian cultures to be more reserved. Also  certain numbers in Mandarin are a sign of good luck such as 8(八), while number 4(四)sounds like death(死)which is a bad omen. This makes them score higher on AQ questions such as “I usually notice car numbers and/or similar strings of information”.  (If you’re curious, you can take the test yourself by clicking the link at the bottom of this post).  This definitely implicates the idea that there could be more autistic traits in Asia, as it is merely down to cultural norms.

Unfortunately this opens more questions! Where do we draw the line at what really is an Autistic trait and what is just a typical personality trait? According to a global survey 2, the prevalence of ASD is much lower in eastern countries. The reasons are double-edged: over-diagnosis in the West and under-diagnosis in the East. In some areas in Asia, mental disorders are still taboo and people are reluctant to get their children diagnosed. I notice this happening in Singapore, especially when people directly stare at my brother in disgust.

In any case, current ideas of Autistic symptoms definitely lead me to the conclusion that the symptoms may not be universal around the world.


Link to AQ questionnaire



1) Freeth, M., Sheppard, E., Ramachandran, R., & Milne, E. (2013). A cross-cultural comparison of autistic traits in the UK, India and Malaysia. Journal of autism and developmental disorders, 43(11), 2569-2583.

2)  http://sfari.org/news-and-opinion/news/2011/researchers-track-down-autism-rates-across-the-globe