The Double Interview Task: Assessing the Social Communication of Children with Asperger Syndrome

Qualitative Differences

The abstract nature of a social communication disability can only be partly captured quantitatively. The overall quality of the interviews of children with Asperger Syndrome provided a better insight into their difficulties involving social cognition. However, there was a great deal of variance in the kinds of errors made within the interviews of children with Asperger Syndrome. For example, there was variance in the number of errors that children with Asperger Syndrome made during the interview task. While conducting the interviews, some children with Asperger Syndrome's performance on the interview task appeared qualitatively different than their peers who are developing typically while in other children with Asperger Syndrome differences in were difficult to distinguish. There was also a range of performance in children with Asperger Syndrome in the types of errors that were made. For example, the performance of children whose errors were comprised mainly of shallow questions may appear more similar to the performance of children who are developing typically than a child whose errors were in diverting the topic of conversation back to themselves or their own interests. By diverting the topic back to themselves and only taking about their own experiences, the communicative exchange became one-sided and the natural reciprocity of conversation was lost. This supports the understanding that there is a spectrum of theory of mind/perspective taking deficits (Sigman, Yirmiya & Capps, 1995; Yirmiya, Erel, Shaked, Solomonica-Levi, 1998) and that the difficulties that these children have in social communication are uniquely different in each child. The Double Interview Task (Winner, 2002) can be used to assess how an individual functions on the perspective-taking spectrum based on the individual and their unique difficulties.

Winner (2002) reports that the double interview task explores an individuals' overall ability to:

Shift perspective taking away from thinking about themselves to thinking about others.

Organize their thoughts into language that moves in a purposeful direction toward someone else's area of interest.

Formulate questions and follow up with more specific questions to explore another person's interest (p. 187).

Results show that the Double Interview Task does indeed explore these areas. Differences in the quality of the interviews conducted were shown between children with Asperger Syndrome and children developing typically in the areas of difficulty formulating questions, asking shallow questions, personal interest, diverting the topic back to themselves, repeating a question already asked, revisions, and the need to be redirected. Most likely a combination of deficits in theory of mind (Baron-Cohen, Leslie and Frith, 1985), central coherence (Frith, 1989) and executive function (McEvoy, Rogers, and Pennington, 1993) explain these differences. There appears to be a positive relationship between an individual's theory of mind deficit and their corresponding deficit in central coherence and executive function (Winner, 2002).

A deficit in theory of mind (Baron-Cohen, Leslie, and Frith, 1985) prevents the child from taking the perspective of the person they are interviewing. Impairments in theory of mind are a major feature of this social and communicative deficit (Silliman et. al, 2003). It may be impossible to determine to what degree theory of mind deficits contribute to these difficulties, but a deficit in this area could contribute to all of the difficulties present during the Double Interview Task for children with Asperger Syndrome. A deficit in theory of mind would most likely lead to difficulty formulating questions due to being unable to consider another's perspective. An individual may then divert the topic back to themself, repeat a question already asked of them, or ask a question formulated from their own personal interest.

A lack of ability to organize thoughts as to what to ask the interviewee, or difficulty formulating language in order to ask the interviewee questions could be explained by Central Coherence Theory (Frith, 1989). These children may have difficulty organizing the factual information they are gaining from the examiner into a coherent whole. This lack of ability to organize information into a coherent whole could lead to many false-starts or revisions while asking a question, as if the child is unsure of what direction to go in with the question, shallow questions with no further follow-up questions, and repeated questions that the examiner has already asked the child.

Difficulty organizing thoughts and formulating language to ask the interviewee questions may also be explained by a deficit in executive function (McEvoy, Rogers, and Pennington, 1993). Individuals who have a deficit in executive function often have difficulty planning, conducting an organized search, and flexibility of thought (Ozonoff, Pennington, and Rogers, 1991). They may have difficulty planning for the end result, such as planning which direction to take when asking a question. This difficulty was evident in the number and quality of the revisions used by participants with Asperger Syndrome. Difficulty conducting an organized search and a lack of flexibility in thought could have contributed to the effort that was needed to formulate a question. See appendix G for all questions asked by both groups of participants.

The overall quality of the interviews of children with Asperger Syndrome may be best explained by a deficit in perspective taking. A difficulty assuming another person's perspective and understanding his or her thoughts and feelings (Santrock, 1999) most likely contributes to each of the difficulties shown by children with Asperger Syndrome on the Double Interview Task. If the development of perspective taking does indeed follow a developmental progression (Selman, 1980), it may be that these children are somewhere in the "egocentric viewpoint" of perspective taking. In this stage, the child is able to differentiate between himself and others, but is not able to distinguish between the social perspective (thoughts and feelings) of others and himself (Selman, 1980). This difficulty could account for the difference between groups in diverting the topic back to themselves or their own experiences. Children with a deficit in perspective taking, or at the "egocentric viewpoint" stage of perspective taking would have difficulty understanding that others might not be interested in what they think, or even that others may be thinking something other than what they themselves are thinking. This may explain why the children with Asperger Syndrome talked more than the group developing typically, but overall asked the researcher fewer and qualitatively poorer questions. The Double Interview Task can be used not only to indicate a difficulty in perspective taking, but also to better understand what degree of difficulty an individual with Asperger Syndrome has with perspective taking. This task can also be used to establish a baseline and then measure improvement in perspective taking after receiving services.

Formulating Questions

Children with Asperger Syndrome had more trouble formulating questions to ask the examiner than the children who were typically developing. Overall, it appeared that children with Asperger Syndrome often paused for a longer period of time than the children developing typically and these pauses often appeared more awkward in nature. For example, one child with Asperger Syndrome paused for approximately eight seconds, looking up at the examiner several times and smiling nervously. A child developing typically paused for three seconds and then asked a question without an error. Both of these behaviors were coded as having difficulty formulating questions based on the pause time. Although both of these children appeared to have some difficulty in formulating a question, the child with Asperger Syndrome appeared to be struggling more with the developing a question to ask the examiner.

Revisions

Both children with Asperger Syndrome and children developing typically made revisions while asking interview questions, but overall, the participants with Asperger Syndrome made more revisions. Often times participants with Asperger Syndrome had more false starts and self-interruptions within one question than children who were typically developing. Consider the following two examples. A participant who did not have Asperger Syndrome asked this question:

"(Um, do you have a favorite), (d*) where do you guys hang out, your friends?"

A participant with Asperger Syndrome asked the following question:

"(And why do you) (why are these) (why d* yo*) (why d*) (what ho*) what are your hobbies?" Although these questions were both coded as revisions, the participant with Asperger Syndrome clearly had a more difficult time formulating the question that did the participant developing typically. The participant with Asperger Syndrome used a number of false-starts and the question seemed to lead in several different directions before "what are your hobbies" was formulated.

Shallow Questions

Both groups of participants averaged a high number of shallow questions, however, qualitatively these questions looked different between the two groups of participants. Shallow questions were close-ended in nature and did not solicit deeper information about the researcher with follow-up questions. See Table 11 for examples of shallow questions asked by participants developing typically and participants with Asperger Syndrome.

Table 13

Examples of Shallow Questions

Participants Developing Typically Participants with Asperger Syndrome
Where were you born? Are you a vegetarian?
Do you hang out with your friends a lot? Where is the nearest intersection?
How long did you go to school? When do you ever go out to eat treats?
What's your favorite book? What's your phone number?
Where do you live? How do you take these pictures of your family, your best friend, and your friends?


Although both sets of questions were coded as a shallow questions, it appears as if the shallow questions asked by participants with Asperger Syndrome lacked taking the examiners perspective. These questions were all asked without any discussion before or after the question about the topic of the question. The following is a sample of an interview being conducted by the participant with Asperger Syndrome as C and the examiner as E.

C Do you like working with children?

E I do.

E That's a great question, it's something I like to do.

C (Do do you like), (are) are you vegetarian?

E Am I a vegetarian, no I am not.

C Who are the best friends that you always like to play with?

"Do you like working with children" didn't appear to lack perspective taking, however "Are you a vegetarian?" appeared to lack perspective taking. "Who are the best friends that you always like to play with?" could arguably be a lack of perspective since older people don't typically "play" with friends.

Based on the idea that there are different stages in the development of perspective taking which extend into adolescence, (Selman, 1980; Steele, Joseph, Tager-Flusberg, 2003) it may be that by the time these participants reach adolescence, participants who are developing typically may ask fewer shallow questions based on a more developed perspective taking ability. At that time, the quality of the questions asked may show a more pronounced difference. It has been reported that overall deficits in social communication become more apparent over time (DSM-IV-PR; American Psychiatric Association, 2000).

Diverted Topic. The largest difference in quality of questions between the two groups was in the number of times a participant diverted the topic back to their own experience or interest, making comments about themselves instead of asking a question about the researcher. Consider the following example of diverted topic in an interview conducted by a participant with Asperger Syndrome.

C You mean that you're already graduated from college?

E Um hum.

C Cool.

E I finished college and then I went to graduate school, which is two years after college.

C Oh, cool.

E Yeah.

E I'm about ready to graduate.

C I'm four, guess what.

E What's that?

C I'm four feet by ten, one day when I was at the YMCA indoor pool I touched ten feet.

E Oh you did.

C Yeah.

E Wow.

C Yeah.

E You've come up with some good questions.

C Thanks and my ears didn't pop like mom said they would, okay maybe they popped a little bit.

E Yeah.

E Can you think of anything any other questions you have for me?

C What's your birthday?

This particular participant diverted the topic back to her own experiences or interests six times during the course of the interview. Participants with Asperger Syndrome diverted the topic as many as twelve times compared to diverting the topic two times in interviews conducted by participants who are developing typically. The large difference in the tendency to divert the topic back to themselves between groups highlights the difficulty that individuals with Asperger have in taking another persons perspective.

Redirected. Participants with Asperger Syndrome needed to be redirected more often than participants who are typically developing. A participant was redirected after pauses longer than three seconds or to bring the individual's focus back to asking questions. In the previous example, the examiner redirected the participant by saying "Can you think of anything any other questions you have for me?" after she had diverted the topic of conversation to her own experiences. The higher number of redirections in the participants with Asperger Syndrome is due to the fact that they had a more difficult time formulating questions and a much higher occurrence of diverting the topic back to their own experiences or interests, so they needed to be redirected back to the task of asking questions more times than the children developing typically.

Overall Quality. The error codes used in this study did not account for all of the qualitative differences between these two groups. Some of the questions asked by participants with Asperger Syndrome appeared atypical, but did not fit any of the error code categories. Most of these qualitatively different questions appeared to lack perspective taking.

Often times, after a question such as these, the children with Asperger Syndrome would then divert the topic back to themselves as if the questions were formulated from their own interest instead of from the examiner's perspective. Consider the following examples. Each of the following questions appeared to be created from the child's own personal interest and experiences.

E Can you think of anything else you'd like to know about me?

C How many teeth have you lost?

E I've lost all of my teeth.

C Yeah.

E Since I have all permanent teeth.

C Like Marie.

E Is that your friend?

C Yeah.

E Okay.

C I think she's lost all her (per*) too.

C I still have a few more to lose.

E Oh okay.

C And once her tooth fell out at my house.

E Oh really.

C Yeah, it was summer.

E I see.

E So can you think of anything else?

C No.

This participant with Asperger Syndrome was redirected at the beginning of this example, asked a question that appeared to lack taking the perspective of the examiner, and then diverted the topic back to her own experiences. A similar interaction is seen in the following example from an interview conducted by a participant with Asperger Syndrome.

C (Do you) what's your oldest memory?

E It was a really long time ago, I think I was five when I was having a birthday party and I was sitting in a swing set out in my back yard.

C Um hum.

E And all of a sudden I felt something splash on my head, and a bird had gone to the bathroom on my head in my hair.

C Cool.

E I was not very happy.

E I was pretty upset.

C Yeah.

C You know what one of my oldest memories is

E What's that?

C I can remember one Christmas when I was really really young and I had wrapped something from little people.

E Oh okay.

C So.

C I think it was the school bus that we have downstairs.

Compare the previous examples with the following example from an interview conducted by a participant who is typically developing. It could be argued that "Have you been to Disney World" is a question from his own personal interest, however, this participant did not divert the topic back to himself and asked the examiner several questions regarding her experience in Disney World.

C Where were you born?

E I was born in Illinois.

E Hinsdalle, Illinois.

C I was born in Florida.

E Oh, okay.

C Have you ever been to Disney World?

E I have.

E I went when my brother was six, no he was a baby, I guess I was six.

E And then we were supposed to go again when he was six and I was eleven.

E But then he got sick and we couldn't go.

E I was really mad.

C Why were you mad?

E I was mad because I thought it was his fault we didn't get to go to Disney World.

E Because he was sick.

C Hum.

C How did he get sick?

E He has asthma, and I think his asthma was really acting up.

Although the error codes used in this study captured differences between the two groups, it is important to consider all of the qualitative differences between them in order to have a more complete picture of the difficulties children with Asperger Syndrome have in everyday communication.