User:Kiley Fagan/Monotropism Sandbox

Monotropism, a typical feature of autism, is when an individual has a restricted range of interests and can only pay attention to what is in his or her attention tunnel. This hypothesis was developed by Dinah, Lesser, and Murray and was published in 2005. Monotropic individuals tend to become too focused on a certain object or activity and find difficulty in shifting their attention, whereas a polytropic individual is capable of spreading his or her attention to multiple things at one time. Monotropic individuals often display stereotypies which occur because the individual focuses his or her attention on one thing, and repeats it until the attention moves. It is also related to monoprocessing, which is defined as the ability to only process information from one source at a time. This is a way to cope with their hypersensitivity to sensory information.

Wendy Lawson, an adult with Asperger Syndrome, states that some of her difficulties include “…change in routine, expectation, instruction, daily schedule, movement of attention, and even incorporating another channel into the present scenario.” They also tend to be more satisfied with commands that are implemented immediately rather than commands involving planning ahead and therefore it is often hard for these individuals to understand language that is referencing future actions. Wendy Lawson also states that monotropic individuals think in “closed pictures”, meaning they take pictures literally. For example, they may not be able to associate a cartoon animal with the same animal in real life.

Neurobiology
Individuals with monotropism have problems sustaining performance because of attention regulation dysfunction, meaning that something is wrong with their behavioral control system. Children with monotropism generally perform poorly at tasks involving executive function, attention, processing speed, and motor coordination. It has been found that children with autism have significantly lower reading scores than normal children and both children with autism and children with attention deficit hyperactivity disorder (ADHD) perform poorly in attention tasks as compared to a non-disabled child. Children with autism and ADHD also performed significantly worse in tasks pertaining to reading, attention, graphomotor skills, and processing speed. Neuropsychological functioning is similar in children with high-functioning autism and ADHD.

A defining characteristic of individuals with monotropism is that they have problems involving shifting, keeping, and engaging attention. Multiple studies have suggested that cerebellar abnormalities could correlate with these trends, and that in these individuals the cerebellum must work harder than normal to achieve tasks. The prefrontal areas have been known to have greater excitation in the brains of these children as well. The amount of attention available is limited, so cognitive processes are forced to compete. Tasks that require a broad attention span include social interaction, language, and shifting attention, therefore monotropic individuals have problems with all of these. They struggle with top down processing and do not react well to unanticipated change. Sometimes the individuals deregulation of thought turns into a psychotic disorder.

The fusiform gyrus is known to be activated by human faces and has been found to be hypoactive in autistic children, however this is not the only disorder in which this is the case. Eye gaze is also known to activate the superior temporal gyrus, which is less active in monotropic children with autism. These children often cannot imitate or comprehend gestures. However, some have hyperactive olfactory pathways and are able to identify people by their smell. Dysfunctional neural circuits are characteristic of autism Some regions under investigation to be a potential source of autism include the frontal lobes, temporal lobes, insula, limbic system, corpus callosum, thalamus, brainstem, and cerebellum, and therefore these areas could be related to monotropism.

Executive Functions
Typically, monotropic individuals have problems with cognitive processes that make up executive functioning, including planning, generativitiy, mental flexibility, and self-motivation. It has been shown that executive functioning is directly related to the frontal and prefrontal cortices and that dopamine influences many executive functions including attention, motor activity, social behavior, and perception of the outside world. Other disorders that show problems with executive functioning include Autism Spectrum Disorders, Attention Deficit Disorder, Bipolar Disorder, and Schizophrenia.

Specific memory related executive functioning problems that monotropic individuals typically display involve retrospective memory, prospective memory, and executing intentions. In particular, Williams, Boucher, Lind, and Jarroid have performed studies showing that children with autism spectrum disorders (ASD's) have particular problems with time based prospective memory whereas event based prospective memory seems to be normal. This could be because of problems with self-awareness and mentalizing ability, a characteristic of monotropism. They also are known to have problems with working memory, inhibition, sustained attention, and attentional flexibility.

Theory of Mind
Monotropic individuals usually have a deficit in Theory of Mind, which is defined as the ability to understand what other people feel and think. The main emotion associated with Theory of Mind that monotropic individuals lack is empathy. The majority fail at false belief tasks, however some people question whether this failure could be because of poor language processing or memory.

Signs and Symptoms
Monotropic individuals have trouble processing multiple things at once, particularly when it comes to multitasking while listening. Some have trouble taking notes in class while listening to a teacher, while others are so extreme that they cannot look at a person's face and comprehend what they are saying simultaneously. A common tendency is for individuals to avoid multiple sensory situations because of this hypersensitivity. Some common signs of a monotropic individual include:
 * Inability to infer and imply things from situations
 * Short attention spans
 * Difficulty multitasking
 * Inappropriate reactions to situations
 * Repetitive behaviors such as stereotypies or stimming
 * Obsession with parts of objects
 * No peer relationships
 * Social problems
 * Inability to share emotions, empathy
 * Delayed or no speech
 * Resistance to change
 * Inability to step into someone else’s shoes

In order for a child to be diagnosed with an ASD, he or she must exhibit a restricted and repetitive behavior (RRB). These behaviors arise due to the inability of the monotropic individual to shift attention and cause obsession with an object or ritual. An often symptom of ASD’s is a motor impairment, but that is not classified as a criteria for diagnosis. Lesser and Murray describe the mind of a monotropic individual to work much like that of a hunter, in which the person fully believes what is currently being seen, and suppresses knowledge learned previously. This mind is capable of suppressing pain and focusing attention on something else. It has the ability to develop great depth in an interest or skill rather than gaining breadth in an array of interests.

Behavioral Experiments
In a study by Crane, Pring, Ryder, and Hermelin, savants were testing along with typical individuals with ASD's in the Wisconsin Card Sorting Test, which is designed to test design fluency and set-shifting. This test showed that savants have better fluency and monitoring than typical individuals with ASD's, but performed at similar levels on tasks unrelated to the individual's specific ability.

It has been found that there is decreased cerebellar activity in autistic children in areas regarding shifting peripheral attention, performing attention tasks, and exploring tests. Regarding attention related events, parietal lobe activity and frontal lobe activity have been seen to decrease as well.

A study in which autistic adults were tested via Positron Emission Tomography (PET) while performing language tasks showed that activity in the left frontal area and dentate nucleus was lower in the control group during the listening tasks, but was higher during the motor task of repeating language. Sturm, Fermell, and Gilberg conducted a study that tested children with ASD’s, mostly Asperger’s, that had a normal to high Intelligence Quotient (IQ). They found that 99% of them had severe social interaction dysfunction, 75% had motor problems, and 94% had restricted interests.

Ravizza, Solomon, Ivry, and Carter tested the relationship between attention and motor deficits via a finger tapping task. They found that attention was not directly related to motor deficits and that there was also not a correlation of motor deficits and restricted interests. However, there was a direct correlation between motor deficits and stereotyped behaviors.

Treatment
Treatment for monotropic individuals currently is similar to treatment for autistic individuals. Mary Coleman in the book The Neurology of Autism, states "individualized, in-depth clinical and laboratory assessments and integrative parent-physician-scientist cooperation are the keys to a successful ASD management". Some typical management strategies include educational comprehensive programs, Applied Behavioral Analysis (ABA), speech and language therapy, Occupational Therapy, Sensory Integration Therapy, and psychopharmacology. To assist monotropic individuals in shifting their attention as well as understanding the emotions of others, Dinah, Lesser, and Murray propose that certain steps could be helpful. These include: Certain drugs have also proven to be effective to treat specific behaviors characteristic of monotropic individuals. When children with monotropism have quickly changing moods, self injure themselves, and are aggressive, the anti psychotic risperidone is often prescribed. Serotonin has been shown to decrease repetitive behaviors and neuroleptic drugs can be prescribed for antidepressant and stimulant needs.
 * Increasing connections with strangers through the child's interests.
 * Improve understanding in lacking areas
 * Make tasks more attainable by decreasing the number and complexity of them.
 * Make tasks and connections more meaningful.