**3. Atypical development of self-related processes in ASD**

There is general consensus among developmental theorists [e.g. 10,11] that early interper‐ sonal communication is central to the establishment of the self in normal development. A large body of research literature indicates that early processes underlying self-other awareness are impaired or delayed in autism including gaze following, abnormal re‐ sponse to sound and deficits in attention [12], showing of objects, responding and orient‐ ing to own name [13], looking at other's faces [14], pretend play, protodeclarative pointing and gaze monitoring [15], empathy and imitation [16], joint-attention behaviour [17], affect and personal relatedness [18,19].

#### **3.1. Self recognition and awareness**

The ability to recognize one's own face in the mirror is considered a test for 'self-aware‐ ness'. Self-recognition as measured by mirror tests [20] in 18 months old children has been depicted as a developmental milestone in self-conception and described as the 'ach‐ ievement of a cognitive self' [21]. Not only is self recognition essential for developing a concept of self, and self-other differentiation, it is also a prerequisite for later developing theory of mind abilities, as a stable self concept is the basis for being able to read the mental states of others. Research data on self-recognition reveals that autistic children's responses to their mirror images are qualitatively different from those of normal children [22]. Children with ASD have deficits of self-awareness as measured by a self-recogni‐ tion test [23] they show little interest in their own mirror images and have been descri‐ bed as relatively 'face inexperienced' [24].

The prefrontal cortex, especially the Right Hemisphere (RH) plays a critical role in the recognition of one's own face [25] as evidenced by functional imaging studies. Face per‐ ception studies in individuals with ASD suggest abnormal functioning in the fusiform face area as well as amygdala, brain regions associated with the 'social brain' (e.g. 26,27] involving the RH.

#### **3.2. Self/other differentiation**

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

There is general consensus among developmental theorists [e.g. 10,11] that early interper‐ sonal communication is central to the establishment of the self in normal development. A large body of research literature indicates that early processes underlying self-other awareness are impaired or delayed in autism including gaze following, abnormal re‐ sponse to sound and deficits in attention [12], showing of objects, responding and orient‐ ing to own name [13], looking at other's faces [14], pretend play, protodeclarative pointing and gaze monitoring [15], empathy and imitation [16], joint-attention behaviour

The ability to recognize one's own face in the mirror is considered a test for 'self-aware‐ ness'. Self-recognition as measured by mirror tests [20] in 18 months old children has been depicted as a developmental milestone in self-conception and described as the 'ach‐ ievement of a cognitive self' [21]. Not only is self recognition essential for developing a concept of self, and self-other differentiation, it is also a prerequisite for later developing theory of mind abilities, as a stable self concept is the basis for being able to read the mental states of others. Research data on self-recognition reveals that autistic children's responses to their mirror images are qualitatively different from those of normal children [22]. Children with ASD have deficits of self-awareness as measured by a self-recogni‐ tion test [23] they show little interest in their own mirror images and have been descri‐

The prefrontal cortex, especially the Right Hemisphere (RH) plays a critical role in the recognition of one's own face [25] as evidenced by functional imaging studies. Face per‐ ception studies in individuals with ASD suggest abnormal functioning in the fusiform

of self-other relationship and the basis for understanding other minds.

**3. Atypical development of self-related processes in ASD**

[17], affect and personal relatedness [18,19].

750 Recent Advances in Autism Spectrum Disorders - Volume I

bed as relatively 'face inexperienced' [24].

**3.1. Self recognition and awareness**

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‐ tion of oneself and others.

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

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

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 or totally lack body awareness. Russell [41] suggested that the 'body schemas of persons with autism are poorly specified' resulting in an atypical experience of agency. A sense of agency is a central aspect of human self-consciousness and refers to the experience of oneself as the agent of ones actions. Based on his executive function account of impaired action monitoring Russell [42] put forward the hypothesis that individuals with autism are im‐ paired in distinguishing between self and others. In contrast, a recent study by Williams and Happè [43] suggests that individuals with ASD are aware of their agency as indicated by their ability to monitor their own actions.

rived from the Greek word 'autos' ('self') and since Kanner's time this focus on the self as atypical applies to all individuals with ASD. Extreme egocentricity was one of the diagnostic criteria for Asperger Syndrome proposed by Gillberg & Gillberg [68]. Frith and de Vigne‐ mont [69] suggest that there are differences to reading other minds depending on whether the other person can be understood using an 'egocentric' or an 'allocentric' standpoint. From an egocentric point of view other people are understood only relative to the self whereas from an allocentric stance the mental state of a person is independent from the self. These theorists suggest that individuals with ASD suffer from an imbalance between both point of views, 'they are unable to connect an egocentric to an allocentric stance and can only adopt extreme forms of either' [70]. This very detailed analysis of mindreading further illustrates the different and unique aspects of awareness of self and others in individuals with ASD.

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

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

753

Awareness that we are the same person across time, also defined as temporally extended self-awareness [71] is an essential part of one's self-concept. Although the results of two re‐ cent studies [72,73] indicate that individuals with ASD have undiminished temporally ex‐ tended self-awareness as assessed by the delayed self-recognition task, this task may not adequately measure self-awareness as suggested by Lind & Bowler [74]. Indirect evidence suggests that temporally extended self-awareness is impaired in ASD based on their prob‐ lems with theory of mind as well as some aspects of temporal cognition [75]. Alternative ex‐ planations are the autobiographic memory difficulties [76] and also the well-documented language impairments in ASD. Language is a medium with which we monitor ourselves

Conceptions about oneself and others develop from an early age and depend largely on the emergence of language. At around 18 months of age children start referring to themselves as 'I' and begin using the word 'you' for others, indicating a further development in their selfother awareness. According to Kircher and David [78] 'the symbolic presentation of the self in language is the personal pronoun I'. Language difficulties such as pronoun reversal, use of third person perspective, impoverished inner speech, and impaired narrative have a neg‐

There is substantial clinical and research evidence of impaired pragmatic language use in children with ASD as indicated by pronoun reversal errors ('I'/'me/'you') [79-82] reflecting general difficulties with their sense of self, as well as problems in self-other differentiation.

Peeters et al. [83] suggested that the reason children with autism sometimes communicate from a third-person perspective instead of a first- vis-à-vis second person perspective is that in contrast to typically developing children they possess a non-social basis of self-other cate‐ gorization. Use of a third person perspective also has consequences for attribution of mental states, and mentalizing ability in general. As argued by Northoff and Heinzel [84] a third person perspective is an indication of a fragmented image of self and other. Adults with

ative effect on mental processes and also restrict certain aspects of self-awareness.

**3.6. Self awareness across time**

**3.7. Language and awareness of self**

and it allows us to experience past, present and future [77].

Support for a dominant role of the right hemisphere in the above processes is substantial. The right posterior parietal lobe is generally associated with spatial and bodily awareness [44,45]. Activation of right inferior parietal lobe correlates with a sense of ownership in ac‐ tion execution [46]. Additional research evidence [47] based on transcranial magnetic stimu‐ lation (TMS) supports the significance of the right temporo-parietal junction in the maintenance of a coherent sense of one's body.

#### **3.4. Theory of mind, emotions and self-awareness**

An essential component of self-awareness is the ability to be aware of other minds. A multi‐ tude of studies have provided evidence that theory of mind is lacking or delayed in ASD, or develops differently than in neurotypicals [for a substantive review see 48]. Deficits in mind‐ reading may also affect the ability to reflect on one's own mental states [49] resulting in di‐ minished self-awareness. There is some evidence suggesting that the ability to think about one's own thoughts depends on the same cognitive and neural processes as mindreading [50]. Equally, emotions play an important role in self-awareness. The development of the ca‐ pacity to experience, communicate and regulate emotions is considered to be the most im‐ portant event in infancy [51]. One of the main characteristics of autism is lack of empathy and emotional engagement with others [52,53]. Children with autism have difficulties with interpreting emotions, are deficient in processing their own emotional experiences and pay little attention to emotional stimuli in general [e.g. 54-57]. Due to this inability to empathize and emotionally engage with others individuals with ASD are totally focussed on their own interests and concerns.

A network of structures important for theory of mind processing includes the superior tem‐ poral sulcus and the adjacent temporo-parietal junction, the temporal poles and the medial prefrontal cortex [58; see also 59 for a review). Research evidence implicated the RH in theo‐ ry of mind reasoning across various tasks [60, 61]. The neural substrates for emotions and empathy are complex [62] involving amygdala, ventral medial prefrontal cortex. Recent imaging studies point to an involvement of a 'mirror neuron circuit' for empathy [63,64].

#### **3.5. Egocentrism/Allocentrism**

In apparent contrast to the mentalizing impairment even among very high functioning indi‐ viduals with ASD is their often-documented increased sense of self or total focus on the self [65,66,67] that is also reflected in numerous biographical accounts. The term 'autism' is de‐ rived from the Greek word 'autos' ('self') and since Kanner's time this focus on the self as atypical applies to all individuals with ASD. Extreme egocentricity was one of the diagnostic criteria for Asperger Syndrome proposed by Gillberg & Gillberg [68]. Frith and de Vigne‐ mont [69] suggest that there are differences to reading other minds depending on whether the other person can be understood using an 'egocentric' or an 'allocentric' standpoint. From an egocentric point of view other people are understood only relative to the self whereas from an allocentric stance the mental state of a person is independent from the self. These theorists suggest that individuals with ASD suffer from an imbalance between both point of views, 'they are unable to connect an egocentric to an allocentric stance and can only adopt extreme forms of either' [70]. This very detailed analysis of mindreading further illustrates the different and unique aspects of awareness of self and others in individuals with ASD.

#### **3.6. Self awareness across time**

or totally lack body awareness. Russell [41] suggested that the 'body schemas of persons with autism are poorly specified' resulting in an atypical experience of agency. A sense of agency is a central aspect of human self-consciousness and refers to the experience of oneself as the agent of ones actions. Based on his executive function account of impaired action monitoring Russell [42] put forward the hypothesis that individuals with autism are im‐ paired in distinguishing between self and others. In contrast, a recent study by Williams and Happè [43] suggests that individuals with ASD are aware of their agency as indicated by

Support for a dominant role of the right hemisphere in the above processes is substantial. The right posterior parietal lobe is generally associated with spatial and bodily awareness [44,45]. Activation of right inferior parietal lobe correlates with a sense of ownership in ac‐ tion execution [46]. Additional research evidence [47] based on transcranial magnetic stimu‐ lation (TMS) supports the significance of the right temporo-parietal junction in the

An essential component of self-awareness is the ability to be aware of other minds. A multi‐ tude of studies have provided evidence that theory of mind is lacking or delayed in ASD, or develops differently than in neurotypicals [for a substantive review see 48]. Deficits in mind‐ reading may also affect the ability to reflect on one's own mental states [49] resulting in di‐ minished self-awareness. There is some evidence suggesting that the ability to think about one's own thoughts depends on the same cognitive and neural processes as mindreading [50]. Equally, emotions play an important role in self-awareness. The development of the ca‐ pacity to experience, communicate and regulate emotions is considered to be the most im‐ portant event in infancy [51]. One of the main characteristics of autism is lack of empathy and emotional engagement with others [52,53]. Children with autism have difficulties with interpreting emotions, are deficient in processing their own emotional experiences and pay little attention to emotional stimuli in general [e.g. 54-57]. Due to this inability to empathize and emotionally engage with others individuals with ASD are totally focussed on their own

A network of structures important for theory of mind processing includes the superior tem‐ poral sulcus and the adjacent temporo-parietal junction, the temporal poles and the medial prefrontal cortex [58; see also 59 for a review). Research evidence implicated the RH in theo‐ ry of mind reasoning across various tasks [60, 61]. The neural substrates for emotions and empathy are complex [62] involving amygdala, ventral medial prefrontal cortex. Recent imaging studies point to an involvement of a 'mirror neuron circuit' for empathy [63,64].

In apparent contrast to the mentalizing impairment even among very high functioning indi‐ viduals with ASD is their often-documented increased sense of self or total focus on the self [65,66,67] that is also reflected in numerous biographical accounts. The term 'autism' is de‐

their ability to monitor their own actions.

752 Recent Advances in Autism Spectrum Disorders - Volume I

maintenance of a coherent sense of one's body.

interests and concerns.

**3.5. Egocentrism/Allocentrism**

**3.4. Theory of mind, emotions and self-awareness**

Awareness that we are the same person across time, also defined as temporally extended self-awareness [71] is an essential part of one's self-concept. Although the results of two re‐ cent studies [72,73] indicate that individuals with ASD have undiminished temporally ex‐ tended self-awareness as assessed by the delayed self-recognition task, this task may not adequately measure self-awareness as suggested by Lind & Bowler [74]. Indirect evidence suggests that temporally extended self-awareness is impaired in ASD based on their prob‐ lems with theory of mind as well as some aspects of temporal cognition [75]. Alternative ex‐ planations are the autobiographic memory difficulties [76] and also the well-documented language impairments in ASD. Language is a medium with which we monitor ourselves and it allows us to experience past, present and future [77].

#### **3.7. Language and awareness of self**

Conceptions about oneself and others develop from an early age and depend largely on the emergence of language. At around 18 months of age children start referring to themselves as 'I' and begin using the word 'you' for others, indicating a further development in their selfother awareness. According to Kircher and David [78] 'the symbolic presentation of the self in language is the personal pronoun I'. Language difficulties such as pronoun reversal, use of third person perspective, impoverished inner speech, and impaired narrative have a neg‐ ative effect on mental processes and also restrict certain aspects of self-awareness.

There is substantial clinical and research evidence of impaired pragmatic language use in children with ASD as indicated by pronoun reversal errors ('I'/'me/'you') [79-82] reflecting general difficulties with their sense of self, as well as problems in self-other differentiation.

Peeters et al. [83] suggested that the reason children with autism sometimes communicate from a third-person perspective instead of a first- vis-à-vis second person perspective is that in contrast to typically developing children they possess a non-social basis of self-other cate‐ gorization. Use of a third person perspective also has consequences for attribution of mental states, and mentalizing ability in general. As argued by Northoff and Heinzel [84] a third person perspective is an indication of a fragmented image of self and other. Adults with ASD also appear to have difficulties with first person pronoun usage [85]. Of particular in‐ terest might be the fact, that Hans Asperger often used to refer to himself from a third per‐ son perspective [86].

The prevailing view is that episodic memory is created in the neocortex and subsequently stored in the medial-temporal lobes and after a time becomes independent and is distribut‐ ed in neocortical networks [104]. Whereas the left temporal lobe is dominant for the acquisi‐ tion of new verbal information, episodic information involves mainly the right fontal lobes [105, 106]. Neuroimaging studies provide evidence for right frontal involvement in the proc‐ essing of autobiographic memories [e.g. 107]. The RH is especially important for memories

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

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

755

Many theorists [e.g. 108, 109] have highlighted the importance of the narrative self and ar‐ gued that the autobiographical self is a similar construct as the narrative self. Individuals create their own identity by constructing autobiographical narratives or life stories [110]. The benefits of a personal or narrative self are significant; a narrative mediates self-under‐ standing and creates coherence out of life's experiences. Narrative emerges early in develop‐ ment and narrative and self are inseparable [111]. The creation of a narrative self depends on various cognitive capacities, including working memory, self-awareness, episodic memory and reflective metacognition, a sense of agency, the ability to attribute action to oneself to‐ gether with a capacity for temporal integration of events, a fully functioning pronoun sys‐ tem, an ability to differentiate between self and non-self as well as a sense of one's own body

The mechanisms responsible for each of the above dimensions are impaired in autism and as a consequence individuals with ASD have great difficulties in constructing a self-narra‐ tive. If autobiographical material cannot be provided, the narrative is disoriented and con‐ fused and in many cases is no narrative at all but only confabulation [113], which is often the case in autism. As a result, the narrative of individuals with ASD, and the self that is repre‐ sented in this narrative, is quite vague and not representing the true self. Research evidence

Language and symbolic functions are localized in the left hemisphere, whereas narrative abilities are considered to be a function of the right hemisphere. There is a significant evi‐ dence for RH contribution to social language and many of the functions associated with au‐ tobiographic memory specifically those with emotional contents. In addition, narrative organisation depends on coordination of activity among various brain regions [117] and as suggested by Belmonte [118] malfunction in neural connectivity may be the underlying

To summarize, there is substantial evidence that the main components of self-awareness in‐ cluding self recognition, self-other differentiation, body awareness, theory of mind, inter‐ subjectivity, emotion processing, language (pronoun reversal, inner speech, third person perspective), autobiographical memory and narrative self are impaired in ASD. Our review of neural substrates underlying these processes has highlighted the significance of the Right

confirms deficits in narrative abilities in individuals with ASD [114-116].

with emotional contents.

that is based on proprioceptive-motor processes [112].

problem with autistic narrative.

Hemisphere.

**3.9. The narrative self**

A fundamental role in self-awareness is attributed to inner speech [87] that is impaired in ASD [88]. When asked about the nature of their thoughts, a group of adults with Asperger syndrome reported mainly images and actions as their only inner experience and made no reference to inner speech or emotions [89]. Many individuals with ASD are visual thinkers and rely heavily on visualization to process information [90].

A recent fMRI study [91] provided evidence of underintegration of language and imag‐ ing in autism by showing that individuals with ASD are more reliant on visualization to support language comprehension. These authors suggest that cortical underconnectivity is the reason for the lack of synchronization between linguistic and imaginal processing in autism. Supporting these findings are the results of an imaging study on daydream‐ ing [92] indicating that autistic individuals do not 'daydream' about themselves or other people. This study also points to a link between daydreaming and the construction of self and self-awareness.

In summary, language is of fundamental significance to self-awareness and necessary for forming a clear identity of self and others. Another important dimension in the formation of the self that is also dependent on language is autobiographical memory as well as the con‐ struct of a narrative self.

#### **3.8. Autobiographical memory**

Many influential theorists [93,94] associate the development of self with the emergence of autobiographical or episodic memory. The components necessary for a fully functioning autobiographical memory are a basic memory system, spoken or signed language, under‐ standing and production of narrative, temporal understanding, self-awareness and theory of mind [95]. Autobiographical memory not only depends on these cognitive constructs but is also specifically concerned with events that have specific meaning to the individu‐ al. This personal significance evolves through emotions and motivations that are con‐ structed in interaction with others. Autobiographical disturbances can arise from combined deficits in the realms of memory, emotion and self-related processing which are intricately connected, both behaviourally and neurologically [96].

The majority of components that make up an autobiographic memory system are im‐ paired in autism. There is significant evidence that individuals with ASD have circum‐ scribed episodic memory impairments, e.g. they have an impaired recall for personally experienced events [97-101]. As suggested by Millward et al [102] individuals with ASD remember real-life episodes less well than other people because they have no 'experienc‐ ing self'. Wheeler et al [103] in their investigation of episodic memory in autism conclud‐ ed that remembering of personal events requires the 'highest form of consciousness, autonoetic consciousness (self-knowing), which is dependent of self-awareness'.

The prevailing view is that episodic memory is created in the neocortex and subsequently stored in the medial-temporal lobes and after a time becomes independent and is distribut‐ ed in neocortical networks [104]. Whereas the left temporal lobe is dominant for the acquisi‐ tion of new verbal information, episodic information involves mainly the right fontal lobes [105, 106]. Neuroimaging studies provide evidence for right frontal involvement in the proc‐ essing of autobiographic memories [e.g. 107]. The RH is especially important for memories with emotional contents.

#### **3.9. The narrative self**

ASD also appear to have difficulties with first person pronoun usage [85]. Of particular in‐ terest might be the fact, that Hans Asperger often used to refer to himself from a third per‐

A fundamental role in self-awareness is attributed to inner speech [87] that is impaired in ASD [88]. When asked about the nature of their thoughts, a group of adults with Asperger syndrome reported mainly images and actions as their only inner experience and made no reference to inner speech or emotions [89]. Many individuals with ASD are visual thinkers

A recent fMRI study [91] provided evidence of underintegration of language and imag‐ ing in autism by showing that individuals with ASD are more reliant on visualization to support language comprehension. These authors suggest that cortical underconnectivity is the reason for the lack of synchronization between linguistic and imaginal processing in autism. Supporting these findings are the results of an imaging study on daydream‐ ing [92] indicating that autistic individuals do not 'daydream' about themselves or other people. This study also points to a link between daydreaming and the construction of self

In summary, language is of fundamental significance to self-awareness and necessary for forming a clear identity of self and others. Another important dimension in the formation of the self that is also dependent on language is autobiographical memory as well as the con‐

Many influential theorists [93,94] associate the development of self with the emergence of autobiographical or episodic memory. The components necessary for a fully functioning autobiographical memory are a basic memory system, spoken or signed language, under‐ standing and production of narrative, temporal understanding, self-awareness and theory of mind [95]. Autobiographical memory not only depends on these cognitive constructs but is also specifically concerned with events that have specific meaning to the individu‐ al. This personal significance evolves through emotions and motivations that are con‐ structed in interaction with others. Autobiographical disturbances can arise from combined deficits in the realms of memory, emotion and self-related processing which

The majority of components that make up an autobiographic memory system are im‐ paired in autism. There is significant evidence that individuals with ASD have circum‐ scribed episodic memory impairments, e.g. they have an impaired recall for personally experienced events [97-101]. As suggested by Millward et al [102] individuals with ASD remember real-life episodes less well than other people because they have no 'experienc‐ ing self'. Wheeler et al [103] in their investigation of episodic memory in autism conclud‐ ed that remembering of personal events requires the 'highest form of consciousness,

autonoetic consciousness (self-knowing), which is dependent of self-awareness'.

are intricately connected, both behaviourally and neurologically [96].

and rely heavily on visualization to process information [90].

son perspective [86].

754 Recent Advances in Autism Spectrum Disorders - Volume I

and self-awareness.

struct of a narrative self.

**3.8. Autobiographical memory**

Many theorists [e.g. 108, 109] have highlighted the importance of the narrative self and ar‐ gued that the autobiographical self is a similar construct as the narrative self. Individuals create their own identity by constructing autobiographical narratives or life stories [110]. The benefits of a personal or narrative self are significant; a narrative mediates self-under‐ standing and creates coherence out of life's experiences. Narrative emerges early in develop‐ ment and narrative and self are inseparable [111]. The creation of a narrative self depends on various cognitive capacities, including working memory, self-awareness, episodic memory and reflective metacognition, a sense of agency, the ability to attribute action to oneself to‐ gether with a capacity for temporal integration of events, a fully functioning pronoun sys‐ tem, an ability to differentiate between self and non-self as well as a sense of one's own body that is based on proprioceptive-motor processes [112].

The mechanisms responsible for each of the above dimensions are impaired in autism and as a consequence individuals with ASD have great difficulties in constructing a self-narra‐ tive. If autobiographical material cannot be provided, the narrative is disoriented and con‐ fused and in many cases is no narrative at all but only confabulation [113], which is often the case in autism. As a result, the narrative of individuals with ASD, and the self that is repre‐ sented in this narrative, is quite vague and not representing the true self. Research evidence confirms deficits in narrative abilities in individuals with ASD [114-116].

Language and symbolic functions are localized in the left hemisphere, whereas narrative abilities are considered to be a function of the right hemisphere. There is a significant evi‐ dence for RH contribution to social language and many of the functions associated with au‐ tobiographic memory specifically those with emotional contents. In addition, narrative organisation depends on coordination of activity among various brain regions [117] and as suggested by Belmonte [118] malfunction in neural connectivity may be the underlying problem with autistic narrative.

To summarize, there is substantial evidence that the main components of self-awareness in‐ cluding self recognition, self-other differentiation, body awareness, theory of mind, inter‐ subjectivity, emotion processing, language (pronoun reversal, inner speech, third person perspective), autobiographical memory and narrative self are impaired in ASD. Our review of neural substrates underlying these processes has highlighted the significance of the Right Hemisphere.
