Amodal Bahrick PDF

Bahrick, L.E., & Todd, J.T. (2012).
Multisensory processing in autism spectrum disorders: Intersensory processing disturbance as a basis for atypical development.
In B. E. Stein (Ed.), The new handbook of multisensory processes (p. 657-674), Cambridge, MA: MIT Press.
36 Multisensory Processing in Autism

Spectrum Disorders: Intersensory
Processing Disturbance as a Basis for
Atypical Development
Lorraine E. Bahrick and James T. Todd
Autism spectrum disorder (ASD) is a neurodevelop- functioning, including reduced eye contact and atten-
mental disorder with symptom onset prior to age 3. tion to social partners, poor joint attention skills, little
Although there is great variability in symptom severity imitation, poor facial recognition, and altered emo-
and intellectual functioning, ASD is defined by a triad tional responsiveness (e.g., Dawson et al., 2004; Mundy,
of symptoms, including impairments in social function- 1995; Mundy & Burnette, 2005; Volkmar, Paul, Klin, &
ing and interaction, impairments in communication, Cohen, 2005). Children with ASD also show atypical
and restricted, repetitive, and stereotyped behaviors, patterns of attention and sensory processing. Com-
interests, and activities (DSM-IV-TR: American Psychiat- pared to typically developing (TD) children, children
ric Association, 2000). In this chapter we develop the with ASD are said to show sticky attention or overselectivity,
view that typical social and communicative functioning including impairments in disengaging attention from
rests on a foundation of intersensory/multisensory pro- competing stimulation to orient to new events (Landry
cessing skills that develop and emerge across the first 6 & Bryson, 2004; Rincover & Ducharme, 1987), particu-
months of life and are further refined across develop- larly to social events (Dawson, Meltzoff, Osterling,
ment (see also Bahrick, 2010). Intersensory processing Rinaldi, & Brown, 1998; Dawson et al., 2004; Swetten-
entails perception of unified and coordinated informa- ham et al., 1998). They also show heightened attention
tion across the senses, including visual, auditory, tactile, to detail relative to global information (see Brock,
and proprioceptive stimulation. Critical skills, such as Brown, Boucher, & Rippon, 2002; Frith & Happ, 1994;
social orienting and joint attention, which are found to Happ, 1999; Happ & Frith, 2006), enhanced visual
be impaired in autism, also rely on a foundation of search, and certain enhancements in visual and audi-
intersensory functioning (see also Mundy & Burnette, tory processing, including discrimination of surface
2005). Attention, perception, learning, and interacting properties such as pattern and feature information
with the social world of people, language, and meaning- (Mottron, Dawson, Soulires, Hubert, & Burack, 2006;
ful action depend on integrating dynamic, rapidly ORiordan, Plaisted, Driver, & Baron-Cohen, 2001).
changing auditory, visual, tactile, and proprioceptive However, this heightened or enhanced processing is
information from social and nonsocial events. Below we thought to reflect low-level perceptual processing of
briefly describe the typical development of these skills simple objects and events, and sensory impairments are
across infancy and their links to social and communica- evident as the complexity of the stimuli grows (Bertone,
tive functioning. We then examine evidence of intersen- Mottron, Jelenic, & Faubert, 2005; Minshew & Hobson,
sory skills and impairments in individuals with ASD. 2008). For example, the processing of faces is impaired
Finally, we evaluate intersensory processing disturbance (Dawson, Webb, & McPartland, 2005; see Schultz, 2005,
as a potential basis for explaining fundamental impair- for a review). How and when do these impairments in
ments in autism, including social and communicative attention, sensory processing, and social and communi-
functioning as well as stereotyped, repetitive cative functioning develop, and how are they interre-
behaviors. lated? Characterizing early behavioral markers and the
By 3 years of age, children with ASD show a variety nature of developmental cascades that lead to increas-
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of impairments in social and communicative ing symptom severity in ASD is currently a significant
SteinThe New Handbook of Multisensory Processes

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Bahrick, L.E., & Todd, J.T. (2012). Multisensory processing in autism spectrum disorders: Intersensory processing disturbance as a basis for atypical development.
challenge facing scientists and practitioners. It is crucial autism spectrum disorders. We propose that intersen-
for early detection of children at risk for developing sory processing, an even earlier-developing system, may
ASD, and early detection, in turn, is critical for develop- constitute another fundamental area of disturbance in
ing more effective interventions. autism and in turn would cause impairments to these
Accomplishing these goals relies on a clear and and other related skills critical to social and communi-
detailed understanding of the typical development of cative functioning.
attention and social and communicative functioning. A Recent findings provide evidence of increasingly
better understanding of what guides and constrains early onset of symptoms in ASD. Siblings of children
typical development will provide a basis for identifying with autism, who have a greater risk for developing
atypical developmental trajectories and generating test- ASD, show symptoms of the broad phenotype (symptoms
able hypotheses about their origins. Small differences that fall along the spectrum of behaviors associated with
in developmental timing can have large effects on autism) in the first year of life (Cassel et al., 2007;
developmental outcomes, as effects of early experience Dawson et al., 2002; Merin, Young, Ozonoff, & Rogers,
are amplified across developmental cascades (Bahrick, 2007), and findings of neurodevelopmental anomalies
2010; Knudsen, Heckman, Cameron, & Shonkoff, 2006; occur even in prenatal development (see Akshoomoff
Mundy & Burnette, 2005; Smith & Thelen, 2003; Turke- et al., 2002, for a review). It has thus become increas-
witz & Devenny, 1993). New skills are built on the foun- ingly clear that research efforts should focus on identi-
dation of prior input and skills, which in turn are fying impairments in fundamental skills that emerge
developed and regulated in bidirectional interaction and develop early, at least within the first year of life
with feedback from the social and physical environ- (Cassel et al., 2007; Ibanez, Messinger, Newell, Lambert,
ment. Understanding which skills and input are most & Sheskin, 2008; Rogers, 2009; Young, Merin, Rogers,
fundamental for regulating this delicate balance across & Ozonoff, 2009). Moreover, applying a developmental
development is critical to understanding atypical devel- perspective is critical to understanding developmental
opment (Karmiloff-Smith, 1998; Karmiloff-Smith & disorders. This focus can reveal critical links between
Thomas, 2003). impairments in social and communicative functioning
Consistent with this systems perspective, investigators and development of prior skills on which these capabili-
of autism generally agree that identifying precursors or ties rest.
areas of impairment that are primary and have the
potential to affect a wide range of later-developing Intersensory Perception in Typical
symptoms is critical to early diagnosis and intervention Development
(e.g., Landa, 2007; Sigman, Dijamco, Gratier, & Rozga,
2004; Zwaigenbaum et al., 2005). The symptoms of The world of objects and events provides a continuous
autism emerge and worsen across development, affect- flux of changing stimulation to all our senses concur-
ing an increasingly wide variety of areas, including rently. It provides far more stimulation than can be
social, communicative, and cognitive functioning, and attended or perceived at any given time. Adults are
associated neural development (Mundy & Burnette, adept at selectively attending to unitary multimodal
2005; Sigman et al., 2004; Volkmar, Lord, Bailey, Schultz, events that are relevant to their needs and goals (such
& Klin, 2004). Unfortunately, diagnosis is not typically as the face and voice of a person speaking) and ignor-
made until 1824 months or later, when significant ing information that is irrelevant. This presents a fun-
delays in social and communicative functioning are damental challenge for infants. How do naive perceivers
already well established (Akshoomoff, Pierce, & Cour- determine which sights and sounds constitute unitary
chesne, 2002; Dawson et al., 2002; Sigman et al., 2004; events and which are unrelated? How and when do they
Stone et al., 1999; Webb & Jones, 2009). Thus, identify- develop economical and efficient patterns of selective
ing fundamental early-developing skills that provide a attention to maximize detection of relevant informa-
foundation for social and communicative functioning tion and ignore the vast amount of irrelevant sensory
and establishing the extent to which they are impaired variation? An understanding of the nature and trajec-
or intact in young children with autism are central to tory of the typical development of attention and inter-
this effort. Accordingly, much research effort has sensory processing of social and nonsocial events is key
focused on disturbances in early attentional processes to understanding the nature, basis, and timing of atypi-
such as social orienting (Dawson et al., 1998, 2004) and cal development of attention and intersensory process-
joint attention (Leekam & Moore, 2001; Mundy, 1995; ing in children with autism.
Mundy & Burnette, 2005; Mundy, Sullivan, & Master- Research demonstrates that these skills emerge
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george, 2009), both of which are seen as hallmarks of rapidly across the first 6 months of life (see Bahrick,
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2010; Bahrick & Lickliter, 2002; Gibson, 1969; Gibson speaking. In this illusion, temporal synchrony overrides
& Pick, 2000; Kellman & Arterberry, 1998; Rochat, spatial incongruity, illustrating the powerful role of
1999). Infants establish increasingly efficient patterns temporal synchrony in unifying attention to audiovi-
of selectively attending to people, faces, voices, and the sual events. Sensitivity to amodal information can also
movements of objects. Across the first 6 months of life, act as a buffer against learning inappropriate associa-
they learn to follow gaze, detect contingencies, engage tions across the senses. When attending to a pattern of
in dyadic social interactions, and categorize objects and stimulation, such as the sounds of speech, concurrent
events in a manner consistent with adults (Flavell & but unrelated patterns, such as movements of nearby
Miller, 1998; Flom, Lee, & Muir, 2007; Harrist & Waugh, objects or people, are not attended because they typi-
2002; Moore, 2006; Mundy & Burnette, 2005; Rakison cally do not share the same temporal structure as the
& Oakes, 2003). What guides these remarkable devel- speech.
opmental achievements? Research has demonstrated Typically developing infants are adept at detecting
that one fundamental basis for organizing and guiding amodal information even in the first months of life
selective attention and perceptual development is the (Bahrick & Pickens, 1994; Lewkowicz, 2000; Walker-
detection of intersensory redundancy and amodal Andrews, 1997; see also Lewkowicz & Lickliter, 1994).
properties of stimulation (see Bahrick, 2010; Bahrick & They can perceive common temporal relations between
Lickliter, 2002; Lewkowicz, 2000). sights and sounds in both social and nonsocial events.
Amodal information is information that is not spe- By 2 months, infants detect face-voice synchrony during
cific to a particular sense modality but can be redun- speech (Dodd, 1979; Lewkowicz, 2010; Lewkowicz, Leo,
dantly specified across more than one sense (auditory, & Simion, 2010; Morrongiello, Fenwick, & Chance,
visual, tactile, proprioceptive). Amodal information 1998). A few months later they detect the spectral infor-
(e.g., synchrony, rhythm, tempo, intensity) includes mation common to the shape of the mouth and certain
changes along three basic dimensions of stimulation: speech sounds (Kuhl & Meltzoff, 1982; Kuhl, Williams,
time, space, and intensity (see Bahrick, 2009; Bahrick & Meltzoff, 1991) and perceive emotion common to
& Lickliter, 2002). Because all events occupy a particu- faces and voices (Flom & Bahrick, 2007; Walker-
lar spatial location, occur across time, and have a char- Andrews, 1997). Infants are highly sensitive to infant-
acteristic intensity pattern, virtually all events provide directed speech and prefer it over adult-directed speech
amodal information. For example, across the visual and (Cooper & Aslin, 1990; Fernald, 1985; see Soderstrom,
tactile modalities, shape, size, and texture are amodal 2007, for a review). This provides exaggerated temporal
and can be specified in either modality. Similarly, across patterning and intensity and pitch changes across the
auditory and visual stimulation, synchrony, rhythm, face and voice, magnifying amodal information. Infants
duration, tempo, intensity, and changing location can also engage in dyadic synchrony with a social partner,
be also be specified by multimodal stimulation. Changes timing their movements and vocalizations in a turn-
in these parameters of stimulation can also convey taking pattern with an adult partner (Jaffe, Beebe, Feld-
emotion (happy vs. sad vs. angry) as well as specify com- stein, Crown, & Jasnow, 2001; Tronick, 1989; see Harrist
municative intent (e.g., prosodic cues in speech for & Waugh, 2002, for a review). This highly intercoordi-
approval vs. prohibition). nated mutual exchange of sounds, touch, and move-
By detecting amodal information, perceivers attend ment is a foundation for communication and social
to unified, multimodal events rather than unrelated development (Bahrick, 2010; Jaffe et al., 2001; Rochat,
streams of auditory, visual, and tactile stimulation. For 1999; Tronick, 2007). Infant sensitivity to amodal infor-
example, if one detects the temporal synchrony, rhythm, mation in nonsocial events is equally impressive. Infants
and tempo common to a speakers face and voice, a can relate moving objects with their impact sounds on
unified eventthe person speakingis selectively the basis of temporal synchrony (Bahrick, 1983, 1987,
attended and perceived. Evidence indicates that amodal 1988; Lewkowicz, 1992, 1996), their common tempo of
information, particularly temporal synchrony, provides action (Bahrick, Flom, & Lickliter, 2002; Spelke, 1979),
the glue that binds information across the senses and rhythm (Bahrick & Lickliter, 2000; Mendelson &
organizes early perceptual development (Bahrick, 2010; Ferland, 1982), and collocation (Fenwick & Morrongi-
Bahrick & Lickliter, 2002; Lewkowicz, 2000). The ven- ello, 1998). They can also detect more fine-grained tem-
triloquism effect (Alais & Burr, 2004; Radeau & Bertel- poral information such as the temporal microstructure
son, 1977) takes advantage of this principle. By moving specifying the substance and composition of moving
the dummys mouth in synchrony with his speech objects (Bahrick, 1983, 1987, 1988, 1992). Thus, inter-
sounds, the ventriloquist creates a common amodal sensory processing skills develop rapidly across infancy, Q
pattern, giving the impression that the dummy is and by 6 months, infants detect and attend to amodal
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information across a wide range of social and nonsocial critical skills emerge from a foundation of detecting
events. amodal information made available by redundancy
Research has demonstrated that infants detect amodal across the senses.
information developmentally prior to other (modality- When the same amodal information (e.g., rhythm,
specific) properties of events and that perceptual pro- tempo, intensity) is concurrently and synchronously
cessing proceeds in order of increasing specificity, from available to multiple senses, this is termed intersensory
global to increasingly more specific information redundancy (Bahrick & Lickliter, 2000, 2002). Intersen-
(Bahrick, 2001; Gibson, 1969). For example, temporal sory redundancy has been found to be highly salient to
synchrony is detected prior to more specific information humans and animals alike, and this salience appears
about a particular object or event such as its color, shape, grounded in fundamental neural principles (see Calvert,
or pitch of the sound it makes (Bahrick, 1992, 1994, Spence, & Stein, 2004, for a review). Most importantly,
2001). This pattern of increasing specificity is a corner- intersensory redundancy promotes heightened neural
stone of perceptual development (Gibson, 1969). Early responsiveness as compared with the same information
detection of amodal information such as temporal syn- presented to each modality alone (Stein & Meredith,
chrony effectively functions as the gatekeeper to further 1993). The intersensory redundancy hypothesis (IRH)
perceptual processing, allowing general information (Bahrick & Lickliter, 2000, 2002), a model of early selec-
from unitary multimodal events to provide a coherent tive attention, provides a framework for understanding
framework for incorporating more specific detail. This how and under what conditions attention is allocated to
orderly progression, where amodal information leads different properties of stimulation (amodal vs. modality
and modality-specific information is detected somewhat specific), how salience hierarchies are created, and how
later, promotes perceptual coherence and prevents this guides perceptual development.
piecemeal processing where details are perceived before According to the IRH, highly salient intersensory
the development of a general event structure (Bahrick, redundancy recruits selective attention to multimodal
2010). Intriguingly, deficits in this area are considered to events and their redundantly specified properties at the
be primary impairments in autism. Individuals with expense of other properties of stimulation. Thus, selec-
autism are described as having a perceptual-cognitive tive attention to amodal properties (rhythm, tempo,
style characterized by piecemeal processing and weak intensity) is enhanced in multimodal stimulation as
central coherence, enhanced detection of detail at the compared with these same properties experienced in
expense of a general context or global framework (Brock unimodal stimulation. This is termed intersensory facilita-
et al., 2002; Frith & Happ, 1994; Happ & Frith, 2006; tion. Redundancy across the senses makes amodal prop-
Mottron et al., 2006; Plaisted, 2001). erties stand out from the background of other properties
The development of a surprising variety of skills rests of stimulation. In contrast, when the same events are
on detection of amodal information, including detec- experienced unimodally, such as hearing speech or
tion of a speaker in a crowd, perception of emotional watching a persons actions, modality-specific proper-
expressions, and communicative intent in audiovisual ties (such as color and pattern of the face and clothes
speech, all areas of impairment in ASD. Amodal infor- or pitch and timbre of the voice) become more salient,
mation, particularly audiovisual synchrony, is also criti- in part because intersensory redundancy is not available
cal for learning the arbitrary relation between words to compete for and capture attention.
and the objects to which they refer, a cornerstone of Predictions of the IRH have been supported across a
language development (Gogate & Bahrick, 1998; wide range of infant studies. For example, research has
Gogate, Walker-Andrews, & Bahrick, 2001; Hollich, found that younger infants detect the rhythm and
Newman, & Jusczyk, 2005). For example, by 7 months, tempo of a toy hammer tapping in bimodal redundant
infants learn to pair a speech sound with an object when stimulation (synchronous sights and sounds of impact)
the object is moved in synchrony with the sound but but not in unimodal, nonredundant stimulation (when
not if the object is still or moved asynchronously (Gogate they can see or hear the hammer tapping alone, or
& Bahrick, 1998). Infants also learn to distinguish self when the sights and sounds of the hammer are asyn-
from other on the basis of amodal visual-proprioceptive chronously presented) (Bahrick, Flom, et al., 2002;
information. By 3 to 5 months infants can detect the Bahrick & Lickliter, 2000, 2004). A few months later in
congruence between the proprioceptive feedback from development they can detect the rhythm and tempo in
their own movements and the visual experience of that both redundant bimodal and nonredundant unimodal
movement and prefer to look at the movements of stimulation (Bahrick & Lickliter, 2004). In contrast, in
other infants over the self (Bahrick & Watson, 1985; unimodal visual stimulation, when redundancy is not
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Rochat & Morgan, 1995; Schmuckler, 1996). These competing for attention, infants detect visual properties

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including the orientation of the hammers motion tion to the skills of a perceiver (see Bahrick, 2010;
(upward vs. downward) but not until later in develop- Bahrick & Lickliter, in press; Bahrick, Lickliter, Castel-
ment do they detect its orientation in bimodal synchro- lanos, & Vaillant-Molina, 2009). Thus, although these
nous stimulation where intersensory redundancy attentional biases are most evident in early develop-
focuses attention on the amodal properties of rhythm ment, they are likely to be evident across the life span,
and tempo (Bahrick, Lickliter, & Flom, 2006; Flom & particularly under conditions of high cognitive load,
Bahrick, 2010). Similar results have been found for task difficulty, and attentional demands.
infant detection of amodal properties in social events. Because children with autism show a social orienting
For example, emotion and prosody (based on amodal impairment (Dawson et al., 1998, 2004; Mundy & Neal,
redundant information) are detected at the expense of 2001), it seems critical to understand how and when
information supporting face and voice identification typical social orienting emerges and develops. Although
(based on unimodal nonredundant information) in there are a variety of hypotheses for its basis, it is gener-
multimodal stimulation in very early development (Cas- ally agreed that social stimuli hold a special status for
tellanos & Bahrick, 2008; Flom & Bahrick, 2007; Shuman young infants and that even very young infants show a
& Bahrick, 2007; Vaillant-Molina & Bahrick, in press). preference for social over nonsocial events (e.g., Farah,
This attentional trade-off between detection of amodal Wilson, Drain, & Tanaka, 1998; Gauthier & Nelson,
and modality-specific properties as a function of type of 2001; Legerstee, 1992; Morton & Johnson, 1991;
stimulation guides perceptual development in an Valenza, Simion, Cassia, & Umilt, 1996). Despite this
orderly progression. widely held belief, little is known about how and when
Thus, infant sensitivity to intersensory redundancy in this preference emerges and develops and what condi-
multimodal stimulation promotes the development of tions promote its development.
an attentional salience hierarchy where amodal proper- We have proposed that the salience of intersensory
ties recruit attention prior to other properties of events. redundancy plays a fundamental role in this develop-
Attention to properties of objects and events proceeds mental process (Bahrick, 2010; Bahrick, Todd, et al.,
in order of attentional salience with the most salient 2009). Compared to nonsocial events, social events
properties processed first and other properties pro- provide extraordinary amounts of intersensory redun-
cessed later in exploratory time (Bahrick, 2010; Bahrick, dancy that likely recruit and maintain attention to faces,
Gogate, & Ruiz, 2002; Bahrick & Newell, 2008; Craik, voices, gesture, and audiovisual speech. According to
2005; Craik & Byrd, 1982; Craik & Lockhart, 1972). this view, attention to social events is a result of experi-
With age and experience with events, infants process- ence interacting with the social world, abstracting
ing skills become more efficient, and they progress increasingly finer levels of intersensory redundancy,
though attentional salience hierarchies more rapidly. and is thus refined and shaped across development.
Given that most events are multimodal, on balance, this Accordingly, infants should demonstrate a gradual
hierarchy also creates a processing priority for amodal emergence of attention to social events across the first
properties over modality-specific properties of stimula- weeks and months of life, with heightened interest in
tion across development. This salience hierarchy is social events that provide the greatest amount of inter-
important for organizing and regulating perceptual sensory redundancy. Surprisingly, little research has
development by ensuring that meaningful, coordinated systematically investigated the emergence of attention
patterns of sensory stimulation pop out amid the vast to social vs. nonsocial events across infancy.
amount of concurrent stimulation and by allowing As a first step in this direction we assessed the nature
general event contexts and global structure to provide and development of infant preferences for social versus
a framework for perception of specific details (see nonsocial events as a function of whether or not they
Bahrick, 2010; Bahrick & Lickliter, 2002). In effect, this provided intersensory redundancy across the ages of 2
salience hierarchy bootstraps the development of coor- to 8 months. Data from more than 700 infants tested in
dinated, coherent perceptual processing, preventing infant control habituation procedures in our lab over
piecemeal processing and weak central coherence that the past decade were recoded and analyzed (Bahrick,
characterize perceptual processing in ASD. Thus, the Todd, et al., 2009). Infants had received either social
fundamental processes that promote coherent percep- (i.e., women speaking using infant-directed speech) or
tual processing develop in early infancy. nonsocial events (i.e., objects striking a surface) under
Moreover, salience hierarchies exert the greatest conditions of either redundant audiovisual stimulation
influence when attentional resources are most limited, (with natural synchronous sounds) or nonredundant
such as in early development, under conditions of com- unimodal visual stimulation (silent). Findings indicated Q
peting stimulation, or when tasks are difficult in rela- that younger infants showed longer looks, more

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processing time and less disengagement than older glue that binds information across the senses and a
infants and that, overall, infants showed greater atten- buffer against learning inappropriate associations
tion to events that provided intersensory redundancy across the senses, these processes would be compro-
than those that did not. Moreover, significant differ- mised and become more effortful than in typical devel-
ences between attention to social and nonsocial events opment. First, even small impairments in detecting
emerged across development, including longer looks, synchrony and other amodal properties in infancy and
more processing time, and less disengagement from beyond would compromise selective attention to unitary
social events. Attention to social events providing inter- multimodal events.
sensory redundancy was maintained across 2 to 8 This would impair audiovisual localization (e.g., the
months of age, whereas attention to nonsocial events face of a speaker pops out in a crowd due to audiovi-
and events providing no redundancy declined. sual synchrony), and localizing events in the context of
These findings indicate a gradual emergence of competing stimulation would be more difficult, requir-
enhanced attention to social, audiovisual speech events ing more time or alternative strategies. Imprecise syn-
over both nonsocial object events and unimodal visual chrony detection would also cause multimodal events
social events between 2 and 8 months of age. They are to seem more disjoint and characterized by more loosely
consistent with the view that social orienting emerges connected streams of auditory, visual, tactile, and pro-
gradually across infancy as a function of intersensory prioceptive stimulation. Moreover, stimulation from
redundancy. Further studies are currently under way to concurrent but unrelated events (e.g., a fan blade
assess the contributions of overall amount of stimula- turning; a meaningless action) may be more easily con-
tion and intersensory redundancy to social orienting. fused or mistakenly blended with focal events (e.g.,
Together, these findings are consistent with the view voice of a person), requiring more time and effort to
that intersensory processing and the salience of amodal sort out. These tendencies would promote processing
properties of stimulation provide a fundamental basis of events consistent with reports of piecemeal process-
for the emergence and development of attention to ing and weak central coherence (Happ & Frith, 2006).
social events across infancy. Second, in typical development, unitization (similar
to binding) of synchronous auditory and visual stimula-
Intersensory Perception in Atypical tion effectively simplifies and reduces the overall
Development amount of experienced stimulation (see Spear & McK-
inzie, 1994). Thus, typically developing perceivers
Because of the critical role of intersensory processing detect invariant patterns across synchronous streams of
in the typical emergence of social orienting and the auditory and visual stimulation such as audiovisual
deficits in social orienting and related skills seen in speech or music. These patterns are normally perceived
children with autism, we explore here intersensory pro- as unitary rhythmic patterns rather than patterns in
cessing disturbance as one important basis for the fun- separate modalities. In contrast, altered synchrony
damental impairments in social and communicative detection could impair unitization, resulting not only in
functioning in autism. Social events provide an extraor- reduced coherence and integration across modalities
dinary amount of intersensory redundancy and are typi- but also in the experience of a greater overall amount
cally more variable and complex than nonsocial events of perceived stimulation and complexity. In the case of
(Adolphs, 2001; Dawson et al., 2004); therefore, an complex multimodal stimulation, such as social interac-
impairment in intersensory processing skills would typi- tion, for individuals with imprecise intersensory skills,
cally impact social attention to a greater extent than the sheer amount of dynamically changing multimodal
attention to nonsocial events. Decreased intersensory stimulation could be experienced as confusing, aver-
processing efficiency could reduce the salience and sive, and well beyond the optimal range of sensory
processing priority given to social events. Even a small stimulation. This could discourage perceptual process-
difference in intersensory processing skill could amplify ing and social engagement, promoting social orienting
across development, resulting in substantial differences impairments typically seen in ASD.
in overall attention to social events as well as producing Third, imprecise detection of intersensory redun-
cognitive differences in later development (also see dancy could alter the typical salience hierarchy where
Bahrick, 2010; Mundy & Burnette, 2005). amodal information is detected prior to modality-
How might impaired or imprecise detection of inter- specific information, both across development and
sensory redundancy affect perception of multimodal within an episode of exploration. This typical sequence,
events and, in turn, alter developmental trajectories? which effectively simplifies sensory stimulation and helps
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Because sensitivity to amodal information is both the to organize perception of detail within the context of a

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general event or object structure, would be disrupted. events compared with TD and/or non-ASD develop-
Alteration of this salience hierarchy would also promote mentally delayed (DD) children? Although a growing
piecemeal processing, where modality-specific detail research effort on this topic (see Iarocci & McDonald,
may be attended prior to perceiving a unitary event, 2006, for a review) now reveals a variety of intersensory
again leading to an abundance of loosely connected, impairments in autism, there is little understanding of
poorly integrated information as the focus of attention. the nature, basis, and extent of these impairments, nor
Fourth, impaired detection of intersensory redun- is there agreement regarding the conditions that
dancy would also lead to enhanced unimodal visual promote altered intersensory processing in autism. To
and/or auditory processing in some domains. Decreased evaluate evidence for an intersensory processing distur-
unitization and altered salience hierarchies would bance in ASD, we review findings of audiovisual process-
enhance attention to modality-specific detail and ing of social and nonsocial events from four areas of
promote processing of local over global information, focus, each characterized by different methods and
consistent with observations of weak central coherence addressing somewhat different research questions: (1)
and enhanced perceptual functioning (Happ & Frith, intersensory matching of auditory and visual stimula-
2006; Mottron et al., 2006). For example, detail such as tion from speech, affective events, and nonsocial events,
the appearance of the clothing, jewelry, or the pitch or (2) intersensory integration in audiovisual speech per-
pattern of a voice may be attended without the general ception as measured by tasks such as the McGurk and
social/communicative context of the event. At the same speech in noise tasks, (3) the intersensory temporal
time, an altered unisensory profile in which the modal- integration window, and (4) intersensory perception
ity-specific properties of events were selectively attended and attentional disengagement. Because of space con-
and processed at the expense of amodal properties, straints we have focused our review on audiovisual inter-
could lead to further atypical intersensory processing, sensory functioning, the area of greatest research focus.
in a mutually reinforcing cycle. However, studies investigating other modalities, includ-
In sum, it is apparent how alterations in intersensory ing proprioceptive-visual functioning (Gergely, 2001)
processing, a cornerstone of social orienting and inter- and mirror neuron system functioning (a multisensory
action, could significantly contribute to impairments in neural network that responds to both observed and
social orienting and interaction in ASD. Multimodal performed actions) (see Gallese, Rochat, Cossu, & Sin-
stimulation would likely be experienced as more igaglia, 2009; Oberman & Ramachandran, 2007; Wil-
complex, less unitized and cohesive, and overstimulat- liams, Whiten, & Singh, 2004), also provide evidence
ing, shifting processing resources toward unisensory for intersensory impairments.
information and modality-specific detail. These altera- In our review we emphasize a number of factors that
tions of attention would decrease infant responsiveness impact conclusions drawn from intersensory research,
to typical social stimulation (i.e., social orienting impair- including task complexity (simple vs. complex) and
ments), in turn eliciting altered social and communica- stimulus type (social vs. nonsocial). We explore whether
tive input from adult caretakers. Thus, further social, intersensory processing disturbances are more pro-
emotional, and communicative development, which all nounced in social than nonsocial events. Because social
rely on social interaction, affective exchange, and joint events are typically more complex and variable than
attention, would be compromised and in turn would nonsocial events and provide exaggerated intersensory
impair subsequent language, social, and cognitive redundancy, a general intersensory processing distur-
development (see Bahrick, 2010; Mundy & Burnette, bance would be expected to lead to greater impair-
2005). Because development is a self-organizing, inter- ments in processing social events than nonsocial events.
active system, where skills in one stage promote the Compared with typically developing controls, individu-
input and provide the basis for interaction in subse- als with ASD may show comparable processing of
quent stages, small differences in intersensory function- simpler, low-level stimuli (including those in a variety of
ing can amplify and continue to feed back across nonsocial events) but impaired processing of more
development, creating a widening gap between typical complex stimuli, including social events (Bertone et al.,
and atypical developmental trajectories. 2005; Minshew & Hobson, 2008). In addition, where
possible, we evaluate evidence of intersensory process-
Evaluating Evidence for Intersensory ing disturbances in light of changes in unisensory audi-
Processing Disturbance in Autism tory and visual function. We ask if there is evidence of
compromised unisensory processing and, if so, are mul-
To what extent and under what conditions do individu- tisensory processing deficits found once these unisen- Q
als with ASD show atypical processing of multimodal sory processing deficits have been controlled? Given the

8466_036.indd 663 12/21/2011 6:04:15 PM
tight link between the two, evidence that intersensory Loveland et al. (1995) found that children with ASD
processing disturbances are a fundamental impairment were impaired in detecting face-voice affective corre-
rather than solely the result of unisensory impairments spondence (with synchrony controlled) compared to
is important for understanding underlying mechanisms DD controls (matched for verbal and mental age), and
of development. both groups showed improved performance when tem-
poral synchrony was available. In contrast, the two
Intermodal Matching in ASD groups showed no difference in detecting intermodal
correspondence between inanimate objects and their
A popular method for studying intersensory perception sounds. This study thus suggests some sensitivity to face-
in early development is the intermodal preference pro- voice synchrony and greater intersensory processing
cedure (Bahrick, 1983, 1987; Spelke, 1976). In this deficits for social as opposed to nonsocial events in
method, two side-by-side visual events are presented ASD. It should be noted, however, that it is difficult to
with an accompanying soundtrack that matches one of draw conclusions about the basis of these differences,
the events (e.g., is synchronous or shares the same as social and nonsocial events typically differ in terms
tempo or rhythm) and is incongruent with the other of stimulus complexity, predictability, amount of stimu-
event (e.g., out of synchrony or displays a different lation, and, in the above study, synchrony. Although
tempo or rhythm). Evidence of auditory-visual intermo- many differences are inherent in comparisons of social
dal matching is found in 3- to 4-month-old typically versus nonsocial events, some studies have made an
developing infants (Dodd, 1979; Spelke, 1976) and is effort to equate or assess task complexity and
indicated by a proportion of total looking time to the predictability.
sound synchronous display that is significantly greater For example, Bebko, Weiss, Demark, and Gomez
than chance (50%). The intermodal preference proce- (2006) attempted to address this issue by presenting
dure requires no verbal skills and places low cognitive both simple and complex social events along with non-
demands on the child, making it ideal for testing inter- social events. They assessed whether children with ASD
sensory integration in nonverbal participants. This task, showed evidence of integrating audio and visual infor-
however, does not easily lend itself to tests of unimodal mation on the basis of temporal synchrony compared
functioning, and thus, unisensory measures are typi- to TD and DD controls matched on adaptive function-
cally not included. ing. Two identical side-by-side films of a nonsocial event
Several studies have demonstrated intersensory (e.g., Mousetrap game), a simple social event (woman
matching in individuals with ASD. Children and adoles- counting), or a complex social event (woman telling a
cents with ASD showed preferential looking to the story) were presented with their accompanying
visual display of a nonsocial event that matched a soundtracks that were temporally synchronous with one
soundtrack (Loveland et al., 1995; Walker-Andrews, of the films. All groups showed significantly greater
Haviland, Huffman, & Toci, 1994) as well as to faces than chance looking to the sound-synchronized dis-
and voices that were matched for affective expressions plays of the nonsocial event. In contrast, only DD and
(Haviland, Walker-Andrews, Huffman, & Toci, 1996; TD children looked significantly more to the sound-
Loveland et al., 1995). Klin, Lin, Gorrindo, Ramsay, and synchronized social events (both simple and complex
Jones (2009) found reduced preferences for point dis- linguistic), whereas children with ASD showed chance
plays of human actions, suggesting decreased interest responding. Further, a significant negative relationship
in social events, but looking was positively correlated between time spent looking away from the complex
with degree of audiovisual synchrony. In contrast, TD linguistic social events and linguistic abilities in chil-
children preferred socially relevant stimuli regardless of dren with ASD emerged. Children with ASD thus
degree of synchrony. Together, these findings suggest showed impaired audiovisual matching on the basis of
that individuals with autism show sensitivity to audiovi- temporal synchrony for social but not nonsocial events.
sual synchrony and increased attention to higher levels These findings are consistent with an intersensory
of synchrony. processing impairment in ASD, primarily affecting
Intersensory impairments have also been docu- social events. No measures of unimodal processing
mented. Using measures of event-related potentials, (audio or visual only) were taken, leaving open the
Magne, de Gelder, van Engeland, and Kemner (2008a) question of whether the impaired multisensory process-
found evidence of intact early perceptual processing of ing could be linked to impaired unisensory processing
facial expressions but impaired audiovisual processing abilities. Further, Bebko et al. (2006) reported no dif-
of fearful faces and voices in ASD as compared with TD ferences in time spent looking away from social versus
Q
adults. In intermodal matching behavioral studies, nonsocial events. Future studies should also assess time

8466_036.indd 664 12/21/2011 6:04:15 PM
spent looking to the social versus nonsocial stimuli to potentials. Further, although few studies have com-
determine the extent to which differences in matching pared intersensory functioning for speech versus non-
could be associated with differences in looking time to social stimuli, one study (Mongillo et al., 2008) found
social versus nonsocial events. intersensory impairments for social tasks (McGurk and
audiovisual gender matching) but no impairments for
Intersensory Integration in Speech in ASD nonsocial tasks (audiovisual matching of ball size and
composition). Despite inconsistencies across studies, in
Research on intersensory integration in speech has typi- summary these findings demonstrate that children with
cally assessed the extent to which visual speech influ- ASD show evidence of intersensory processing of audio-
ences the perception of auditory speech in individuals visual speech (e.g., McGurk illusions; unimodal-bimodal
with ASD as compared with typical development, and transfer effects) but that these intersensory abilities as
the conditions under which evidence for impairments well as unimodal processing may be impaired when
versus integration are most apparent. At least two pro- compared with TD controls (typically matched for
cedures for assessing audiovisual integration of speech verbal ability and/or mental age). These findings also
events have been used: the McGurk effect and speech- indicate a close connection between unisensory and
in-noise tasks. Both tasks can also be used to measure intersensory abilities, with deficits in unisensory pro-
unimodal visual processing when the auditory stimula- cessing having clear effects on intersensory integration,
tion is silent (lipreading), or unimodal auditory pro- but also that the demonstrated intersensory deficits may
cessing in the absence of a dynamic visual display. extend beyond those predicted on the basis of unisen-
In the McGurk task (MacDonald & McGurk, 1978; sory function.
McGurk & MacDonald, 1976), evidence of audiovisual Speech-in-noise tasks assess integration of audiovisual
integration is inferred from the perception of an illu- speech by presenting the visual image of a speaker syn-
sory percept (the McGurk effect). For example, when chronized with auditory speech embedded in back-
the visual display of a speech sound (e.g., seeing /ga/) ground noise. The level of background noise relative to
is mismatched with a temporally synchronous soundtrack the speech signal can be manipulated and signal-to-
(e.g., hearing /ba/), the resulting illusion represents a noise ratios (SNRs) and individual thresholds deter-
synthesis of the visual and audio information (e.g., per- mined. Typically developing individuals show enhanced
ceiving /da/). Such a synthesis is considered to reflect identification of the speech signal (detection at lower
the underlying integration of the visual and auditory SNRs) when the visual stimulus is present, indicating
cues. Even young infants show the McGurk effect audiovisual integration. Smith and Bennetto (2007)
(Burnham & Dodd, 2004; Desjardins & Werker, 2004; assessed intersensory and unimodal speech processing
Rosenblum, Schmuckler, & Johnson, 1997). Overall, in adolescents with ASD versus TD controls. They found
children and adolescents with ASD report perceiving that individuals with ASD required larger SNRs (louder
audiovisual illusions in the McGurk task, but they per- speech signals compared to background noise) than
ceive significantly fewer illusions (e.g., approximately TD controls, suggesting less benefit from the visual
40% less) than controls (de Gelder, Vroomen, & Van stimulus (impaired integration). Unimodal visual (lip-
der Heide, 1991; Mongillo et al., 2008; Williams, reading) impairments were also found. However, once
Massaro, Peel, Bosseler, & Suddendorf, 2004), suggest- these unisensory effects were controlled, the deficits in
ing impaired intersensory integration. However, audiovisual speech processing were still evident and
Williams, Massaro, et al. (2004) found that impaired were thus attributed to a unique intersensory deficit,
integration was attributable to impaired unimodal above and beyond the unisensory deficits.
visual processing and that intersensory performance It is clear from all the above findings that individuals
improved following training in lipreading. This demon- with autism show evidence of audiovisual integration in
strated successful transfer of unimodal visual skills to speech as well as evidence of impairments in audiovi-
facilitate intersensory processing in ASD (see also sual integration. However, the basis for intersensory
Massaro & Bosseler, 2003). In contrast, de Gelder et al. impairments is still unclear. The extent to which inter-
(1991) found no differences in lipreading between ASD sensory impairments arise from differences in unimodal
and control groups and demonstrated impaired audio- processing (lipreading, attention to the face, auditory
visual integration and impaired face processing in ASD. speech detection), intersensory processing, or both is
Magne, de Gelder, van Engeland, and Kemner (2008b) not yet known. As described above, several studies have
found no impairments in early, low-level integration but shown clear differences in intersensory processing
significant impairments in late, phonological audiovi- above and beyond those of unimodal processing differ- Q
sual integration according to measures of event-related ences (de Gelder et al., 1991; Magne et al., 2008b;

8466_036.indd 665 12/21/2011 6:04:15 PM
Smith & Bennetto, 2007). Others find unimodal differ- reported was not significantly different from TD con-
ences and/or multisensory differences but have not trols, indicating intact intersensory processing. However,
assessed their relative contributions, and one study this illusion is dependent on the stimulus onset asyn-
found multisensory differences directly attributable to chrony (SOA) between the flash and the beeps; as these
unimodal differences (Williams, Massaro, et al., 2004). become more temporally disparate, the illusion
In addition, given that social orienting impairments weakens. Given the fundamental role of temporal pro-
(Dawson et al., 1998, 2004) and impairments in face cessing and unitization of audiovisual stimuli for both
processing (Dawson et al., 2005; de Gelder et al., 1991; social and nonsocial event perception in typical devel-
Schultz, 2005) characterize ASD, decreased attention to opment, manipulating the temporal parameters of
the facial stimuli in the McGurk and speech in noise these stimuli is of particular significance.
studies by individuals with ASD could impair perfor- Foss-Feig et al. (2010) presented the flash-beep stimuli
mance in both the visual and audiovisual conditions. at different SOAs to assess differences in the temporal
Reduced attention to and processing of the face thus binding window, the time frame across which auditory
could be both a basis for unisensory impairments and and visual stimuli are integrated, for 8- to 17-year-old
an outcome of unisensory and multisensory impair- children with ASD as compared with mental-age-
ments. Consistent with this view, intersensory speech matched TD controls. Children with ASD reported per-
processing improvements following training in lipread- ceiving the flash-beep illusion at greater SOAs (300
ing were found (Massaro & Bosseler, 2003; Williams, msec) than TD controls (150 msec). Thus, children
Massaro, et al., 2004), possibly resulting from enhanced with ASD showed evidence of successful audiovisual
attention to the face, unimodal to multimodal transfer integration, although across a much larger temporal
of learning, or both. Although studies attempt to ensure processing window than TD children. This finding sug-
that subjects attend to face stimuli (Magne et al., gests that individuals with ASD may show more extensive
2008a; Williams, Massaro, et al., 2004), little relevant but less temporally precise audiovisual integration.
data are generally reported. Given the close link This difference could have profound implications for
between unisensory and multisensory functioning, it is perception. Less temporally precise and more extended
important for future studies to quantify and directly temporal binding of visual and auditory stimulation
compare visual attention measures across ASD and would particularly impair audiovisual processing in
control groups. Further, studies of speech processing noisy environments, those with multiple concurrent mul-
typically have not included nonsocial comparisons (but timodal events, such as social contexts (also see related
see Mongillo et al., 2008), and thus the extent to which evidence of reduced distracter effects as a function of
impairments are enhanced for social stimuli as com- greater attentional load in TD [Lavie, 1995, 2005] and
pared with nonsocial stimuli is not known. Thus, taken ASD [Remington, Swettenham, Campbell, & Coleman,
together, the findings of audiovisual speech perception 2009]). For example, it could impair audiovisual local-
research provide evidence for intersensory impairments ization (of a speaker in a crowd), decreasing the pop
in ASD, typically along with reduced sensitivity to visual out effect and reducing unitization, leading to mis-
speech information, and point out the close associa- taken blending of unrelated concurrent auditory and
tions among intersensory impairments, unisensory visual stimuli, and promoting more disjointed or piece-
impairments, and visual attention to faces. meal processing of auditory and visual stimulation. This
could alter typical salience hierarchies (amodal prior to
Audiovisual Temporal Integration Window in modality-specific processing). In naturalistic social envi-
ASD ronments there would be many instances of accidental
synchrony between unrelated streams of auditory and
Another multisensory illusion, the flash-beep task, can be visual stimulation. Thus, noisy environments would
considered to be a nonsocial analogue to the audiovi- likely be confusing and/or aversive to individuals with
sual speech tasks. It assesses the influence of auditory a wider, less precise temporal binding window. In an
stimulation (beeps) on the perception of visual stimula- effort to reduce uncertainty and overall perceived
tion (flashes of light). In this procedure, when two amount of stimulation, individuals with a wider tempo-
beeps are presented along with a single flash, respon- ral window may show increased attentional selectivity to
dents typically report perceiving an illusion of two visual simpler, more predictable patterns, including self-con-
flashes (Shams, Kamitani, & Shimojo, 2000). Van der tingent stimulation or tightly coupled patterns of motor,
Smagt, van Engeland, and Kemner (2007) reported auditory, and/or visual stimulation. In contrast, in an
that individuals with ASD also perceived the illusion of uncluttered, quiet environment with low levels of stimu-
Q
a second flash and that the number of second flashes lation and single audiovisual events (with little chance

8466_036.indd 666 12/21/2011 6:04:16 PM
of accidental synchrony from unrelated events), audio- tion in an environment abounding with imprecisely and
visual integration and intermodal learning may be unpredictably coupled patterns of sensory stimulation.
enhanced, facilitating unitization and effectively simpli- Participating in simple repetitive perception-action
fying multimodal stimulation. In this case, more pre- loops may help some children with ASD compensate for
dictable, tightly coupled patterns of multimodal an atypically wide temporal binding window and a
stimulation may be more attractive and of greater inter- reduced focus on amodal and global pattern informa-
est to individuals with a wider temporal binding window. tion by creating simple, salient, self-generated patterns.
Of great interest for future research would be uncover- Attending to simple synchronized patterns may in turn
ing the nature of changes in the temporal binding gradually facilitate experience-dependent narrowing of
window across development in children with ASD. It is the temporal binding window across development.
known that infants have a wider window than adults However, this narrowing would likely occur at a much
(Lewkowicz, 1996, 2010), and with experience the slower pace than in typical development.
window becomes more precise and narrowed to
conform to the typical parameters of auditory-visual Intersensory Perception and Attentional
onset asynchronies in social and nonsocial events. Thus, Disengagement
the wider window observed in ASD suggests the possibil-
ity of less experience-dependent narrowing in ASD than Impaired attention disengagement, sometimes referred
in typical development. to as sticky attention or overselectivity, is known to be a
A wider, less precise intersensory processing window fundamental characteristic of autism (Landry & Bryson,
may also contribute to the repetitive and stereotyped 2004; Swettenham et al., 1998; Wainwright & Bryson,
behaviors observed in some individuals with ASD, such 1996). Although its basis is unclear, some propose that
as arm waving, twirling, producing repetitive sound a domain general disengagement deficit underlies
sequences, and spinning or banging objects (Lewis & the development of ASD (Courchesne, Chisum, &
Bodfish, 1998; Richler, Huerta, Bishop, & Lord, 2010; Townsend, 1994; Landry & Bryson, 2004). It affects
Turner, 1999). Repetitive behaviors could serve to hone areas as basic to social interaction as orienting to ones
and shape the temporal integration window across own name (Dawson et al., 2004) and joint attention
visual, auditory, proprioceptive, and tactile stimulation. (Mundy & Burnette, 2005). However, experimental
Repeated experience with precise synchrony across research on this topic has focused primarily on uni-
different forms of stimulation facilitates coupling of modal visual stimulation using primarily static images,
multimodal systems and likely promotes experience- assessing disengagement from a central visual target to
dependent narrowing of the temporal integration a peripheral one using a modified spatial orienting task
window. Such behaviors may include perception-action (see Johnson, Posner, & Rothbart, 1991). Although we
loops involving recurrent, predictable coupling of have learned a great deal about visual attention using
motor, auditory, visual, and/or tactile stimulation, this approach, it is not known how such findings might
similar to that described by Piagets primary circular translate to the natural environment of dynamic, mul-
reactions (Piaget, 1952). Primary circular reactions timodal events.
appear similar in form to the repetitive behaviors and We propose that a disturbance in intersensory pro-
patterns of self-stimulation observed in some individu- cessing would reduce the attentional salience of inter-
als with ASD. Such multimodal perception-action loops sensory redundancy and lead to significant impairments
are considered a cornerstone of cognitive development in orienting and disengagment of attention to unified
(Piaget, 1952) and generate stable, predictable inter- multimodal events, particularly in complex environ-
sensory patterns that link perception and action across ments. Impaired integration and/or a wider temporal
time and space. For example, each time the infant binding window would likely impact social events to a
opens his hand or shakes a rattle, he can simultaneously greater extent than nonsocial events given their greater
feel, see, and/or hear the perfectly contingent and syn- complexity and faster pace, making social stimulation
chronous proprioceptive-visual/auditory stimulation. It more challenging and cognitively demanding for indi-
is now appreciated that multimodal perception-action viduals with ASD.
loops drive neural change and connectivity (see Ghaza- We recently developed a paradigm to extend investi-
nfar & Schroeder, 2006; Sheya & Smith, 2010; Smith & gations of attention disengagement and orienting to
Thelen, 2003) serving to integrate sensory and motor more naturalistic, dynamic, multimodal events (Bahrick,
systems. Thus, individuals with ASD may be drawn to Todd, Vaillant-Molina, Sorondo, & Ronacher, 2010;
repetitive behaviors, in part, because they provide more Newell, Bahrick, Vaillant-Molina, Shuman, & Castella- Q
predictable and well-integrated multisensory stimula- nos, 2007). The Multisensory Attention Assessment

8466_036.indd 667 12/21/2011 6:04:16 PM
Protocol (MAAP) presents videos of naturalistic social speech perception, the temporal integration window,
and nonsocial events in a procedure that blends fea- and attention disengagement, indicates that children
tures of the three-screen visual orienting tasks (Johnson and adolescents with ASD show a significantly altered
et al., 1991; Landry & Bryson, 2004) and the intermodal intersensory processing profile when compared with
preference method (Bahrick, 1983, 1987; Spelke, 1976) TD children. Despite inconsistencies across methods
and is easily used with infants and children. In this and findings, a number of general conclusions have
paradigm, trials consisting of a silent, dynamically emerged, and these set the stage for future study.
changing central visual event followed by two side-by- First, individuals with ASD show relatively intact inter-
side events (along with a soundtrack synchronized with sensory processing abilities across a number of domains,
one peripheral event) are presented. In some trials, the particularly for nonsocial and simple events. For
central event is terminated just prior to the onset of the example, they showed no impairments in intermodal
peripheral events (orienting trials), whereas in other matching of nonsocial events in several studies (Bebko
trials, the central event stays on along with the periph- et al., 2006; Loveland et al., 1995; Mongillo et al., 2008;
eral events (disengagement trials). Intermodal match- Walker-Andrews et al., 1994), evidence of intact audio-
ing and latency to orient and disengage to the visual speech integration for simple syllables in multi-
audiovisual events are assessed. Separate blocks of trials modal as compared to unimodal control conditions in
present social versus nonsocial events. two studies (Massaro & Bosseler, 2003; Williams,
Findings of our preliminary study demonstrate that Massaro, et al., 2004), and no difference in attentional
relative to TD children, children with ASD showed orienting to audiovisual events in the absence of com-
impairments in disengaging and maintaining attention peting stimulation (Newell et al., 2007). Second, indi-
to social events when there was competing stimulation viduals with ASD show impaired intersensory functioning
from the concurrent central event but were less for more complex events, particularly those with a
impaired in disengaging and attending to nonsocial social context. For example, they showed deficits in
events. Also, in the absence of competing stimulation, intermodal matching for simple and complex social
attention switching (orienting) did not differ from that events but no deficits for nonsocial events (Bebko et al.,
of controls (Newell et al., 2007). Further, children with 2006), impaired audiovisual speech integration as
ASD as compared with TD controls showed decreased indexed by a reduced McGurk effect (de Gelder et al.,
attention (more looking away, shorter looks, and less 1991; Mongillo et al., 2008), impaired audiovisual pro-
looking time) to social, but not nonsocial, events cessing for speech but not nonsocial events (Mongillo
(Bahrick, Todd, et al., 2009). They also showed impaired et al., 2008; Smith & Bennetto, 2007), and greater dis-
intermodal matching compared to TD controls, dem- engagement deficits to look at social as compared with
onstrating no preference for the sound-synchronous nonsocial events (Newell et al., 2007). We suggest that
over asynchronous social or nonsocial events (Bahrick individuals with ASD typically show the greatest impair-
et al., 2010). Further, attention to social events was ments in processing social events because social events
found to be negatively related to symptom severity in are inherently more multimodal, unpredictable, and
autism, with less looking to social events correlated with provide greater amounts of temporal variability and
more symptoms. intersensory redundancy than nonsocial events
Together, these findings indicate greater attentional (Bahrick, 2010). Third, children with ASD also show
impairments for social events (which are more complex unisensory impairments that necessarily limit intersen-
and amplify intersensory redundancy) than for nonso- sory functioning. For example, reduced lipreading
cial events, particularly in the context of competing (Williams, Massaro, et al., 2004), face processing
stimulation. They suggest that impaired intersensory (Dawson et al., 2005; de Gelder et al., 1991; see Schultz,
functioning is one likely basis for the development of 2005), and detection of speech in noise (Smith & Ben-
disengagement deficits in ASD. This domain-general netto, 2007) have all been found in ASD. Fourth, chil-
impairment would have its greatest impact on attention dren and adolescents with ASD appear to have a larger
in noisy environments and for complex events such temporal window for integrating audiovisual events
as social events, in which attentional resources are (Foss-Feig et al., 2010), suggesting less precise and
challenged. more temporally extended integration. This could lead
to impaired binding of auditory, visual, and propriocep-
Summary and Conclusions tive stimulation, impaired selective attention to sound-
specified events in the context of accidental synchrony
Evidence across the diverse topics reviewed in this from competing stimulation, piecemeal processing of
Q
chapter, including intermodal matching, audiovisual multisensory stimulation, and amplification of social

8466_036.indd 668 12/21/2011 6:04:16 PM
orienting impairments across development. On the promote more typical intersensory processing and, in
other hand, a larger window may promote attention to turn, generalize to more complex social events, cascad-
and participation in simple, repetitive perception- ing across a wide variety of related domains of
action loops that provide more easily detectable pat- impairment.
terns of synchrony, enhancing links among auditory, Developing a deeper understanding of the role of
visual, and motor stimulation. In sum, individuals with intersensory impairments in ASD poses multiple chal-
ASD appear to show atypical processing of multimodal lenges for future research. Investigating developmental
stimulation, particularly for complex social events, and trajectories for intersensory processing impairments
more typical processing of simple and nonsocial events, will be critical to enhancing our understanding of
with the greatest impairments in the context of compet- mechanisms, causal relations, and implications for
ing stimulation. This may both underlie and contribute intervention. Few studies have taken a developmental
to social orienting impairments in autism. perspective. Teasing out the role of unisensory versus
Based on the available evidence, however, the under- multisensory impairments within single research designs
lying mechanisms resulting in the autism phenotype(s) (including differential attention and processing of faces
are difficult to distill. Given impairments in unisensory and speech) will also enhance our understanding of
processes, including reduced attention to the face and underlying mechanisms. Considering frequent con-
speech, it is difficult to determine the extent to which founds across studies, such as task difficulty and com-
intersensory impairments derive from unisensory defi- plexity for social and nonsocial events, would facilitate
cits and the extent to which multisensory processes are translation of findings across studies. Experimentally
uniquely affected. Sorting out the basis of impairment manipulated levels of intersensory redundancy would
is a challenge for future research. help to clarify the nature of relations between intersen-
Regardless of the basis, impaired intersensory func- sory processing and attention deficits in autism. Assess-
tioning would be expected to have a wide cascade of ing relations between intersensory impairments and
consequences across development. Intersensory redun- symptom severity would provide insight into individual
dancy is highly salient and organizes and constrains differences and the specificity of intersensory impair-
typical perceptual development. It is the glue that binds ments to ASD. Finally, bringing together multiple levels
stimulation across the senses, functioning as the gate- of analysis, including genetic, neural, and physiological,
keeper for further processing of unitary events, and to converge with findings of behavioral studies will also
promoting the development of salience hierarchies be critical to developing a deeper understanding of the
such that attention to general information precedes interrelated system of influences underlying intersen-
acquisition of more specific detail. Intersensory pro- sory functioning and impairments.
cessing also biases attention to social events. Impaired
intersensory functioning would affect all of these Acknowledgments
domains underlying social orienting impairments and
cascade to other skills that rely on intersensory func- The research and theory development reported here
tioning, including joint attention, social interaction, were supported by grants from NIH (RO1 HD053776,
and language learning, and in turn amplify disturbance K02HD064943), Autism Speaks (#1906), and the
in later social and communicative functioning (Bahrick, Marino Autism Research Institute.
2010; Mundy & Burnette, 2005). Moreover, we have also
argued that impaired intersensory processing would References
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Bahrick, L.E., & Todd, J.T. (2012).

36 Multisensory Processing in Autism

SteinThe New Handbook of Multisensory Processes

658 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 659

SteinThe New Handbook of Multisensory Processes

660 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 661

SteinThe New Handbook of Multisensory Processes

662 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 663

SteinThe New Handbook of Multisensory Processes

664 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 665

SteinThe New Handbook of Multisensory Processes

666 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 667

SteinThe New Handbook of Multisensory Processes

668 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 669

SteinThe New Handbook of Multisensory Processes

670 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 671

SteinThe New Handbook of Multisensory Processes

672 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

Multisensory Processing in Autism Spectrum Disorders 673

SteinThe New Handbook of Multisensory Processes

674 Lorraine E. Bahrick and James T. Todd

SteinThe New Handbook of Multisensory Processes

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