Self-awareness has been investigated both theoretically and empirically by a wide range of disciplines (1-3). This has included the exploration of self-awareness among specific clinical groups, such as patients with right-hemisphere stroke, frontal lobe damage, schizophrenia, and autism. Still, a comprehensive model of self-awareness is lacking (3), and even the functional importance of self-awareness has not yet been established (4). The lack of a comprehensive model of self-awareness limits the current understanding of variations in and deficits of self-awareness.
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties with social communication and interaction as well as by repetitive patterns of behavior, interest, or activity, including differences in sensory responses (5). Specific characteristics of self-awareness are not specified in the current diagnostic criteria. However, the term
Addressing the concept of self-awareness and its potential differences among individuals with ASD should not be perceived as a devaluation of or a challenge to the validity of either the self-awareness or the selfhood of persons with ASD. Self-awareness and the experience of self are unique and valid for all persons. However, for each individual, the concept of the self and self-awareness may be more or less efficient for helping individuals to navigate in the world in a way that supports his or her everyday needs, helps him or her to reach goals, and meets his or her personal values. Insight into the characteristics and mechanisms of self-awareness may help people of all degrees of ability to calibrate this fine instrument and thereby improve their ability to navigate and manage the challenges of life.
The aim of this short paper is to sketch a conceptual framework for describing self-awareness to begin to integrate the accumulating knowledge about characteristics of and variations in self-awareness related to ASD. The formulation of a conceptual framework is important as a future common ground for the design and interpretation of new studies, theoretical discussions, and clinical work. It is especially important that the framework encompass the wide individual variation in self-awareness that may characterize ASD due to the heterogeneity of the condition. The framework presented consists of different putative levels and dimensions of self-awareness that are identified in selected theoretical contributions. It aims to span not just the “what” of self-awareness but also the more procedural and functional aspects of “how” and “when.”
Most theories tend to distinguish among different levels of self-awareness. On the basis of a review of nine different theories of self-awareness, Morin (9) has suggested four levels that can work as reference points for different theoretical conceptions and that may help researchers to compare, contrast, and integrate these theories: 1) unconsciousness; 2) consciousness; 3) self-awareness; and 4) meta-self-awareness. At the unconscious level, the organism is unresponsive to both the self and the environment. At the level of consciousness, the organism focuses attention on the environment and on processing stimuli. At this level, a basic sense of self is involved, but mainly as a primitive experience of one’s body in relation to the environment, with the sense of self being implicit and diffuse. At the level of self-awareness, the organism focuses attention on the self and on certain aspects of the self more directly. At the level of meta-self-awareness, an awareness of the self as being aware of either the environment or the self is added. Two dimensions are seen as underlying the graded distinctions between the levels: the perception of self in time and the complexity of the information being accessed and processed (9). At the lower levels, the information processed is of a more sensory and perceptual nature; this information is primarily situated in the immediate present. At the higher levels, the information processed is more conceptual and complex; this information is linked to the present as well as to the past and the future, thereby enabling the individual to plan, act, and monitor his or her actions on the basis of both previous experiences and future goals.
The question of self-awareness among individuals with ASD has been addressed theoretically by different authors, some from within the autism research community (10-14) and others from a more philosophical standpoint (15-17).
Hobson (10) argues that self-awareness is dependent on the individual being a self. With inspiration from Buber’s theoretical work (18), Hobson specifies two modes of being a self and therefore of self-awareness. In the first mode, which Hobson calls
Powell and Jordan (11) have suggested that individuals with ASD are characterized by deficits in personal episodic memory. They describe deficits of both encoding and recall that arise from problems with the development of an “experiencing self” responsible for coding events as something experienced by and thus belonging to the self. Deficits in this encoding would lead to deficits in personal episodic memory, with the person being able to recall personal facts and knowledge but “unable to remember themselves as performing actions, participating in events or possessing knowledge and strategies” (11: p. 361). The experiencing self is also seen as allowing the individual to search his or her memory independently of specific situational cues, with the recall of episodic memory otherwise being dependent on situational clues (11). Powell and Jordan see this independence of situational clues as essential for problem solving that involves reflection on personal experiences, strategies, and knowledge. In relation to Morin’s levels, remembering personal facts and knowledge seems to relate to the level of consciousness and self-awareness, whereas remembering the self as acting and participating and as processing knowledge and strategies seem to relate to the level of meta-self-awareness, both due to the representational complexity of the self and to the implied perception of the self across time. Powell and Jordan’s reflections are primarily focused on the flexible use of personal information in time, but the dimension of conceptual abstraction is also relevant to the descriptions of experiences being encoded as personal and this conceptualization as being essential for later recall.
Frith and Happé (12) build on the cognitive account that persons with ASD may have impaired “theory of mind” (ToM), which refers to the ability to represent the mental states of the self and others. Frith and Happé focus on introspection and suggest that a mind without introspective awareness would consist only of first-order representations, which would primarily be descriptions of objects and events on a concrete descriptive and perceptual level. What may be different in individuals with ASD would be a meta-representational level, where the first-order representation is re-represented, thereby differentiating the propositional attitude (e.g., desire, belief, pretense), the content (i.e., believing “X”), and the source status (i.e., who holds the belief: the self or the other). Potential problems that follow from a lack of or differences at the level of meta-representations may include the difficulties to distinguish between one’s own and others’ opinions or trouble understanding why you act as you do. More recently, Happé (19) has expanded and further defined some of the potential downstream developmental effects of problems with “reading [one’s] own mind.” Happé also highlights how some of these developmental effects may also be beneficial, such as the personal perspective being less conforming and less restricted by assumed knowledge (19). The differences in self-awareness among individuals with ASD are understood primarily as differences at the meta-representational level of processing, which are also responsible for problems representing other people’s thoughts or ToM. In relation to Morin’s levels (9), the differences among individuals with ASD as proposed by Frith and Happé seem to fall mainly at the level of meta-self-awareness.
Raffman (15), who is coming from a philosophical perspective, suggests different ways of conceptualizing deficits of self-awareness and highlighting the different levels of awareness introduced in Frith & Happé’s argument (12). Raffman views self-knowledge as a cognitive achievement, whereas self-awareness is viewed in two different senses: a “thin” sense of self-awareness and a “strong” sense of self-awareness. The thin sense of self-awareness involves the direction of attention and is non-conceptual; it is viewed as direct, immediate, and non-inferential. The strong sense of self-awareness is characterized as introspection and self-knowledge. Self-awareness in the thin sense is the source of introspection and self-knowledge and as such the foundation of self-awareness in the stronger sense (15). Self-awareness in the strong sense involves a conceptual judgement, in ToM terms, of the thin sense of self-awareness; this conceptual judgement is involved in both the conceiving and reporting of this knowledge. In relation to ASD, Raffman argues that difficulties with self-awareness could be understood more as difficulties with representing and reporting mental states in ToM terms rather than as a lack of awareness of these states as such. Raffman goes on to add the possibility that some of the differences in self-awareness in individuals with ASD could be related to potential differences in the self-ascription of mental states based on differences in perceptual processing.
Raffman suggests that differences in self-awareness among individuals with ASD is a question of the character of the mental state one is having rather than a question of having or not having mental states as such (15). Raffman adds to the discussion of the relationships between the levels and makes explicit how more basic deficits or differences can affect the higher levels of processing. Thus, deficits or differences in self-awareness—although they may be seen at a higher level of awareness processing—may be explained by processing difficulties at more basic levels (e.g., perception), because these are the source of self-awareness and so influence all levels. In relation to Morin’s levels (9), the strong sense of self-awareness is seen as indicative of meta-self-awareness, whereas the thin sense of self-awareness is related to both the level of consciousness and the level of self-awareness. Raffman’s suggestions with regard to self-awareness among individuals with ASD place a potential difference at the levels of meta-self-awareness and consciousness, with potential differences here influencing the higher levels of processing (15).
McGeer (16) argues that self-awareness is the direction of attention during an experience of the world. In self-reports, it is these experiences of the world that are being reported directly. In contrast with the levels suggested by Frith and Happé (12), McGeer (16) argues to collapse the distinction between an experience and the awareness of that experience. When you are aware of “X,” it is not the experience of something that you are aware of; rather, you are simply experiencing “X,” and during this experience you are aware of “X” itself. In this sense, McGeer also seems to challenge the notion that a concept or representation of the self is necessary for this type of self-awareness. However, McGeer does recognize a cognitive awareness as a sophistication of this basic self-awareness, which includes the understanding that the actuality of world may differ from one’s subjective experience. In relation to Morin’s levels (9), cognitive self-awareness is clearly related to the level of meta-self-awareness. The level of direct self-awareness during the experience seems related to both consciousness and self-awareness, and it seems in many ways to be closely related to Raffman’s thin sense of self (15). The connection to ASD is less explicit. In line with Raffman’s second suggestion, McGeer suggests that differences in sensory perception may influence the developmental process of higher-order social cognitive abilities, thereby resulting in social cognitive difficulties, which is one of the defining characteristics of ASD.
Williams (14) addresses aspects of self-awareness in his review of studies examining the “theory of own mind.” Williams concludes that, although an awareness of one’s own mind—the psychological self, is dependent on metarepresentations, this level of representation is not so necessary for reflexive awareness of the physical self. Further, differences in self-awareness that have been described for persons with ASD seem to be primarily evident in relation to tasks and aspects related to awareness of the psychologicial self. With this in mind, Williams (14) argues for the relevance of distinguishing between the physical and psychological domains of the self in the understanding of self-awareness. Recent studies of interoception (percieving the internal state of one’s body) have indicated that persons with ASD may be characterised by atypical interoception (20), which challenges the idea of intact awareness of the physical domain of the self in these persons. However, Shah and colleagues (21) investigated the relevance of comorbid alexithymia and found that “Alexithymia, not autism, is associated with impaired interoception” (19: p. 215).
The distinction between the physical and psychological domains of the self as suggested by Williams is not explicitly represented in Morin’s levels of awareness (9), and whether it makes sense to consider the level of meta-self-awareness in relation to the domain of the physical self is not quite clear. In Table 1, this distinction has been merged with Morin’s levels of awareness, and the presented theories of deficits or variations in self-awareness among individuals with ASD have been mapped onto the model. With the distinction between the physical and psychological domains of the self, it becomes clear that the differences suggested by the other authors are also primarily related to the domain of the psychological self.
Suggested differences in self-awareness for persons with autism spectrum disorder mapped onto levels of self-awareness and domains of the self
Specific difficulties related to awareness of the psychological self (W) | |||
4. Meta-self-awareness Being aware that one is self-aware | Difficulties with meta-representing (FH) Difficulties with conceptualizing or reporting in mentalizing terms (R) | ||
3. Self-awareness Focusing attention on the self; processing self-information | Problems with the conceptual differentiation of the self from other-selves (H) Experiences not encoded as personal (PJ) | ||
2. Consciousness Focusing attention on the environment; processing external stimuli | Differences in perceptual processing leading to different mental states affecting later levels of awareness (R) Differences in sensory processing (M) | ||
1. Unconsciousness Being unresponsive to the self and the environment |
As mentioned previously, Morin’s levels are defined by the perception of the self in time and the complexity of the information being accessed and processed. Morin further identifies and promotes the variables of frequency, amount, and accuracy of self-awareness as relevant for understanding an individual’s level of self-awareness. The term
Being self-aware is not always necessary and may sometimes be a hindrance to effective functioning, especially if the individual is not able to flexibly regulate his or her self-awareness. I would suggest that it is necessary to consider an additional dimension that addresses the attunement between the organism and the context. Here, the idea of
In addition, what is relevant may change quickly if elements of the context or the individual’s motive changes. Sometimes self-awareness of certain self-information may hinder efficient behavior, such as becoming aware of a trembling voice when commencing an academic presentation or ruminating on past actions while trying to go to sleep. Similarly, a lack of self-awareness may be equally disruptive, such as not registering or differentiating the bodily signals of stress and anxiousness until actually experiencing a “meltdown.” Timing reflects that the awareness of the same bodily signals at any other time, while still potentially relevant, may not be as helpful as being aware of them in a specific situation in which it is still possible to influence the situation and one’s own reaction to the situation. Relevance is often highly interrelated with timing. The term
To sum up, the framework suggested for understanding and discussing variations and differences in self-awareness in individuals with ASD revolves around four levels of self-awareness across varying domains of the self. In various theoretical positions related to self-awareness among individuals with ASD, differences in self-awareness have been suggested at all levels (except the level of unconsciousness); however, these differences may relate primarily to the psychological domain of the self. The levels are differentiated on the basis of the degree of conceptual complexity and the perception of the self in time and are, as such, closely related to the content of awareness. More procedural and functional aspects of self-awareness are highlighted with the concept of