Cross-modal extinction in a boy with severely autistic behaviour and high verbal intelligence.

Anecdotal reports from individuals with autism suggest a loss of awareness to stimuli from one modality in the presence of stimuli from another. Here we document such a case in a detailed study of A.M., a 13-year-old boy with autism in whom significant autistic behaviours are combined with an uneven IQ profile of superior verbal and low performance abilities. Although A.M.'s speech is often unintelligible, and his behaviour is dominated by motor stereotypies and impulsivity, he can communicate by typing or pointing independently within a letter board. A series of experiments using simple and highly salient visual, auditory, and tactile stimuli demonstrated a hierarchy of cross-modal extinction, in which auditory information extinguished other modalities at various levels of processing. A.M. also showed deficits in shifting and sustaining attention. These results provide evidence for monochannel perception in autism and suggest a general pattern of winner-takes-all processing in which a stronger stimulus-driven representation dominates behaviour, extinguishing weaker representations.