Reality Monitoring and Metamemory in Adults with Autism Spectrum Conditions
J Autism Dev Disord
Reality Monitoring and Metamemory in Adults with Autism Spectrum Conditions
Rose A. Cooper 0 1
Kate C. Plaisted-Grant 0 1
Simon Baron-Cohen 0 1
Jon S. Simons 0 1
0 Autism Research Centre, Department of Psychiatry, University of Cambridge , Cambridge , UK
1 & Jon S. Simons
Studies of reality monitoring (RM) often implicate medial prefrontal cortex (mPFC) in distinguishing internal and external information, a region linked to autism-related deficits in social and self-referential information processing, executive function, and memory. This study used two RM conditions (self-other; perceivedimagined) to investigate RM and metamemory in adults with autism. The autism group showed a deficit in RM, which did not differ across source conditions, and both groups exhibited a self-encoding benefit on recognition and source memory. Metamemory for perceived-imagined information, but not for self-other information, was significantly lower in the autism group. Therefore, reality monitoring and metamemory, sensitive to mPFC function, appear impaired in autism, highlighting a difficulty in remembering and monitoring internal and external details of past events.
monitoring; Autism; Episodic memory; Metacognition; Metamemory
Reality Monitoring and the mPFC
Episodic memory is the ability to recall details of a specific
event, such as temporal, visuo-spatial, and cognitive
Department of Psychology, University of Cambridge,
Downing Street, Cambridge CB2 3EB, UK
, while source memory
specifically refers to memory for the specific context in which an
event was experienced, facilitated by source monitoring
processes that evaluate memory characteristics and
facilitate the source memory decision
(Johnson et al. 1993)
example, discriminating between internal and external
sources of information is referred to as ‘reality monitoring’
(Johnson et al. 1993)
, where internally-generated memories
are likely to contain more cognitive operations (e.g.
thoughts) than externally-generated memories, which in
turn are more likely to contain a greater number of
(Johnson and Raye 1981)
monitoring processes can either be relatively automatic or more
strategic if, for example, two sources are quite similar in
The prefrontal cortex (PFC) has been widely implicated
in source memory, with evidence from lesion patients and
functional neuroimaging converging to support a role of
the PFC in the retrieval of a range of source contexts
(Dobbins et al. 2002; Duarte et al. 2005; Simons et al.
2002, 2005; Turner et al. 2008)
. However, the medial PFC
(mPFC) appears to be particularly sensitive to the
dissociation between internal and external sources, such as
perceived and imagined contexts, compared to other types
of source judgements
(Brandt et al. 2014; Simons et al.
2006; Turner et al. 2008)
Simons et al. (2008)
the neural basis of memory for two different forms of
internal–external information: ‘self’- or ‘other’-generated
information and ‘perceived’ or ‘imagined’ information.
Interestingly, a relatively caudal mPFC region showed
significantly greater activity during discrimination of
selfother relative to perceived-imagined sources, with the latter
being associated with more rostral mPFC activity,
highlighting functional specialization despite highly
overlapping activity associated with source retrieval.
The region of the mPFC identified by
Simons et al.
during the self-other discrimination consistently
exhibits activity during mentalizing
(Gilbert et al. 2006)
ability to consider different perspectives of ourselves and
others. The mPFC is thought to play a central role in
reasoning about the self and others
(Amodio and Frith 2006;
Buckner and Carroll 2007; Saxe et al. 2006)
, with evidence
supporting the relationship between mPFC activity and
distinguishing between objects processed in relation to
oneself or someone else
(Kim and Johnson 2012)
region has also been associated with memory for
(Bergstrom et al. 2015; Zhu et al. 2012)
and with the benefit of self-referential encoding on source
(Leshikar and Duarte 2013)
. Conversely, the more
rostral region of the mPFC identified by
Simons et al.
, active during perceived-imagined reality
monitoring, is involved in multi-task coordination
(Gilbert et al.
, in line with evidence that the rostral mPFC is
sensitive to switching between perceptual and cognitive
(Gilbert et al. 2005)
. The functional distinction
within mPFC has been supported by
Gilbert et al. (2007)
who observed caudal mPFC activity for mentalizing versus
non-mentalizing tasks and rostral mPFC activity during
perception versus imagining, leading to the suggestion that
the rostral mPFC is involved in monitoring internal and
external processes and attention switching. Such processes
also contribute to metamemory, monitoring the accuracy of
one’s memory, which has been linked with mPFC function
(Baird et al. 2013; Do Lam et al. 2012; see Fleming and
Dolan 2012 for a review)
, further supporting the
importance of the mPFC for monitoring the internal and external
details of our memories.
Memory and Reality Monitoring in Autism
Autism spectrum conditions (henceforth, autism) are
associated with deficits in social and self-referential
(Lombardo and Baron-Cohen 2011;
Frith 2001; Williams 2010)
and much neurological
evidence points to the mPFC as an important site of
dysfunction underpinning these characteristics
2009; Uddin 2011)
. Reduced mPFC activity has been
reported in individuals with autism during tasks requiring
(Frith 2001; Murdaugh et al. 2012; White et al.
, with mPFC activity levels distinguishing less
between ‘self’ and ‘other’ during self-reference and
selfother judgement tasks than in typical individuals
and Courchesne 2008; Lombardo et al. 2009)
that representations of self- and other-related information
may not be as distinct.
Subtle memory deficits also exist in autism, largely
consisting of impaired episodic memory but intact
(Boucher et al. 2012; Bowler et al.
. Impaired episodic memory in autism has been
suggested to result from mPFC dysfunction (Brezis 2015),
influenced by deficits in mentalizing
(Lind 2010; Lind et al. 2014)
, and some
evidence has suggested disproportionate deficits in
monitoring and retrieving information regarding the self and
others. For instance, individuals with autism have impaired
recollection of social details relative to other perceptual
details (O’Shea et al. 2005) and reduced memory for
(Brezis et al. 2013)
, as well as a
specific reduction in recollection of socially salient aspects
(Bruck et al. 2007)
. With regard to the ‘self’,
individuals with autism exhibit a reduced self-reference
effect in memory
(Grisdale et al. 2014; Henderson et al.
2009; Lombardo et al. 2007)
, and episodic memory in
autism is less organised around self goals
(Crane et al.
and is less likely to be retrieved from a first-person
(Lind and Bowler 2010; Lind et al. 2014)
However, episodic memory deficits involving non-social or
non-self oriented stimuli
(e.g. Bowler et al. 2007, 2014;
Cooper et al. 2015)
call into question whether memory
deficits in autism are solely characterised by mentalizing
and self-reference deficits. Investigating reality monitoring
in autism may thus provide valuable insights to resolve this
However, findings from reality monitoring studies in
autism have been inconsistent and have largely focused on
self-other source memory alone. Some studies have
observed an impairment in the ability of individuals with
autism to recollect whether they or someone else
performed an action
(Lind and Bowler 2009; Maras et al.
2013; Russell and Jarrold 1999)
, whereas other studies
have reported no difference in self-other reality monitoring
(Farrant et al. 1998; Grainger et al. 2014a; Hill and
Russell 2002; Zalla et al. 2010)
. Across most of these
studies, the number of participants and trials has been
small, limiting the power to uncover subtle differences. It is
interesting to note that the studies with the most trials
(Maras et al. 2013)
and most participants
(Lind and Bowler
both observed deficits in self-other source memory.
However, these studies only examined one type of reality
monitoring and cannot determine whether a deficit in
processing information in relation to the self and others is
specifically responsible for the reality monitoring
impairment. Only one study has compared reality monitoring of
self-other and perceived-imagined sources in children with
autism, demonstrating a deficit across both conditions
(Hala et al. 2005)
. Hala et al. interpreted their results as
supporting an executive function framework, as a primary
mentalizing deficit would have predicted a disproportionate
reduction in self-other reality monitoring. Therefore,
reality monitoring differences in autism may not be solely
driven by difficulties processing information about the self
and others, but may be also influenced by the monitoring
demands of the task.
The findings of Hala et al. could possibly be explained
by evidence of atypical mPFC activity during switching
between internal and external information in individuals
(Gilbert et al. 2008)
Gilbert et al.
compared an internal-external attention orienting
task and a mentalizing task, finding that individuals with
autism showed a distinct lack of neural functional
specialization between the tasks, which could lead to
generalised rather than specific reality monitoring impairments.
Consistent with Hala et al.’s suggestion of monitoring and
attention switching influences on memory deficits in
autism, recent evidence has demonstrated a strong relationship
between executive function and episodic memory in these
(Goddard et al. 2014; Maister et al. 2013)
Additionally, the benefit of task support, such as providing
retrieval cues to support memory retrieval, on recall and
source memory in autism
(Bowler et al. 2004; Maras et al.
further highlights the influence of retrieval
monitoring demands on memory deficits. Specifically, it is
believed that memory impairments in autism increase as
the complexity of the task demands increase
; suggesting that monitoring and attention
switching requirements during retrieval may influence
deficits seen in source recall and episodic memory. Direct
evidence for monitoring impairments during memory tasks
in autism comes from studies showing a reduction in
metacognition, specifically, impaired metamemory as
shown by less accurate ‘feeling of knowing’ judgements
(Grainger et al. 2014b; Wojcik et al. 2013)
and a reduced
relationship between confidence and recognition memory
(Wilkinson et al. 2010). These findings suggest that a
deficit in autism in distinguishing between internal and
external sources of information in memory might also
extend to an impairment in monitoring the accuracy of
these source memory decisions, which has yet to be
The aim of the current study is to investigate the pattern
of reality monitoring and metamemory impairments in
adults with autism, due to known mPFC dysfunction in this
population and the role of this region in reality monitoring
and metamemory, to compare the influence of self/social
information processing with monitoring and switching
between internal and external processes on memory in
autism. We adapted the task used by
Simons et al. (2008)
allow us to assess recognition memory as well as source
memory and memory confidence. The task tests
participants’ ability to discriminate between self-other and
perceived-imagined sources in memory and to monitor the
accuracy of these source memory decisions. This task has
increased sensitivity relative to previous studies and
allowed us to assess each kind of source memory within the
same task, thereby controlling for any extraneous processes
that may have influenced the findings of previous studies
examining one type of source alone. The reality monitoring
task has been used in a number of previous studies,
exhibiting sensitivity to individual differences in typical
(Simons et al. 2006, 2008; Gilbert et al. 2010; Buda
et al. 2011)
, and in individuals with proneness to or risk of
(Lagioia et al. 2011; Simons et al.
. We aimed to test whether the ‘self’ has a reduced
benefit on recognition memory and source memory in
autism, and whether memory for self-other sources might
be disproportionately impaired in adults with autism due to
a reduction in mentalizing, or whether discriminating
between perceived and imagined sources might also be
impaired, reflecting a more general deficit in monitoring
information in memory. To this end, we also assessed
metacognitive sensitivity to test whether metamemory
deficits extend to source memory in autism.
Twenty-four participants with a diagnosis of autism (13
females, 11 males) and twenty-four control participants (13
females, 11 males) took part. All participants were aged
between 18 and 45, and had normal or corrected-to-normal
vision and hearing. No participant in the control group had
a known current or historical diagnosis of any psychiatric,
neurological or developmental condition. Participants in
the autism group had a formal diagnosis of
high-functioning autism (N = 2) or Asperger Syndrome (N = 22)
according to DSM-5
(American Psychiatric Association
or ICD-10 criteria, and received their diagnosis
following specialist assessment by a qualified clinician. All
participants were administered the Autism Spectrum
(AQ; Baron-Cohen et al. 2001)
, the short-form
Raven’s advanced progressive matrices
(Arthur and Day
, the WAIS-III vocabulary test
semantic and phonological fluency tests. The AQ is a 50
item questionnaire measuring self-reported autistic traits,
the short-form Raven’s Matrices assesses non-verbal
abstract reasoning to complete 12 items, yielding a
maximum score of 12. The WAIS vocabulary test requires
participants to define a series of 33 words, with a maximum
score of 66, and the semantic and phonological verbal
fluency tests requires participants to generate as many
words as possible beginning with the letter ‘b’ or
associated with the category ‘animals’, respectively, in 90 s. The
WAIS vocabulary test and Raven’s matrices were chosen
as short but reliable measures of verbal and non-verbal
ability, and the verbal fluency test was administered as a
control because the memory task used involved generating
words. The groups were matched on age, years of
education, verbal and non-verbal ability, and phonological and
semantic fluency (all p [ .33; see Table 1), and the autism
group scored significantly higher on the AQ than the
control group (t(46) = 12.91, p \ .001).
Participants with autism were recruited from a
participant database held by the Cambridge Laboratory for
Research into Autism, and the Cambridge Autism Research
Centre’s participant database. Control participants were
recruited via an existing participant database maintained by
the Behavioural and Clinical Neuroscience Institute
(BCNI), Cambridge University, as well as via social media
adverts. Ethical approval for this study was obtained from
the Cambridge Psychology Research Ethics Committee.
Participants gave written informed consent prior to taking
part and were paid a standard honorarium for their time.
Design and Procedure
The computer-based reality monitoring task included 144
study phase trials and 216 test phase trials (including the
studied stimuli and 72 new stimuli) divided into 6
studytest blocks. The stimuli consisted of common word pairs
(e.g. ‘‘Batman and Robin’’), collated from previous studies
(Simons et al. 2006, 2008; Buda et al. 2011)
extensively piloted the word-pairs to ensure their familiarity (see
‘‘Appendix’’). The word-pairs were studied in one of four
encoding conditions: ‘self-perceived (SP)’, ‘self-imagined’
(SI), ‘experimenter-perceived’ (EP), and
‘experimenterimagined’ (EI), with 36 word-pairs per condition. For ‘self’
word-pairs, participants were instructed to read the
wordpair out loud and, for ‘experimenter’ word-pairs, they were
informed that the experimenter would read the word-pair
out loud. ‘Perceived’ trials were those in which both words
in the word-pair were shown on the screen and ‘imagined’
word-pairs were trials in which just the first word and the
first letter of the second word were displayed (e.g.
‘‘Batman and R____’’) and the participant or experimenter had
to imagine the second word in the pair before saying the
word-pair aloud (see Fig. 1). If the participant struggled to
complete the word-pair in an ‘imagine’ trial then they were
encouraged to generate and speak aloud a suitable guess.
Each test phase was completed immediately after
studying all 24 word-pairs in the block. Participants were
tested on the first word from each of the studied word-pairs
or the first word from a new, unstudied, word-pair. For half
of all 36 words tested per block, they were tested on their
memory for whether the corresponding word-pair had been
said by ‘self’ or the ‘researcher’ during the study phase or
if the word was new (‘Self/Experimenter’ or ‘SE’
condition), and, for the other half, if the second word of the
word-pair had been ‘seen’ or ‘imagined’ during the study
phase or if the word was new (‘Perceived/Imagined’ or ‘PI’
condition) (see Fig. 2). Therefore, of all 144 studied words,
72 were tested in the SE condition and 72 were tested in the
PI condition, with each test condition including 18
wordpairs from each of the four encoding conditions. Both
accuracy and time taken to respond were measured. For
each word, participants indicated their confidence on a
continuous scale of ‘low’ to ‘high’. Confidence was
determined by the duration the participant held down their
response key to move a bar on the screen from low to high
(range 0–1000 ms). Participants were instructed to think
about how confident they were in each of their responses
and to use the whole confidence range accordingly
throughout the task. The order of the SE and PI test
conditions was counterbalanced across the 6 blocks.
Presentation of the word pairs as old or new was counterbalanced,
as was studying the word-pairs in each of the four study
conditions and testing the word-pairs in either the SE or PI
condition. Trials were pseudorandomised so that no more
than three trials in a row were from the same condition for
both study and test phases. Participants were given an
instruction sheet and completed a practice task before
starting the experiment.
After the reality monitoring task, participants completed
a debriefing questionnaire and the AQ. Participants then
completed the Raven’s matrices followed by the verbal
fluency tasks and the WAIS vocabulary sub-test. The tasks
were completed in this order for every participant and the
total testing session lasted up to 1 hours.
All analyses were conducted using two-tailed tests at a
standard alpha level of .05. Effect sizes are reported using
eta-squared (g2) values for analyses of variance
(ANOVAs) and Cohen’s d for t tests. First, overall recognition
memory during both the SE and PI test conditions was
assessed, and it was then tested whether recognition
memory was affected by encoding condition and if this
differed between groups. Analyses of source memory used
a conditional measure of source accuracy, defined as the
proportion of correct source responses for word-pairs
correctly recognised. Analyses assessed overall source
memory in the SE and PI test conditions, accuracy for each
source within the SE and PI test conditions (S vs E; P vs I,
respectively), and then to see how source memory accuracy
in the SE and PI test conditions is affected by encoding
condition (P vs I; S vs E, respectively). Analyses then
focused on source metamemory, defined as the trial-by-trial
correlation between source memory accuracy (0, 1) and
confidence (0–1000). This measure of metamemory was
chosen due to the continuous nature of the confidence
response and to maximise sensitivity to detect subtle
differences in metacognition over and above discrete ratings.
To assess recognition memory accuracy, d’ was calculated
for both the SE and PI test conditions. Recognition ‘hits’
were defined as the percentage of studied words correctly
identified as old regardless of the source the participant
chose, and false alarms (FAs) were defined as the
proportion of new items misattributed to one of the two sources.
A 2 group (autism, control) 9 2 test condition (SE, PI)
ANOVA on recognition d’ revealed no main effects or
interaction between factors (Fs \ .2, ps [ .7, g2 \ .01),
demonstrating that recognition d’ did not differ between
the autism (mean = 2.89, std = 0.53) and control
(mean = 2.85, std = 0.62) groups. The proportion of
studied words correctly recognised was high in both the SE
(autism: mean = 0.87, std = 0.08; control: mean = 0.88,
std = 0.06) and PI (autism: mean = 0.87, std = 0.09;
control: mean = 0.89, std = 0.06) test conditions. T tests
performed on confidence ratings and time taken to
correctly reject new words also showed no difference between
the groups (ts \ 1, ps [ .5, ds \ 0.17). Therefore,
recognition memory of the autism and control groups was very
Effect of Encoding Condition on Recognition
To investigate the effect of encoding condition on
subsequent recognition memory, an ANOVA was conducted on
recognition of words studied in each of the four encoding
conditions using a 2 (S, E) 9 2 (P, I) 9 2 (autism group,
control group) analysis (see Table 2 for mean recognition
accuracy by encoding condition). A self-reference effect
was observed as the proportion of recognised words was
significantly higher for previously self-spoken items than
for experimenter items, F(1,46) = 53.65, p \ .001,
g2 = .28, and this effect did not differ between the groups
(F \ .2, p [ .7, g2 \ .01). A significant generation effect, a
benefit of imagining items on later recognition, was also
observed, F(1,46) = 97.29, p \ .001, g2 = .30, which did
not differ between the groups (F \ .1, p [ .8, g2 \ .01).
There was no significant interaction between SE and PI
(F = 2.3, p = .13, g2 = .01), which did not vary by group
(F = 0.0, p [ .9, g2 \ .01). Therefore, recognition
memory of the autism and control groups was similarly affected
by encoding condition.
To first compare whether source memory differed between
groups and whether this varied according to test condition,
a 2 group (autism, control) 9 2 test condition (SE, PI)
ANOVA was conducted. In this case, SE and PI source
accuracy reflects how well participants could distinguish
self and experimenter sources and perceived and imagined
sources, respectively. Source accuracy was significantly
higher in the SE condition than in the PI condition,
F(1,46) = 29.71, p \ .001, g2 = .39, an effect which did
not differ between groups (F \ .2, p [ .7, g2 \ .01).
However, the autism group were found to have
significantly lower source memory accuracy than the control
group, F(1,46) = 4.43, p = .04, g2 = .09 (see Fig. 3). The
same ANOVA was repeated using confidence and RT for
source memory responses. Participants were more
confident, F(1,46) = 13.66, p \ .001, g2 = .22, and faster,
F(1,46) = 214.42, p \ .001, g2 = .82, for their SE source
decisions than PI source decisions. Confidence did not
significantly differ between the autism (mean = 732,
std = 115) and control (mean = 779, std = 133) groups
(F = 1.7, p = .20, g2 \ .04), which did not vary between
test conditions (F = 1.7, p = .19, g2 \ .04). Similarly, RT
did not differ between the autism (mean = 1.83 s,
std = 0.29) and control (mean = 1.79 s, std = 0.25)
groups (F \ .5, p [ .5, g2 \ .01), which did not vary
between test conditions (F = 1.2, p [ .2, g2 \ .03).
Therefore, while overall source memory accuracy was
reduced in the autism group, confidence and RT for source
memory decisions did not differ between the groups.
was significantly higher for previously self-spoken items as
opposed word pairs read by the researcher, F(1,46) =
16.34, p \ .001, g2 = .26, an effect which also did not
differ between the groups (F \ .5, p [ .5, g2 \ .01) (see
Table 3 for mean source accuracy values). Therefore, the
pattern of source memory accuracy was similar between
groups when looking at source memory across the various
test and encoding conditions, also showing self-reference
and generation effects.
Memory for Individual Sources
To investigate whether accuracy for indentifying individual
sources (e.g. different proportions of correct source
responses for self and experimenter words pairs) differed
between groups, 2 ANOVAs were conducted, one in each
test condition. A 2 (group: autism, control) 9 2 (source: S,
E) ANOVA in the SE condition revealed that participants
were significantly more likely to correctly identify the
source of experimenter-spoken word-pairs than self-spoken
word-pairs, F(1,40) = 54.63, p \ .001, g2 = .54, an effect
which did not significantly differ between groups (F \ 1.8,
p = .19, g2 \ .04). In a second 2 (group: autism,
control) 9 2 (source: P, I) ANOVA in the PI condition, neither
the main effects of source nor the interaction between
source and group were significant (Fs \ 1, ps [ .3,
g2 \ .02) (see Table 3 for mean source accuracy values).
Effect of Encoding Condition on Source Memory
To investigate how source memory accuracy was affected
by encoding condition, two ANOVAs were conducted, one
within each test condition. The first 2 (group: autism,
control) 9 2 (encoding condition: P, I) ANOVA for SE
source accuracy revealed that SE source memory was
significantly higher for word-pairs that had been imagined
at encoding as opposed to perceived, F(1,46) = 47.48,
p \ .001, g2 = .51, an effect that did not differ between
groups (F \ 1.3, p [ .27, g2 \ .03). For the PI test
condition, a 2 (group: autism, control) 9 2 (encoding
condition: S, E) ANOVA revealed that later PI source memory
To measure metamemory, a within-subject correlation
coefficient, using Fisher’s r to z transformation, was
calculated for each participant between trial-by-trial source
memory accuracy and confidence. A 2 (group) 9 2 (test
condition: SE, PI) ANOVA on metamemory scores (see
Fig. 4) revealed no difference between the SE and PI
conditions (F \ .1, p [ .7, g2 \ .01), and no overall
difference between the 2 groups (F \ 1.2, p [ .29, g2 \ .03).
However, a significant interaction between group and
condition, F(1,46) = 5.33, p = .03, g2 = .10, was due to
the autism group showing significantly lower metamemory
in the PI condition compared to the control group,
t(46) = 2.59, p = .01, d = 0.75, but there was no
difference between the groups for metamemory in the SE
condition (t \ 1, p [ .39, d \ .24). Nonetheless,
metacognitive sensitivity in both conditions in both groups was
greater than 0 (ts [ 7.8, ps \ .001, ds [ 1.6).
To verify that the metamemory differences were not due
to other aspects of performance that might influence the
within-subject correlations (e.g. source memory accuracy,
mean confidence, confidence variability), 3 low source
memory performers and 3 high source memory performers
from the autism and control groups respectively were
removed to create 2 groups (each N = 21) that were
matched on source memory accuracy (p [ .53) and
remained matched on mean confidence (p [ .39),
variability of confidence responses (p [ .26), and all
demographic variables (ps [ .23)
(see Grainger et al.
2014b for a similar approach)
. Repeating the ANOVA on
metamemory revealed the same selective significant PI
metamemory deficit in the autism group, F(1,40) = 4.33,
p = .04, g2 = .09; t(40) = 2.73, p = .01, d = 0.79, and
no difference in SE metamemory (t \ 1, p [ .5, d \ 0.16)
compared to the control group. Therefore, a deficit in PI
metamemory in the autism group seems to be somewhat
dissociable from their overall source memory deficit, as
further suggested by a lack of correlation between these
two scores (r = .23, p = .29).
The current study tested reality monitoring in adults with
autism, with the aim of resolving previous inconsistent
findings by directly contrasting two types of reality
monitoring which are considered to differ with regard to
underlying mentalizing processes within the same task. We
also assessed the effect of self-referential processing on
both recognition and source memory in autism, to test
whether difficulties processing information in relation to
the self may contribute to memory impairments in autism.
Lastly, we assessed metamemory in autism to determine
whether previously documented metamemory impairments
extend to source memory and, thus, whether individuals
with autism have a difficulty differentiating and monitoring
internal and external details of their memories. Both groups
exhibited an equal benefit of self-referential processing and
imagining on later recognition relative to other encoding
conditions. However, the autism group were impaired at
remembering the source of studied word-pairs, an effect
which did not differ according to whether self-other or
perceived-imagined source discriminations were tested.
Furthermore, the pattern of source responses did not differ
between the groups and, as for recognition, both groups
showed a benefit of self-referential processing and
generation on subsequent source memory. Finally, an analysis of
metamemory revealed that the autism group exhibited
intact metamemory for self-other source discriminations
but reduced metamemory for perceived-imagined source
discriminations, indicating that the ability to monitor the
accuracy of perceptual and cognitive details of source
memory may be impaired in autism.
The finding that self-related encoding processes
benefitted both subsequent recognition and source memory in
autism is inconsistent with the view that autism is
accompanied by atypical self-referential processes
(Lombardo and Baron-Cohen 2011)
. Rather, it suggests that
individuals with autism are able to use the self as an
effective organisational encoding strategy, an aspect of
memory that has been thought to be impaired
(Crane et al.
. A reduced effect of the self on memory has not been
demonstrated consistently in autism, with some studies
reporting a reduced benefit of the self on subsequent
memory in autism
(Henderson et al. 2009; Lombardo et al.
and others indicating an intact benefit of self-related
(Grainger et al. 2014a; Lind and Bowler 2009;
Williams and Happe´ 2009)
. Therefore, one interpretation
of the results from the current study is that self-related
encoding can enhance subsequent memory in autism to the
same degree as in typical controls. Alternatively, an
account that may be more likely to explain the current
findings involves the possibility of a distinction between
the ‘psychological’ self and the ‘physical’ self in autism,
with the former being impaired and the latter intact
. The aforementioned studies reporting a reduced
influence of the self have primarily used conceptual
encoding tasks (such as ‘‘does this adjective describe
you?’’), whereas studies observing a benefit of the self on
memory, including the current study, have used
actionbased encoding tasks (such as ‘‘say this word out loud’’). A
dissociation between ‘self-reference’ and ‘self-enactment’
has been proposed to explain these findings
. Future research should, therefore,
compare source memory for self-oriented conceptual and
action-based contexts to directly test the influence of the
self on episodic memory in autism.
However, even if conceptual self- processing were
disproportionately impaired in autism, it would seem unlikely
to be able to fully account for the reality monitoring
impairment found in the current study, where source
memory for word-pairs was reduced to a similar degree
regardless of whether the source discrimination was
selfother or perceived-imagined. The source memory deficit
observed here may help to resolve previous inconsistent
reality monitoring findings in autism
(e.g. Lind and Bowler
2009, Grainger et al. 2014a)
, confirming that reality
monitoring impairments do exist, even though the effect may
evident only in particularly sensitive tasks. This
heterogeneous reality memory impairment also has another
implication, namely that mentalizing, considered particularly
important for the discrimination of self-other information
(Simons et al. 2008)
, may not fully account for the reality
monitoring deficit found in autism. This interpretation is
supported by evidence from
Lind and Bowler (2009)
like in the current study, observed a self-other reality
monitoring deficit in autism in the presence of a
self-enactment effect and, interestingly, reality monitoring ability
in autism did not relate to performance on a separate
mentalizing task, suggesting a dissociation between reality
monitoring and mentalizing processes in autism. Further
evidence comes from other studies of source memory and
recollection reporting an impairment in autism that have
not involved reality monitoring conditions, instead
focusing on retrieval of spatial, temporal, and visual context
(Bowler et al. 2004, 2014; Massand and Bowler 2013)
although it is worth noting that evidence of a deficit in
visual-spatial source memory in autism has not always
been observed consistently
(Bowler et al. 2015; Souchay
et al. 2013)
. Nonetheless, the deficits in source memory
reported here are consistent with findings from other types
of tasks measuring the ability of individuals with autism to
recollect context information, such as a reduction in
‘remember’ responses when recognising words or objects
(Bowler et al. 2007; Cooper et al. 2015; Meyer et al. 2014)
and reduced specificity of autobiographical memory
and Bowler 2010; Maister et al. 2013)
, further illustrating
memory deficits that appear to extend beyond
self-referential and social processes.
An overall source memory impairment could perhaps
suggest generalised PFC dysfunction in autism, although it
is important to note that the link between a reality
monitoring deficit and PFC dysfunction in autism can only be
indirectly speculated upon based on the current study.
However, this possibility seems reasonably likely
considering the importance of the PFC in source memory
(Mitchell and Johnson 2009)
, with functional specialization
within this area of the brain proposed to reflect several
distinct processes that contribute to source memory
(Dobbins et al. 2002; Fletcher and Henson 2001)
Another possibility, which has been more widely
advocated in recent years, is that autism is characterised by
reduced long-range connectivity between prefrontal and
(Courchesne and Pierce 2005; Just et al.
which would indirectly impair frontal functions,
such as monitoring and integrating information in memory.
Due to the importance of the PFC for source memory, and
episodic memory in general, future research should aim to
study the PFC and its connectivity to other regions of the
episodic memory network
(see Mitchell and Johnson 2009)
in autism to establish the neural correlates of impaired
source memory and to investigate the specific cognitive
processes, possibly supported by the PFC, that might
contribute to source memory impairments. Although, it
cannot be directly inferred that the same brain regions or
networks will underpin the same memory functions in
typical individuals and individuals with autism.
The present finding of impaired metamemory in the PI test
condition in autism also fits well with a source memory
deficit, further supporting the notion of a difficulty monitoring
information within memory. This is the first study to
demonstrate impaired metamemory for source information in
autism, extending previous findings of atypical
feeling-ofknowing (FOK) judgements in autism
(Grainger et al. 2014b;
Wojcik et al. 2013)
. Although both retrospective confidence
judgements and prospective FOK judgements measure
metamemory, evidence suggests they may be functionally
and neurally dissociable (Fleming and Dolan 2012).
Therefore, the observation that adults with autism also exhibit
retrospective metamemory deficits for source memory
judgements extends our knowledge concerning
metacognitive awareness in this population. It is important to note,
however, that the autism group only exhibited impaired
metamemory in the PI condition and not the SE condition, a
distinction that was not predicted. One reason for this
difference may be the relative difficulty of the source
discriminations; both groups found the SE sources easier to identify
than the PI sources, meaning that evidence for SE source
memory decisions was likely to be easier to monitor. Once
source details become more overlapping and harder to
differentiate as might be the case for PI sources, the ability of
individuals with autism to monitor the accuracy of their
memories might reduce. Alternatively, preserved
metamemory in the self-other condition may have been attributable to
intact action-monitoring, as previously discussed, whereas
the perceived-imagined source condition predominantly
relied on consideration of perceptual and cognitive details
independent of agency. It is therefore important for future
studies to test metamemory in autism within different types of
context, similarity, and difficulty, for example, to clarify
exactly when metamemory is impaired in autism.
The confidence-based metamemory deficits observed
here are, however, in line with findings from an
autobiographical memory study in autism which found that
participants with autism rated their own memories as less
salient and coherent
(Lind et al. 2014)
, possibly suggesting
a reduction in the subjective quality of episodic memory,
with difficulty visualizing and monitoring memory details.
In support of this proposal, there is evidence that
metamemory deficits in autism may be characterised by
underconfidence in correct memories
(Grainger et al.
. Conversely, there was no overall reduction in
confidence for source memory in the current study, perhaps
suggesting that monitoring and accessing information
during retrieval might be impaired rather than the quality of the
memory once retrieved. The source monitoring framework
assumes that recollection is a graded process
; therefore, research in autism would benefit
from investigating both access to and the quality of episodic
memories in autism rather than using traditional
‘all-ornone’ methods such as a binary choice between two sources
or ‘remember’ versus ‘know’ judgements. Future studies
could explicitly test the quality of recollected information in
autism by adapting source memory tasks to assess ‘partial’
(e.g. Dodson et al. 1998)
, or the ‘precision’
with which memories are recollected
. Future research should also focus on developing
specific teaching methods and learning strategies to
ameliorate the source memory and monitoring deficits provided
here, possibly via the use of structured retrieval cues and
minimising memory load.
In conclusion, this study investigated reality monitoring
for two different types of source discrimination, self-other and
perceived-imagined, in adults with autism. The autism group
exhibited a reduction in reality monitoring for both types of
source discrimination, which was accompanied by a deficit in
metamemory when evaluating visual-perceptual and
cognitive sources. These results imply that impaired monitoring
and attention switching may play a role in source memory
deficits in autism. Due to the link between reality monitoring,
source memory, and the prefrontal cortex in the typical
population, one possibility is that the source and metamemory
deficits in autism could arise due to prefrontal dysfunction or
reduced prefrontal-posterior connectivity. However, further
research would be needed to directly test this association,
which, alongside qualitative aspects of recollection, is an
important area of episodic memory to investigate in autism.
Acknowledgments This research was supported by a James S.
McDonnell Scholar Award to J.S.S., and an Economic and Social
Research Council Award to R.A.C. We would like to thank all the
participants who gave their time for this experiment, as well as the
Autism Research Centre, Cambridge for helping with participant
recruitment for this study.
Author Contributions RAC and JSS designed the experiment;
RAC collected and analysed the data; RAC, KCPG, SB-C, and JSS
interpreted the results and wrote the manuscript.
Open Access This article is distributed under the terms of the
Creative Commons Attribution 4.0 International License (http://crea
tivecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a
link to the Creative Commons license, and indicate if changes were
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birds and bees
Wallace and Gromit
one and only
push and pull
sticks and stones
safe and sound
Spongebob and Squarepants
apples and pears
Barbie and Ken
before and after
ladies and gentlemen
Slug and Lettuce
ketchup and mustard
dustpan and brush
bangers and mash
Rosie and Jim
Sonny and Cher
north and south
Pride and Prejudice
dazed and confused
Posh and Becks
give and take
Hansel and Gretel
Holmes and Watson
ping and pong
stocks and shares
law and order
Sylvester and Tweety
cigarettes and alcohol
nook and cranny
Shrek and Donkey
stars and stripes
hope and glory
yin and yang
odds and ends
look and listen
guys and dolls
nuts and bolts
heaven and earth
fish and chips
terms and conditions
Pimms and lemonade
Coca and Cola
rise and fall
French and Saunders
fun and games
left and right
salt and pepper
Donald and Daisy
meet and greet
Mercedez and Benz
cops and robbers
Starsky and Hutch
done and dusted
rhythm and blues
topsy and turvy
ebony and ivory
bat and ball
Johnson and Johnson
Ernst and Young
Crabtree and Evelyn
David and Goliath
in and out
tit and tat
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black and white
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fools and horses
Ross and Rachel
bride and groom
Marks and Spencer
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fame and fortune
null and void
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fair and square
jelly and icecream
Beavis and Butthead
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meat and potatoes
Charles and Diana
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high and low
open and shut
tortoise and hare
Dolce and Gabbana
time and again
drum and bass
strawberries and cream
sugar and spice
parsley and thyme
now and then
Thelma and Louise
Brad and Angelina
Dorothy and Toto
Lilo and Stitch
kit and kat
Dastardly and Muttley
Itchy and Scratchy
mind and body
war and peace
Mary and Joseph
Guns and Roses
good and bad
king and queen
spaghetti and meatballs
snakes and ladders
Tom and Jerry
back and forth
Mitchell and Webb
fingers and toes
Morecambe and Wise
husband and wife
Lennon and McCartney
fruit and veg
arm and leg
drink and drive
bread and butter
crash and burn
Punch and Judy
lock and key
Chandler and Monica
Humpty and Dumpty
dead and buried
Abercrombie and Fitch
trial and error
Bosnia and Herzegovina
Procter and Gamble
dawn and dusk
shirt and tie
stand and deliver
knife and fork
diamonds and pearls
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