**2. Review of studies investigating the self in ASD**

The question whether individuals with ASD have a different sense of self than people with‐ out ASD, i.e. 'neurotypicals' has fascinated researchers and clinicians for decades. Kanner [2] in 1943 already noted self-deficits in the children he described, including their difficulties in maintaining a constant self-concept, and associated problems of adapting their fragile

self-concept to changing environments. Asperger [3] (1974, p. 2026) refers to a disturbance and a weakness of the self in children with 'autistic psychopathy'. Psychoanalytic theories considered autism as a disorder of the self [4] based on the lack of ability in establishing sta‐ ble internal representations of themselves and of others. The German psychiatrist Lutz [5] (1968) interpreted autism as a disturbance of self-consciousness, self-related activities and self-perception. Powell and Jordan [6] (1993) suggested that individuals with ASD lack an 'experiencing self' that provides a personal dimension for ongoing events. This is consistent with Frith's [7] suggestion of an 'absent self' in autism. Hobson [8] put forward a develop‐ mental account of the self in autism emphasising impaired interpersonal relatedness, 'inter‐ subjectivity' and its far-reaching consequences for the development of the self. In a recent study investigating whether children with autism show abnormal self-other connectedness, Hobson and Meyer [9] found a failure in autism to identify with another person. These au‐ thors suggest that this process of identifying with others is crucial for a normal development of self-other relationship and the basis for understanding other minds.

face area as well as amygdala, brain regions associated with the 'social brain' (e.g. 26,27]

Atypical Sense of Self in Autism Spectrum Disorders: A Neuro-Cognitive Perspective

http://dx.doi.org/10.5772/53680

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The ability to differentiate between self and other is also essential for the development of self-awareness, which appears to be impaired in autism. In particular, the recognition of a separate existence of other people seems to be delayed in children with autism [28,29]. At‐ tentional abnormalities, such as 'tunnel vision', the tendency to think in a monotropic man‐ ner have been suggested by some as the cause of 'self-other problems' in ASD [30]. Donna Williams [31] interprets monoprocessing as the inability to process simultaneously informa‐

In neurotypicals the middle cingulate cortex and ventromedial prefrontal cortex are in‐ volved in self/other processing. In contrast, atypical neural responses have been reported in individuals with ASD. A recent fMRI study [32] investigating the attribution of behavioural outcomes to either oneself or others while playing an interactive trust game revealed a lack of brain activity in the cingulate cortex indicating diminished 'self responses' in individuals with ASD. However, 'other responses', attributing actions to other people were intact. Previ‐ ous research data using trust games [33] had demonstrated that cingulate cortex activation is consistent with self-response patterns generated during interpersonal exchanges. Chiu et al*.* [34] interpreted their data in terms of a deficit in ASD in monitoring their own intentions in social interactions and thus contributing to impaired theory of mind abilities, lack of in‐ trospection and self-referential processing. Of particular interest is the fact that the 'im‐ paired self-responses' in the ASD group correlated with their behavioural symptom severity, i.e. the lesser activity along cingulated cortex the more serious were their behaviou‐ ral symptoms. Similar results have been reported by Lombardo et al. [35] also demonstrat‐ ing atypical neural responses from the middle cingulate cortex during a self-referential processing task. This study also provided a link between these deficits and early social im‐ pairments in autism. In addition, these authors also demonstrated reduced functional con‐ nectivity between ventromedial prefrontal cortex and lower level regions (e.g. somatosensory cortex) in individuals with ASD during these self- representation tasks.

Previous studies identified the right inferior parietal lobe, along with frontopolar and soma‐ tosensory regions [36,37] as critical for distinguishing between self and other. Additional da‐ ta [e.g. 38] demonstrate that SI and SII cortices, which contribute to the mirror-neuron

Knowing oneself and knowing one's body are closely related concepts. In his review on body image and the self, Goldenberg [39] argues that the acquisition of body image is not innate but acquired through experiences of one's own and other bodies. Likewise, Jordan and Powell [40] believe that a body concept develops from interacting with others. Anecdo‐ tal reports indicate that some children and adults with autism have an insecure body image

system, are also crucial for preserving a sense of self.

**3.3. Body awareness, sense of agency**

involving the RH.

**3.2. Self/other differentiation**

tion of oneself and others.
