Authored by Dr Patrick Dwyer – 9 min read time
Over the last few decades, many autism researchers have been searching for some core experience, brain difference, or processing difference that might lie at the heart of autism. However, autism has proven difficult to understand: time and again, initial excitement about new theories has dimmed as autism’s diversity, complexity, and richness defy simplistic attempts to understand it.[1] Even so, one theory of autism seems to be still growing in popularity decades after it was first developed: the monotropism account. Unlike most theories of autism, the monotropism account was originally developed by autistic people,[2] who were thus able to draw on both research and lived experience.
Monotropism is about attention. Now, “attention” might seem like a dull word – featuring in authority figures’ demands that we should “pay attention” to this or that – but attention determines what enters our conscious awareness. Attention fundamentally shapes our experience of the world.
The monotropism account suggests autistic people are biased to focus attention unusually narrowly – like a sort of narrow “spotlight” or “tunnel” – on particular things that are interesting to a specific individual. Crucially, because attention has a limited capacity, autistic people are thus left with fewer resources to process everything else. Furthermore, once autistic people are in an attention tunnel, shifting to focus on something else can become a sluggish process.
What evidence supports the monotropism account?
One important piece of evidence is that monotropism seems to be consistent with many autistic people’s lived experiences. There’s also evidence suggesting that monotropic focus can emerge early in life[3]: researchers have observed sluggish shifting of or “sticky” attention in infants later diagnosed as autistic.[4] Moreover, the centrality of monotropism to autism is supported by the fact that intense interests (e.g., in topics or objects) are part of the autism diagnostic criteria. Indeed, the richly positive experiences Julia Bascom eloquently describes as the “obsessive joy of autism” could be a crucial and positive manifestation of monotropism.
However, not all manifestations of monotropism are similarly positive. For example, Sonny Hallett writes about how monotropic focus might help cause “loops of concern,” where people focus and ruminate over worries and problems. In our autism and ADHD research, we have indeed found that people with hyperfocused attention are also more likely to report negative, ruminative repetitive thinking – as well as depression and anxiety.[5]
Monotropic focus might also intensify sensory experiences. If people focus narrowly on a pleasant stimulus, this might manifest as sensory seeking, whereas narrow focus on an unpleasant stimulus could lead to sensory hyperresponsiveness and overwhelm. People who tend to think monotropically might also be vulnerable to sensory hyperresponsiveness if they are overwhelmed and bombarded with so many stimuli that they cannot focus. On the other hand, if people are successful in monotropically focusing their attention, they would have few resources available to process a stimulus outside the attention tunnel and might thus be hypo- or under-responsive to it. In some of our research, we saw that all of these patterns – hyper- and hypo-responsiveness and sensory seeking – were related to attention differences in young autistic children.[6] We also saw that self-reported attention differences in adults were related to self-reported auditory hyperresponsiveness[PD1] .[7]
Can these ideas be leveraged?
Fergus Murray has been collecting a lengthy list of all the contexts where people have been applying monotropism ideas in practice. For example, when teachers leverage students’ intense interests, it might promote better experiences, success, and relationships at school.
It also occurs to me that the “state of the art” autism supports for young children – the developmental relationship-based interventions (DRBIs) as well as the more controversial naturalistic developmental behaviour interventions (NDBIs) – are based on the idea that autistic children are motivated by certain interests. Adults then need to follow autistic children’s interests to engage them socially, hopefully in a fun way, which can be crucial for learning. This is very compatible with the monotropism account.
Does this mean we’ve “figured out” autism?
Not necessarily!
Our concept of monotropism is still quite vague. We haven’t really connected it with concepts or processes from cognitive (neuro)science.[8] Indeed, so far, just one questionnaire has been developed to measure monotropism (and only in adults), and as I write, that measure is still going through scientific peer review. Even after the questionnaire is published, researchers might still revise it and develop other measures and tasks for measuring monotropism. We also need to think more about how to measure monotropism as a state: that is, how to study specific situations where people focus monotropically.
As we continue to improve our ability to measure monotropism, we will need to continue studying how common it is, when it emerges, and whether it predicts emergence of other aspects of autism. This should give us a good idea of how central monotropism is.
Moreover, there are existing attention ideas that sound very similar to monotropic focus. One of these is flow: a concept of intense, positive absorption in optimally challenging tasks developed through research in mostly-neurotypical people. Another is hyperfocus: a state of intense concentration that is often studied in ADHD and schizophrenia. These concepts seem to overlap with monotropic focus, but exactly how much they are overlapping versus distinct remains to be clarified.
This also points to how, even though both autism and ADHD involve attention differences and frequently occur together, we haven’t done a great job connecting our attention research across the two diagnoses. Indeed, there’s a bit of a paradox around attention in both autism and ADHD. At times, attention in both autism and ADHD seems to be intensely hyperfocused, but at other times, it seems to be distractible and susceptible to being captured. What’s with that? A core feature of the monotropism account is that only some things are intensely interesting for a given person, but why, and what happens when one is not interested?
Finally, even if the monotropism account is fundamentally correct that this sort of attention difference lies at the heart of autism, this would still be a descriptive account. I hope it can help autistic people (and those around us) make better sense of our experiences. But it doesn’t tell us why these experiences happen, neurobiologically speaking – it is not an explanatory theory.
Author:
Dr Patrick Dwyer
OTARC Research Fellow
Patrick.Dwyer@latrobe.edu.au
[1] For one example, the mirror neuron hypothesis of autism is now widely discredited.
As another example, the theory that autism is fundamentally about difficulty with theory of mind and understanding others’ thoughts and perspectives is complicated by evidence that this sort of processing is often intact in autism and may not be that closely related to real-world social difficulties. Autistic scholars and advocates also point out that non-autistic people often have trouble understanding autistic perspectives, so this is hardly a one-way problem!
Meanwhile, the theory that autistic people lack social motivation is contradicted by evidence of autistic people’s social interest – besides which, it would hardly be surprising if neurodivergent people who might struggle to find meaningful social connection in a neurotypical world could grow tired of seeking it.
In general, any social-focused account of autism also struggles to explain non-social aspects of autism, like sensory differences or repetitive behaviours, whereas a domain-general account can easily explain both social and non-social aspects.
Even the theory that autism is characterised by stronger excitatory brain signals relative to inhibitory brain signals struggles to deal with some studies showing no group differences or even appearing to show the opposite pattern, suggesting the theory could only be true of some autistic people and/or in certain brain pathways.
[2] Dinah Murray, Wenn Lawson, and Mike Lesser.
[3] Which is important if we’re trying to develop a theory of autism. Since autism emerges early in life, anything that lies at the heart of autism must therefore emerge at least as early as autism does!
[4] These observations have been made even though the tasks that measure “sticky attention” generally aren’t trying to make their stimuli specifically interesting to a given autistic person.
[5] Of course, this is not to discount the fact that autistic people often have negative experiences, such as being discriminated against or experiencing sensory overwhelm. Thus, we shouldn’t attribute the autism mental health crisis to some sort of cognitive processing difference alone: rumination might exacerbate things, but these negative experiences are crucial to understanding mental health in autism.
[6] Although we need to replicate this finding, and we also need to confirm whether the attention differences emerge before and predict the sensory differences.
Our study also didn’t find autistic children were more likely than non-autistic children to display the “sticky” attention pattern I mentioned before, contrary to prior research, although this might have to do with the task timing as well as the fact the stimuli weren’t designed to be interesting.
[7] But again, we don’t yet know for sure which comes first – attention or sensory hyperresponsiveness/overwhelm. Our best guess is that an early attention difference might emerge first and cause the sensory hyperresponsiveness. Having these distressing and overwhelming sensory experiences might then make people anxious, and they might start vigilantly scanning their environment for signs a negative sensory experience might be about to happen – perhaps increasing people’s hyperfocus on negative sensory stimuli and worsening the hyperresponsiveness. But all we know for sure is that these things are related – which comes first is a matter of informed speculation.
[8] We do have the sticky attention research, but we’re just assuming that can be seen as monotropism, especially since the original developers referred to attention shifting difficulties in their seminal 2005 paper. And like I mentioned, the tasks do not capture whether people are motivated by specific interests.
[PD1]This is forthcoming in Journal of Attention Disorders
